Annual Report and Accounts 2011/12 by The Clatterbridge Cancer Centre

Annual Report and Accounts 2011/12

To provide the best cancer care to the people we serve

Annual Report and Accounts 2011/12 Presented to Parliament pursuant to Schedule 7, the National Health Service Act 2006

Contents Annual Report Chairman & Chief Executive Statement Directors’ Report Operating & Financial Review (OFR) Patient Care Developing our Services Governance Annual Governance Statement

6 8 10 13 18 33 52

Quality Report Review of Quality Performance 2011/12 Priorities for Improvement Statements of Assurance from the Board Other Information Performance against key national priorities and national core standards Annex Statements Statement of Director’s responsibilities in respect of the Quality Report Acronyms

69 77 81 90 92 95 101 103

Annual Accounts Foreword to the Accounts Statement of accounting officer’s responsibilities Statement of Directors’ responsibilities Independent Auditor’s Report Notes to the Accounts Remuneration Report

107 108 109 110 132 137

Introduction Chairman & Chief Executive Statement Reaching the end of the financial year 2011/12 is an opportune time to reflect on the work of the Trust during the course of the year and our progress on delivering the Trust’s vision of providing the best cancer care to the people we serve. The Trust retains the registration without qualification agreed by the Care Quality Commission (CQC) with only standard restrictive conditions. Standard restrictive conditions cover what regulated activities can be carried out at the Trusts premises, these are stated below: x x

Treatment of disease, disorder or injury Diagnostic and screening procedures

We are pleased to report that the Trust continues to provide the highest quality of care possible and in recognition of this the Patient Environment Action Team (PEAT) assessment results for 2012 for environment, food and privacy and dignity all received ‘excellent’ ratings. The Trust has achieved the majority of operating standards in respect of relevant NHS targets in 2011/12. The Trust’s 62 day cancer waiting time standard has been met. This is a considerable achievement in the context that a significant proportion of patients are referred towards the end of or even after the 62 day period. We continue to work with our colleagues in the healthcare system to ensure that our patients receive timely treatment and the Trust delivers sustainable achievement of the required standard. The Trust’s commitment to provide safe services is reflected in the achievement of the very challenging standard in respect of clostridium-difficile infections. The Independent Regulator of Foundation Trusts ‘Monitor’ has awarded the organisation the best rating possible for financial risks. The Trust has achieved a strong balance sheet with a revenue surplus, which has enabled us to continue our investment programme to upgrade facilities and services in the Trust. The Trust has approved plans to continue this investment in 2012/13. The Trust’s new radiotherapy centre collocated with The Walton Centre NHS Foundation Trust in North Liverpool has become a successful and integral part of the delivery of our services taking our excellent radiotherapy treatments closer to the patients we serve. The Trust continued its close working with our Commissioners to deliver our shared vision for the development of cancer services in Merseyside and Cheshire. In particular agreement has been reached on funds to be provided to support our proposed investment in Liverpool which will see the opening of our new cancer centre and the remodelling of our other services and facilities by 2017/18. We are delighted to be able to report that 2011/12 has been an immensely successful year for our charity ‘Clatterbridge your cancer centre’. The generous donations from our supporters, both individual and corporate, enabled us to raise £1,200,000, an increase of some 20% on the previous year. This has allowed the Trust to supplement its NHS funds with more investment in the patient care environment and our research capability and capacity than would otherwise have been possible. 5

Clearly 2011/12 has been a productive year for the Trust but there are significant challenges facing the Trust in the coming years. The most significant of these relate to the financial pressures which the NHS will experience. How these pressures will impact on our services is still not known but they are likely to create a more demanding environment in which we will have to operate. Nevertheless, we are confident that with the support of our Governors and Members and the exceptional level of commitment and hard work of our Staff 2012/13 will prove to be an equally successful year for the Trust. We are pleased to announce that following public consultation during 2011 the Independent Regulator, Monitor approved the request to amend the Trust’s constitution allowing the Trust’s name to be revised from “Clatterbridge Centre for Oncology NHS Foundation Trust” to “The Clatterbridge Cancer Centre NHS Foundation Trust” with effect from 1st April 2012.

Alan White, Chairman

Andrew Cannell, Chief Executive

Directorsâ&#x20AC;&#x2122; Report Vision, Mission and Values The Trust has a clear picture of its fundamental purpose and its role in contributing to the health of all the individuals in the population it serves. The Trustâ&#x20AC;&#x2122;s vision summarises the obligations it feels and its mission outlines the key attributes of service delivery it will measure itself against. The vision and mission provide the yardstick used by the Trust to inform its decision-making. Vision To provide the best cancer care to the people we serve. Mission / core purpose To improve health and wellbeing through compassionate, safe and effective cancer care. The Trust is proud of its ethos, which in turn is derived from the organisational values subscribed to by all our staff. These values are fundamental to the culture of the organisation and guide the behaviours we should exhibit in caring for our patients, both current and future. Values x Putting people first x Passionate about what we do x Achieving excellence x Committed to our future x Always improving our care Trust profile Clatterbridge Centre for Oncology (CCO) is the provider of nonsurgical oncology (chemotherapy and radiotherapy services) to the population of Merseyside and Cheshire and the Isle of Man. The Trust is one of the largest networked cancer centres in the UK. We treat in excess of 27,000 patients per year, registering almost 8,000 new patients each year and providing more than 131,000 attendances for treatment. We serve a population of 2.3 million in Merseyside, Cheshire and the Isle of Man. We employ over 860 staff and volunteers and spend approximately ÂŁ77m per year on all aspects of cancer treatment, diagnosis and care. The hub of the cancer centre is located on the Clatterbridge Health Park in Bebington, Wirral. Within the centre we provide a range of radiotherapy (including low energy proton beam treatments) and chemotherapy treatments in outpatient and inpatient settings. We also provide outpatient consultations, diagnostic imaging services and support services. The majority of outpatient and chemotherapy treatments are provided in District General Hospitals and other specialist hospitals around the network serviced by the Trust. In addition the Trust has a satellite radiotherapy facility in North Liverpool and we provide the Acute Oncology medical service across the network.

The Trust is part of the Merseyside and Cheshire Cancer Network and the Cancer Taskforce and is a full participant in all Clinical Network Groups and Multi-disciplinary Teams. Background Information Clatterbridge Centre for Oncology (CCO) was licensed as a NHS Foundation Trust from 1st August 2006. It is the only NHS cancer centre in England dedicated solely to the provision of radiotherapy and chemotherapy to patients with cancer. The treatment centre has undergone significant financial investment over the past five years and now hosts one of the best equipped radiotherapy centres in the UK. The Trust has a dedicated specialist oncological radiology service with a range of modern imaging equipment. Research and development, including participation in national and international clinical trials, is an important feature of the cancer centre. The Trust has an established track-record of providing high quality cancer care by expert staff, state of the art equipment, cytotoxic therapy and a well established research programme. High quality care has been demonstrated by our excellent performance in respect of all mandated targets and indicators, the achievement of national awards and accreditations and continuous patient feedback. We are now poised at one of the most significant points in our history. The Trust is committed to the development and implementation of plans for a major capital investment in a World Class cancer centre located in Liverpool. This is a once in a generation opportunity to design oncology services to ensure the people of Cheshire, Merseyside and beyond benefit from world class care that is of the highest possible quality. This will help us to play our part in overcoming the specific cancer challenges that face Cheshire and Merseyside e.g.: x x

More than 5,500 people die each year from cancer in Cheshire and Merseyside The number of new cancer cases and the number of cancer deaths in this region are significantly higher than the national average (new cases of lung cancer in Cheshire and Merseyside are 15% and 23% higher than the national average for men and women respectively). The incidence of cancer is expected to rise significantly in the next few years

Our proposals aim to achieve the following: x x x x

Better care for the sickest patients by providing our in-patient beds adjacent to an acute hospital Greater clinical collaboration Improved research capacity and opportunities Improved access for many of our patients

The Trust is one of only two English NHS Trusts that focuses exclusively on the care and treatment of people with cancer and it is the only Trust that is dedicated solely to non-surgical oncology. We are also the only provider of a low energy proton beam treatments in the UK. We have a strong track record of leading transformational change and delivering high quality care over many years. We aim to continue on this journey through the delivery of this strategic plan. 8

We have a well established and distributed chemotherapy service model which was the forerunner of local service provision. We are one of the first cancer centres to support the development of an Acute Oncology service across all our local District General Hospitals with Accident and Emergency departments. We possess state of the art technology enabling complex/innovative treatments, and an integrated radiotherapy/imaging department. We have also developed a satellite radiotherapy centre aimed at providing care as close to the patients’ home as possible. We are leading on the development of comprehensive survivorship programmes including the Department of Health pilot programme. We run a comprehensive oncology education programme through our Clinical Education Department and benefit from increasing opportunities in research with academic departments and close links with local universities. We have a strong reputation in both the local and national community and are well loved by our patients (demonstrated by our consistently excellent patient survey results) and have strong community support including a much valued volunteer service. All this is achieved through expert, dedicated staff, supported by a values driven organisational culture.

Operating & Financial Review (OFR) Financial Summary The Trust has again had a successful year and has achieved or exceeded all of its key financial targets. The Trust’s financial position is detailed in the accounts included as part of this report, however the table below summarises performance in the key areas. Financial Target Planned income & expenditure surplus of £1.0m Earnings Before Interest, Tax, Depreciation and Amortisation (EBITDA) of £6.13m I&E surplus margin of 2.1% EBITDA margin of 8.8% Return on Assets employed of 3.9% Liquid ratio of 71.1 days (measures liquidity of the Trust. The higher the ratio the more liquid the Trust) Overall Financial Risk Rating determined by the independent regulator (Monitor) of 4. (where 5 represents lowest financial risk and 1 highest) Prudential Borrowing Limit (PBL): The long term prudential borrowing limit is set by Monitor. The Trusts current cumulative long term limit is £14.2m. Private Patient Income Cap: Under the terms of authorisation as a Foundation Trust private patient income must not exceed 4.6% of total clinical income

Outcome Achieved actual surplus of £3.37m Achieved actual EBITDA of £7.80m Achieved margin of 5.0% Achieved margin of 10.4% Achieved return of 7.6% Achieved ratio of 115.3 days Achieved Financial Risk Rating of 5.

CCO have an outstanding loan of £4.5m against the PBL limit. In addition the long term obligations relating to finance leases (£0.31m) are scored against the PBL. The total of £4.81m is well within the permissible limit. Private Patient income of £0.64m represents approximate 0.95% of total Trust clinical income. Therefore the Trust has remained within the Private Patient Income Cap.

Key Financial Risks The majority (89.5%) of the Trust’s income is received for the provision of non-surgical cancer treatments to the residents of Merseyside, Cheshire, and parts of Lancashire, North Wales and the Isle of Man. In 2011/12 approximately 24% of the Trust’s clinical income was funded by Payment by Results (PbR) national tariffs, with the remainder from locally determined prices. Both PbR and the local tariff arrangements are based on the principle that the Trust is reimbursed based on activity performed. Therefore a reduction in activity levels represents a financial risk to the Trust. However the Trust is able to mitigate in part against this risk by: x x x

Agreeing local tariffs with commissioners for 76% of clinical income that are not, therefore, subject to the same degree of price volatility as the nationally determined tariffs within Payment by Results. Continuing to agree funding for cancer drug developments based on actual drug usage. Where possible, employing contract tolerances to reduce in year income volatility

As in previous years, a key concern for the forthcoming financial years will be the impact of the reduction in public expenditure on the NHS. The Trust is working with commissioners and other stakeholders across the health economies as part of the North West Quality, Innovation, Productivity and Prevention (QIPP) process to ensure quality cancer services can be maintained whilst increasing productivity and efficiency. As part of the QIPP process the Trust will be required to deliver its own challenging organisational cost improvement programme (CIP) and improvements in unit efficiency. Non-delivery of this target represents a key financial risk to the Trust. However this risk is reduced to the extent that the savings target was achieved in 2011/12 and the 2011/12 programme has been identified. Activity As noted above, the majority of the Trust’s income is derived from providing non surgical cancer treatments and support (such as Radiotherapy, Chemotherapy, palliative care, diagnostic imaging, psychiatric and other support). During 2011/12 the Trust has continued to experience growth for its services and for Chemotherapy in particular. Radiotherapy activity was below plan for most of the year, and although it started to increase in the latter part of the year, cumulative activity was slightly less than planned. The number of patients admitted to the hospital as in-patients also fell in year, but was offset by an increase in day case admissions. Proton therapy activity was in line with the plan for the year. Activity

2011/12 Actual

2011/12 Plan

% Variance

% Growth Forecast 2011/12

Chemotherapy attends Radiotherapy attends Proton therapy attends Admitted patient care spells Out-patient consultations

39,343 102,423 728 4,468 83,154

35,057 103,087 720 4,377 77,832

12.2% -0.6% 1.1% 2.1% 6.8%

5% 1.9% 5% 1% 1%

Forecast growth is related to the increase in estimated numbers of our relevant catchment population, and is based on the same assumptions that underpin the Trust’s 3 year Forward Plan. The percentage growth represents an average of the previous 5 years rather then a 10

projection based solely on the last 12 months. Due to relatively low patient numbers (circa 100 – 120 p.a.) the Proton Therapy activity is quite volatile year on year and although the growth forecast of 5% may appear high, it only equates to approximately 6 additional patients in the year. Other Income and Non-healthcare Activities As noted above, the majority of the Trust’s income is derived from providing clinical cancer services. In addition, the remaining 10.5% of income is derived from: x x x x x

Undertaking research & development Education and training External drug sales to the private sector Hosting non-clinical services, such as the National Cancer Services Analysis Team. In CCO’s accounts income for these services matches expenditure and therefore there is no impact on the Trust’s EBITDA and overall I&E surplus. Support from charities and recharges to other NHS and non-NHS bodies.

Investment Activity The Trust invested £2.5 million in capital expenditure on buildings and replacement of capital equipment in 2011/12. The main schemes were: x x x

£1.58 million to replacement, upgrade and enhance medical equipment at the Centre £0.87 million to refurbish the Trust’s buildings. £0.08 million to replacement IM&T equipment.

All of the above building projects represented investments in assets that are protected to deliver cancer services to our patients as part of the core business of the Trust, with the expectation that the improvements will build on the existing high standard of care provided. Although the expenditure of £2.5 million in 2011/12 is relatively low compared to recent years (for example, the comparable figure was £10.5 million) the Trust is planning capital expenditure in 2012/13 of £9.8 million, and a further £8.7 million over the following 2 years. The main schemes will be to commence the final phase of the ward refurbishment programme, provide for an additional MRI scanner and continue with its on-going equipment enhancement and replacement programme. A number of projects are also planned to improve Information Management and Technology services at the Trust. Looking to the future, the Trust is currently working to produce a business case to support investment in a new cancer centre run by Clatterbridge Cancer Centre in the centre of Liverpool. The project is currently at strategic outline case stage, and if successfully approved would expected to be completed by 2018. Charitable Funding The Board of CCO are also the Corporate Trustee of Clatterbridge Centre for Oncology Charitable Funds. During 2011/12 £444k has been spent by the charity in support of the Foundation Trust. The main areas of expenditure were: 11

x x x x

Contribution to capital - £123k Research & development - £ 26k Improving patients welfare - £281k Improving staff welfare - £13k

Going Concern The following financial accounts statements have been prepared on a going concern basis. After making enquiries the directors have a reasonable expectation that the NHS Foundation Trust has adequate resources to continue in operational existence for the foreseeable future. For this reason they continue to adopt the going concern basis in preparing the accounts. Accounting Policies Accounting policies comply with International Financial Reporting Standards (IFRS) and a full list of these policies is included as part of the Annual Accounts.

Patient Care Performance against key targets 2011/12 18 weeks performance CCO has performed well (all figures are currently YTD) against the existing requirements to see and treat patients within 18 weeks, whether they are admitted or non-admitted. Performance against these key targets is as follows: x 96.9% of admitted patients were seen within 18 weeks from the initial GP referral to treatment (target threshold 90%) x 97.8% of non admitted patients were seen within 18 weeks from initial GP referral to treatment (target threshold 95%). x RTT admitted (95th percentile target of 23.0 weeks) performance is 15.6 weeks x RTT non-admitted (95th percentile target of 18.3 weeks) performance is 15.2 weeks. Additionally non Cancer Waiting time’s specific performance can be seen as follows: x No patient has waited longer than 6 weeks (target 13 weeks) for Imaging (CT and MRI at CCO) x We have had 1 incidence of a MRSA bacteraemia (our target is no more than 0). x We have had 8 incidences of Clostridium Difficile (our target is no more than 8) Cancer Waiting Times performance All Cancer Waiting Time targets were included for all of 2011/12. All figures are currently Year to Date. Performance is as follows:

x x x x x x

There were no direct English GP referrals and therefore the 2 week waiting rule has not been invoked. 97.9% of patients were treated within 31 days from the time of decision to treat for first treatments (target threshold 96%) 98.8% of patients were treated within 31 days from the time of decision to treat for Chemotherapy subsequent treatments (target threshold 98%) 97.0% of patients were treated within 31 days from the time of decision to treat for Radiotherapy subsequent treatments (target threshold 94%) 80.1% of patients were treated within 62 days (Classic) from the date of urgent GP referral (threshold 79%). The Trust will not be monitored against the 62 day screening pathway since insufficient numbers of patients were referred and therefore the ‘de minimus’ rule comes into being.

The 62 day cancer waiting time standard This target continues to be a challenge for the Trust due to the fact that as a Tertiary centre we are the last in the patient pathway to receive the patient and this occurs in many incidences after the 62 day timescale has already been reached. Further work across the Network of which CCO is a partner will continue to review Patient Pathways in order to improve the efficiency and effectiveness where appropriate. Regulatory ratings The Regulator (Monitor) assesses the performance of Foundation Trusts quantifying performance in two distinct categories: Financial and Governance. For 2010/11 in their assessments of the Annual Plan, Monitor determined that the Trust should be awarded a financial risk rating of ‘4’ which was subsequently improved to a ‘5’ for the quarterly performance in the latter part of the year (the best possible financial risk rating). In 2011/12 the Trust received a financial risk rating of ‘4’ for the annual plan which is predicted to have improved to a ‘5’ for each of the quarterly performance reports. Governance Ratings 2011/12 Annual Plan 2011/12 Financial 4 risk rating Governance Green risk rating

Q1 2011/12

Q2 2011/12

Q3 2011/12

Q4 2011/12

Amber-Red

AmberGreen

Green

In quarter 1 the Trust received an Amber-Red rating which was due to failing both the C. Difficile (C.diff) and 62 day classic targets. During this quarter the Trust introduced a more sensitive C.diff testing methodology and consequently identified more cases than under the previous methodology. The Trust acknowledges that meeting the C.diff target will continue to be a challenge due to the low 13

target, the use of broad spectrum antibiotics in immunosuppressed patients and the increased sensitivity of the new methodology. Failure of this target was also the reason for the Amber-Green rating in quarter 2. The Trust does not believe it can meet the 62 day cancer screening target in its current form due to the late point at which it receives referrals and continues to work with referring Trusts to improve the pathways in respect of this target. Although the Trust breached the C.diff target in quarters 1 and 2, we are pleased to report that for the year the Trust was compliant with 8. Governance Ratings 2010/11 Annual Plan 2010/11 Financial 4 risk rating Governance Green risk rating

Q1 2010/11

Q2 2010/11

Q3 2010/11

Q4 2010/11

AmberGreen

Green

AmberGreen

For the majority of the year the Trust received Green ratings with the exception of quarters 1 and 4 when it received Amber-Green ratings. In quarter 1 this was due to failing the Clostridium difficile (C-diff) target which the Trust had an objective for 2010/11 to have fewer than 12 cases. For quarterly reporting purposes the target is calculated at 3 per quarter. Although the Trust breached the target for quarter 1 reporting 6 cases, it was pleased to report that for the year the Trust was compliant with 10 cases. In quarter 4 this was due to failing the 31 day radiotherapy subsequent and MRSA screening targets. The Trust reviewed its waiting list management and earliest clinically appropriate date for treatment as part of its action plan to address the 31 day cancer target. In relation to the MRSA screening target, the Trust held discussions with its commissioners and the SHA regarding the removal of the requirement for repeat screening of patients who attend frequently for chemotherapy. This target was subsequently removed in 2011/12. Care Quality Commission (CQC) Assessment and Review Independent Risk Management Assessments Unannounced Inspection by the Care Quality Commission The Trust has not been subject to any inspections from the Care Quality Commission (CQC) in 2011 / 2012. Achievement of NHSLA level 3 In November 2010 the Trust was again successfully assessed against NHSLA level 3 (the highest available). The assessment reflects the Trustâ&#x20AC;&#x2122;s robust risk management systems and processes and the extent to which a risk aware culture is embedded in the organisation.

Maintenance of ISO 9001:2008 Standard The ISO 9001:2008 Standard is a national (externally assessed) standard based around the principles of customer satisfaction, a systematic approach to management, and encouraging a culture of continual improvement across all departments within the Trust. CCO is thought to have been the first NHS Trust to achieve this accreditation for the organisation as a whole. The accreditation is reviewed periodically and it is pleasing to report that it has been retained throughout 2011/12. Patient Environment Action Team (PEAT) During the year the Patient Environment Action Team undertook an assessment for environment, food and privacy and dignity. The results of this assessment show the Trust continues to provide the highest quality of care with all three areas receiving ‘excellent’ ratings. Progress towards targets as agreed with local commissioners The Trust agreed a number of targets with its commissioners as CQUINS (Commissioning for Quality and Innovation Payment Framework) initiatives. These are: x Reduce avoidable death, disability and chronic ill health from VenousͲthromboembolism (VTE) x Improve responsiveness to personal needs of patients x To review and develop the acute oncology scheme x To study and pilot alternative care settings for chemotherapy x Improve patient experience of waiting times at Trust and satellite clinics x Trial to examine costs & benefits of in vivo dosimetry x Improve the communication between clinicians and patients x Implement national cancer strategy recommendations and stretch targets The monetary total for the amount of income in 2011/12 conditional upon achieving quality improvement and innovation goals was £812,909, and the monetary total for the associated payment in 2010/11recieved was £809k. Equality Public Sector organisations have been required to demonstrate how they are actively working to reduce health inequalities by promoting equality and working to eliminate discrimination, whilst maintaining a commitment to respect human rights. Moreover, they need to demonstrate the outcomes of this work, in particular, showing how they have assessed the impact of policies, strategies and action plans on the local population and its workforce. Part of the Equality Act 2010 specific duties, which came into force on 10th September 2011, requires that public sector bodies should: x x x

Publish Information outlining how they will comply with the general duty by 31/1/2012. Publish details on their workforce breakdown and the local population by various equality denominations e.g. age, race etc., by 31/1/2012. Undertake a revised equality screening process to replace equality impact assessments called an Equality Analysis, in functions, services and policies. 15

x x

Formulate one objective for each protected characteristic, by 5th of April 2012. All information published on how they will meet the equality duty must be presented in such a manner that it is accessible to the public.

Aims of the Equality Duty Assurance Report In creating an inaugural equality duty assurance report (published on 31st January 2012) CCO is not only aiming to ensure that it is meeting the legal duties to promote equality and challenge unlawful discrimination, but also to ensure that consideration of equality and human rights issues is incorporated into day-to-day practice across the organisation. Intended outcomes will be equal access to services for all groups and reduced health inequalities and improved health outcomes for patients. Safeguarding employees across the protected characteristics and a commitment to advance equality of opportunity across the organisation are also key components. The document aims to provide reassurance that the strategic direction of CCO for promoting equality and eliminating discrimination since April 2011 underpins its adherence to the general duty of the Equality Act 2010 and binding specific duties of the equality duty. Moreover, it may serve as a stepping stone towards formulating strategies and actions that build upon the previous achievements made, under the single equality scheme (2009-2012) and related equality action plans. Scope of the Equality Duty Assurance Report This equality duty assurance report sets out the commitment of the Trust in how it will endeavour to adhere to statutory obligations, building upon progress achieved under previous equality schemes and directives. Workforce Analysis Report 2011 This report (published on 31st January 2012) looks at the profiles of people accessing workforce and employment related opportunities at CCO, based on requirements defined within the new single equality duty and related elements within other equality and employment legislation and it accompanies the Equality Duty Assurance Report (see above). The report looks at the profiles of people accessing workforce and employment related opportunities at CCO, based on requirements defined within the new single equality duty and related elements within other equality and employment legislation. Recommendations from both reports will help inform the inaugural equality strategy, as directed by the requirements of the new public sector single equality duty, which came into effect from 5th of April 2011, as the second tranche of legislation emanating from the Equality Act 2010. Both reports are published in the Equality & Diversity section of the CCO website.

Developing our Services Chemotherapy The Trust provides chemotherapy primarily for solid tumour patients for the population of the Merseyside and Cheshire Cancer Network. An oncologist service is also provided to the Isle of Man. The service model is based on providing safe and effective care and treatment as close to the patient’s home as possible providing choice where possible and clinically appropriate. During 2011/12 we have seen significant growth in our chemotherapy activity and we are currently delivering approximately 3,000 spells per month. Over 90% of the treatments are delivered in outpatient clinics with 70% of patients receiving their treatment at a clinic close to their home. These clinics are located at: x x x x x x x x x

CCO: Delamere Day case unit Countess of Chester Hospital Halton Hospital: Can Treat Centre Southport Hospital Aintree University Hospital: Marina Dalglish Centre Royal Liverpool Hospital: Linda McCartney Centre Liverpool Heart and Chest Hospital Liverpool Women’s Hospital St Helen’s Hospital: Lilac Centre

The inpatient facility is on the Clatterbridge site and is delivered primarily on Sulby Ward with some chemotherapy being given on Conway Ward (e.g. 5FU) for patients also receiving radiotherapy. The chemotherapy is delivered by specialist chemotherapy nurses who are trained to assess patients when they attend for treatment and to decide whether or not to proceed with the chemotherapy on that day or refer the patient back for medical review. Many clinics now operate a nurse delivered model of care which enables reduced patient waiting times, improved quality and efficiency. A key development for us during 2011/12 was the commencement of a feasibility study looking at the provision of chemotherapy delivered in the community comparing chemotherapy delivery in patient’s homes, within a GP setting and versus the traditional hospital setting. We will be widening the study during 2012/13 to also look at the use of a mobile clinic. The aim of this study is to continue to provide chemotherapy as close to where the patient lives as possible to provide safe and effective care whilst continually improving the patient experience. Pharmacy Outpatients & Homecare The need to continue to improve the patient experience has been the rationale for adopting models of care that are more community focused. This approach improves the dispensing of outpatient prescriptions and the expansion into homecare delivery services, which will increase patient choice and access to medicines, as well as enhancing the patient experience through reduced waiting times. 17

The Trust will continue to implement the transformational change required to deliver a fit for purpose outpatient pharmacy service that will allow patients to be put first, staff to remain empowered to apply their professional expertise, and for operational and financial efficiencies to be unlocked. This will allow CCC to compete with other commercial organisations offering dispensing and homecare. Radiotherapy Radiotherapy is delivered on both the Clatterbridge Health Park site and at The Clatterbridge Cancer Centre, Liverpool (CCCL) which has given patients real choice as to where they have their radiotherapy. Overall the radiotherapy service has seen growth in the region of 2% so far in 2011/12 with an expected total of around 89,000 radiotherapy treatments of external beam radiotherapy being delivered by the end of the financial year. Growth is predicted to be 1.9% p.a. or more for the next few years and detailed modelling is underway to ensure capacity is available as required. The development of the satellite radiotherapy provision has improved patient experience for those treated nearer to home and has also enabled an increase in the provision of Stereotactic Radiosurgery. The service treats Acoustic Neuromas, arteriovenous malformation (AVMs) and some brain metastases. CCCL treats in the region of 100 patients per day, all outpatients and mainly those being treated for breast, lung, or prostate tumours. A key innovation at CCCL has been the establishment of Radiographer-led review of patients at this site. CCCL has three Linacs all capable of delivering a range of techniques including Image Guided Radiation Therapy (IGRT) and Intensity Modulated Radiation Therapy (IMRT). The Clatterbridge main site has 9 Linacs with 7 being used clinically each day and 2 as service efficiency machines which allows for great flexibility in the service. There are a wide range of very complex treatments being delivered at this site including Stereotactic Body Radiotherapy and considerable amounts of IMRT and IGRT. The Physics Department has provided mentorship and support to other centres setting up IMRT programs. Brachytherapy has also seen advances with the introduction of Papillon therapy, Image Guided planning of patients being treated for cervical cancer. March 2012 will see the introduction of High Dose Rate Brachytherapy for prostate cancer which will complement the low dose rate service already offered. In 2012 there is a planned replacement of one of the planning CT scanners which will further improve image quality for planning of radiotherapy and an upgrade to the computer planning systems. The installation of a second MRI scanner at CCO will also enable more MR planning to be carried out and there is a drive to explore the use of PET:CT planning in 2012/13. Patient information evenings were piloted at CCCL in 2011 which proved successful in reducing the anxiety levels of patients who had not yet started treatment. In 2012 we will pilot a similar scheme at the Clatterbridge site although with significant modification due to the range of treatments being delivered.

Inpatient Services and Triage The majority of CCCâ&#x20AC;&#x2122;s cancer care is most appropriately delivered in an out patient setting. However, the clinical needs of some patients or the nature of the treatments provided entails an in patient stay for one or more nights. Inpatient services are provided on three wards, Sulby, Mersey and Conway â&#x20AC;&#x201C; giving a total of 71 beds. Within that bed capacity there is a dedicated Teenage and Young Adult unit based on Sulby ward with 4 en suite rooms and a central communal area. Patients between the ages of 18 and 24 where possible are cared for within this area. This is the Principle Treatment Centre for the Merseyside and Cheshire Cancer Network. Within Conway Ward there is a dedicated 2 bedded area that has been developed for the management of acutely unwell patients. The aim of these beds is to provide an area where there is a higher ratio of nursing staff to patients (1 nurse to 2 patients) enabling patients to be monitored more closely. The Critical Care Nurse Practitioners provide support to both nursing and medical staff when patients need a higher level of care than is usually required in the ward environment. The overall aim of these beds is to enable some patients who, in the past, might have been transferred to another hospital, to receive extra support to remain at the hospital and continue treatment, or enable patients to be stabilised and transferred safely to other hospitals when required. Conway and Sulby ward have been refurbished in recent years to provide a ward environment that is suitable for our patients with an increase in single rooms and washing facilities. Bays now have only 3 beds with a bathroom/ shower room for each bay. Mersey ward will be refurbished in a similar way in 2012. A key objective of the Trust is to provide more treatments in the outpatient setting. The result of this is a general reduction over time in the number of inpatient beds required, however the acuity of patients requiring inpatient care is increasing. It has been identified that patients requiring admission in an emergency, generally as a result of toxicities caused by their cancer treatment or oncology emergencies, require rapid assessment and treatment. The current ward configuration is being redesigned to meet these needs and the refurbished Mersey ward will incorporate an emergency admissions unit to cohort this group of patients to one area facilitating rapid assessment and commencement of treatment. To support this, the telephone triage service is being expanded to provide telephone advice to all patients receiving treatment at the Trust. This will also be the link to the Acute Oncology services across the network, providing a single point of contact for patients and health professionals seeking support or advice. The refurbished Mersey ward will also have a planned short stay area predominately for patients undergoing theatre procedures or treatments with a short defined length of stay, enabling this area to close over weekends thus increasing the efficiency of the inpatient service. The theatre service provides a variety of brachytherapy treatments that includes low and high dose rate radiotherapy along with assisting in the planning and delivering of other forms of radiotherapy such as implants that provide reference markers for treatment planning, and examinations under anaesthetic. The demand for invasive and closely targeted radiotherapy treatments is likely to increase in the future and theatre services aim to be at the forefront of the development of this form of radiotherapy.

The priorities for development of the inpatient service over the next 5 years will be to ensure nursing staff have the competencies to provide high quality, safe and effective care to an increasingly unwell and elderly patient group in a safe and conducive environment, whilst reducing length of stay, improving discharge planning, and preventing unnecessary admissions. Holistic, patient centred care forms the heart of the inpatient service which acknowledges the need not only to provide the highest quality cancer treatments but support to patients to return home safely at the end of their care. Inpatient nursing services also work closely with the Specialist Palliative Care Team and Cancer Rehabilitation and Support Team (CReST) Team supporting patients to manage their illness, promote independence and ensuring patients at the end of their lives have a dignified death in their preferred place of care. Diagnostic Imaging The Diagnostic Imaging Department primarily provides diagnostic, staging, re-staging and follow-up investigations for patients undergoing chemotherapy and radiotherapy at CCO or satellite clinics. Imaging services are also provided to the local GPs and Wirral Hospital University Trust (WUHT) via Service Level Agreements. The Diagnostic Imaging Department has four internal departments. These are: x x x x

CT MR Nuclear Medicine (gamma camera) X-ray and ultrasound

There is a CT scanner, an MR scanner and one SPECT CT gamma camera. A direct digital general x-ray room, a fluoroscopy room, an ultrasound scanner and a mobile x-ray set. The Trust hosts the Cheshire and Merseyside PET/CT service one and a half days a week. The service is provided by an independent sector company, Alliance Medical Limited, using a mobile scanner. One of the Trustâ&#x20AC;&#x2122;s Consultant Radiologists is part of the local PET/ CT reporting team. The Diagnostic Imaging Department supports the Research and Development activities of the Trust by providing scanning and reporting services and RECIST measurements as required at appropriate points in the patient journey. In 2012 a second MR scanner will be installed to provide additional capacity, equipment functionality and so allow further development of MR scanning for radiotherapy planning purposes. Supportive Care The definition of supportive care services for the development of service plans is that covered by the scope of the Supportive and Palliative Care Improving Outcomes Guidance (NICE). The key aims of the service are: x

To ensure that patientsâ&#x20AC;&#x2122; physical, psychological, spiritual, social and financial needs are assessed at key points such as diagnosis, at commencement of treatment, during

x x

and at the end of treatment, at relapse and when death is approaching, and that all possible steps are taken to ensure that these needs are met. Supportive care should be provided in a way that ensures effective interprofessional communication within teams and between them and other service providers with whom the patient has contact. The provision of supportive care services within CCO is diverse with roles and functions sitting within a number of directorates.

User involvement and support groups The Trust is committed to involving its stakeholders, including patients, in the design and development of its services. The framework for engagement is within the Trusts Patient Experience Strategy and is coordinated by the Patient Experience Manager providing advice and support to staff on appropriate methodology to ensure user involvement is meaningful. The Patient Experience Manager is supported by a Patients Council and PALs volunteers who provide a valuable patient / public perspective and are involved in a number of initiatives including participating in interview panels for CReST members. Further public involvement is greatly facilitated by the work of the Trust’s Council of Governors. A number of patient involvement initiatives and programmes are also in place to provide focused support and involvement. These include the following: x

The Teenage and Young Adult team facilitate a monthly support group for 16-24 year olds. This is a social group that aims to get young people from across the network meeting each other and enabling them to support each other through peer support.

The Lymphoedema Support Group provides support for patients with Primary and Secondary Lymphoedema and their carers.

The National Survivorship Initiative is an educational program as part of a National Study which aims to address patient self management of symptoms and side effects following cancer treatment. As each course is completed, an evaluation by the project leads informs subsequent courses to ensure that they meet the needs of the individual.

A Carer’s group is in place whose aim is to implement a carer’s assessment for the carers of all patients who attend the centre.

Information Information services are provided in three main ways: x

The Trust has a Macmillan Cancer Information and Support Services (MCISS). These are staffed by healthcare professionals supported by volunteers who provide a ‘meet and greet’ service. The service has established excellent relationships with support groups across the network and provides a listening ear to both patients and

carers and is able to signpost them to appropriate services within the Trust or their own local area. x

A comprehensive range of patient information leaflets are provided free to patients at key points in their care and treatment. The Trust has gained the Information Standard Accreditation for written information.

Health promotion advice is also provided through a number of events such as Pink (breast cancer) and Blue (menâ&#x20AC;&#x2122;s health) days providing focused information for specific tumour types.

Psychological support services The psychological support service is comprised of psychological medicine consultants, registrars, trained counsellors and a CLIC Sargent Clinical Psychologist for Teenage and Young Adult service (TYA) cross network post). Social support services A social worker and a Macmillan Welfare Benefits Advisor provide support to our patients. The Oncology Social Worker will liaise with the community Social Services Department, other local authority services and voluntary agencies and advocate on behalf of the patients who need care packages at home, residential/nursing home care, intermediate care, or have other problems at home. They also provide social and emotional support to the whole family. In addition we host two Cancer and Leukaemia in Childhood (CLIC) Sargent Social Workers within the TYA with one of these based at the Royal Liverpool University Hospital. Spiritual support services A chaplaincy service is provided via a service level agreement by Wirral University Teaching Hospital NHS Foundation Trust (WHUT). The Trust is embedding the â&#x20AC;&#x153;Opening the Spiritual Gateâ&#x20AC;? program. This involves raising awareness and developing skills amongst clinical staff regarding: x x x x

Understanding the meaning of spirituality Communication Recording and reporting Pulling it all together

A quiet room is available for patients and carers; this can also be used for religious observance, although no religious artefacts are kept within this area. General palliative care including care of dying patients General palliative care is provided by staff within the wards. The Trust has implemented the Liverpool Care Pathway for the Dying Patient. The use of the pathway is audited and 22

reported to Integrated Governance on an annual basis by the specialist palliative care team who include this information in their annual report. A project has commenced in early 2012 to implement further end of life care tools. The Trust’s refurbishment programme has included an increase in single rooms improving the environment for the dying patient. The Trust has a specialist palliative care team which compromises a Consultant in Palliative Medicine and a team of specialist palliative care nurses, one of whom is a Macmillan post holder. There is also a palliative and supportive care coordinator. The nursing team provides a 7 day 9-5 face to face service. Rehabilitation services Rehabilitation services are provided by clinical and support staff who make up the Cancer Rehabilitation and Support Team (CReST) as detailed above. Developments within the Rehabilitation services include: x The late effects clinic (LEC). x On-Track. A project awarded the 2012 Inspire Mark utilising access to sport, educational and vocational activities to support people of all ages following treatment for cancer. x Moving Forward/ IMPACT (Information for Self Management Program After Cancer Treatment). A project part of the National Cancer Survivorship Initiative (NCSI) set up to help patients better manage post treatment symptoms and long term side effects of pelvic cancers. x Older Person’s Pilot Project – A pilot testing: o new methods of clinical assessment of older people with a diagnosis of cancer o coordinating and delivering short-term practical support packages for older people undergoing treatment o promoting age equality to address age discriminatory behaviour in cancer services. Complementary therapy services The Trust provides a hand and foot massage service to patients via its volunteer service. A dedicated complementary therapy service and room is available to patients providing massage, aromatherapy and reflexology sessions, delivered by trained and registered therapists. Services for families and careers, including bereavement care The Trust has a ‘day after death service’ which provides an individual service for relatives/next of kin of the deceased to attend the Trust following the death of the patient. This involves: x

An individual appointment with one of the Clinical Nurse Specialists or Ward Managers 23

x x

A pre arranged appointment time with the Registrar to register the death Contact details for future support needs.

Overview of education and training The Clinical Education Department at CCO is committed to promoting the quality of care for people with cancer through education and professional development. The Department offers a range of educational programs such as study days, short courses and degree level modules which are aimed at health and social care practitioners and support staff who have an interest in cancer care. The department is also able to accommodate the educational needs of individual organisations upon request. Clinical Education runs a number of oncology programmes and pathways in association with both the Faculty of Health and Social Care University of Chester, and the University of Liverpool Modules may be taken as stand-alone modules, or used to contribute towards a diploma or degree pathway. Some programmes are available as distance learning. In 2008 the Trust has developed in partnership with the Faculty of Health and Social Care Board of Studies at the University of Chester a Practice Development and Research Partnership (PDRP). The aims of the PDRP are to develop, extend and increase research and practice development activities and projects whilst building on individual and team skills, confidence, knowledge and experience. The partnership also aims to link together practice development, research and education. The Trust also delivers Advanced Imaging Clinical Schools to visiting delegates from all around the world, on behalf of Varian Medical Systems. In 2005, we became the first oncology centre in the United Kingdom to install a linear accelerator with an On-Board Imager (OBI) system. The OBI is a state-of-the-art imaging device that can be used to improve the accuracy of patient positioning and to allow the tracking of tumour motion. Varian subsequently chose us, as pioneers in the use of this equipment, to host and deliver training courses for their customers. In September 2007, we provided Europe’s first training school on Image-Guided Radiotherapy (IGRT) to an audience of oncologists, physicists and radiographers from Russia, Norway, Italy, Spain and Scotland. In April 2010, the School was expanded to include Respiratory Gating and Varian’s Real-time Position Management (RPM) system as well. The RPM system allows the movement of a patient’s tumour to be correlated with their breathing, thereby offering the possibility of delivering radiotherapy treatment in only part of the breathing cycle. The Schools have been run every year since 2007 on four or five occasions per year, typically in February, April, June, September and November. CCO runs an annual "Radiobiology & Radiobiological Modelling in Radiotherapy" course for delegates from around the world. The course provides a greater understanding about both the basis of radiation treatment for cancer and the use of radiobiological modelling in evaluating and improving treatments. This event brings together some of the world's leading experts in a specialist but increasingly important subject area - for this reason it attracts global interest. In July 2010 the course received full endorsement from E.S.T.R.O., Europe’s leading Radiotherapy Society. The Trust is a training site for a range of pre-registration radiotherapy students. The students are placed within the radiotherapy department for the majority of their clinical training. The Trust also provides clinical placements for nursing students. 24

Overview of research and development The establishment of a comprehensive cancer centre based at the new Royal site will bring together state of the art facilities, academia and key NHS partners. This will strengthen existing research collaborations and enable new ones to develop. CCO is a member of the Liverpool Health Partners (LHP) and the Liverpool CRUK Cancer Centre. These important alliances support CCOâ&#x20AC;&#x2122;s strategic goal to secure a national reputation for excellence in research. The Trust continues to actively support the development of the Academic Unit of Oncology. CCO recognises the importance of such academic leadership and sees it as an excellent opportunity to strengthen its relationship with the University of Liverpool. The Academic Unit is led by Professor Dan Palmer (Chair of Medical Oncology) and will seek to attract external research funding from the National Institute for Health Research, local and national charities, as well as from pharmaceutical industry collaborations. The Trust has recently invested in a number of research posts to support the development of an early phase trials portfolio at its satellite clinic in the Royal Liverpool Hospital. This work will come under the umbrella of the Liverpool Early Drug Development Unit (LEDDU), which is a collaboration between CCO, the University of Liverpool and the Royal Liverpool and Broadgreen University Hospitals NHS Trust. The Trust has also committed to fund a Chair of Radiation Oncology, Senior Lecturer and Senior Physicist to further strengthen the Academic Unit. Following a national review of radiotherapy research, the National Cancer Research Institute (NCRI) established the Clinical and Translational Radiotherapy (CTRad) Working Group. CTRad has a broad, strategic remit to develop an ambitious portfolio of practice changing trials. Several CCO employees are members of the different CTRad work streams, which focus on basic science, phase I-II trials, phase III trials, new technologies and quality assurance. The development of a locally-led, internationally competitive portfolio of radiation oncology research is a key objective for CCO. Research Leads and workshops We have appointed Research Leads in both Chemotherapy and Radiation Oncology. These individuals have been charged with driving the development of research in key clinical areas. The following multi-disciplinary research workshops have been established: x x x x x x x

Lung cancer Rarer cancers (ocular and cutaneous melanoma, gynae and brain) Breast cancer Urological cancers GI cancers Acute Oncology / support care Head and neck cancers

These workshops are responsible for developing new research proposals suitable for submission to national funding calls. The Chair of Medical Oncology and Senior Lecturer are active members of these workshops. Representatives from the Liverpool Cancer Trials Unit are also in attendance. 25

Physics Research Group The CCO Physics Research Group has enhanced the Trust capabilities in relation to radiological modelling and radiation dosimetry applicable to clinical radiotherapy. Software has been developed that enables external beam radiotherapy to be optimised in terms of maximising local control. Due to active collaborations with colleagues in Vancouver, Cardiff and Liverpool University Computing Department we are very close to possessing a comprehensive Monte-Carlo based patient dose computation facility. The Douglas Cyclotron The Trust has the only Proton Therapy Facility in the United Kingdom for the treatment of eye cancers. Patients are referred from all over the UK and Ireland. The Unit has a long standing collaboration with the National Physical Laboratory (London) on proton dosimetry, which has included graphite calorimetry, proton ionometry and other detectors such as alanine pills, Pressage and BANG gels, and Gafchromic films. Monte-Carlo modelling of the beamline, using several codes, has been carried out in collaboration with the Physics Department of the University of Liverpool. Acute Oncology The Trust in partnership with Merseyside & Cheshire Cancer Network (MCCN) are at the forefront of service development in the new but rapidly evolving field of Acute Oncology which encompasses all aspects of emergency non surgical oncology care. A network of acute oncology services has now been implemented across the local network of acute hospitals. The services are provided by an acute oncology team employed by CCO but based in the acute hospitals. Gene Therapy The Trust has been involved in early phase gene therapy work for the past three years. We have a number of clinical oncologists with experience in this area. The Trust has a dedicated gene therapy suite within our pharmacy department and we are currently registered with the Health & Safety Executive for Class 1 and 2 studies. All our gene therapy work is conducted via our Trusts' Gene Therapy Committee and in accordance with robust gene therapy governance systems, processes and a full set of gene therapy specific standing operating procedures, and a gene therapy code of practice. The Merseyside and Cheshire Cancer Research Network (MCCRN) The Trust has hosted the MCCRN since its inception in 2002. The purpose of the MCCRN is to benefit patients by providing infrastructure and support to local NHS organisations and to increase recruitment of patients into National Institute for Health Research Clinical Research Network (NIHR CRN) cancer portfolio studies. It also aims to improve the integration, quality and speed of cancer research. The MCCRN serves a local population of circa 2.14 million and 12 Trusts, 5 of which are specialist Trusts. The MCCRN operates in a challenging

setting, compounded by complex service configurations but this is successfully managed by a highly mobile oncology team and supportive Clinical Nurse Specialist community. The NCRN is a target driven organisation with a commitment to achieve the high level objectives set out by the National Institute for Health Research (NIHR). Its primary aim is to increase the number of cancer patients entered into NIHR studies and ensure they recruit to time and target (target recruitment is specified at local feasibility stage). A secondary objective is to continue to increase recruitment into randomised controlled trials (RCTs) beyond the original target of 7.5% of incidence cases. In Merseyside and Cheshire approximately 8800 patients with cancer or a pre malignancy have been recruited into clinical trials since the introduction of the MCCRN in 2002. Patient recruitment has increased from 4.8% in 2001/2 to 18.7% in 2010/11. CCO supports patient recruitment at its Wirral base and in its satellite clinics at ten NHS Trusts. The Trust has received national commendation for its high recruitment into a number of NIHR cancer studies. Developing our Workforce HR Policies and Processes The 2010 Equality Act contained a provision to create a single equality duty for public sector bodies. This year, we published our first Equality Duty Assurance Report, which confirmed that the Trust continues to promote Equality and eliminate discrimination in line with our legal duty. The Trust’s Equality, Diversity & Human Rights Steering Group (EDHRSG) advises the Trust Board, and endorses a range of initiatives, reports and actions. The Disability Sub-Group of the EDHRSG has representatives of staff, patients, carers and volunteers. The Group continues to advise on improvements to the experiences of disabled patients, including ensuring that information is available in a range of formats. For example, the Trust engaged with the Deaf Community to host a multi-professional half-day session to offer more information on cancer and its treatments. The Group is also considering ways of encouraging greater self-declaration of disability by staff. Our annual Workforce Equality Analysis collected data across each protected characteristic, made comparisons with our local population, and produced recommendations for improvements in policy and procedure. Foundation Trust Governors and members also form an important part of the Trust’s Equality Governance arrangements through participation in various Groups and forums. Staff Survey The Trust used a variety of methods to communicate and engage with its staff this year, in addition to the Team Brief process and the various formal Consultative, Negotiating and Health and Safety Committees. We held our annual Start the Year event in April, at which staff were invited to discuss the Trust’s annual plans and targets with the Executive Directors. The Chief Executive held Open Forums with staff throughout the year, to give them the opportunity to hear directly from him, and to ask questions.

Staff are also kept up to date by the Trustâ&#x20AC;&#x2122;s intranet site, and the staff newsletter. As we plan our future service strategies, we will place the utmost importance on the engagement and involvement of our staff. The Trust achieved impressive results from the National Staff Survey carried out in 2011, scoring above average for acute specialist Trusts in 26 out of the 38 key findings. There was no change in our performance from 2010 in 37 of the 38 findings, with 1 finding showing a decrease in performance. We achieved the best score amongst our reference group of specialist acute Trusts in 11 of the key findings. In summary: x x x

The response rate fell by 2% compared with 2010 There was one key finding, concerning attendance at health and safety training, where our score deteriorated compared with 2010. In all other areas, there was no statistically significant change* Our top 4 ranking scores and bottom 4 ranking scores are shown below: 2010/11

Response rate

Trust

2011/12

National Average

Trust

National Average

50%

55%

Top 4 Ranking Scores

Trust

National Average

Trust

National Average

Trust commitment to work life balance Percentage of staff using flexible working Intention to Leave Job

3.70

3.53

3.74

3.5

No change*

73%

65%

73%

65%

No change*

2.32

2.46

2.33

2.54

No change*

91%

90%

93%

90%

No change*

Role makes a difference to patients

48%

Trust Improvement/ Deterioration

52%

2% deterioration

Bottom 4 Ranking Scores

Trust

National Average

Trust

National Average

Percentage staff working extra hours Staff reporting errors, near misses or incidents witnessed in last month Staff experiencing physical violence from staff in last 12 months Staff suffering from work-related stress in last 12 months

69%

65%

70%

67%

No change*

96%

95%

96%

No change*

24%

26%

27%

No change*

We achieved the best score among acute specialist Trusts in the 11 key findings below: x x x x x x x x x x x

Staff believing their role makes a difference to patients Staff rating the Trustâ&#x20AC;&#x2122;s commitment to work-life balance Staff using flexible working Good opportunities to develop potential at work Staff intention to leave their job Recommending CCC as a place to work or receive treatment Work-related injury Equality & Diversity training in last 12 months Experiencing discrimination at work Job satisfaction Good communication between senior managers and staff

Future priorities and targets The proportion of staff reporting working additional hours, and experiencing work-related stress, will be addressed through the Trustâ&#x20AC;&#x2122;s Health and Wellbeing Plan, part of our revised Human Resources and Organisational Development Strategy. We will review the support available to staff experiencing stress, and develop a Workforce Plan to ensure that we have the right number of staff available with the right skills. A further Stress Audit will be carried out early this year. Attendance at Health and Safety training will be monitored through a revised training management system, and reported to the Trustâ&#x20AC;&#x2122;s Integrated Governance Committee. This training will emphasise the importance of reporting errors or near-misses, including any instances of physical violence. Through the implementation of our HR & OD Strategy, in partnership with our staff organisations, we aim to make further improvements to our working environment, and become an employer of choice. Improvements following Patient Surveys and Care Quality Commission Reports The Trust consistently scores in the top 20% of all Trusts in the majority of questions in the national CQC patient survey. However, we recognise that there is always scope for improvement. Key areas of service improvement following the review of the survey have included: x x x x x x x

Improved ward design (as part of the ward refurbishment programme) to reduce noise at night. One ward remaining. Continually monitor waiting times within departments Increased frequency of cleaning in high use areas Service efficiency LINACs to enable patient waits to be minimised Encourage the use of patient pagers in radiotherapy and Delamere Day Case Unit to improve the patient experience of waiting times Increase in nursing establishment in wards. More frequent food surveys

Improvements in patient/carer information Throughout 2011/12 we have continued the programme of ongoing improvement of the information provided to our patients and carers. We are accredited by The Information Standard for our internally produced patient information leaflets proving our commitment to providing trustworthy health and social care information for our patients. The Information Standard mark signposts trustworthy information, so the public can find it quickly and easily. The process of accreditation has resulted in improved governance processes around information production and document control allowing us to demonstrate to the public that our information is both credible and reliable. Complaints handling The Trust continues to have a low number of complaints (14 in 2011/12). Complaints are managed by our Patient Experience Manager who provides an integrated complaints, PALs and patient and public involvement service and who forms part of our Clinical Governors Support Team. All complaints are reviewed and responded to by the Chief Executive. Information on complaints and lessons learned are shared with all staff via our Team Brief and information provided to the public via annual clinical governance road shows held in public areas of the Trust. The Council of Governors Patient Experience Committee receives complaints/PALs quarterly reports, and on a quarterly basis review the handling of complaints received during that time. Summary of Complaints 2011/12 Total complaints received

Subject matter of complaint Treatment and Care Communication Discharge Staff attitude

8 2 1 3

All complaints are fully investigated and responded to within required timescales. Partnerships and Alliances Clatterbridge Cancer Charity (formerly Clatterbridge Your Cancer Centre) 2011/12 has seen The Clatterbridge Cancer Charity go from strength to strength, raising a massive ÂŁ1.2million to help our patients and their families, a 20% increase on the previous year. Such a result really demonstrates how committed our supporters are, that during a time when the nation is tightening its belt, they are giving so generously to allow us to continue the work we do. We would never have been able to achieve so much this year without the continued support from our charity volunteers, donors and fundraisers. 30

Every year, thousands of people raise vital funds for The Clatterbridge Cancer Charity, the only charity directly raising money for Clatterbridge cancer patients and their families. Their donations help us to fund vital research, up to date treatment, world class equipment and lifechanging support services, which would otherwise be unavailable. This year, the charity funded a number of projects at Clatterbridge, notably the full refurbishment of our Mould Room. Patientâ&#x20AC;&#x2122;s who have head and neck cancer, are fitted with masks here to allow absolute precision and improve safety for our patients during treatment. This ÂŁ100,000 appeal allowed a full refurbishment of the unit, completely transforming the facilities we provide and changing the experience for hundreds of patients each year. The charity has also funded a number of cancer research programmes this year, exploring treatment for different types of cancer, aiming to reduce some of the more painful side effects of chemotherapy and a study into how a cancer diagnosis affects people on a personal and emotional level. Alongside these projects, the charity continues to fund services which enhance the lives of our patients and their families at a very difficult time in their lives, such as complementary therapy, counselling, a free wig service and gym equipment for our teenage patients, amongst many other of the services that make Clatterbridge such a unique and special cancer centre. Thank you to the thousands of individuals, groups, organisations, trusts and companies who have supported the charity over the last year, every single penny you have donated has helped to change lives. Further information about our charity can be found at www.clatterbridgecc.org.uk Development of Private Patient Facility The September 2011 Trust Board appointed PWC and Pinsents Mason as commercial and legal advisors to assist with production of a business case and commercial and legal advice as part of the subsequent procurement process. Private Patient Joint Venture As part of an extension of the services it provides the Trust is currently concluding a voluntary OJEU to establish a joint venture private patient facility with a private sector partner at its Clatterbridge site. At its April 2012 Trust Board, the Trust appointed a preferred partner. Subject to final negotiations, the Trust intends to open a Private Patient Facility with a private partner early in 2013. Academic Unit of Oncology We continue to work in partnership with Liverpool University to develop an academic unit of oncology and associated research developments. The Chair of Medical Oncology took up post in April 2011.

Governance NHS Foundation Trust Code of Governance All requirements of the Monitor Foundation Trust Code of Governance have been met in full. Council of Governors Working together with the Board During the last year our Board of Directors and Governors have worked together in a number of ways to ensure that the Governors’ views are understood and that they receive appropriate support. Since early 2010 the Senior Governor (or in their absence another public governor) has attended Board of Directors (known as Trust Board) meetings to ensure transparency between the Board and Council. To supplement the attendance of the Chair of Audit Committee at the Council meetings, the Trust implemented the attendance of a ‘public’ governor at the Audit Committee. This ensures that any matters identified are considered and where any action or improvement is needed. In preparing the Annual Plan, the Board must have regard to the views of the Council of Governors. The Council of Governors has been involved in the process of developing the Annual Plan through a number of forums: x The Board and Governors away day October 2011 x Chief executive presentations to the Council e.g. updates on performance, strategic and operational issues x The work of the Strategy Committee and their reports to the Council. In addition to that outlined above a ‘Public’ governor attends the Investment Committee to ensure Governor contribution to future developments for the organisation such as the investment in Liverpool. The Council of Governors have the responsibility to hold the Board of Directors to account for the performance of the Trust, to ensure this happens a ‘public’ governor has been in attendance at the Integrated Governance Committee. This gives the Council the opportunity to receive detailed information on a selection of key performance indicators and the Trusts approach to key areas. The Senior Governor has met with the Chairman throughout the year to ensure Governors are kept up to date on any developments within the Trust. In addition the Senior Governor has produced updates for Governors which were circulated electronically. Council of Governor’s roles and responsibilities and working arrangements The Governors are elected as part of an independent process managed by Electoral Reform Services, in line with the Trust constitution.

The Council of Governors meets at least 3 times per year in public and fulfils its legal obligations as outlined in the constitution. In addition to Council meetings, there are three Committees: Membership, Communications & Fundraising, Patient Experience and Strategy. The Council of Governors has revised and approved its standing orders to govern its conduct and provide a governance framework for its meetings which includes the development of its sub committees. Each of these committees has identified an Executive and a Non-Executive Director for advice purposes. In addition the Director of Nursing & Quality has a specific role in supporting and working with the Council of Governors playing a key role in developing links between the Board committees and the Council of Governors ensuring that key strategic themes are being addressed. During the year the development needs of Governors are also reviewed to ensure that they are able to fulfil their responsibilities. Throughout the year Governor information sessions have been held with presentations from Executive Directors and relevant external experts such as Auditors. During this financial year the Auditors were not requested to provide any non-audit services.

Composition of the Council of Governors The Council is made up of 28 Governors, public, staff and nominated organisations, serving a fixed three year term of office. Liverpool Sefton St Helens & Knowsley Warrington & Halton Chester, Ellesmere Port & Vale Royal Wirral, Wales and the rest of England Staff governors Nominated organisations

3 2 2 2 2 4 6 7

Total:

Governors Name

Elected public, elected staff, nominated

Representing

Meetings Held

Meetings Attended

Member of Committee (see key)

Year Term ends

Michael Ashley

Elected Public

Warrington & Halton

Resigned

Trevor Benn

Elected Public

PE (Chair)

2014

Peter Benson (until Sept 11)

Elected Staff

Wirral, Wales and the rest of England Non Staff

2011

Lawrie Black

Elected Public

PE, MCF

2014

Andrea Chambers

Nominated

2012

Michele Christopherson

Elected Public

Chester, Ellesmere Port and Vale Royal Manx Cancer Help Association Sefton

PE, N&R

2012

Stuart Clutton

Elected Public

Warrington & Halton

MCF (Chair)

2014

Alan Comyns (until Sept 11) Tom Fisher (until Sept 11)

Elected Public

2011

PE, N&R

2011

Denys Floyd (until Sept 11) Alan Griffiths

Elected Public

Chester, Ellesmere Port & Vale Royal Wirral, Wales and the rest of England St Helens & Knowsley

MCF

2011

Elected Public

St Helens & Knowsley

Resigned

Cathy Gritzner

Nominated

Wirral PCT

Resigned

Sonia Holdsworth

Nominated

Macmillan Cancer Support

2014

Eileen Howlett

Elected Staff

2014

Charles Hubbard

Elected Staff

Volunteers, Service Providers, Contracted Staff Sefton

2013

Jill Johnson

Elected Public

MCF

Corrie Lowry

Elected Public

2013

Pam McCarron

Elected Staff

Wirral, Wales and the rest of England Wirral, Wales and the rest of England Radiographer

2013

Ray Murphy

Nominated

2012

John Navein

Elected Public

Cheshire & Merseyside Caner Network Task Force Liverpool

2014

Gerry Oâ&#x20AC;&#x2122;Connell

Elected Public

St Helens and Knowsley

2014

*Gill Oliver

Elected Public

MCF

2012

Andrew Pettitt

Nominated

Chester, Ellesmere Port and Vale Royal The University of Liverpool

2012

Cherry Povall

Nominated

MCF

2011

Ros Randles

Elected Public

2013

Cheryl Rosenblatt

Elected Public

Metropolitan Borough of Wirral Wirral, Wales and the rest of England Liverpool

PE, MCF

2013

Kate Smith

Elected Staff

Nurse

PE, N&R

2012

Richard Sturgess

Nominated

2012

Jeremy Such (until Sept 11) Karen Swale

Nominated

Aintree University Hospitals NHS Foundation Trust Macmillan Cancer Support

Resigned

Elected Staff

Non Clinical

ST (Chair), N&R MCF

John Thornton

Elected Staff

Other Clinical

2013

Nicky Thorp

Elected Staff

Doctor

2013

Yvonne Tsao

Elected Public

Liverpool

PE, MCF

2012

*Senior Governor PE Patient Experience ST Strategy

Elected Public

MCF N&R

Membership, Communication & Fundraising Nomination & Remuneration

2013

We would like to express our thanks to former Public Governors: Alan Comyns, Denys Floyd and Tom Fisher; Staff Governors: Peter Benson; Nominated Governor: Jeremy Such. Each served as a Governor during 2011/12 for a period of time, and have since resigned from their role, not been re-elected or re-appointed or were ineligible for re-election as outlined in the constitution. We would like to offer our sympathies to the family of former Governor Celia Tryers, who sadly passed away in June 2011. Elections Election processes were held and completed in July and September 2011 and the outcomes were announced at the Annual Members Meeting on 29th September 2011. Declaration of Interests A copy of the Register of Interests is available via the Trust website www.clatterbridgecc.nhs.uk, alternatively you can contact Andrea Leather on 0151 482 7799 to request a copy. Remuneration Committee The Remuneration Committee consists of 6 governors, one of whom will act as Chair (who will have a casting vote) and decides the terms and conditions of office including the remuneration and allowances of the Non Executive Directors. Also see note 3.6 of the Annual Accounts. Nominations Committee (Non Executive Directors) Non Executive members of the Board including the Chairman are appointed (and removed) by the Council of Governors at a General Meeting, as outlined in the constitution. The Nomination (Appointment) Committee for the Non Executive Directors is made up of the Chairman (or the Vice Chairman if the Chairman is standing for re-appointment) and at least three elected Governors. This Nomination Panel is responsible for appointing Non Executive Directors by identifying appropriate candidates through a process of open competition, which takes account of the policy maintained by the Council of Governors and the skills and experience required. During this year the Nominations Committee has recommended the re-appointment of Louise Martin until 31st July 2013 and the appointment of Alison Hastings (with effect from January 2012 for an initial term of office of three years) which were subsequently approved by the Council of Governors at its meeting in November 2011. Both of these processes were in line with the Trustâ&#x20AC;&#x2122;s constitution.

He continues to have a central role in supporting the current Reform Agenda for the NHS, particularly in the development of GP Commissioning and supports several Department of Health reference groups for current policy implementation. He also serves on the National Institute for Health and Clinical Excellence (NICE) Commissioning Steering Group and the Care Quality Commission's Stakeholder Committee. Louise Martin – Senior Independent Director (from 1st January 2011) Re-appointed by the Council of Governors (3rd term of office, 1 year) until July 2013. Louise was appointed as a Non-Executive Director at the Trust in April 2001. She has worked within the UK National Health Service for 15 years in a number of clinical and managerial posts. In 1998 Louise left the NHS to head the project company managing the delivery of a major first-wave PFI scheme at South Manchester University Hospitals NHS Trust. Louise now works for Health Care Projects Ltd, a subsidiary of ‘Innisfree’ the Infrastructure Investment Company, where she acts as Project Director. Graham Morris - Vice Chair (from 1st January 2011) Re-appointed by the Council of Governors (2nd term of office, 3 years) until November 2012. Graham became a Non-Executive Director in December 2005. He is a qualified accountant (FCCA) and worked for 33 years in the electricity industry. During that time Graham gained extensive experience of finance, regulation and corporate strategy, heading up the finance function of SP Manweb plc following Scottish Power’s take-over. During this period he also worked in America, working on the merger of PacifiCorp, an American subsidiary acquired by Scottish Power in 1999. Graham was until recently Director of Finance and Information Governance for Urgent Care 24 Ltd, a not-for-profit social enterprise, committed to carrying on business in relation to health and well-being for the benefit of the community. Helen Porter – Director of Nursing & Quality Helen has been a cancer nurse for over 28 years. She has worked within 4 cancer centres holding a variety of clinical and non-clinical posts. She has played a role in the national and international cancer nursing agenda through being on the committees of the RCN Cancer Nursing society; RCN Haematology Society and the International Society of Nurses in Cancer Care. She has been at the Trust since August 2000 joining as Director of Nursing. Four of these years were also spent as the Lead Cancer Nurse for the Merseyside and Cheshire Cancer Network. Rob Smith – Director of Operations & Performance Rob joined CCO as Director of Operations at the end of February 2011. Rob has worked in a variety of NHS posts, starting in London and then in the North West since 2002. Prior to joining the Trust, Rob was Associate Director for Acute services at Stockport NHS Foundation Trust. Before that he was Deputy Director of Operations and Acting Director of 38

Carol Eastwood Appointed by the Council of Governors (2nd term of office, 3 years) until December 2011. In September 2007 Carol retired as a Vice President in Corporate Information Services in Astra Zeneca, one of the worlds leading pharmaceutical companies. She joined ICI from university as a research scientist and was appointed as Chief Analyst for Zeneca Specialities in 1995. Carol has been a member of many different external committees, including European Research programmes, Information Governance in the Pharmaceutical industry and Regulatory Compliance. She was appointed Non-Executive Director February 2007. Alison Hastings Appointed by the Council of Governors (1st term of office, 3 years) until December 2015 Alison trained as a journalist in 1983 and was Head of Training and Staff Development for Thompson Newspapers before becoming Editor of the Evening Chronicle in Newcastle in 1996. She is now the BBC Trustee for England and Vice President of the British Board of Film Classification as well as a media consultant. Dr David Husband â&#x20AC;&#x201C; Medical Director David has been Medical Director since 2000. Following a degree in Biochemistry, he trained in medicine at the University of Leeds. Post-graduate training in general internal medicine and endocrinology and diabetes followed in Leeds and Newcastle. David came to Clatterbridge to train in Clinical Oncology in 1985 and was appointed Consultant in Clinical Oncology in 1992. He has served on the Board in various capacities since 1996, having been Clinical Director of Radiotherapy from 1996-2001 and Medical Director since December 2000. He continues to work as a clinician with interests in head and neck oncology and neuro oncology and attends clinics with clinicians from Wirral Hospital, the Countess of Chester, Royal Liverpool University Hospital, Walton Neurology and Neurosurgery, University Hospitals Aintree, and St Helens and Knowsley Trusts. During a varied career David has worked in some 20 Hospitals. James Kingsland Appointed by the Council of Governors (1st term of office, 3 years) until January 2014. James has 23 years clinical experience as a Wirral GP as well as over 10 years of Department of Health advisory work. He is the National Clinical Commissioning Network Lead on behalf of the Department of Health having previously been the National Practice Based Commissioning Clinical Network Lead from April 2009. James served as Chairman of the National Association of Primary Care for 4 years from September 2004 and became President of the organisation in September 2008.

Planning at North Cheshire Hospitals. Rob has particular interest and experience in service improvement initiatives and large scale organisational change projects. Alan White – Chairman Re-appointed by the Council of Governors (3rd term of office, 3 years) until July 2013. Alan was appointed as Chairman in 1999. Alan retired from Local Government following 10 years as Chief Executive of Wirral Metropolitan Council, the eighth largest organisation of its type in England, employing over 17,000 staff and with an operational budget of £360m, the chief executive role was both challenging and high profile. He led a successful bid for ‘City Challenge’ status as an inner city re-generation initiative developed by the then Secretary of State, Michael Heseltine. The initiative depended on the development of new partnerships between Wirral MBC and major business corporations, which included Lever Bros, General Motors and Mobil Oil. As Chair of the ‘City Lands Board’, the organisation established to lead the implementation, Alan led a 5-year programme of investment, which generated £37m of public sector and some £285m of private sector investment. Declaration of Interests The Chairman has no other significant commitments. A copy of the Register of Interests is available via the Trust website www.clatterbridgecc.nhs.uk, alternatively you can contact Andrea Leather on 0151 482 7799 to request a copy. Board & Committee meetings Appropriate Board Roles and Structure The Trust Board regularly reviews its committee structure to ensure that the organisation has in place appropriate structures to enable it to fulfil its purpose and the effectiveness of the Trust’s system of internal control and has adopted the Integrated Governance Model identified in the Integrated Governance Handbook 2005. Currently the structure is as follows: x x x x x x

Monthly Board meetings, except August (all meetings are closed to the public) Audit Committee (5 times per year) Integrated Governance Committee (bi-monthly) Remuneration Committee (Ad hoc) Nominations Committee (Ad hoc) ‘Task and Finish’ Committees: q Investment (bi-monthly with effect from February 2012)

The Board delegates specific functions to its committees identified within their terms of reference. The terms of reference of all Board committees are reviewed regularly as part of the annual review of the Constitution, Corporate Governance Manual and related policies led 39

by the Corporate Governance Manager and updated to reflect changes in the operating environment and best practice. In addition the Board conducts an annual review of the risks of delivering the annual plan as well as monitoring performance against the plan and ensuring risks are mitigated. Through the delivery of the annual plan any required changes to management processes and structures are identified. This may be done internally or with external expert advice (e.g. in 2011/12 the management structure for radiotherapy and diagnostic imaging was changed following an external report that the Trust commissioned from an imaging specialist). There is a system in place whereby there is a review of each Board meeting focusing on the content and performance of the Board agenda and the discussions and challenge. During 2011/12 this system was developed from an unstructured discussion to a structured written feedback supporting the discussion which enables the Chair to systematically review the performance of the Board meeting and to amend future agendas as required. The Trust considers that it operates a balanced and unified Board with particular emphasis on achieving an appropriate balance of skills and experience. This is reviewed as part of the Board development programme, as well as whenever a vacancy arises. Board Development The Board development program is developed using a dynamic approach ensuring there are ongoing development opportunities to strengthen capacity and performance and to enhance strategic functioning. The program of Board development is developed with input from reviews of Board effectiveness e.g. the output of the NHS Institute for Innovation and Improvement Board Development Tool (BDT) and from an internal skills gaps analysis. Consideration is also given to the strategic challenges that the Board faces and new legislation that the Board needs to be appraised of. The Board has also taken advantage of external programmes which included individual board member participation in leadership development programs and the majority of the Board participating in a program focusing on quality â&#x20AC;&#x2DC;Boards on Board: â&#x20AC;&#x2DC;from the topâ&#x20AC;&#x2122; program facilitated by the NHS Northwest Leadership Academy and the Institute for Healthcare Improvement. In addition to the use of the BDT a skills gaps analysis was undertaken to identify key topic areas for Board development. Board Effectiveness The Trust has embedded a robust approach to reviewing Board effectiveness. This is done at individual Board member level and as a corporate entity. Performance evaluation of the Chair is undertaken by the Senior Independent Director with input from the Senior Governor who then reviews the results with the Nominations Committee of the Council of Governors. The Chair undertakes the performance evaluations of the Non Executive Directors (NEDs). In addition, to enable Governors to observe the performance of the NEDs, the NEDs attended the Council of Governors meetings and during 2011/12 the 40

Trust Board has invited Governors to attend the Trust Board, Audit Committee, Integrated Governance Committee and the Investment Committee. The Chair undertakes the review of the performance of the Chief Executive. It is the responsibility of the Chief Executive to review the performance of the executive directors. In 2011/12 the Board commissioned the NHS Institute for Innovation and Improvement to conduct a review of the Board using their Board Development Tool (BDT). Individual Development In addition to the Board development process, in February 2011 the Executive Directors as part of their personal development agreed to undertake a 360o appraisal process managed by John Davies, Executive Coaching and Management Consulting. The outcome of this process was completed during May 2011. Board Development Days The Board development day programme has continued and will build on delivering against needs identified through the use of the BDT, the survey of Board members on development needs and on going review of Board needs against the changing climate of the NHS. Development days have been and will continue to be developed both in house utilising internal skills and competencies and will use external facilitation where required. External Review of Performance In 2011/12 the Health Service Journal published a report called ‘Brilliant Boards’ (30th June 2011). This report identified that just three organisations were high performers across three perspectives. The Trust is one of these Boards. Following our involvement with the NHS Institute for Innovation and Improvement Board Development Tool the coaches from the Leadership Academy who facilitated the Trust during this process published a further report in the HSJ ‘Board Brilliance Unpacked’ (12th April 2012) reporting on what is was like to work with a high performing Board. Board Mandatory Training It is essential that Board members, like all staff members undergo their mandatory training. For Board members this primarily focuses on the Boards role and responsibilities in relation to existing and new legislation. This is conducted on an annual basis. In March 2012 the Board undertook its mandatory training which included: x Fire Safety x Health & Safety x Bribery Act. Audit Committee The Audit Committee – chaired by Graham Morris - provides the central means by which the Trust Board ensures effective internal control arrangements are in place. In addition, the Audit Committee provides a form of independent check upon the executive arm of the Board. 41

During this year the Audit Committee undertook the following pieces of work to ensure the effective discharge of its responsibilities: x Committee review of the financial statements x Setting and reviewing progress of the annual internal audit plan using a risk-focused approach, linked to the controls assurance framework x Receiving regular reports from both Internal Audit and External Auditors x Agreeing and reviewing the work of the Trustâ&#x20AC;&#x2122;s counter fraud officer x Undertaking a self assessment of its work and effectiveness, and identifying any training needs x Reviewing and updating its terms of reference x Approving bad debt write offs and contract extensions. Integrated Governance Committee The role of the Integrated Governance Committee is to ensure that the appropriate governance structures are in place and operating effectively for: x x x x x

Corporate Governance Clinical Governance (including Risk Management) Information Governance Research Governance Financial Governance

During the year the Integrated Governance Committee delivered against its terms of reference in particular: x

Ensuring a robust compliance framework is in place to meet the various statutory obligations focusing in particular on: o CQC regulatory requirements o Health and Safety legislation o NHS Constitution o Equality and Diversity

Ensuring delivery against specified Trust strategies including: o Quality o Patient and Public Involvement (including reviewing complaints, concerns, comments and compliments) o Risk Management o Organisational Development o Equality Action Plan

Performance: o Monitored the achievement of all performance targets as set by the CQC and our commissioners. o Monitored the achievement of all performance targets as set by CCO (e.g. workforce statistics) o Oversaw the delivery of action plans developed from the national staff and patient survey programmes

Finance: o Monitored the delivery of the CIP programme/QIPP o Ensured that investments made by the Trust are in line with the Trust’s approved Investment Policy o Ensured accurate coding systems are in place and monitored o Reviewed areas of financial risk ensuring appropriate mitigation is put in place.

Investment Committee The role of the Investment Committee is to ensure that investments made by the Trust are in line with the Trust’s approved Investment Policy and that where authority to act as the investment decision maker is devolved elsewhere that those groups/committees are exercising their responsibilities in respect of investment decisions effectively. During the year the Investment Committee delivered against its terms of reference in particular: Reviewed and maintained the Trust’s Investment Policy Reported on its activities to the Trust Board Acted as the project sponsor for major investment decisions Assured itself that responsibility for the investment decision making role is discharged appropriately if it is devolved to other committees or groups x Reviewed all investment decisions to ensure that they are consistent with the Trust Board’s annual plans x Reviewed all investment decisions to ensure that external reporting requirements are met e.g. Monitor’s Compliance Framework, Risk Evaluation in Investment Decisions guidance. x x x x

Remuneration Committee The Remuneration Committee consists of the Chairman and other Non-Executive Directors and decides the terms and conditions of office including the remuneration and allowances of the Executive Directors, including pension rights and any compensation payments. The Committee is chaired by the Chairman and has met on 2 occasions, see table below. Also see note 3.6 of the Annual Accounts. Nomination Committee The Nomination / Appointment Committee for a Chief Executive is made up of the Non Executive Directors, chaired by the Chairman. The appointment is subject to the approval of a majority of the members of the Council of Governors present and voting at a general meeting. The Nomination / Appointment Committee for the Directors is made up of a committee consisting of the Chairman, the Chief Executive and the other Non Executive Directors. During 2011/12 the Committee was not required to meet. 43

Attendance at Board of Directors and Board Committee meetings Board of Directors No of meetings held for 2011/12 Andrew Cannell Helen Porter Rob Smith Yvonne Bottomley David Husband Alan White James Kingsland Carol Eastwood Alison Hastings Louise Martin Graham Morris Jan Burns x x x

Audit

Integrated Investment Governance Committee 5

EXECUTIVE DIRECTORS 11 4** 4 10 3** 4 11 2** 4 10 5** 3 8 2 NON EXECUTIVE DIRECTORS 11 9 3 7/8 3/4 4 3/3 1/1 9 5 4 10 5 1/1* 11 4 3

Remuneration Committee 2

2 1 2 1 0

1 1 2 2 2 2

2 1 1/1 1/1 1 2 2

All meetings were quorate *The Non Executive Director membership of this Committee changed in January 2012. Attendance has been shown with the number of meetings held whilst the individual was a member of the relevant Committee. ** Identifies the number of meetings the Executive Directors have been in attendance.

Membership Membership is open to any individual who is over the age of 16, is entitled under the constitution to be a member of one of the public constituencies or the staff constituencies, and has completed the relevant application form. Our staff membership operates on an ‘opt out’ basis. As with staff all volunteers (with service longer than 12 months) are automatically members unless they choose to ‘opt out’. The term ‘staff’ includes third party service providers to the hospital eg domestics and porters. If members wish to contact their individual Governor or a Director they can do so by contacting Andrea Leather, Corporate Governance Manager on 0151 482 7799 or email andrea.leather@clatterbridgecc.nhs.uk or governor@clatterbridgecct.nhs.uk There is a ‘members only’ section available on the Trust website.

Public Constituency Staff Constituencies Doctor Nurse Non clinical Other clinical Professional Radiographer Non staff Public Constituencies Wirral, Wales and rest of England Liverpool Sefton Warrington and Halton St Helens and Knowsley Chester, Ellesmere Port and Vale Royal

2011/12 (plan)*

2011/12 (actual)

2012/13 (estimated)

64 171 305 154

69 173 291 160

70 173 303 168

150 144

150 184

151 190

1603 768 1198 508 634 553

Maintain current level of membership

Staff constituency members as of March 31, 2012 totalling 1027 Public constituency members as of March 31, 2012 totalling 5264

*Within its Annual Plan 2011/12 the Trust’s was to preserve the current membership levels whilst developing ways to engage with younger people and hard to reach groups whilst maintaining the public membership with no fewer than 5,500. As outlined in the table above, the number of public members has continued to grow with 70 new members joining the Trust. A large proportion of our members come from our patient population. The number of public members identified as ‘leaving’ is predominantly due to members dying (96 out of 262) rather than opting to stop being a member. The majority of the remaining 166 have been picked up as being members who have moved home without notifying the Trust, which is highlighted following circulation of articles such as the Trust magazine. Membership Strategy The Trust has a Membership Strategy that is reviewed by the Membership, Communications and Fundraising Committee of the Council of Governors (CoG) and approved by the full Council of Governors. The Committee receives a progress report on membership activity at each of its meetings. The Membership Strategy was reviewed during 2011and approved by the full Council of Governors at its meeting on 19th January 2012. The review process ensured it encompassed guidance contained within the Monitor Code of Governance. In particular the Committee considered: x How to best engage with our members x How we communicate with members x How to engage with hard to reach groups such as ethnic minorities x How we ensure ease of access for members to the Governors x How we address equality and diversity issues x How to encourage members to partake in Governor elections. 45

Public Interest Disclosures The Trust has in place a full range of HR policies to support staff and advise managers. The Trust engages in formal and informal consultation with staff to ensure a partnership approach is in place. Formal consultation primarily occurs via the Trust’s JCNF (Joint Consultative and Negotiating Forum) and the LNC (Local Negotiating Forum). Start of Year Events are held with the Chief Executive and Executive Directors to address staff directly when any service changes are proposed (e.g. our plans for investment in Liverpool). In addition the Trust Board engages staff through the Patient Safety Campaign leadership rounds where Executive and Non Executive Directors visit all departments on a rotational basis. Staff are informed about policy changes via the monthly Team brief which is cascaded throughout the organisation. During the year Executive Directors have undertaken a ‘job shadowing’ programme across all areas of the Trust. This process has enabled the Executive’s to gain a clearer understanding of working processes within departments that are outside of their portfolios. It is also an opportunity for staff to demonstrate their areas of expertise and knowledge and discuss how improvements in service could be accommodated. The Trust continues to enhance its intranet with input from staff across the organisation and give staff access to a variety of information eg rumour board, policies and corporate documents, communications, human resources and learning development. During 2011/12 the Trust launched a consultation to propose changing its name to ‘Clatterbridge Cancer Centre NHS Foundation Trust’. The alternative was to maintain the existing name. The rationale for this proposal will be to adopt a name that: x x x

resonates with the purpose and history of the organisation can be used flexibly and without confusion at the multiple locations at which the Trust delivers its service can be aligned with the name and branding of the Trust’s charity (which would also be renamed).

The outcome of the consultation was then considered by the Board at its meeting in December 2011 and the Board approved the name change to: The Clatterbridge Cancer Centre NHS Foundation Trust. The name change was then recommended and subsequently approved by the Council of Governors on 23rd January 2012. The Independent Regulator, Monitor approved the request to amend the Trust’s constitution allowing the Trust’s name to be revised from “Clatterbridge Centre for Oncology NHS Foundation Trust” to “The Clatterbridge Cancer Centre NHS Foundation Trust” with effect from 1st April 2012. The Regulator confirmed that the constitution changes requested were consistent with schedule 7 of the NHS Act 2006 and otherwise appropriate. There were no serious incidents involving data loss or confidentiality breach to report during this year. Patient and Public Involvement Activity During 2011/12 the Trust has continued to engage with patients and stakeholders to further develop its services. Activities have included:

The Trust holds an annual open event for LINks (Local Involvement Networks) members and representatives from local OSC’s which focuses on our Quality accounts. This year’s event was in November. The feedback is very positive.

The Patient’s Council has continued to assist us with: o Local surveys o Lay reading of new documentation o Engaging with current patients o Staff interviews

Since June 2007 the Trust has given every patient completing a course of treatment at the centre a patient experience feedback from to ensure that the Trust has ‘real time’ information about the patient’s experience which it can act upon. This has proved an effective method of monitoring our services and consolidating good work that goes on all around the centre. Results are available on the Trust website. We received 3800 forms this year which has provided valuable information for the Trust. The views and experiences of people who use our services have influenced our service priorities and plans through a number of mechanisms. These include: x x x x x x

Our Patient and Public Involvement Strategy Our Governors and members as a Foundation Trust Patient and carer involvement in specific projects Responding to complaints and praise. Review of all complaints by our Governors Videoing patient stories which has provided us with a valuable insight into our patients experiences

Specific examples of these include: x

The Trust works in partnership with its Council of Governors to develop its annual service plans which form the Trusts corporate objectives. Governors have the opportunity to suggest plans and priorities and form an integral part of the approval process for the plans.

Examples where patient experience has informed change includes: x x x x x x x x x x

Redesigning the treatment bays in our chemotherapy day case unit to improve visibility of nursing staff Changes to the rostering of chemotherapy nurses to improve continuity of care Implementation of a numbered ticketing system to improve waiting times for blood tests Improvements made to signage around the Trust Verification of our equality objectives and action plan Improvements in waiting times Provision of refreshments out of hours Facilitated visits for support groups Pre treatment open days at our satellite radiotherapy centre have been very successful giving patients and their carers/relatives opportunity to see the treatment machines before their first visit. Review of videos of patient stories at each Board meeting. 47

Local Involvement Network (LINk) The Centre has established relationships with the local LINk groups, in particular Liverpool, Knowsley, Warrington, Sefton and Wirral and is looking forward to strengthening this relationship as the groups develop. Sickness Absence Data Overall sickness absence for 2011 -12 was almost identical to that in 2010-11 (4.14%). The three most common reasons for absence were anxiety/stress, musculoskeletal disorders, and back problems Staff Health and Wellbeing remains one of the cornerstones of the Trust’s HR Strategy. A programme of Health Promotion activities is planned for 2012-13, covering nutrition, fitness, health and safety, and emotional wellbeing. We also offer an Employee Assistance Programme which provides confidential counselling, family support, and legal and financial advice to staff and their families. We will continue to work closely with our Occupational Health provider to improve the services available to our staff, and we will continue to engage with our staff to ensure that we work together to improve their health and wellbeing. Yearly quarter

Trust performance 2011/12

Q1 (April – Jun) Q2 (July – Sept) Q3 (Oct – Dec) Q4 (Jan – Mar) Annual

3.51% 3.85% 4.41% 5.02% 4.13%

Health and Safety The safety of patients, staff and visitors is paramount and therefore CCO continues to encourage a pro-active approach to health and safety to ensure that as a Trust we comply with existing and new health and safety legislation. All staff groups have access to our specialist team comprising of health and safety, moving and handling, fire and security. In addition, advice is available from radiation protection, infection control and occupational health. As part of our pro-active approach risk assessments are reviewed by all departments to identify any potential risks and put controls in place to prevent were possible any injuries or illness to patients, staff and visitors. The last 12 months a comprehensive fire training program has been implemented with new evacuation equipment being purchased, fire marshal training being delivered and all activated fire alarm response reported and assessed. To support staff with knowledge and information for health and safety, fire, security and manual handling annual training sessions are provided for all staff groups and workbooks have been developed for staff to complete as an alternative form of learning. There were 51 reported staff accidents in 2011/2012 which fell into the following categories manual handling, struck by or against, needle stick, slips, trips, falls and burns. Regular reports on all accidents, dangerous occurrences and ill health are presented at our bimonthly health and safety committee and action plans are implemented. Staff Communication Actions taken by the NHS Foundation Trust to maintain or develop the provision of information to, and consultation with employees. Team Brief Chief Executive delivers corporate updates through Team Brief to all senior managers once a month. This information is then disseminated to all staff through meetings, email and intranet. Intranet The Trust had a dedicated intranet site for staff. This includes a range of information including news updates, policies and procedures, e-learning, discussion forum. Communication Champions Each department has a representative to communicate messages to their teams. The group meet every month. Staff Open Forum The Chief Executive holds monthly open forums for all staff to attend. There is no set agenda and staff can ask questions on all working matters.

Start of Year Event Every April the Executive Team holds a staff event. The event looks at the achievements in the last financial year and plans for the year ahead. The event also includes a workshop to encourage staff engagement. C3 magazine Magazine communicating Trust news to staff, patients and members. Distributed two times a year. Staff roadshows The Executive Team run departmental roadshows to communicate top level messages. Notice boards Notice boards are situated in staff breakout areas and used to communicate a range of messages via posters, flyers. Emails The Communications Team distributes emails to all staff to communicate corporate messages.

Annual Governance Statement Scope of responsibility As Accounting Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the NHS foundation trustâ&#x20AC;&#x2122;s policies, aims and objectives, whilst safeguarding the public funds and departmental assets for which I am personally responsible, in accordance with the responsibilities assigned to me. I am also responsible for ensuring that the NHS foundation trust is administered prudently and economically and that resources are applied efficiently and effectively. I also acknowledge my responsibilities as set out in the NHS Foundation Trust Accounting Officer Memorandum. The purpose of the system of internal control The system of internal control is designed to manage risk to a reasonable level rather than to eliminate all risk of failure to achieve policies, aims and objectives; it can therefore only provide reasonable and not absolute assurance of effectiveness. The system of internal control is based on an ongoing process designed to identify and prioritise the risks to the achievement of the policies, aims and objectives of Clatterbridge Centre for Oncology NHS Foundation Trust (CCO), to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically. The system of internal control has been in place in Clatterbridge Centre for Oncology NHS Foundation Trust for the year ended 31 March 2012 and up to the date of approval of the annual report and accounts. Capacity to handle risk The Trust is committed to providing high quality services in a safe and secure environment. As Chief Executive I have overall responsibility and accountability for all aspects of risk management within the Trust, making sure that the organisational structure and resources are in place to ensure this occurs. Senior leadership is delegated through the directors and operationally through departments and committee structures. This covers all aspects of governance relating to our service delivery, including: quality governance, infection control, clinical care, radiation protection, Care Quality Commission (CQC) Regulatory Requirements, Monitors Compliance Framework, finance, contracts, information technology, health and safety, cancer standards peer review, research, and employment practices. The Audit Committee has overarching responsibility for ensuring that risk is managed effectively within the organisation. This role is supported by Board committees that oversee specific aspects of the risk portfolio and which also ensure that the Trust continually learns from good practice. The system provides a central steer whilst supporting local ownership in managing and controlling risks to which the Trust may be exposed. These systems are further supported by the evaluation of the effectiveness of risk management and control systems and implementation of recommendations from external assessments to promote both organisational and individual learning and the dissemination of good practice within the Trust. Bespoke learning and development is provided according to individual role requirements such as Trust Board members, senior managers and all staff. 51

Risk Management training is mandatory for all staff including senior managers and Board members. Clear delegated authority is defined within the Corporate Governance Manual and the Trust’s Risk Management Strategy. The Risk Management Strategy is underpinned by a number of risk related policies and procedures which provide further information and guidance to staff in the management of risk. The Trust is committed to continually reviewing its risk management process and endeavours to ensure that it learns from best practice. A key example of this is the adoption of the Integrated Governance Model as defined in the Integrated Governance Handbook (DH 2005) and the implementation of Monitor’s Quality Governance Framework (2011). The risk and control framework The key elements of the Trust’s Risk Management Strategy are to manage and control identified risks, whether clinical, non-clinical or financial, appropriately. This is achieved through a sound organisational framework which promotes early identification of risk, the coordination of risk management activity, the provision of a safe environment for staff and patients, and the effective use of financial resources. It ensures that staff are aware of their roles and responsibilities and outlines the structures and processes through which risk is assessed, controlled and managed. The Trust Board approved a revised Risk Management Strategy in February 2010. The Trust Board determines the risk appetite of the Trust. Levels of acceptable risk are determined by working within agreed Trust policies and procedures. An acceptable risk is one which has been accepted after proper evaluation, with all the possible controls in place. Risks are identified through feedback from many sources such as, formal risk assessment, the assurance framework, incident reporting, audit data, complaints, legal claims, patient and public feedback, stakeholder/partnership feedback and internal/external assessment. The Trust Board has endorsed the Quality Strategy, the Operational Budget Plan and the Risk Management Strategy. In addition, a range of Trust-wide policies and procedures further supports the risk management processes. The risk and control framework continues to be reviewed and developed. In 2011/12 this included: x x x x x x x

Annual review of the approved Trust Board committee structure in line with the principles of Integrated Governance to ensure its continued effectiveness. Full implementation of Monitor’s Quality Governance Framework. Continued development of the operation of the Trust’s Risk Register. Continued full compliance with the new regulatory requirements set out by the Care Quality Commission to ensure ongoing full registration without conditions. The Trust continued to work and develop arrangements with third party organisations within the local health economy and on a wider scale to ensure delivery of quality healthcare services and secure appropriate funding. Continuous improvements were made in 2011/12 in order to continue to meet all mandated targets. Any new and emerging risks have been kept under review such as maintaining income flows and key relationships with commissioners and implications of CCG commissioning. 52

x x

Identification of future risks which may affect the Trust in relation to the proposed relocation of CCO’s hub to the Royal Liverpool site. The Trust Board has continued to review all significant risks monthly at its Board meeting ensuring risk mitigation plans are in place and that the Board approves any changes to the assessment of risk based on the impact and the efficacy of the controls in place.

The Trust Board has reviewed Monitor’s Quality Governance Framework including performance against all best practice areas at its Board meeting in April 2011. Overall the Trust Board is assured that it has in place robust Quality Governance. At its review the Board identified a small number of areas where it wishes to implement the good practice examples provided by Monitor. These were integrated into the revised Quality Strategy which was approved by the Board in June 2011. The Trust Board receives a quarterly quality report detailing performance against the delivery of its stated quality objectives and performance information on a range of quality metrics. The quality of performance information is assessed and assured through data quality audits and reviews by our internal and external auditors. The Trust Board reviews the Care Quality Commission monthly Quality and Risk Profile at each Board meeting together with updated action plans to address any areas of risk. The Integrated Governance Board Committee has responsibility for the ongoing monitoring of compliance with the CQC registration requirements. It does this through the review of the individual regulations and associated outcome measures such as patient survey results and audits against each of the required outcomes. Additional information is provided following CQC inspections and reviews and from planned internal audits as part of the Trust’s audit schedule. The Trust has appointed an Executive Director as the Senior Information Risk Officer. Risks relating to data security are assessed through the completion of the Department of Health’s Information Governance Toolkit. The Trust has assessed itself as securing a score of 79% (a “Green” rating) against the Department of Health’s Information Governance Toolkit in 2011/12; The Trust achieved Level 2 against the requirements of the Information Governance Statement of Compliance as required by Monitor’s Compliance Framework, where relevant information risks identified in the course of the Trust’s incident reporting processes are investigated and lessons learned. The implementation of the Trust’s IM&T Strategy, including the application of data security principles continues to be subject to scrutiny at the Information Management & Technology (IM&T) Programme Board. The Trust has embedded an assurance framework at a corporate level and across all areas of the organisation. The corporate assurance framework identifies those risks deemed as strategically significant to the Trust’s objectives, the controls in place to manage / mitigate those risks and the assurances received by the Trust. All Board members have been involved in the development, identification, quantification and prioritisation of the risks and the subsequent action planning to address areas for improvement. Significant risks are escalated to the Trust Board as they arise and subsequent updates are made to the Assurance Framework. Each high scoring risk has an individual risk mitigation plan developed by the responsible Executive Director. Each directorate is also required to develop a directorate level assurance framework to support the delivery of the directorate objectives. This further embeds the organisation wide risk aware culture. The current major risks both in year and for the future are: x

The potential impact of the changing commissioning landscape. 53

x x x x x x x x

The ability to deliver our Investment in Liverpool plans Maintaining the required skills within the Board The ability to deliver the scale of change planned Ensuring we have the right skills and competencies within the workforce. The potential impact of competition and choice The volatility of the changes in treatments for cancer affecting demand Ensuring quality is not affected by our cost improvement programme. The potential impact of changes in healthcare funding.

The Trusts major risks all have robust risk mitigation plans and are reviewed at each Board meeting. Risk management is embedded throughout the Trust. This is demonstrated by the incident reporting arrangements within the Trust where this is openly encouraged. The Trust operates a ‘fair blame’ culture with a clear approach to identifying the causes of incidents, learning lessons from them and providing feedback and support to staff involved in incidents. Assurance of this process is gained by the achievement of NHSLA level 3 (since November 2007) and the Trust wide ISO 9001:2008 quality management system accreditation. Engagement with public stakeholders in managing risks which may impact on them is undertaken in a number of ways, principally through: x x x x

The Trust Board working closely with the Council of Governors Communication and engagement with our members Delivery against our Patient Experience Strategy Provision of accurate patient information (accredited with the Information Standard Quality Mark)

The foundation trust is fully compliant with the registration requirements of the Care Quality Commission. As an employer with staff entitled to membership of the NHS Pension Scheme, control measures are in place to ensure all employer obligations contained within the Scheme regulations are complied with. This includes ensuring that deductions from salary, employer’s contributions and payments into the Scheme are in accordance with the Scheme rules, and that member Pension Scheme records are accurately updated in accordance with the timescales detailed in the Regulations. Control measures are in place to ensure that all the organisation’s obligations under equality, diversity and human rights legislation are complied with. The foundation trust has undertaken risk assessments and Carbon Reduction Delivery Plans are in place in accordance with emergency preparedness and civil contingency requirements, as based on UKCIP 2009 weather projects, to ensure that this organisation’s obligations under the Climate Change Act and the Adaptation Reporting requirements are complied with.

Review of economy, efficiency and effectiveness of the use of resources As the Accounting Officer, I am responsible for ensuring that the organisation has arrangements in place to secure value for money in the use of resources. The Trust achieves this through the following systems: x x x x

Setting and monitoring the delivery of strategic and operational objectives Monitoring and review of organisational performance Delivery of efficiency savings Workforce review

Annually the Trust produces a service strategy which incorporates a supporting financial plan for approval by the Board of Directors. The strategy approved by the Board of Directors informs the detailed annual financial and performance plans. The Board monitors performance monthly through the corporate Finance & Performance Report, which provides information on current and forecast financial performance, achievement of savings targets, capital investment, contract activity and performance against key targets. Reports on specific issues relating to economy, efficiency and effectiveness are commissioned by the Audit Committee from the Trustâ&#x20AC;&#x2122;s Internal Auditors and it also receives reports from the External Auditors as required. The Audit committee monitors closely the implementation of Audit recommendations. Effective performance has been demonstrated through: x x

The achievement of the majority of key NHS targets: The financial risk rating of 5 as determined by the independent regulator Monitor.

Annual Quality Report The Directors are required under the Health Act 2009 and the National Health Service (Quality Accounts) Regulations 2010 (as amended) to prepare Quality Accounts for each financial year. Monitor has issued guidance to NHS foundation trust boards on the form and content of annual Quality Reports which incorporate the above legal requirements in the NHS Foundation Trust Annual Reporting Manual. In preparing the Quality Report, directors are required to take steps to satisfy themselves that: x

the quality report presents a balanced picture of the foundation trustâ&#x20AC;&#x2122;s performance over the period covered;

the performance information reported in the Quality Report is reliable and accurate;

there are proper internal controls over the collection and reporting of the measures of performance included in the Quality Report, and these controls are subject to review to confirm that they are working effectively in practice;

the data underpinning the measures of performance reported in the Quality Report is robust and reliable, conforms to specified data quality standards and prescribed definitions, is subject to appropriate scrutiny and review; and the Quality Report has 55

been prepared in accordance with Monitorâ&#x20AC;&#x2122;s annual reporting guidance (which incorporates the Quality Accounts regulations) as well as the standards to support data quality for the preparation of the Quality Report. The following steps have been put in place to assure the Board that the Quality Report presents a balanced view and that there are appropriate controls in place to ensure the accuracy of the data. 1.

Governance and leadership

The Director of Nursing and Quality is responsible for the Quality Strategy and the Quality Accounts. The Board receives a quarterly quality report which is built on the structure of the annual Quality Accounts to ensure that progress against priorities and monitoring of performance measures are reviewed throughout the year and to ensure that the Quality Report is balanced. The Director of Finance (DoF) is responsible for corporate leadership of data quality as lead director for Information Governance. The DoF has overall strategic responsibility for data quality, and this responsibility is not delegated. The Trust has in place a Data Quality Policy which ensures that the Trust holds good data quality processes and procedures in place to provide assurances to themselves as well as external users of their information. This Policy covers all patient data collected by the Trust. The Data Quality Policy states that all staff responsible for entering data in the Trustâ&#x20AC;&#x2122;s Electronic Patient Record (EPR) system are required to attend annual refresher training as per the Information Governance toolkit standards. Data quality is regularly reviewed and reviews are reported through the Information Governance Committee. The Trust has in place and IM&T Strategy. This strategy drives the IM&T Programme Board which has as a responsibility to monitor risks and ensure the correct operation of security and Information Governance policies including compliance with the Data Protection and Freedom of Information Acts. The strategy identifies clearly that the Trust has specific objectives and targets (Delivery Plan), the achievement of which must be supported by the IM&T strategy. Information governance in relation to assessment of risk is clearly identified within the Risk management Strategy. All risks are fed into the organisational risk register. Risks associated with data quality audit reports are included in the organisational risk register. The Quality Report includes information on both good performance and areas for improvements which provides a balanced picture of the Trusts performance. The majority of indicators relate to performance of the whole Trust. As part of the Board approval process, the two clinicians on the Trust Board (Medical Director and Director of Nursing and Quality) will explicitly approve the data included in the Quality Report.

Policies

The policies and procedures that relate to the quality of the data in the quality accounts are: x x x x x x x x x

Quality Strategy Risk Management Strategy Data quality policy Incident reporting policy Clinical coding policy and procedure Clinical systems training policy Records management policy Information risk policy Data protection policy

All Trust policies and procedures are reviewed periodically and updated when needed in accordance with the Trusts Document Management Policy. Staff are informed of all policy changes via the monthly clinical governance report at Team Brief. Where significant policy changes are made formal launches may be delivered. 3.

Systems and processes

There are systems and processes in place for the collection, recording, analysis and reporting of data which are focused on securing data which are accurate, valid, reliable, timely, relevant and complete. The Trust has in place a Business Continuity Plan and Disaster recovery arrangements. Both of these are regularly tested. 4. People and skills Staff training is identified within the Data Quality Policy. Roles and responsibilities in relation to data quality are clearly defined and documented, and incorporated where appropriate into job descriptions and are reflected in the KSF framework. The body has put in place and trained the necessary staff, ensuring they have the capacity and skills for the effective collection, recording, analysis and reporting of data. Staff collecting, recording, analysing and reporting data are assessed on their adherence to the data quality standards set by the Trust through the data quality audit program. 5. Data use and reporting Clinical data is reported at Board level primarily within the quarterly quality report, with evidence of Board challenge in response.

The Trust has arrangements in place to ensure that data supporting reported quality information is actively used in decision making processes, and is subject to a system of internal control and validation. The Information Governance Sub-Committee reviews data quality audits on a quarterly basis and a Data Quality Group meets monthly to analyse detailed quality reports. Operational and performance reports are produced on a monthly basis and key quality indicators are included in a corporate balanced scorecard which is reviewed by the Trust Board and Executive Team. Detailed reports are produced on a weekly basis and reviewed by the Trustâ&#x20AC;&#x2122;s Management Group. Internal and external reporting requirements are regularly reviewed and data provision is aligned to management and operational needs. Data used for reporting to those charged with governance are also used for day-to-day management of the Trusts business, via a combination of reports which are published onto a Management Information System website, automated e-mail reports to individual users and reports produced for specific management meetings. Data quality and performance reports are routinely provided to staff groups who create the data using various clinical and business systems, to reinforce understanding of their wider role and importance. Data which are used for external reporting are subject to rigorous verification. A range of reports are used to monitor the quality of data reported externally and a variety of audit processed are used routinely All data returns are prepared and submitted on a timely basis, and are supported by a clear and complete audit trail. Where appropriate data is triangulated against other sources of information such as patient feedback and is included within scorecard reports. Review of effectiveness As Accounting Officer, I have responsibility for reviewing the effectiveness of the system of internal control. My review of the effectiveness of the system of internal control is informed by the work of the internal auditors, clinical audit and the executive managers and clinical leads within the NHS foundation trust that have responsibility for the development and maintenance of the internal control framework. I have drawn on the content of the quality report attached to this Annual report and other performance information available to me. My review is also informed by comments made by the external auditors in their management letter and other reports. I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the board, the audit committee and the Integrated Governance Committee and a plan to address weaknesses and ensure continuous improvement of the system is in place. The Board of Directors reviews performance across a range of indicators, which include both corporate and national objectives and those measures of performance included in the Quality Accounts. Achievement of both local and national objectives and measures of performance is an important function of the Trust Board; in ensuring our effectiveness in doing this a number of measures are in place across the Trust: 58

x Individual department have as series of key performance indicators which are monitored on a monthly basis. In addition to this there is also a trust wide set of key performance indicators that are reviewed each month at Trust Board, these cover waiting times, infections control as well as finance. x Weekly performance management meetings take place to manage performance against waiting times as well as ensuring that forward planning around service capacity takes place. x Three times a year the executive directors meet with each clinical department to formally review performance against objectives, management of clinical governance & risk, financial management and delivery against national waiting time targets. x A “red/amber” rating by Monitor for quarter 1, an “amber/green rating for quarter 2 and a ‘green’ rating for quarter 3 in 2011/12 for governance with a forecast of green for quarter 4. The ‘red/amber” rating in quarter 1 relates to the Trust breaching the Cdifficile and the 62 day targets. The amber/greed relates to failing to meet its C. difficile trajectory. x Achievement of all key financial duties and a Monitor financial risk rating of 5 for quarters 1, 2 and 3 with a forecast of a rating of 5 for quarter 4. x Regular Audit Committee review to ensure up to date and relevant financial policies and procedures are maintained. x The Trust has been granted full registration without conditions as a service provider from the Care Quality Commission in March 2010 for the treatment of disease, disorder or injury and for diagnostic and screening procedures. x The Trust Board receives a quarterly Quality Report which is built on the structure of the annual Quality accounts to ensure that progress against priorities and monitoring of performance measures in reviewed throughout the year. The Audit Committee provides a central means by which the Trust Board ensures effective internal control mechanisms are in place. This includes receiving and reviewing reports from both Internal Audit and our External Auditors: Internal Audit concluded that the systems and processes in place regarding the Assurance Framework are designed and operated to meet the requirements of the Annual Governance Statement (AGS). The overall assessment was that an assurance framework has been established which is designed and operating to meet the requirements of the AGS and provide reasonable assurance that there is an effective system of internal control to manage the principle risks identified by the organisation. They have also provided significant assurance overall across a range of individual opinions arising from risk based audit assignments reported throughout the year. x Approving the clinical governance assurance framework.

The Trust Board has received external assurance of its systems of internal control by: x Accreditation for National Health Service Litigation Authority for Trusts (NHSLA) level 3. x Maintaining a quality management accreditation (ISO9001:2008) across the whole Trust from the British Standards Institute (BSI) The Integrated Governance Committee provides a core function of monitoring any clinical risks and ensuring appropriate mitigations are in place. Throughout the year it has done this through: 59

x x x x x

Approval of the clinical audit plans and receiving regular clinical audit reports Reviewing all relevant national guidance and recommendations (e.g NCEPOD and NICE) to ensure best practice is implemented Receiving and reviewing reports on all incidents reported including SUIs Receiving external assurance reports and monitoring action plans where deficiencies are identified Providing assurance to the Board on risk identification and mitigation.

Conclusion In conclusion there are no significant internal control issues which have been identified.

Signed

Andrew Cannell Chief Executive

Date: 30th May 2012

Statement as to disclosure to auditors (s418) See Annual Accounts Remuneration report See note 3.4 & 3.5 in Annual Accounts Also information in Remuneration section of Board of Directors / Council of Governors Benefits in kind See note 4.3 Annual Accounts Definition of “salary and allowances”/ Compensation for loss of office See note 3.4 & 3.5 in Annual Accounts and Remuneration section of Board of Directors Pension disclosures See note 3.5 Annual Accounts General Companies Act disclosures (s416) See Annual Accounts Further Companies Act disclosures (s416 and Regulation 10 and Schedule 7 of the Regulations) See Annual Accounts Statement of accounting officer’s responsibilities See Annual Accounts

2011/12

Quality Report

Contents Statement on Quality from the Chief Executive

Review of Quality Performance 2011/12: x Improving Patient Safety x Improving Patient Experience x Improving Clinical Effectiveness

Priorities for improvement: x Improving Patient Safety x Improving Patient Experience x Improving Clinical Effectiveness

Statements of assurance from the Board

Other Information: x Safety indicators x Clinical effectiveness indicators x Patient experience indicators

Performance against key national priorities and national core standards

NHS Outcomes Framework Domains

Annex statements

Statement of Directorâ&#x20AC;&#x2122;s responsibilities in respect of the Quality Report

101

Acronyms

103

Statement on Quality from the Chief Executive Quality is at the heart of what all our staff aims to achieve for all the patients in our care. It is thanks to the professionalism, expertise and commitment of our staff that we are able to provide a high quality service. We have clearly defined our Core Purpose as providing excellent care to people with cancer. Our Vision is to provide the best cancer care to the people we serve. To deliver our vision we have made it our Mission to improve health and well being through compassionate, safe and effective cancer care. Our values, developed with our staff demonstrate our commitment to how we work: x Passionate about what we do x Putting people first x Achieving excellence x Committed to our future x Always improving our care This year has seen the Trust continue to take forward the aims and objectives of its Quality Strategy. The Trust Board has ensured that Quality is a key agenda item at each Board meeting and it oversees the delivery of the Trust’s priorities and initiatives identified in its Quality Report. As a Foundation Trust we also work closely with our Council of Governors to ensure that it supports the Trust Board in shaping the Quality Strategy and is kept appraised of progress in the delivery of the plans it contains. The Governors also receive the quarterly Quality Report and their Patient Experience Committee has continued to review all patient complaints in detail. Throughout this year we have worked with our staff and our key stakeholders to continue to improve the quality of our services. This year has seen a number of key developments and challenges for the Trust including: x

We have met all of our mandated waiting times targets.

I am particularly pleased to be able to report again that we have achieved against our clostridium difficile target. We have had one case of MRSA bacteraemia. The first for seven years.

The achievement of the 62 day cancer waiting time target continues to be a challenge for the Trust due to the fact that as a Tertiary treatment centre we are at the end of the patient’s pathway and therefore dependent on timely referrals from secondary care.

Patient survey results. We have scored consistently in the top 20% performing Trusts in both the annual staff and patient surveys. Whilst all of the questions in these surveys are important one particular staff survey question provides me with assurance of the quality of care. When staff were asked ‘if a friend or relative needed treatment, I would be happy with the standard of care provided by this Trust’ 96% replied yes. Our annual PEAT (Patient Environment Action Team) assessment has also demonstrated 65

good performance with excellent ratings being given for environment, food and privacy and dignity. x

I am pleased to report that the Trust was able to make the required declaration of full compliance against the delivering same sex accommodation requirements in March 2012.

I am pleased to announce that following public consultation during 2011 the Independent Regulator, Monitor approved the request to amend the Trust’s constitution allowing the Trust’s name to be revised from “Clatterbridge Centre for Oncology NHS Foundation Trust” to “The Clatterbridge Cancer Centre NHS Foundation Trust” with effect from 1st April 2012. As Chief Executive I am confident that the Trust provides a high quality service and that these Quality Accounts demonstrate this. To the best of my knowledge the information in these accounts are accurate. In summary, CCO has a good track record in delivering a quality service to our patients. As Chief Executive I have a personal commitment to lead the drive for continual quality improvement. We will continue to deliver against the objectives we have set and will continue to improve quality in the challenging times ahead.

Andrew Cannell Chief Executive

Date:

30th May 2012

Review of Quality Performance 2011/12 The Trust Board has agreed the priorities for quality improvement for 2011/12 which were included in our Quality report for 2010/11. The Board continued to monitor performance against its quality improvement strategy through a quarterly quality report to the Board. This report was also presented to the Council of Governors each quarter. The areas for improvement were identified through an engagement process with: its staff through its senior managers via the development of departmental Delivery Plans; its Governors at a Board and Governors away day in October with its lead Commissioner and Cancer Network at its contract meetings and with LINks and Overview and Scrutiny Committee members at a patient experience Workshop in November 2011.

Improving Patient Safety To implement a 24 hour a day, 7 day a week telephone advice service in line with the Acute Oncology Cancer Peer review standards specification This priority was developed in conjunction with our commissioners based on draft cancer Peer Review Standards. Once the final standards were published the requirement had changed. In agreement with our commissioners the priority was to the development of guidelines for 24/7 on-call consultant led service. Guidelines for the management of acute oncology presentations in A&E departments have been produced for use within the region to ensure a standardised approach to the management of oncology patients throughout the network area which will improve patient safety.

Example guideline: Generic Management Guideline for Chemotherapy/Radiotherapy Induced Side-Effects Grade 1

Grade 2

Grade 3

Grade 4

Mild

Moderate

Severe

Life threatening

Actions

x x x

Refer to specific toxicity guideline Complete triage log Advise to call back if toxicity worsens

x x x x x

Refer to specific toxicity guideline Complete triage log If 1 grade 1 toxicity to do a follow-up call within 24 hours. Advise to call back if toxicity worsens If 2 grade 1 toxicities to escalate to RED

x x x

x x

Refer to specific toxicity guidelines and general principles for management of patients admitted with toxicities. Complete triage log Admit; assessment, investigation and parental management. If not requiring admission ensure, FBC, U&E checked, ensure advice given re-good oral intake, follow up daily If admitted to District General Hospital inform Acute Oncology Team Inform Oncology Team

Other factors to consider x x x x x x

Urgent Admission â&#x20AC;&#x201C; temperature, chest pain, bleeding? Are they neutropenic? Is the toxicity not settling despite outpatient advice? Is the patient a poor historian or difficult to contact by phone? Patient compliance, comprehension or ability to follow instructions? Is the patient becoming weak or dehydrated?

Neutropenic sepsis requires URGENT admission with Broad Spectrum IV antibiotics

Please ensure the Acute Oncology Team are informed as soon as possible of patient 68 admissions 70

Quality in Nursing at Clatterbridge â&#x20AC;&#x2DC;Quality in Nursing at Clatterbridgeâ&#x20AC;&#x2122; (QINC) is a tool developed to drive the improvement of the key areas of quality in the inpatient service. At the start of 2011, 13 standards were highlighted as being key principles to achieving high quality care. Eight of the standards were categorised as a priority to improving our patient care. Those standards (highlighted in bold) have been monitored on a quarterly basis within each in patient area, performance for each element was RAG rated and sent to Ward Managers in the form of a report. Each Ward Manager was then tasked with creating an action plan to address those issues raised within the reports. The eight standards highlighted are: x x x x x x x x

Reduction in the number of inpatient falls Improve the quality of documentation of nursing care Reduction in the number of pressure ulcers Improve nutrition and hydration Improve discharge planning Improve medicines management Improve management of patients at risk of venous thromboembolism Prevent failure to rescue

At the beginning of the project: x x x

4 standards showed to have significant Red RAG rating which has fallen to 1 at the end of the first year. None of the standards resulted in full Green RAG rating in April 2011; however data collected in April 2012 showed 6 of the 8 standards to have all Green status. Individually each ward has seen consecutive improvements as well as overall improvements as a Trust on a quarterly basis. Overall 2011-2012

20 18 16 14 12 Red Amber Green

10 8 6 4 2 0 April

July

December

March

A review of the data from the April 2011 â&#x20AC;&#x201C; 2012 will be take place and a plan created to address both the standards that still require improvements and the inclusion of remaining 17 original standards. These are: x x x x x x x x

Organisation and Management of the Clinical Area Safeguarding Patients Pain Management Environmental Safety End of Life Care Person Centred Care Elimination, Communication Infection Control

In summary The aim of the QINC tool was to primarily raise awareness of issues that posed a risk to the quality of nursing care provided on the inpatient wards resulting in improved quality of care and less harm. Staff involvement in the QINC work is evident on the wards, with individual staff members and small teams taking responsibility for improving care and knowledge in the eight areas on the wards. This has been achieved through good leadership from the ward management team in supporting all staff members to be involved in the QINC project and encouraging individual ownership of smaller projects within the ward staff. Awareness raising events on the wards and QINC information boards highlight to staff, patients and visitors what is being done to improve the quality of care being provided. Patient involvement is also essential to this project, as it has been demonstrated patients are not always made aware of the risk assessment and other interventions that nurses are carrying out. This project has highlighted a need for patients to be more involved in everyday discussions and decisions about their nursing care. The next steps are: x x x

to analyse clinical incident data to determine whether there have been real improvements in harm as a result of this project Identify key areas for the next 12 months Create consistent and visible way of demonstrating achievements within the ward

Implementation of a rapid communication tool The Trustâ&#x20AC;&#x2122;s action plan for managing the deteriorating patient includes individual case reviews, table top exercises following fast bleep and cardiac arrest calls, and the implementation of a Rapid Communication Tool (SBAR). Initial work has included revising the tool to meet the specific needs of our patient population e.g. what treatment they are on and putting the tools/prompts together that we are going to use. The pre audit of witnessed hand over will be done in May, then the SBAR tool piloted on Conway for the month of June, then a post audit will be carried out. 70

Improving Patient Experience To undertake a feasibility study and patient survey on alternative care settings for the delivery of chemotherapy closer to home Clatterbridge in the Community The Clatterbridge Cancer Centre delivers chemotherapy treatments in collaboration with seven district hospitals across the Merseyside and Cheshire region. In providing these clinics we are able to deliver chemotherapy much closer to the patients’ home and feedback received positively reinforces this option as a huge benefit to them. We have now taken this a step further by offering the option to receive chemotherapy treatment at a GP surgery, or at home as part of our ‘Clatterbridge in the community’ pilot. The Government White Paper, ‘Our Health, our care, our say’ (1), promotes patient choice and transfer of services closer to people’s homes. We currently give 56% of our chemotherapy treatments off site; chemotherapy in the community is an extension of this. The pilot is underway to assess the feasibility and benefits of delivering outpatient chemotherapy treatments away from the hospital setting. The pilot is assessing patient experience, safety and also monitoring costs of delivery. Ultimately this will help to inform the chemotherapy service model of the future and assist in developing new and innovative ways of delivering treatments. Evidence suggests that patients treated in the community may experience reduced side effects and compliance rates may improve, although few formal studies have been undertaken to evaluate such a service. Experienced chemotherapy nurses from Clatterbridge are carrying out the study using suitable patients and carefully selected chemotherapy regimes. Treatments administered so far include Trastuzumab, Zoledronic acid, Capecitabine and Denosumab. Patients will be involved in completing a specially designed questionnaire & also to participate in focus groups to give us feedback on their experience. All the patients recruited so far have found the experience to be positive and some of their views have been detailed below. “I was able to spend the day with my sister visiting from overseas rather than spending time in the hospital.” One patient is attending the Hospice as a day patient and is able to have her bloods done there. The chemotherapy nurse then checks the results and delivers her chemotherapy tablets and administers Denosumab the following day. This means she avoids having to return to the hospital for another visit. According to our experienced chemotherapy nurse, another lady said “that to come to hospital meant that her daughter had to take time off work to bring her and then leave her, if the clinic was running late, whilst she collected her children from school, then return to hospital to collect her. This was causing the patient and her daughter much anxiety and distress” She really appreciated the opportunity of having her treatment at home. Two patients have returned to work and now find it easier to make appointments with the Clatterbridge in the community team and to fit this in with work than coming to the hospital. 71

Patients who have reduced mobility have found the service most useful as they are not as reliant on others and also it reduces the time with which they have to spend having treatment. 1. Our Health, Our Care, Our Say: a new direction for community services. White paper: Department of Health, January 2006

Reduction in patient reported waiting times in departments Patient reported waiting times in all departments have continued to be monitored through the real time patient survey. High level information is put onto the Trusts website and detailed reports are provided to the Trust Board, Council of Governors and to individual departments. Each clinical department has put into place actions to improve the patient experience and patient waiting times. These include: Chemotherapy Phlebotomy Service: Actions to improve waiting times: x x

Additional staff have been put into the phlebotomy service each morning A ticket based queue management system now ensures patients are seen in order. This has been particularly effective.

Chemotherapy Nursing Service: x x x x

Systems have been revised to prioritise new patients and those having quick treatments e.g. (peripherally inserted central catheters (PICC line) flush Schedule it; a resource management system is now available in all the treatment bays. This is now updated in real time The nurses are now organised into teams in each treatment bay. As well as improving waiting times this also improves the patient experience as patients see the same nurses for each treatment Patients are encouraged to have bloods taken the day before or half hour before their chair appointment

Radiotherapy There has been an overall percentage improvement due in part to a pilot programme involving two treatment units on the CCO site â&#x20AC;&#x201C; M10-2 and V6-1, where the standard appointment time has been increased from 12mins to 15mins to reflect the change in complexity in the treatment process. The pilot has clearly shown that there is a benefit to this move and the next stage to introduce this to other treatment units is under discussion. We have also continued to invest in having two fully maintained radiotherapy LINACs available as â&#x20AC;&#x2DC;service efficiency machinesâ&#x20AC;&#x2122; which enables patients to be transferred to another machine to continue their treatment in the event of machine breakdown. Outpatient department Initial discussions have taken place with Trusts who host our Consultant Outpatient Clinics. This has included an agreement to collect baseline data in order to inform and prioritise work 72

for improvement. The baseline data will include information showing how long patients wait from appointment time to being seen by the Doctor or Nurse in the Outpatient setting. If certain clinics are seen to be performing poorly against the 30 minute waiting time standard work, in conjunction with our key clinicians, will be undertake to identify possible areas for improvement. Where concerns have been raised within year, steps have been taken for individual clinics to be reviewed and where appropriate steps taken for improvement, such as changing clinic templates. As part of the Service Level Agreement discussion this year, additional requirements have been included into the Key Performance Indicators in order to ensure information is collated for analysis and review to facilitate discussions regarding required improvements where appropriate.

Improving Clinical Effectiveness Develop a framework for service improvement and re-design which supports both the Trusts Quality Strategy and the efficiency programme The service improvement framework has been implemented as part of the Trust QIPP programme and is focussed on achieving improvements in service quality and efficiency. During 2011/12 the project governance structure was developed and the four key work streams identified. By the end of the year each project had developed its project structure (using PRINCE 2 methodology) and initial workshops / rapid improvement events were held. The initial areas of focus are: x x x x

Radiotherapy Chemotherapy Inpatients Medical records

Integrated mortality review programme

30 day mortality post chemotherapy Data for all CCO chemotherapy patients & monthly 30 day mortality data is provided to individual consultants for review. 2 monthly mortality meetings are held to identify trends and any areas for concern are investigated. Recommendations for changes in practice are disseminated by the Medical Director to all consultants and their teams. 90 day mortality post radiotherapy 90 day mortality post radiotherapy data also continues to be extracted and reviewed as above.

The Trust has recently secured the purchase of the Lightfoot Sfn mortality management solution software which will provide a platform for ongoing and detailed analysis of mortality data in real time. The Trust Consultants now receive a regular detailed report of their own 30 day mortality figures and the report facilitates anonymised internal benchmarking. Each Consultant also is in receipt of their patient list as part of this report to facilitate interrogation and auditing of their patient deaths and this will be essential data analysis for presentation at revalidation. 5 year survival 5 year survival calculations for extended tumour groups are reported annually in the clinical governance annual report. We have provided the North West Cancer Intelligence Service (NWCIS) with our survival data with the aim of obtaining national comparison performance data going forward. NWCIS have advised they would not recommend us to compare the trust survival performance directly with the national figure without some form of adjustments. The most common adjustment is case mix i.e. TNM. However, as the national data completeness of TNM is poor, we are advised that this will not be a possibility. The Trust also requested curve survival rates for national comparison and a breakdown of the survival figures by staging for confirmed cases i.e. stage I, II, III and IV but the NWCIS were unable to provide this. Mortality case sheet review A suitable and sustainable model is being developed to provide a programme of regular multidisciplinary, peer reviewed mortality review meetings in the Trust. These meetings will identify harm events and prevent avoidable deaths. The Trust has appointed a Consultant Clinical Oncologist in April 2012 as Consultant Clinical Audit Lead who will work in collaboration with the Head of Clinical Governance & Practice Development and the Medical Director to finalise the delivery of Trust Mortality Review Meetings and liaise with all medical staff in this respect. Global Trigger Tool This monthly in patient case sheet review continues to be undertaken to identify possible harm events, to include 30 day mortality from discharge and neutropenic sepsis mortality. Data is uploaded on the IHI Extranet as part of the Patient Safety First Campaign initiative. Areas of concern are disseminated by the Clinical Governance Manager to relevant staff groups for action. This activity continues with a renewed emphasis on trend analysis and a subsequent reduction in harm events in 2012, linked with the Patient Safety Thermometer initiative commenced in April 2012 Weekly review of all inpatient deaths/ Use of LCP and preferred place of care A weekly review of all inpatient deaths, captured in the Cause of Death Record, continues and will be incorporated into the planned Mortality Review Meetings.

Priorities for improvement The three main priorities for the Quality Strategy have been developed through an ongoing programme of engagement with the Trust Board, our Council of Governors, our Commissioners and with LINks and Overview and Scrutiny Committee representation from across the network. The three priorities are integrated into our Trust Strategic Plan and our Annual Plan which have been developed in conjunction with the Council of Governors Strategy Committee. Priorities in each section have been developed in conjunction with our commissioners and are included within our contract for 2012/13 as CQUINS. Due to the size of the population that it serves the Trust has endeavoured to engage with all LINkS and Overview and Scrutiny Committees in developing the Quality Accounts and key priorities. In November the Trust held an engagement event to which it invited LINkS and OSC representatives from across Merseyside and Cheshire. At this event the Trust presented information on the delivery against its 2011/12 key priorities and performance against key metrics and held a workshop to discuss the priorities for 2012/13. The Trust will continue to use these engagement events to continue to improve engagement with LINks (and their successor organisations) and Overview and Scrutiny Committees over the coming year. Representation from LINks and OSCs LINk

OSCs

Wirral (5)

Wirral (3)

Cheshire West & Chester (2)

Sefton (1)

Other Wirral Older Peopleâ&#x20AC;&#x2122;s Parliament (1)

In addition to the three main priorities additional developments building on last years priorities have been included. Improving Patient Safety Patient Safety Safety thermometer

Source CQUINs

Engagement Lead commissioner

Monitoring of progress Trust Board Monitoring of CQUIN at contract quality meetings with lead commissioner

Council of Governors

Expected areas of improvement Improved patient safety and harm free care

A requirement of the national CQUINS is to introduce the data collection part of the Safety Thermometer. This is a monthly review of all inpatients to determine if they are ‘harm free’ reviewing specifically the following harms: x Falls x Pressure ulcers x Catheters with UTIs x VTE Our patient safety priority for 2012/13 broadens the scope of the mandated requirements to ensure that we review the baseline data in April on implementation of the thermometer and that we set clear objectives and milestones for improvements in all harm areas. Progress and achievement of this priority will be by quarterly reports to the Trust Board.

Building on last years priorities Patient Safety Telephone advice line

Expected areas of improvement Improved patient safety Improved patient experience

We have continued to look at how we can develop the telephone advice line (triage) further. The current triage service provides a 24hr 7day a week telephone advice service for patients receiving chemotherapy. A recent audit showed that there are over 700 calls per month to the service. This suggests that the service is well utilised and provides a valuable point of contact for this group of patients. Although the finalised Acute Oncology Peer Review Standards did not include the provision of a network wide telephone triage service, Clatterbridge Cancer Centre NHS Foundation Trust has continued with the plans to expand the current chemotherapy triage service to include a service to all patients receiving treatment at CCC. A new triage facility will be adjacent to the acute assessment unit (see below) and will provide a dedicated space for patients be assessed as well a telephone service. The timescale for the opening of this facility is dependant on the refurbishment of the ward and is estimated to be Oct 2012. Progress and achievement of this priority will be by quarterly reports to the Quality Strategy Committee. Improving Patient Experience Patient Experience Development of ‘achieving excellence’ improvement plans

Source Internal

Engagement Trust Board Council of Governors

Monitoring of progress

Expected areas of improvement

Senior managers forum

Improved patient safety

Trust Board

Improved patient experience

Development of ‘achieving excellence’ improvement plans. The Trusts Vision is To Provide the Best Cancer Care to the People We Serve. Aspiring to achieve excellence is key to achieving this vision and achieving excellence is one of our core values. This framework aims to enable departments to review their current service provision and to develop an action plan to continue on the journey to achieving excellence. The components of excellence used in this framework are: x Harm free care x Patient Outcomes x Patient experience x Use of technology x Expert staff x Understanding how we compare Progress and achievement of this priority will be by quarterly reports to the Senior Managers Forum. Building on last years priorities Patient Experience Chemotherapy closer to home

Expected areas of improvement The aim will be improved patient experience

This year we will build on the initial pilot where we provided chemotherapy in GP surgeries and in patients’ homes. We aim to widen the scope of the pilot and to pilot an innovative service model where we use a mobile unit (large lorry created to provide a mobile, patient friendly medical clinical environment) to provide chemotherapy closer to patients’ homes. Progress and achievement of this priority will be by quarterly reports to the Chemotherapy Steering Group. Improving Clinical Effectiveness Clinical Effectiveness Acute assessment unit

Source

CQUINs

Engagement Lead commissioner Cancer Network Council of Governors

Monitoring of progress Trust Management group / QIPP group Monitoring of CQUIN at contract quality meetings with lead commissioner

Expected areas of improvement Improved patient safety Improved patient experience Improved clinical effectiveness

Developing an acute assessment unit Many of our patients will develop acute problems relating to their disease or treatment. Currently patients are admitted to any of our inpatient wards depending on bed availability. During 2012/13 we plan to develop an acute assessment unit, linked to our telephone advice line (triage service) which will provide a dedicated clinical in patient area staffed by expert professionals with appropriate technology to provide the best care possible. The key objectives are to: x Improve patient pathway for unplanned admissions x Reduce length of stay for unplanned admissions x Admission avoidance through triage expansion x Create consistency of care for all patients x Increase patient safety through development of robust patient pathways and timely assessment and initiation of treatment x Ensure efficiency Progress and achievement of this priority will be by monthly reports to the QIPP steering group.

Building on last years priorities Clinical Effectiveness

Expected areas of improvement

QIPP framework

2012/13 saw the implementation of the program governance and the identification and early work on the four identified project areas. 2012/13 will see the full implementation of these projects in: Radiotherapy â&#x20AC;&#x201C; Treatment pathway and treatment and organisation in Linacs Chemotherapy - Improved scheduling for patients leading to reduced waiting times and increased throughput Inpatients - New acute admissions process providing a more consistent service quality and reduced length of stay Medical records - Reduced hospital appointment cancellations, saving staff time and reducing inconvenience and anxiety from appointment cancellations Progress and achievement of this priority will be by monthly reports to the QIPP steering group.

Statements of Assurance from the Board Information on the review of services

During 2011/12 The Clatterbridge Cancer Centre NHS Foundation Trust provided and/or subcontracted two NHS services. The Clatterbridge Cancer Centre NHS Foundation Trust has reviewed all the data available to them on the quality of care in two of these NHS services. The income generated by the NHS services reviewed in 2011/12 represents 100 per cent of the total income generated from the provision of NHS services by The Clatterbridge Cancer Centre NHS Foundation Trust for 2011/12. The data reviewed covers the three dimensions of quality – patient safety, clinical effectiveness and patient experience.

Information on participation in clinical audits and national confidential enquiries During 2011/12 nine national clinical audits and one national confidential enquiries covered NHS services that The Clatterbridge Cancer Centre NHS Foundation Trust provides. During 2011/12 The Clatterbridge Cancer Centre NHS Foundation Trust participated in 100% national clinical audits and 100% national confidential enquiries of the national clinical audits and national confidential enquiries which it was eligible to participate in. The national clinical audits and national confidential enquiries that The Clatterbridge Cancer Centre NHS Foundation Trust was eligible to participate in during 2011/12 are as follows: x x x x x x x x x

National Lung Cancer Audit - LUCADA NBOCAP - National Bowel Cancer NCASP - Head & Neck Cancer - DAHNO NCEPOD – Coronary Arrest Procedure (CAP) study National audit of delays commencing and completing chemoradiotherapy and the implementation of image guided brachytherapy for cervix cancer in the UK in 2010/11 National Care of the Dying Audit – Hospitals Round 3 2011 Audit of the Medical Use of Red Cells A National Audit of adjuvant breast radiotherapy technique and tumour bed boost practice in early breast cancer after breast-conserving surgery UK Ipilimumab rare melanoma audit

The national clinical audits and national confidential enquiries that The Clatterbridge Cancer Centre NHS Foundation Trust participated in during 2011/12 are as follows: x x

National Lung Cancer Audit - LUCADA NBOCAP - National Bowel Cancer 79

x x x x x x x

NCASP - Head & Neck Cancer - DAHNO NCEPOD – Coronary Arrest Procedure (CAP) study National audit of delays commencing and completing chemoradiotherapy and the implementation of image guided brachytherapy for cervix cancer in the UK in 2010/11 National Care of the Dying Audit – Hospitals Round 3 2011 Audit of the Medical Use of Red Cells A National Audit of adjuvant breast radiotherapy technique and tumour bed boost practice in early breast cancer after breast-conserving surgery UK Ipilimumab rare melanoma audit

The national clinical audits and national confidential enquiries that The Clatterbridge Cancer Centre NHS Foundation Trust participated in, and for which data collection was completed during 2011/12, are listed below alongside the number of cases submitted to each audit or enquiry as a percentage of the number of registered cases required by the terms of that audit or enquiry. x x x x x x x x x

National Lung Cancer Audit - LUCADA = 734/735 (99.9%) - couldn’t upload 1 record as patient had 2 lung primaries NBOCAP - National Bowel Cancer = 924/924 (100%) NCASP - Head & Neck Cancer - DAHNO = 157/205 (77%) - 48 records could not be uploaded due to incomplete data from the secondary hospital NCEPOD – Coronary Arrest Procedure (CAP) study = 1/1 patient (100%) National audit of delays commencing and completing chemoradiotherapy and the implementation of image guided brachytherapy for cervix cancer in the UK in 2010/11 = 24/24 (100%) National Care of the Dying Audit – Hospitals Round 3 = 20/20 2011 Audit of the Medical Use of Red Cells = 37/37 (100%) A National Audit of adjuvant breast radiotherapy technique and tumour bed boost practice in early breast cancer after breast-conserving surgery = 64/66 (97%) for 2 patients, case notes were not available at time of audit but are available now UK Ipilimumab rare melanoma audit = 2/2 patients (100%)

The reports of 5 national clinical audits were reviewed by the provider in 2011/12and The Clatterbridge Cancer Centre NHS Foundation Trust intends to take the following actions to improve the quality of healthcare provided x x x x x

National Lung Cancer Audit – based on the annual report recommendations, the Trust will continue to submit data for 2012-13 NBOCAP - based on the annual report recommendations, the Trust will continue to submit data for 2012-13 DAHNO - based on the annual report recommendations, the Trust will continue to submit data for 2012-13 NCASP - National Oesophago-Gastric Cancer - the Trust will continue to submit data for 2012-13 NCEPOD – Coronary Arrest Procedure (CAP) study (Awaiting audit report)

The reports of 25 local clinical audits were reviewed by the provider in 2011/12 and The Clatterbridge Cancer Centre NHS Foundation Trust intends to take the following course of action to improve the quality of healthcare provided.

Clinical Audit

Action

Platinum pemetrexed doublet chemotherapy in mesothelioma and its effect on drain site recurrence Efficacy and tolerability of 1st line chemotherapy in elderly patients (>70) with NSCLC Re-audit of nursing documentation of patients pressure ulcer care

Findings discussed at Lung Tumour Specific Group (TSG) and Mesothelioma therapeutic pathway developed. Confirmed good practice

Prescribing of GCSF

Re-audit after 6 months following any changes which have been put in place Redesign the current protocol to mention VIDE in G-CSF policy as it is not currently on the same page as the G-CSF policy and may easily be overlooked Ensure that reasons for prescribing pegfilgrastim are documented in each patient’s medical notes. Consider primary pegfilgrastim with Epi-CMF or taxotere-containing regimes as these both have a high incidence of febrile neutropenia (FN) requiring secondary prophylaxis. Review possible aids to prescribers in prescribing prophylactic pegfilgrastim e.g. a table of risk factors for febrile neutropenia or a table showing the risk of developing febrile neutropenia for each of the most commonly used regimens. Educate prescribers in prescribing pegfilgrastim for both primary and secondary prophylaxis of febrile neutropenia. Educate prescribers about the importance of appropriate documentation for off-protocol prescribing.

Pressure Ulcer awareness Launch Turning/positioning charts discussed next meeting. Improve access to cushions (especially out of hours) To investigate the situation whilst we await the central store. To add a reminder to the turning chart i.e specific day for re assessment Education surrounding the current Maxims as well as ensuring the new Maxims ‘Edit’ button will not be used in the same way. Awareness raising of some changes to the Waterlow score. New pathway introduced into the admission pack as a prompt for staff, To role this out to all in patient wards. To improve Waterlow scoring education for staff once any changes have taken place on Maxims. To check dressings in clinical areas to ensure they comply with the formulary, move to standardising dressing with the central store.

Risk of neutropenic sepsis with neo-adjuvant chemotherapy (AC/EC & Taxotere)

Due to the high number of instances of FN request sent to commissioners for funding for this treatment The findings of the audit to the Breast TSG.

Audit of Inpatient Prescribing Standards at CCO

It is recommended that a re-audit be conducted in six months to ensure the errors have been resolved.

To determine a baseline assessment of pain assessment practice at CCO

There appears to be a clear need and desire for education in pain assessment and management. This enthusiasm is promising particularly when 73% nurses and 35% clinicians report having had no training in pain assessment / management. The Trustâ&#x20AC;&#x2122;s participation in a national study - The Edinburgh Pain Assessment Tool Study (EPATÂŠ) in 2009 has provided an opportunity to receive the educational package which includes implementation of an assessment tool and management plan. Institutionalising pain assessment should ensure a uniform method, frequency and a central point of documentation to ensure good communication between staff. It is hoped that raising the profile of pain assessment and management will improve confidence of staff, promote good clinical practice and ultimately patient experience.

Pressure Ulcer Re-Audit

Improvements required to care plan evaluations made per shift. Re-enforce same with nursing staff.

Capecitabine counselling questionnaire

Liaise with Dr Myint and the healthcare Assistants who co-ordinate clinic about getting bloods done earlier. Co-ordination of clinic to run smoother. Extend service to all CRT colorectal patients formulate a Business Case (as service is currently resource neutral) Participate in the prescribing of oral chemotherapy and /or other supplementary therapy.

Palliative radiotherapy to prostate

Confirmed good practice

Audit of outcomes for brain metastasis patients who have undergone Stereotactic radiosurgery at CCC

Confirmed good practice

2nd Line Docetaxel chemotherapy in Non Small Cell Lung Cancer

Confirmed good practice

Audit reviewing the provision of Parenteral Nutrition (PN) within CCC

PN should continue to be given at CCC with more robust guidelines regarding its provision under the care of a multi professional team. 82

Documentation is produced for the provision of PN written by a multi-professional group and utilising the recommendations in the above documents. Consent of the patientâ&#x20AC;&#x2122;s Consultant should be gained during the process of considering the provision of PN (or the consultant providing cover) before any subsequent action is taken A member of the Nutrition and Dietetic service should be involved in the discussion from the outset, potentially along with a representative from the Pharmacy department within CCO and the aseptic unit at Arrowe Park Hospital, (WHUT) Dr Husband (Medical Director) will ultimately oversee the nutritional care of these patients, potentially reviewing them as part of his weekly ward round (Thursday morning) which is attended by a Dietician and a Nutrition Nurse. Pressure Ulcer Re-Audit January 2012

Improvement required to care plan evaluations each shift (= 12 hour period) Re enforce with nursing staff â&#x20AC;&#x201C; each patients identified as being at risk and/or with an actual pressure ulcer must have a documented evaluation per 12 hour period. Further improvements required on weekly Waterlow risk assessments. Re enforce with staff â&#x20AC;&#x201C; all patients need to have Waterlow repeated each weekly or if condition alters.

Review of Patients treated for Thymoma/Thymic carcinoma over 10 years from 1998 to 2008

Multimodality treatment for thymic tumours represents the preferred therapeutic approach and should be considered in suitable patients. Further randomised trials needed to define the optimum treatment options.

Point Prevalence of Medicines Storage in all clinical areas

Outcome of Divisional areas to be reported to Senior managers in September 2011 for action and feedback. Email Leads with outcome for their area. Submit audit report for circulation. Meet with estates to ensure actions within the trust are consistent. Acting Clinical Services Manager and team to incorporate unannounced spot-checks to wards and departments into pharmacy annual audit programme. Review assessment tool post review feedback. Incorporate into medicines management audit calendar.

Brain Metastases from an Ovarian Cancer

Platinum sensitivity is an important prognostic factor in patients with brain metastases from an ovarian primary tumour. Multimodal therapy using surgery, radiotherapy and chemotherapy should be considered where feasible.

Planned Admissions

Further discussions with Head of Nursing to discuss how in-patient wards can be utilised effectively with consideration of implementing day case areas on Mersey and Sulby wards with access to an examination room. All wards nurse patients receiving chemotherapy/radiation but nurses do not receive formal training. Discuss with Head of Nursing and ward managers the training needs of staff on all wards with consideration of incorporating chemotherapy training for staff on Conway and Mersey wards and radiotherapy training for staff on Sulby ward. To calculate workload of nurse practitioners in pre-assessment clinic. Ascertain whether patients require clinical examination and/or information regarding treatment plan to assist calculating pre-assessment workload. To review roles of nurse practitioners. Discuss with Judi Ebbrell how nurse practitioner roles and skill mix could be adapted to ensure a more timely efficient service.

Chemotherapy for colorectal cancer in elderly patients

Older age does not preclude consideration of appropriate systemic therapy. Patient selection is key and in some patients even single agent chemotherapy can be associated with high rates of grade 3-4 toxicity and lead to early cessation. However, in selected patients, combination chemotherapy may be well tolerated. Similar outcomes can be achieved as in younger populations. Recruitment of more elderly patients into clinical trials should be encouraged.

A comparison of split course vs continuous radiotherapy in patients with anal cancer

The results of this audit suggest well selected elderly patients achieve good outcomes if treated with radical intent, even allowing for age related modifications in treatment.

Review of patients under the age of 18 years treated with radiotherapy for Hodgkinâ&#x20AC;&#x2122;s Disease.

The use of radiotherapy in young patients with Hodgkinâ&#x20AC;&#x2122;s disease continues to be a subject of controversy. Our study confirms that IFRT as part of CMT in patients with Hodgkin's Lymphoma results in acceptable morbidity whilst achieving satisfactory disease control.

Assessing setup errors in lung cancer patients undergoing radical radiotherapy

The above set up margins are evidence based on the systematic and random errors observed in patients undergoing radical radiotherapy based on the imaging policy in current use. They need to be continually assessed at periodic intervals and if there is any change in the imaging policy.

Assessing the benefit of Cone Beam Computed Tomography (CBCT) for prostate radiotherapy patients to assess bladder/rectal volumes

Produce a training package for radiographers and to join the Hybrid study (hypo fractionated bladder protocol). 84

Outcome of patients with brain metastasis from non-small cell lung cancer (NSCLC) with respect to treatment modality

RPA classification is the strongest predictor for outcome following treatment for brain metastasis. These findings can assist in better patient selection and optimising radiotherapy dose fractionation to improve survival outcome. It will be interesting to see if QUARTZ trial supports these findings and clarify the benefit of WBRT in patients with NSCLC.

Care after death for patients not placed on the Liverpool Care Pathway

To design and pilot a care after death form for patients not on the Liverpool Care Pathway.

NICE Guidance audits Clinical Audit

Action

Renal cell carcinoma (first line metastatic) pazopanib Breast cancer - bevacizumab (in combination with a taxane) Colorectal cancer (metastatic) - bevacizumab

Fully Compliant with no outstanding actions or clinical concerns Fully Compliant with no outstanding actions or clinical concerns Fully Compliant with no outstanding actions or clinical concerns Fully Compliant with no outstanding actions or clinical concerns Fully Compliant with no outstanding actions or clinical concerns Fully Compliant with no outstanding actions or clinical concerns NICE did not recommend everolimus for this patient group based on cost effectiveness. However, the funding for the 4 patients identified was approved by the Cancer Drug Fund, hence there is no concern with compliance with NICE guidance as funding was secured elsewhere.

Lung cancer (non-small-cell) - pemetrexed (maintenance) Gastrointestinal stromal tumours (unresectable/metastatic) - imatinib Soft tissue sarcoma - trabectedin Everolimus for the second-line treatment of advanced renal cell carcinoma

Trabectedin for the treatment of relapsed ovarian cancer Lung cancer (small cell) - topotecan

Fully Compliant with no outstanding actions or clinical concerns. Partially Compliant. One patient received IV topotecan hence not complaint to NICE guidance but was compliant with the CCC chemotherapy protocol book at the time of audit. The protocol book has since been amended to reflect the guidance.

Renal cell carcinoma - bevacizumab, sorafenib tosylate and sunitinib

Partially Compliant as 3 patients received 2nd line Sunitinib which was not recommended by NICE but was compliant with the CCC chemotherapy protocol book at the time of audit. The protocol book has since been amended to reflect the guidance.

Renal cell carcinoma (first line metastatic) pazopanib

Fully Compliant with no outstanding actions or clinical concerns.

Re-audit of Sorafenib for the treatment of advanced hepatocellular carcinoma

Non-Compliant with NICE guidance however Fully Compliant with local agreement with Commissioners with no outstanding actions or clinical concerns. 85

Information on participation in clinical research, in the following form of statement

The number of patients receiving NHS services provided or sub-contracted by The Clatterbridge Cancer Centre NHS Foundation Trust that were recruited during that period to participate in research approved by a research ethics committee was 1786.

Use of the CQUIN framework

A proportion of The Clatterbridge Cancer Centre NHS Foundation Trust income in 2011/12 was conditional upon achieving quality improvement and innovation goals agreed between The Clatterbridge Cancer Centre NHS Foundation Trust and any person or body they entered into a contract, agreement or arrangement with for the provision of NHS services, through the Commissioning for Quality and Innovation payment framework. Further details of the agreed goals for 2011/12 and for the following 12 month period are available online at http://www.clatterbridgecc.nhs.uk/aboutcentre/key_documents/public%20documents.html The monetary total for the amount of income in 2011/12 conditional upon achieving quality improvement and innovation goals was ÂŁ812,909, and the monetary total for the associated payment in 2010/11recieved was ÂŁ809k.

Information relating to registration with the Care Quality Commission and periodic/special reviews The Clatterbridge Cancer Centre NHS Foundation Trust is required to register with the Care Quality Commission and its current registration status is registered without conditions for the treatment of disease, disorder or injury and for diagnostic and screening procedures. The Care Quality Commission has not taken enforcement action against The Clatterbridge Cancer Centre NHS Foundation Trust during 2011/12. The Clatterbridge Cancer Centre NHS Foundation Trust has not participated in any special reviews or investigations by the Care Quality Commission during this reporting period.

Information on the quality of data

The Clatterbridge Cancer Centre NHS Foundation Trust submitted records during 2011/12 to the Secondary Uses service for inclusion in the Hospital Episode Statistics which are included in the latest published data. The percentage of records in the published data: x Which included the patient's valid NHS Number was: 100% for admitted patient care and 99.9% for outpatient care. The Trust does not provide accident and emergency care. x Which included the patient's valid General Practitioner Registration Code was: 100% for admitted patient care and 100% for outpatient care. The Trust does not provide accident and emergency care. The Clatterbridge Cancer Centre NHS Foundation Trust Information Governance Assessment Report overall score for 2011/12 was 79% and was graded green. The Clatterbridge Cancer Centre NHS Foundation Trust will be taking the following actions to improve data quality: x All patient activity to be recorded in the EPR system within 5 working days x Regular Admitted and Non admitted patient care accuracy checks to be undertaken in line with the National IG toolkit to sustain level 3 x The Trust has an internal Data Quality Audit programme covering admitted, non admitted and elective care x A new version of the EPR system will be implemented to facilitate the replacement of several paper-based recording forms with structured electronic forms The Clatterbridge Cancer Centre NHS Foundation Trust was subject to the Payment by Results clinical coding audit during the reporting period by the Audit Commission and the error rates reported in the latest published audit for that period for diagnoses and treatment coding (clinical coding) were 0.5%. The results should not be extrapolated further than the actual sample audited. All of our services were reviewed within the sample.

Other information The Board in consultation with stakeholders has determined a number of metrics against which it can measure performance in relation to the quality of care it provides. The Trust has chosen metrics which are relevant to its speciality i.e. non-surgical oncology and which are identified as important to the public. However, this does mean that data is predominantly internally generated and may not be subject to benchmarking at this stage. Safety indicators 2011/12

2010/11

2009/10

2008/09

2007/08

0.52

0.41 0

0.543 0

0.3 0

0.2 0

0.6 0

0.16

0.13

0.196

0.1

0.05

0.58

0.76

0.84

0.76

1.17

22.7

19.1

25.9

2011/12

2010/11

2009/10

2008/09

2007/08

Hospital standardised mortality rate (HSMR)

N/A

36.4

39.3

30 day mortality rate (radical chemotherapy)

1.3% (Apr 11Feb12) 7.9% (Apr 11Feb12) 0.87% (Apr 11Feb12) 13.4% (Apr 11Feb12)

34.8 (Apr 10 – Sept 10) 1.2% (April 10 – March) 9.0% (April 10 – March) 0.74% (April 10 – March) 15.7% (April 10 – March)

1.2%

0.5%

1.4%

7.6%

7.4%

1.2%

0.9%

1.2%

16.2%

17.1%

19.5%

MRSA bacteraemia cases / 10,000 bed days C Diff cases / 1,000 bed days ‘Never Events’ that occur within the Trust Chemotherapy errors (number of errors per 1,000 doses) Radiotherapy treatment errors (number of errors per 1,000 fractions) Falls / injuries / 1,000 inpatient admissions

All indicators: x Data source: CCO Clinical Effectiveness Indicators

30 day mortality rate (palliative chemotherapy) 30 day mortality rate (radical radiotherapy) 30 day mortality rate (palliative radiotherapy)

HSMR:

Data source Dr Foster

Decision to stop monitoring HSMR data from September 2010. Unfortunately the Trust (as a specialist Trust) is not included in the SHMI mortality indicator so this data is unavailable.

Mortality rate: x Data definition: unadjusted mortality rate as a percentage of all cases treated in that category. x Data source: CCC Patient Experience Indicators 2011/12

2010/11

2009/10

2008/09

2007/08

At least 80% of patients rate as ‘always’ in the local patient survey programme when asked ‘I was treated with courtesy and respect’

97%

96%

98%

97%

At least 80% of patients rate as ‘always’ in the local patient survey programme when asked ‘Was the ward / department clean’

95%

94%

92%

95%

At least 70% of patients rate as ‘never’ in the local patient survey programme when asked ‘If they had to wait’

26%

24%

16%

17%

15%

At least 80% of patients rate as ‘always’ in the local patient survey programme when asked if ‘I was included in discussions about my care’

91%

88%

87%

90%

At least 80% of patients rate as ‘always’ in the local patient survey programme when asked if ‘the staff washed their hands’

93%

94%

88%

92%

90%

Patient survey: x Data source: data collected from in-house survey x Survey questions based on annual Care Quality Commission In-patient survey x Target for compliance agreed by the Trust Board as part of our Quality Strategy x Data for 2007/08 only available for part year x In January of last year we changed the question from ‘I had to wait’ to ‘I had to wait more than 20 minutes after my appointment time’ to enable us to better understand the nature of the issue

Performance against key national priorities and National Core Standards 2011/12

2010/11

2009/10

2008/09

Care Quality Commission Registration

Registered without conditions

New for 2009/10

Standards for Better Health declaration

No longer required

Declared full compliance with all 45 standards that it was required to declare against in its mid year declaration to the CQC. The Trust remained compliant throughout the rest of the year.

Declared full compliance with all standards throughout year and at year end

Declared full compliance with all standards except one throughout year and full compliance at year end

Self certification against compliance with requirements regarding access to healthcare for people with a learning disability.

Achieved

New for 2010/11

Clostridium difficile

8 (target no more than 8)

10 (target no more than 12)

8 (target no more than 17)

7 ( target no more than 19)

MRSA bacteraemia Maximum waiting time of two weeks from urgent GP referral to date first seen for all urgent suspect cancer referrals

1 (target no more than 0) 100%

0 (target no more than 1) 100%

0 (target no more than 2) 100%

26 (target no more than 11 cases) 0 (target no more than 2) 100%

2007/08

Maximum waiting time of 31 days for subsequent treatments for all cancers

Chemotherapy: 98.8% (target 98%) Radiotherapy 97.0% target 94%)

Chemotherapy: 98.3% (target 98%) Radiotherapy 93.1% (target 94%)

98.9% (target 98%)

Maximum two month wait (62 day) referral to treatment for all cancers Maximum two month wait (62 day) referral to treatment for all cancers (screening). For admitted patients, maximum time of 18 weeks from point of referral to treatment For nonadmitted patients, maximum time of 18 weeks from point of referral to treatment RTT For admitted patients (95th percentile) RTT For nonadmitted patients (95th percentile) Maximum waiting time of 31 days from diagnosis to treatment for all cancers Screening all elective inpatients for MRSA

80.1% (target Classic 79%)

80.8% (Target 79%)

78.2% *prereallocation (target 79%)

93.3% (target threshold 93%).

94.7% (target 93%)

96.9% (target 90%)

96.2% (target 90%)

95.4% (target 95%)

As at March 2009, 97.3% (target of 90%)

95.9% (target 85%)

97.8%. (target 95%)

98.5%. (target 95%)

97.9% (target 95%)

98.5% (target 95%).

96% (target 90%)

15.6 non reportable due to low numbers (target 23.0) 15.2 (target 18.3)

n/a

97.9% (target 96.0%)

97.7% (target 96%)

99.8% (target threshold 98%).

99.8% (target 98%)

129.3% (elective and non elective)

96.% (elective and non elective)

114.4% (elective only)

N/A due to deminimus (Target Screening 90%)

NHS Outcomes Framework Domains NHS Outcomes Domain

Indicator

CCO Performance

Domain 1: preventing people from dying prematurely

SHMI

Domain 1: preventing people from dying prematurely

Category A ambulance response times

Domain 1: preventing people from dying prematurely and Domain 3: helping people to recover from episodes of ill health or following injury Domain 3: helping people to recover from episodes of ill health or following injury Domain 3: helping people to recover from episodes of ill health or following injury Domain 4: Ensuring that people have a positive experience of care Domain 4: Ensuring that people have a positive experience of care

Ambulance Trust clinical outcomes

Domain 5: Treating and caring for people in a safe environment and protecting them from avoidable harm Domain 5: Treating and caring for people in a safe environment and protecting them from avoidable harm Domain 5: Treating and caring for people in a safe environment and protecting them from avoidable harm

Patient reported outcomes scores (surgery) Emergency admissions to hospital within 28 days Responsiveness to inpatientsâ&#x20AC;&#x2122; needs Percentage of staff who would recommend the provider to friends or family needing care Percentage of admitted patients risk-assessed for Venous Thromboembolism Rate of C Difficile

Rate of patient safety incidents and percentage resulting in severe harm or death.

National Performance

CCO is excluded as a specialist Trust CCO is excluded as a specialist Trust CCO is excluded as a specialist Trust CCO is excluded as a specialist Trust CCO is excluded as a specialist Trust 83.9/100

4.18

National average: 67.4/100 National median 3.9

Q2 performance: All providers of 97.1% NHS funded acute care Q2 88.3% Data not yet available for 2011/12 Data from the National Reporting and Learning System (NRLS) between 1 April 2011 and 30 September 2011 No incidents occurred resulting in severe harm or death.

Not available

Annex Statements Statements from Primary Care Trusts (PCTs), Local Involvement Networks and Overview and Scrutiny Committees: x

NHS Foundation Trusts must send copies of their quality reports to their relevant lead commissioning Primary Care Trusts (PCTs), Local Involvement Networks (LINks) and Overview and Scrutiny Committees (OSCs) for comment prior to publication, and should include these comments in their published quality reports. The lead commissioning PCTs will have a legal obligation to review and comment, while LINks and OSCs will be offered the opportunity to comment on a voluntary basis. There are specific timeframes for seeking and receiving responses.

Statement from NHS Wirral Statement from Lead Commissioner for CCC Quality Accounts As lead commissioner on behalf of nine associates, Wirral CCG is committed to work with Clatterbridge Cancer Centre to produce a safe, high quality service on behalf of patients and their families. We take very seriously our responsibility to ensure that patient needs are met with the best service that CCC can provide. We believe that this Quality Account accurately reflects performance in 2011/12 and highlights priorities agreed with commissioners for 12/13. We have been pleased to see the Trust’s continued good performance against targets continued from last year, particularly for nutritional screening, pressure ulcer assessment and falls prevention. We have been particularly pleased to note an overall improvement in the Trust’s performance against the 62 day target, which has again shown progress against last year’s results, and acknowledge the hard work of the Trust in collaboration with the Cancer Network towards this target. In year improvements have also been made against more recent standards introduced last year, including those for continuing care. Newly introduced reporting in the areas of MSSA and E-Coli bloodstream infections has shown a good performance by the trust in these areas. The Trust has also remained below target on cases of C.Diff and MRSA. The Trust’s continuing declaration of compliance in the area of mixed sex accommodation is also welcome. We have assisted the Trust to pursue their Chemotherapy at Home planning with funding of a pilot through CQUIN monies in 11/12, and funding for the next stage of the pilot, again through CQUIN, in 12/13. Although the implementation of the pilot has been delayed, we will continue to encourage the Trust with regards to this scheme, and look forward to receiving the results of the pilot with a view to longer term implementation.

The Trust achieved full payment on all CQUINs except for one. The CQUIN on improving waiting times in all clinics, including satellite clinics, was not achieved, due to data collection issues. This was disappointing, but we are aware that the Trust is in the process of putting SLAs in place with all satellite clinics to ensure data collection, and that data is now being collected for all clinics at the Clatterbridge site. We will continue to work with the Trust to achieve improvement on this issue, and it has been added to the contract as a service development in 12/13. The acute oncology scheme is continuing to improve patient experience and reduce length of stay in acute trusts. The contract for 12/13 will be jointly commissioned by NHS Wirral and NWSCT. CQUIN schemes for 12/13 have been agreed by both commissioners and are around innovations for patients, reflecting the breath of activity across the Trust and ongoing efforts to improve patient experience. We look forward to seeing the outcome of these schemes next year. We are continually reassured, at contract meetings and in this report, of the high profile and priority given to quality issues, both by the Trust Board and operational staff at CCC. We applaud the Trust for its ongoing efforts, and look forward to working in partnership with CCC and NWSCT in the future to assist in achievement of their Core Purpose – providing excellent care to people with cancer.

Statement from Cheshire West and Chester Overview and Scrutiny Committee At its meeting held on 23 April 2012 the Council’s Health and Wellbeing Scrutiny Committee discussed the Quality Accounts. The Committee recognised the importance of the 62 day cancer waiting time target being embedded within the working practises of all staff within the Trust but accepted that Clatterbridge was the last point on the patient pathway and meeting the target was in many cases dependant on other NHS providers. It welcomed the initiatives being undertaken to provide outpatient treatment as close to the patient’s home as possible and the increase in clinical trials at the Centre.

Knowsley Overview and Scrutiny Board Commentary to Clatterbridge Centre for Oncology NHS Trust “The Knowsley Overview and Scrutiny Board welcomes the opportunity to provide a commentary on Clatterbridge Centre for Oncology NHS Trust Quality Account. The Board has delegated responsibility for considering Quality Accounts to the Chair of the Overview and Scrutiny Board in consultation with the Lead and Deputy Lead Member for the Wellbeing theme. A meeting was convened on Wednesday 9th May to consider the Quality Account document received by the 5 Boroughs Partnership NHS Trust. The three members spent time considering the document and made a number of observations which have formed the basis of the Board’s commentary, as set out below. 94

We focussed our discussions around three priority areas. Our first was the Trust’s Improvement Priorities for 2012-2013 and the achievements highlighted over the previous year. We discussed where we thought work should be commended and whether there were areas where we felt more information may have been useful. Our final observations referred to the layout, style and format of the document, particularly focussing on how the document related to and/or involved the public. We were pleased to see that the Trust provided a detailed narrative about their improvement targets which we found absent in other Reports. We thoroughly support the introduction of the Safety Thermometer which will ensure that the Trust has clear objectives and milestones for improvements in harm areas. We felt that the improvements which had been made over the previous year such as the 24/7 on-call consultation led service and the ‘Quality in Nursing at Clatterbridge’ tool would result in an overall improvement in the quality of services provided by the Trust. We would be interested to see the outcome of the feasibility study on alternative care settings for the delivery of chemotherapy closer to home as we recognise the benefits that this could bring to patients. We would have liked performance information included to see evidence of the improvements made particularly in relation to the reduction in pressure ulcers, patients fall incidents and mortality/survival rates. We also noted that there was quite a lot of information missing from the document where it appears that additional narrative, graphs and statistics will be added. Whilst we are happy to comment on the document as it stands, we would have preferred a more complete document to consider as we felt unable to provide a detailed commentary. In terms of the layout and feel of the document, whilst we think that the use of graphs or charts would help to show the Trust’s progression more accurately, we believe that the narrative is clear and well structured and that the document is very informative and well written. We would like to ask that the name of the Trust is included on the front of the document. In conclusion, we thank the Trust for its interesting report and welcome future engagement in order that we can provide a fair and balanced commentary on the Trust’s achievements in the future.” Commentary provided by Councillor Mal Sharp (Chair of Overview and Scrutiny Board), Councillor Bob Swann (Lead Member for Wellbeing) and Councillor Kay Moorhead (Deputy Lead Member for Wellbeing) on behalf of Knowsley Overview and Scrutiny Board.

Sefton Overview and Scrutiny Board Commentary to Clatterbridge Centre for Oncology NHS Trust The Committee had previously been supplied with the full version of the Clatterbridge Centre for Oncology NHS Foundation Trust’s draft Quality Account. The Trust had been unable to send a representative to the meeting to present its draft Quality Account for 2011/12. 95

RESOLVED: That the draft Quality Account for 2011/12 from the Clatterbridge Centre for Oncology NHS Foundation Trust be received.

Statement from Wirral LINk All the comments and questions raised by Wirral LINk in the statement below were responded to however Wirral LINk have advised that this statement would remain the commentary for the Quality Report.

Statement from Wirral LINk (Local Involvement Network) Wirral LINk have been involved in the Open Events to discuss the Quality Account for Clatterbridge Centre for Oncology for 2011/12 and are pleased to have this opportunity to comment on the contents. A sub group of LINk who look at Quality Accounts for NHS Trusts met to compile this response and the LINk Board may add some of the contents to LINks Action Plan for the coming year. LINk will take utilise the duty of Enter & View and visit Clatterbridge Centre of Oncology premises this year. LINk suggests that the comments below be added to the report at the end of each paragraph to bring the report to life. Please note that LINk is not spelt correctly, consistently, throughout the document. The LINk would like to record that the 24 hour 7 day a week telephone advice service is to be commended and it is noted that this builds on patient safety and improves patient experience. Statement by Chief Executive 2nd to last para Are CCO aware where the case of MRSA derived from? Last para re : 62 day breaches needs to be reworded as it took several attempts to understand the paragraph LINks concern is that the Trust should explain the reasons for appearing to breach the policy (62 days) as this seems unfair and the public should understand the reasons why. PART 2 2nd para It is mentioned that LINks and OSC members were at a patient experience workshop â&#x20AC;&#x201C; were there Service Users at the meeting? 96

Improving Patient Safety To implement a 24 hour a day, 7 day a week telephone advice service in line with acute oncology cancer peer review standards spec. x What are the time frames for implementation? Quality In nursing at Clatterbridge x What does final bullet point mean? : Prevent failure to rescue x 2nd para – 12 months Audit report that links the result to the QINC – LINk noted this item and would be keen to see a copy of the report when it is available. When will this report will be available? Improving Patient Experience To undertake a feasibility study and patient survey on alternative care settings for the delivery of chemotherapy closer to home x

This was noted as a very good approach – particularly choosing “suitable” patients.

Reduction in patient reported waiting times in departments x Typo in first para – should this read “Patient reported waiting times in all departments have continued to be monitored through the real time patient survey”. x 3rd para – ticket based queue management system – could this be cascaded to other Clinics or departments? x Chemotherapy Nursing Service : Typo 3rd bullet : The nurses are x Using the same nurse for the treatment is good practice and to be commended. Improving clinical Effectiveness Develop a framework for service improvement and re-design which supports both the Trusts Quality Strategy and the efficiency programme x No comment Integrated Mortality Review Programme x Terminology should be thought about for example : what does “development of a clinical dashboard” mean?

x x

Improving Patient Experience page 12 “understanding how we compare” – with what? Building on last years priorities: In first para – what is a mobile unit and what does it refer to? This needs more explanation

Improving Clinical Effectiveness Final bullet point : x Ensure Efficiency – by doing what and how is this evidence 97

Statements of Assurances from the board page 14 First par – which two NHS services were provided and/or sub-contracted.

Information on participation in clinical audits and national confidential enquiries pages 14 and 15 Currently no comment is included as there is not enough information available

Use of CQUIN framework page 16 Should the data achieved around contractual arrangements or agreements be added instead of just a link to the website. Information relating to registration with the CQC and periodic/special reviews page 16 Could you please provide a further explanation on “The Care Quality Commission has not taken enforcement action against Clatterbridge Centre…..” Information on the quality of data Not enough information for comment PART 3 PAGE 18/19 AND 20 awaiting further data for 2011/12 before LINk can comment. Performance against key national priorties and national Core Standards pg 21 MRSA – should the actual figure be 1 as referred to in Chief Executives statement? Further data is needed for comment from LINk as there is no data for 2011/12 Page 23 – could we please have an explanation in relation to Domain 4 – ensuring that people have a positive experience of care = 4.18? Wirral LINk looks forward to continuing to work with the Trust over the coming year particularly with regard to LINks Enter & View function. LINk would like to offer the Trust an alternative view to their assurances on patient experience. LINk looks forward to building the relationship with CCO in 2012. Chairman

Diane Hill

Date : 26th April 2012

100

2011/12 Statement of Directors’ Responsibilities in respect of the Quality Report The directors are required under the Health Act 2009 and the National Health Service (Quality Accounts) Regulations 2010 to prepare Quality Accounts for each financial year. Monitor has issued guidance to NHS Foundation Trust Boards on the form and content of annual Quality Reports (which incorporate the above legal requirements) and on the arrangements that Foundation Trust boards should put in place to support the data quality for the preparation of the Quality Report. In preparing the Quality Report, directors are required to take steps to satisfy themselves that: x x

the content of the Quality Report meets the requirements set out in the NHS Foundation Trust Annual Reporting Manual; the content of the Quality Report is consistent with internal and external sources of information including: o o o o o o o o

Board minutes and papers for the period 2011/2012 Papers relating to Quality reported to the Board over the period 2011/2012 Feedback from the commissioners dated 2011/2012 Feedback from governors dated 2011/2012 Feedback from LINks dated 2011/2012 The 2011 national patient surveys The 2011 national staff survey The Head of Internal Audit’s annual opinion over the Trust’s control environment dated March 2012 o CQC quality and risk profiles dated 2011/2012 x x x x

the Quality Report presents a balanced picture of the NHS foundation Trust’s performance over the period covered; the performance information reported in the Quality Report is reliable and accurate; there are proper internal controls over the collection and reporting of the measures of performance included in the Quality Report, and these controls are subject to review to confirm that they are working effectively in practice; the data underpinning the measures of performance reported in the Quality Report is robust and reliable, conforms to specified data quality standards and prescribed definitions, is subject to appropriate scrutiny and review; and the Quality Report has been prepared in accordance with Monitor’s annual reporting guidance (which incorporates the Quality Accounts regulations) (published at http://www.monitornhsft.gov.uk/annualreportingmanual) as well as the standards to support data quality for the preparation of the Quality Report (available at http://www.monitornhsft.gov.uk/annualreportingmanual)).

The directors confirm to the best of their knowledge and belief they have complied with the above requirements in preparing the Quality Report.

101

By order of the Board

Signed Alan White Chairman

Date: 30th May 2012

Signed Andrew Cannell Chief Executive

Date: 30th May 2012

100

102

Acronyms C diff

Clostridium difficile

CQUIN

Commissioning Quality and Innovation

HCAI

Health care associated infection

HSMR

Hospital standardised mortality rate

LCP

Liverpool Care Pathway

MEWS

Modified early warning score

MDT

Multi disciplinary team

MRSA

Meticillin resistant staphylococcus aureas

NCAG

National chemotherapy advisory group

NCEPOD

National confidential enquiry into patient outcome and death

â&#x20AC;&#x2DC;never eventsâ&#x20AC;&#x2122;

Definition used by the National Patient Safety Agency to define a number of incidents that should never happen

PEAT

Patient Environment Action Team

QINC

Quality in Nursing at Clatterbridge

SBAR

Situation, Background, Assessment, Recommendation: a structured method for communicating critical information that requires immediate attention and action contributing to effective escalation and increased patient safety

SHMI

Summary hospital level mortality indicator

101

103

2011/12

Annual Accounts For the 12 months ended 31st March 2012

The The Clatterbridge Clatterbridge Centre Centre for Oncology for Oncology NHSNHS Foundation Foundation Trust Trust st st Accounts Accounts for the for year the year ended ended 31 31 March March 20122012 Contents Contents

PagePage Foreword to the Foreword to Accounts the Accounts

107 105

Statement Statement of the of Chief the Chief Executive's Executive's responsibilities responsibilities as the as accounting the accounting officer officer of of108 106 Clatterbridge Clatterbridge Centre Centre for Oncology for Oncology NHSNHS Foundation Foundation TrustTrust Statement Statement of Directors' of Directors' responsibilities responsibilities in respect in respect of the of Accounts the Accounts

109 107

Independent Independent Auditor's Auditor's Report Report to the to Board the Board

110 108

Statement Statement of Comprehensive of Comprehensive Income Income

112 110

Statement of Financial Position Statement of Financial Position

113 111

Statement of Changes in Taxpayers Equity Statement of Changes in Taxpayers Equity

114 112

Statement Statement of Cash of Cash Flows Flows

116 114

Accounting Policies Accounting Policies

118 116

Notes to the Notes to Accounts the Accounts

132 130

106 104

106

Contents

CLATTERBRIDGE CENTRE FOR ONCOLOGY NHS FOUNDATION TRUST The accounts for the 12 months ended 31 March 2012, have been prepared byPage the Clatterbridge Centre for Oncology NHS Foundation Trust in accordance with paragraphs 24 Foreword the Accounts and 25 oftoSchedule 7 of the National Health Services Act 2006 in the form which105 Monitor has, with the approval of the Treasury directed. Statement of the Chief Executive's responsibilities as the accounting officer of Clatterbridge Centre for Oncology NHS Foundation Trust

106

Statement Signed of Directors' responsibilities in respect of the Accounts

107

Date 30th May 2012

Independent Auditor's Report to the Board Andrew Cannell Chief Executive

108

Statement of Comprehensive Income

110

Statement of Financial Position

111

Statement of Changes in Taxpayers Equity

112

Statement of Cash Flows

114

Accounting Policies

116

Notes to the Accounts

130

Trust

104 105

107

Statement of Chief Executive’s Responsibilities as the Accounting Officer of Clatterbridge Centre for Oncology Contents NHS Foundation Trust The National Health Services Act 2006 states that the Chief Executive is the accounting officer of the NHS Foundation Trust. The relevant responsibilities of accounting officer, Page including their responsibility for the propriety and regularity of public finances for which they are answerable, and for the keeping of proper accounts, are set out in the accounting Foreword to the Accounts 105 officers' Memorandum issued by the Independent Regulator of NHS Foundation Trusts (“Monitor”). Statement of the Chief Executive's responsibilities as the accounting officer of 106 Under the National Health Services Act 2006, Monitor has directed the Clatterbridge Centre Clatterbridge Centre for Oncology NHS Foundation Trust for Oncology NHS Foundation Trust to prepare for each financial year a statement of accounts in the form and on the basis set out in the Accounts Direction. The accounts are prepared on an accruals basis and must give a true and fair view of the state of affairs of Statement of Directors' responsibilities in respect of the Accounts 107 Clatterbridge Centre for Oncology NHS Foundation Trust and of its income and expenditure, total recognised gains and losses and cash flows for the financial year. Independent Auditor's Report to the Board 108 In preparing the accounts, the Accounting Officer is required to comply with the requirements of the NHS foundation trust Financial Reporting Manual and in particular to: Statement of Comprehensive Income 110 - observe the Accounts Direction issued by Monitor, including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent basis; Statement of Financial Position 111 - make judgements and estimates on a reasonable basis; Statement of Changes in Taxpayers Equity 112 - state whether applicable accounting standards as set out in the NHS foundation trust Financial Reporting Manual have been followed, and disclose and explain any material departures in the financial statements; and Statement of Cash Flows 114 - prepare the financial statements on a going concern basis Accounting Policies 116 The Accounting Officer is responsible for keeping proper accounting records which disclose with reasonable accuracy at any time the financial position of the NHS Foundation Trust and to enable him to ensure that the accounts comply with requirements outlined in the above Notes to the Accounts 130 mentioned Act. The Accounting Officer is also responsible for safeguarding the assets of the NHS Foundation Trust and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities. To the best of my knowledge and belief, I have properly discharged the responsibilities set out in Monitor's NHS Foundation Trust Accounting Officer Memorandum.

Signed Andrew Cannell Chief Executive

Date: 30th May 2012 106 104

108

The TheClatterbridge ClatterbridgeCentre Centrefor forOncology OncologyNHS NHSFoundation FoundationTrust Trust st st Accounts Accountsfor forthe theyear yearended ended3131 March March2012 2012

Statement of Directorsâ&#x20AC;&#x2122; Responsibilities in Respect of the Accounts

Contents The Directors are required under the National Health Services Act 2006 to prepare accounts for each financial year. Monitor, with the approval of the Treasury, directs that these accounts give a true and fair view of the state of affairs of the Trust and of the income & expenditure of the Trust for that period. In preparing those accounts, the Directors are requiredPage to; Foreword to thesuitable Accounts select accounting policies, as described on pages 118 to 132 and105 then apply them consistently Statement of the Chief Executive's responsibilities as the accounting officer of 106 make judgements and estimates on a reasonable basis; Clatterbridge Centre for Oncology NHS Foundation Trust state whether applicable accounting standards have been followed, subject to any material departures disclosed and explained in the accounts; Statement of Directors' responsibilities in respect of the Accounts 107 prepare accounts on the going concern basis unless it is inappropriate to presume that the Trust will continue in business. Independent Auditor's Report to the Board 108 The Directors are responsible for keeping proper accounting records which disclose with reasonable accuracy at any time the financial position of the Trust and to enable them to Statement of Comprehensive Income 110 direction ensure that the accounts comply with requirements outlined in the above mentioned of Monitor. The Directors are also responsible for safeguarding the assets of the Trust and hence for taking reasonable steps for the prevention and detection of fraud and other Statement of Financial Position 111 irregularities. The Directors confirm to the best of their knowledge and belief that they have complied with Statement Changes in Taxpayers Equity 112 the aboveofrequirements in preparing the accounts. By Order of the Board Statement of Cash Flows

114

Accounting Policies Signed

116

Andrew Cannell Notes to the Accounts Chief Executive

Date: 30th May 2012

Signed Date: 30th May 2012

Yvonne Bottomley Director of Finance

104 109

109

130

Independent Auditor’s Report to the Council of Governors of Clatterbridge Centre for Oncology NHS FoundationContents Trust We have audited the financial statements of Clatterbridge Centre for Oncology NHS Foundation Trust for the year ended 31 March 2012. The financial statements comprise the Pageof Statement of Comprehensive Income, the Statement of Financial Position, the Statement Changes in Taxpayers’ Equity, the Statement of Cash Flows and the related notes. These Foreword to the have Accounts 105 financial statements been prepared under applicable law and the accounting policies set out in the Statement of Accounting Policies. of thesolely ChieftoExecutive's asClatterbridge the accounting officer 106 ThisStatement report is made the Councilresponsibilities of Governors of Centre forofOncology Clatterbridge Centre for Oncology NHS Foundation Trust NHS Foundation Trust in accordance with Schedule 10 of the National Health Service Act 2006. Our audit work has been undertaken so that we might state to the Council of Governors of the Trust, as a body, those matters we are required to state to them in an Statement Directors' responsibilities in the respect of extent the Accounts auditor’s report of and for no other purpose. To fullest permitted by law, we do107 not accept or assume responsibility to anyone other than the Council of Governors of the Trust, as a body, for our audit work, for this report or for the opinions we have formed. Independent Auditor's Report to the Board 108 Respective responsibilities of the accounting officer and the auditor Statementmore of Comprehensive Incomeof Accounting Officer’s Responsibilities the 110 As described fully in the Statement accounting officer is responsible for the preparation of financial statements which give a true and fair view. Our responsibility is to audit, and express an opinion on, the financial Statement of Financialwith Position statements in accordance applicable law and International Standards on Auditing 111 (UK and Ireland). Those standards require us to comply with the Auditing Practice’s Board’s Ethical Standards for Auditors. Statement of Changes in Taxpayers Equity 112 Scope of the audit of the financial statements Statement of Cash Flows 114 An audit involves obtaining evidence about the amounts and disclosures in the financial statements sufficient to give reasonable assurance that the financial statements are free from material misstatement, whether caused by fraud or error. This includes an assessment of Accounting Policies policies are appropriate to the Trust’s circumstances and have116 whether the accounting been consistently applied and adequately disclosed, the reasonableness of significant accounting estimates made by the accounting officer and the overall presentation of the financial Notes to In theaddition Accounts 130 statements. we read all the financial and non-financial information in the annual report to identify material inconsistencies with the audited financial statements. If we become aware of any apparent material misstatements or inconsistencies we consider the implications for our report. Opinion on financial statements In our opinion the financial statements: x

give a true and fair view of the state of Clatterbridge Centre for Oncology NHS Foundation Trust’s affairs as at 31 March 2012 and of its income and expenditure for the year then ended; and

108 104

110

The TheClatterbridge ClatterbridgeCentre Centrefor forOncology OncologyNHS NHSFoundation FoundationTrust Trust st st Accounts Accountsfor forthe theyear yearended ended3131 March March2012 2012 x

have been prepared in accordance with the NHS Foundation Trust Annual Reporting Contents Manual 2011/12.

Opinion on other matters prescribed by the Audit Code for NHS Foundation Trusts Page In our opinion the information given in the Directorsâ&#x20AC;&#x2122; Report for the financial year for which the financial statements Foreword to the Accounts are prepared is consistent with the financial statements.105 Matters on which we are required to report by exception Statement of the Chief Executive's responsibilities as the accounting officer of 106 We have nothing tofor report where NHS underFoundation the Audit Code Clatterbridge Centre Oncology Trustfor NHS Foundation Trusts we are required to report to you if, in our opinion, the Annual Governance Statement does not reflect the disclosure requirements set out in the NHS Foundation Trust Annual Reporting Manual, is misleading or is not responsibilities consistent with in our knowledge the Trust and other information of Statement of Directors' respect of theofAccounts 107 which we are aware from our audit of the financial statements We are not required assess, nor Board have we assessed, whether all risks and controls Independent Auditor's to Report to the 108 have been addressed by the Annual Governance Statement or that risks are satisfactorily addressed by internal controls. Statement of Comprehensive Income 110 Certificate We certifyofthat we have completed the audit of the accounts of Clatterbridge Centre Statement Financial Position 111 for Oncology NHS Foundation Trust in accordance with the requirements of Chapter 5 of Part 2 of the National Health Service Act 2006 and the Audit Code for NHS Foundation Trusts issued byof Monitor. Statement Changes in Taxpayers Equity 112 Statement of Cash Flows

114

Accounting Policies

116

Trevor Rees for and on behalf of KPMG LLP, Statutory Auditor Notes to the Accounts

130

Chartered Accountants Manchester Date: 30th May 2012

104 109

111

The Clatterbridge The Clatterbridge CentreCentre for Oncology for Oncology NHS Foundation NHS Foundation Trust Trust st st Accounts Accounts for thefor year theended year ended 31 March 31 March 2012 2012 STATEMENT OF COMPREHENSIVE INCOME FOR THE YEAR ENDED Contents 31st March 2012 NOTE

2011/12 ÂŁ 000s

2010/11 ÂŁ 000s

Operating Income from continuing operations

75,296

Page 71,795

Foreword to thefrom Accounts Operating Expenses continuing operations

(70,872)

105 (65,895)

OPERATING SURPLUS / (DEFICIT) 4,424 of Statement of the Chief Executive's responsibilities as the accounting officer

Clatterbridge Centre for Oncology NHS Foundation Trust

Finance costs Finance income 5 Finance expense of - financial liabilities 6.1 Statement Directors' responsibilities in respect of the Accounts Finance expense - unwinding of discount on provisions PDC Dividends payable Net Finance costs Auditor's Report to the Board Independent Share of Profit/(Loss) of Associates/Joint Ventures accounted for using the equity method Statement of Comprehensive Income Corporation tax expense Surplus / (deficit) from continuing operations

Statement of Financial Position

Surplus / (deficit) of discontinued operations and the gain / (loss) on disposal of discontinued operations

Statement of Changes in Taxpayers Equity

SURPLUS / (DEFICIT) FOR THE YEAR

TOTAL COMPREHENSIVE INCOME / (EXPENSE) FOR THE PERIOD Prior period adjustments

TOTAL COMPREHENSIVE INCOME / (EXPENSE) FOR THE YEAR

The notes on pages 132 to 173 form part of these accounts 112

79 (225) 0 (909) (1,055)

95 (259) 107 0 (880) (1,044) 108

0 0

110 0

3,369

4,856

0 3,369

Other Comprehensive Income: Statement of Cash Flows Impairments Revaluations Asset disposals Accounting Policies Share of comprehensive income from associates and joint ventures Movements arising from classifying non current assets as Assets Held for Sale Fair Value gains/(losses) on Available-for-sale financial investments Notesgains/(losses) to the Accounts Recycling on Available-for-sale financial investments Other recognised gains and losses Actuarial gains/(losses) on defined benefit pension schemes Other additions/(reduction) Other reserve movements

104

112

5,900 106

(1,181) 0 0 0 0 0 0 0 0 0 0

111 0

112

4,856

114 0 0 0 116 0 0 0 130 0 0 0 0 0

2,188

4,856

2,188

4,856

1st April 2010 £ 000s Page

Current Assets Inventories 13 718 460 Statement of Directors' responsibilities in respect of the Accounts 5,685 Trade and other receivables 14 5,372 Other financial assets 34 0 0 Cash and cash equivalents 24 24,154 17,033 23,178 Total current Auditor's assets 30,244 Independent Report to the Board

331 107 2,670 0 24,065 27,066 108

31st March 2012 £ 000s

NOTE Non-current assets Intangible assets 7.1 0 0 5 Foreword to the Accounts 105 Property, plant and equipment 8.1 43,387 45,424 37,375 Other financial assets 34 0 0 0 Other assets 15 0 0 0 Statement of the Chief the accounting officer of37,380 106 45,424 Total non-current assetsExecutive's responsibilities as43,387

Clatterbridge Centre for Oncology NHS Foundation Trust

Current liabilities Trade and other payables Statement of Comprehensive Income Borrowings Other financial liabilities Provisions Statement of Financial Position Other liabilities Total current liabilities

16 18

(7,727) (371) 0 (533) (3,270) (11,901)

(7,240) (357) 0 (358) (3,867) (11,822)

(8,416) 110 (107) 0 0 111 (3,351) (11,874)

Statement ofless Changes Taxpayers Equity Total assets currentinliabilities

61,730

56,780

112 52,572

Non-current liabilities Borrowings of Cash Flows Statement Provisions Other liabilities Total non-current liabilities Accounting Policies

(4,440) 0 (3,129) (7,569)

(4,805) 0 0 (4,805)

(5,447) 114 (6) 0 (5,453) 116

54,161

51,975

47,119

22 17

18 22 17

Total assets employed

Notes to the Accounts

Financed by (taxpayers' equity) Public Dividend Capital Revaluation reserve Income and expenditure reserve

130 23

Total taxpayers' equity

21,245 6,036 26,880

21,245 7,385 23,345

21,245 7,819 18,055

54,161

51,975

47,119

The Financial Statements on pages 112 to 117 were approved by the Board on 30th May 2012 and signed on its behalf. Signed: Date: 30th May 2012

Chief Executive

104 113

113

114

Transfers between reserves Surplus/(deficit) for the year Impairments Transfers between reserves Revaluations - property, plant and equipment Impairments Revaluations - intangible assets Revaluations- -Financial property,assets plant and equipment Revaluations Revaluations intangible assets Asset disposals Revaluations Financial assets Share of comprehensive income from associates and joint ventures Receipt of donated assets Movements arising from classifying non current assets as Assets Held for Sale Asset disposals Fair Value gains/(losses) on Available-for-sale financial investments Share of comprehensive income from associates and investments joint ventures Recycling gains/(losses) on Available-for-sale financial Movements arising from classifying non current assets as Assets Held for Sale Other recognised gains and losses Fair Value gains/(losses) on Available-for-sale financial investments Actuarial gains/(losses) on defined benefit pension schemes Recycling gains/(losses) on Available-for-sale financial investments Public Dividend Capital received OtherDividend recognised gainsrepaid and losses Public Capital Actuarial gains/(losses) on defined Public Dividend Capital written off benefit pension schemes Public Dividend Capital received Other movements in PDC in year Public Dividend Capital repaid Reserves eliminated on dissolution Public Dividend Capital Other reserve movementswritten off Other movements in year Taxpayers' Equity in at PDC 31 March 2011 Reserves eliminated on dissolution Other reserve movements Taxpayers' Equity at 31 March 2012

Taxpayers' Equity at 1 April 2010 - as previously stated Prior period adjustment Taxpayers'Equity Equityatat11April April2010 2011- -restated as previously stated Taxpayers' Prior period adjustment Taxpayers' Equity at year 1 April 2011 - restated Surplus/(deficit) for the

STATEMENT OF CHANGES IN TAXPAYERS EQUITY

112 113

0 3,369 0 00 (1,181) 0 00 00 00 00 00 00 00 00 00 00 00 00 00 00 51,9750 0 (2) 54,161

£ 000s 46,558 £ 000s 561 51,975 47,119 0 51,975 4,856

Total

Public Revaluation dividend reserve Public Revaluation capital dividend £ 000s £reserve 000s capital 21,245 6,881 £ 000s 0 £ 000s 938 21,245 7,385 21,245 7,819 0 0 21,245 7,385 0 0 0 0 00 00 0 (165) 0 0 (1,181) 00 0 0 0 00 0 0 00 0 0 00 0 0 00 0 (2) 0 0 00 00 00 00 0 0 00 0 0 00 0 0 00 00 00 0 0 00 0 0 00 0 0 -4340 0 21,245 7,3850 0 0 0 (1) 21,245 6,036

The TheClatterbridge ClatterbridgeCentre Centrefor forOncology OncologyNHS NHSFoundation FoundationTrust Trust stst Accounts for the year ended 31 March 2012 Accounts for the year ended 31 March 2012 Donated Other Income & asset reserves expenditure Donated Other Income & reserve reserve reserves expenditure £ asset 000s £ 000s £ 000s reserve reserve 2,554 0 15,878 £ 000s £ 000s £ 000s -2,554 0 2,177 23,345 00 00 18,055 0 0 0 23,345 00 00 4,856 0 0 0 3,369 00 00 0 165 00 00 0 00 00 00 00 00 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0 02 00 00 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0 00 00 00 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0 4340 0 0 0 0 23,3450 0 0 0 0 0 (1) 0 0 26,880

115

Surplus/(deficit) Surplus/(deficit)for forthe theyear year Transfers Transfersbetween betweenreserves reserves Impairments Impairments Revaluations Revaluations- -property, property,plant plantand andequipment equipment Revaluations Revaluations- -intangible intangibleassets assets Revaluations Revaluations- -Financial Financialassets assets Asset Assetdisposals disposals Share Shareofofcomprehensive comprehensiveincome incomefrom fromassociates associatesand andjoint jointventures ventures Movements Movementsarising arisingfrom fromclassifying classifyingnon noncurrent currentassets assetsasasAssets AssetsHeld Heldfor forSale Sale Fair FairValue Valuegains/(losses) gains/(losses)on onAvailable-for-sale Available-for-salefinancial financialinvestments investments Recycling Recyclinggains/(losses) gains/(losses)on onAvailable-for-sale Available-for-salefinancial financialinvestments investments Other Otherrecognised recognisedgains gainsand andlosses losses Actuarial Actuarialgains/(losses) gains/(losses)on ondefined definedbenefit benefitpension pensionschemes schemes Public PublicDividend DividendCapital Capitalreceived received Public PublicDividend DividendCapital Capitalrepaid repaid Public PublicDividend DividendCapital Capitalwritten writtenoff off Other Othermovements movementsininPDC PDCininyear year Reserves Reserveseliminated eliminatedon ondissolution dissolution Other Otherreserve reservemovements movements Taxpayers' Taxpayers'Equity Equityatat31 31March March2011 2011

Taxpayers' Taxpayers'Equity Equityatat11April April2010 2010- -as aspreviously previouslystated stated Prior Priorperiod periodadjustment adjustment Taxpayers'Equity Equityatat11April April2010 2010- -restated restated Taxpayers'

STATEMENT STATEMENTOF OFCHANGES CHANGESIN INTAXPAYERS TAXPAYERSEQUITY EQUITY

113 113

4,856 4,856 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 51,975 51,975

££000s 000s 46,558 46,558 561 561 47,119 47,119

Total Total

00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 21,245 21,245

00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 -434 -434 7,385 7,385

Public Public Revaluation Revaluation dividend dividend reserve reserve capital capital ££000s 000s ££000s 000s 21,245 21,245 6,881 6,881 00 938 938 21,245 21,245 7,819 7,819

The TheClatterbridge ClatterbridgeCentre Centrefor forOncology OncologyNHS NHSFoundation FoundationTrust Trust Accounts Accountsfor forthe theyear yearended ended31 31ststMarch March2012 2012

00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00

4,856 4,856 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 434 434 23,345 23,345

Donated Donated Other Other Income Income&& asset asset reserves reserves expenditure expenditure reserve reserve reserve reserve ££000s 000s ££000s 000s ££000s 000s 2,554 2,554 00 15,878 15,878 -2,554 -2,554 00 2,177 2,177 00 00 18,055 18,055

TheThe Clatterbridge Centre for Oncology NHSNHS Foundation Trust Clatterbridge Centre for Oncology Foundation Trust st st Accounts for the yearyear ended 31 31 March 20122012 Accounts for the ended March STATEMENT OF CASH FLOWS FOR THE YEAR ENDED 31st March 2012 Contents NOTE

Cash flows from operating activities operating surplus/(deficit) from continuing operations operating surplus/(deficit) from discontinued operations

2011/12 ÂŁ 000's 4,424 0

Foreword to the Accounts

Operating surplus/(deficit)

4,424

Statement theexpense Chief Executive's responsibilities as the accounting Non-cash incomeofand Clatterbridge Centre Depreciation and amortisationfor Oncology NHS Foundation Trust Impairments Reversals of impairments Interest accrued and not paid Statement of Directors' responsibilities in respect of the Accounts Dividends accrued and not paid or received Amortisation of government grants Amortisation of PFI credit Independent Auditor's Report to the Board (Increase)/Decrease in Trade and Other Receivables (Increase)/Decrease in Other Assets (Increase)/Decrease in Inventories Statement of Comprehensive Income Increase/(Decrease) in Trade and Other Payables Increase/(Decrease) in Other Liabilities Increase/(Decrease) in Provisions Statement of Financial Position Tax (paid) / received Movements in operating cash flow of discontinued operations Movements in operating cash flow in respect of Transforming Community Services transaction in Taxpayers Equity Statement of Changes Other movements in operating cash flows Net cash generated from/(used in) operations

officer of

Cash flows from financing activities Public dividend capital received Public dividend capital repaid Loans received from the Department of Health Other loans received Loans repaid to the Department of Health Other loans repaid Capital element of finance lease rental payments Other capital receipts

114 104

116

Page

5,900 0

105

5,900

106

3,325 50 0 9 101 0 0 212 0 (258) 1,146 2,532 175 0 0

2,963 2,690 0 0 107 0 0 0 108 (3,015) 0 (129) 110 (1,176) 119 352 1110 0

0 10 11,726

1120

Statement of Cash Flows

Cash flow from investing activities Interest received Purchase of financial assets Policies SalesAccounting of financial assets Purchase of intangible assets Sales of intangible assets Notes the Accounts Purchase of to Property, Plant and Equipment Sales of Property, Plant and Equipment Cash flows attributable to investing activities of discontinued operations Cash from acquisitions of business units and subsidiaries Cash from (disposals) of business units and subsidiaries Net cash generated from/(used in) investing activities

2010/11 ÂŁ 000's

(28) 7,676

114 79 0 0 0 0 (3,203) 0 0 0 0 (3,124)

95 0 1160 0 0 130 (13,300) 0 0 0 0 (13,205)

0 0 0 0 (250) 0 (119) 123

0 0 0 0 (250) 0 (114) 0

The The Clatterbridge Clatterbridge Centre Centre for for Oncology Oncology NHS NHS Foundation Foundation Trust Trust st st Accounts Accounts for for the the year year ended ended 31 31 March March 2012 2012 STATEMENT OF CASH FLOWS FOR THE YEAR ENDED 31stContents March 2012 Capital element of Private Finance Initiative Obligations 0 0 Interest paid (238) (209) Interest element of finance lease (16) Page (21) Interest element of Private Finance Initiative obligations 0 0 PDC Dividend paid (880) (1,010) Foreword to the Accounts 105 Cash flows attributable to financing activities of discontinued operations 0 0 Cash flows from (used in) other financing activities 0 0 Net cash generated from/(used in) financing activities as the accounting officer (1,481) Statement of the Chief Executive's responsibilities of 106(1,503)

Clatterbridge Centre for Oncology NHS Foundation Trust Increase/(decrease) in cash and cash equivalents

Cash and cash equivalents at 1 April 2011in respect of the Accounts Statement of Directors' responsibilities Cash and cash equivalents at 31 March 2012

7,121

17,033 10724,065 24,154

Independent Auditor's Report to the Board

(7,032)

17,033

108

Statement of Comprehensive Income

110

Statement of Financial Position

111

Statement of Changes in Taxpayers Equity

112

Statement of Cash Flows

114

Accounting Policies

116

Notes to the Accounts

130

115 104

117

Accounting policies and other information Contents Monitor has directed that the financial statements of NHS foundation trusts shall meet the accounting requirements of the Foundation Trust Annual Reporting Manual (FT ARM) which shall be agreed with HM Treasury. Consequently, the following financial statements have Page been prepared in accordance with the FT ARM 2011/12 issued by Monitor. The accounting policies contained in that manual follow International Financial Reporting Standards (IFRS) to the Accounts and Foreword HM Treasury’s FReM to the extent that they are meaningful and appropriate 105 to NHS foundation trusts. The accounting policies have been applied consistently in dealing with items considered material in relation to the accounts. Statement of the Chief Executive's responsibilities as the accounting officer of 106 Clatterbridge Centre for Oncology NHS Foundation Trust Accounting convention These accounts have been prepared under the historical cost convention modified to account Statement of Directors' responsibilities in respectintangible of the Accounts for the revaluation of property, plant and equipment, assets, inventories and107 certain financial assets and financial liabilities. Independent Auditor's Report to thekey Board Critical accounting judgements and sources of estimation uncertainty

108

In the application of the Trust’s accounting policies, management is required to make Statement of Comprehensive Incomeabout the carrying amounts of assets and liabilities 110 judgements, estimates and assumptions that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and other factors that are considered to be relevant. Statement of Financial Position 111 Actual results may differ from those estimates and the estimates and underlying assumptions are continually reviewed. Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period or in the period of revision of Changes in Taxpayers Equity 112 and Statement future periods if the revision affects both current and future periods. Key sources of estimation uncertainty Statement of Cash Flows 114 The following are the key assumptions concerning the future, and other key sources of estimation uncertainty at the end of the reporting period, that have a significant risk of Accounting Policies 116next causing a material adjustment to the carrying amounts of assets and liabilities within the financial year. Notes to the Accounts Annual leave accrual

130

The annual leave accrual is calculated using information provided by managers regarding outstanding annual leave as at 31st March 2012. Provisions Provisions held within the balance sheet contain estimates for future contractual liabilities, employee claims against the Trust (following advice from the Trust’s lawyers) and re branding costs following the Trust’s name change. Further information is shown at note 22.

116

104

118

The Clatterbridge Centre Oncology NHS Foundation Trust The Clatterbridge Centre forfor Oncology NHS Foundation Trust st st Accounts the year ended March 2012 Accounts forfor the year ended 3131March 2012 Clinical negligence costs

Contents The Trustâ&#x20AC;&#x2122;s accounting policy for provisions is described in section 1.10 of the accounting policies and in note 22 of the accounts. Assessment of leases

Page

Leases are assessed under IFRS as being operating or finance leases, which determines Foreword to the Accounts 105 their accounting treatment. The criteria for assessment are to a certain extent subjective, but a consistent approach has been taken through use of a standard template which sets out the relevant criteria. Further information is in section as 1.9the of the accounting policies. Statement of the Chief Executive's responsibilities accounting officer of 106 Clatterbridge Centre for Oncology NHS Foundation Trust Impairment review An annual review is carried out using professional Statement of impairment Directors' responsibilities in respect of athe Accounts valuer to determine 107 non current asset values. Further information on impairments is in section 1.3 of the accounting policies. Independent Auditor's Report to the Board 108 1.1 Income Income inofrespect of services provided is recognised when, and to the extent that, Statement Comprehensive Income 110 performance occurs and is measured at the fair value of the consideration receivable. The main source of income for the trust is contracts with commissioners in respect of healthcare services.of Financial Position Statement 111 Where income is received for a specific activity which is to be delivered in the following financial of year, that income is deferred. Statement Changes in Taxpayers Equity 112 Income from the sale of non-current assets is recognised only when all material conditions of sale haveofbeen and is measured as the sums due under the sale contract. 114 Statement Cashmet, Flows Accounting Policies on employee benefits 1.2 Expenditure

116

Short-term employee benefits Notes to the Accounts 130 Salaries, wages and employment-related payments are recognised in the period in which the service is received from employees. The cost of annual leave entitlement earned but not taken by employees at the end of the period is recognised in the financial statements to the extent that employees are permitted to carry-forward leave into the following period. Pension costs NHS Pension Scheme Past and present employees are covered by the provisions of the NHS Pension Scheme. The scheme is an unfunded, defined benefit scheme that covers NHS employers, general 117 104

119

The Clatterbridge Centre for Oncology NHS Foundation Trust The Accounts Clatterbridge Centre Oncology NHS Foundation Trust 2012 for the yearfor ended 31st March st Accounts for the year ended 31 March 2012 practices and other bodies, allowed under the direction of Secretary of State, in England and Contents Wales. It is not possible for Clatterbridge Centre for Oncology NHS Foundation Trust to identify its share of the underlying scheme liabilities. Therefore, the scheme is accounted for as a defined contribution scheme. Page Employers pension cost contributions are charged to operating expenses as and when they become due. Foreword to the Accounts 105 Additional pension liabilities arising from early retirements are not funded by the scheme except where the retirement is due to ill-health. The full amount of the liability for the Statement Chief to Executive's responsibilities thetime accounting of itself 106 additional costsofisthe charged the operating expenses atasthe the trustofficer commits to Clatterbridge Centre for NHS Foundation Trust the retirement, regardless of Oncology the method of payment. Expenditure on other goods and services Statement of Directors' responsibilities in respect of the Accounts 107 Expenditure on goods and services is recognised when, and to the extent that they have been received, and is measured at the fair value of those goods and services. Expenditure is Independent Auditor's Report to the Board 108 recognised in operating expenses except where it results in the creation of a non-current asset such as property, plant and equipment. Statement of Comprehensive Income 1.3 Property, plant and equipment

110

Statement of Financial Position Recognition

111

Property, plant and equipment is capitalised where: Statement of Changes in Taxpayers Equity 112 x it is held for use in delivering services or for administrative purposes; x it is probably that future economic benefits will flow to, or service potential be provided Statement of Cash Flows 114 to, the trust; x it is expected to be used for more than one financial year; and x The cost of the item can be measured reliably and is a minimum of ÂŁ5k for a single Accounting 116 item or a Policies group of interdependent items. Where a large asset, for example a building, includes a number of components with Notes todifferent the Accounts significantly asset lives e.g. plant and equipment, then these components are130 treated as separate assets and depreciated over their own useful economic lives. Measurement Valuation All property, plant and equipment assets are measured initially at cost, representing the costs directly attributable to acquiring or constructing the asset and bringing it to the location and condition necessary for it to be capable of operating in the manner intended by management. 118

104

120

The TheClatterbridge ClatterbridgeCentre Centrefor forOncology OncologyNHS NHSFoundation FoundationTrust Trust st st Accounts Accountsfor forthe theyear yearended ended3131 March March2012 2012 Any costs arising from financing the construction of the asset are not to be capitalised but are Contents charged to the income and expenditure account in the year which they relate. All assets are measured subsequently at fair value. Land and buildings are revalued every five years. A three year interim valuation is also Page carried out. Valuations are carried out by professionally qualified, external valuers in accordance with the Royal Institute of Chartered Surveyors (RICS) Appraisal and Valuation Foreword thevaluations Accounts are carried on the Modern Equivalent Asset basis which105 Manual. to The assumes that the buildings would be replaced by structures utilising current building techniques and materials. Land is valued on an existing use basis primarily determined by market valuation. Statement of the Chief Executive's responsibilities as the accounting officer of 106 Clatterbridge Centre for Oncology NHS Foundation Trust Assets in the course of construction are valued at cost and are valued by professional valuers as part of the five or three-yearly valuation or when they are brought into use. Statement Directors'(including responsibilities in respectused of the Accounts 107 Plant andof equipment IT equipment) in the Trust tends to be highly specialised in the nature with no reliable means of ascertaining a market value. In accordance with IAS 16, these assets are carried out at Depreciated Replacement Cost (DRC) are not subject to Independent 108 revaluation.Auditor's Report to the Board Subsequent expenditure Statement of Comprehensive Income 110 Subsequent expenditure relating to an item of property, plant and equipment is recognised as an increase in the carrying amount of the asset when it is probable that additional future Statement Financial Positionpotential deriving from the cost incurred to replace 111 economicofbenefits or service a component of such item will flow to the enterprise and the cost of the item can be determined reliably. Statement of Changesof in an Taxpayers Equity the cost of the replacement is capitalised 112 if it Where a component asset is replaced, meets the criteria for recognition above. The carrying amount of the part replaced is derecognised. Other expenditure that does not generate additional future economic benefits Statement Cash Flows 114 or serviceofpotential, such as repairs and maintenance is charged to the Statement of Comprehensive Income in the period in which it is incurred. Accounting Policies Depreciation

116

Items of Property, Plant and Equipment are depreciated over their remaining useful economic Notes the Accounts 130 lives to in a manner consistent with the consumption of economic or service delivery benefits. Freehold land is considered to have an infinite life and is not depreciated. Property, plant and equipment which has been reclassified as â&#x20AC;&#x2DC;Held for Saleâ&#x20AC;&#x2122; ceases to be depreciated upon the reclassification. Assets in the course of construction and residual interests in off-Statement of Financial Position PFI contract assets are not depreciated until the asset is brought into use of reverts to the trust, respectively. Revaluation gains and losses Revaluation gains are recognised in the revaluation reserve, except where, and to the extent that, they reverse a revaluation decrease that has previously been recognised in operation expenses, in which case they are recognised in operating income. 119 104

121

Clatterbridge Centre for Oncology Foundation Trust The The Clatterbridge Centre for Oncology NHSNHS Foundation Trust st st Accounts for year the year ended March Accounts for the ended 31 31 March 20122012 Revaluation losses are charged to the revaluation reserve to the extent that there is an available balance for the asset concerned, andContents thereafter are charged to operating expenses. Gains and losses recognised in the revaluation reserve are reported in the Statement of Comprehensive Income as an item of ‘other comprehensive income’. Page Impairments Foreword to the Accounts 105 In accordance with the FT ARM, impairments that are due to a loss of economic benefits or service potential in the asset are charged to operating expenses. A compensating transfer if Statement of the Chief reserve Executive's responsibilities as the accounting of 106 made from the revaluation to the income and expenditure reserveofficer of an amount Clatterbridge Centre for Oncology NHS Foundation Trust equal to the lower of (i) the impairment charged to operating expenses; and (ii) the balance in the revaluation reserve attributable to that asset before the impairment. Statement arising of Directors' in respect Accounts An impairment from aresponsibilities loss of economic benefitof orthe service potential is reversed 107 when, and to the extent that, the circumstances that gave rise to the loss is reversed. Reversals are recognised in operating income to the extent that the asset is restored to the carrying amount Independent Report tohad the never Boardbeen recognised. Any remaining reversal 108is it would have hadAuditor's if the impairment recognised in the revaluation reserve to the income and expenditure reserve, an amount is transferred back to the revaluation reserve when the impairment reversal is recognised. Statement of Comprehensive Income 110 Other impairments are treated as revaluation losses. Reversals of ‘other impairments’ are treated as revaluation gains. Statement of Financial Position 111 De-recognition Statement Changes Taxpayers Equity Assets intendedoffor disposalinare reclassified as ‘Held for Sale’ once all of the following112 criteria are met: Flowsfor immediate sale in its present condition subject only to 114 xStatement the assetofisCash available terms which are usual and customary for such sales; Policies xAccounting the sale must be highly probable i.e.:

116

o management are committed to a plan to sell the asset; Notes to the Accounts 130 o an active programme has begun to find a buyer and complete the sale; o the asset is being actively marketed at a reasonable price; o the same is expected to be completed within 12 months of the data of classification as ‘Held for Sale’; and o the actions needed to complete the plan indicate it is unlikely that the plan will be dropped or significant changes made to it.

120 104

122

The TheClatterbridge ClatterbridgeCentre Centrefor forOncology OncologyNHS NHSFoundation FoundationTrust Trust st st Accounts Accountsfor forthe theyear yearended ended3131 March March2012 2012 Following reclassification, the assets are measured at the lower of their existing carrying amount and their ‘fair value less costs toContents sell’. Depreciation ceases to be charged. Assets are de-recognised when all material sale contract conditions have been met. Property, plant and equipment which is to be scrapped or demolished does not quality for Page recognition as ‘Held for Sale’ and instead is retained as an operational asset and the asset’s economic life is adjusted. The asset is de-recognised when scrapping or demolition occurs. Foreword to the Accounts 105 Donated, government grant and other grant funded assets Statement of the Chief Executive's responsibilities as the accounting of 106 Donated and grant funded property, plant and equipment assets areofficer capitalised at their fair Clatterbridge Centre for Oncology NHS Foundation Trust value on receipt. The donation/grant is credited to income at the same time, unless the donor has imposed a condition that the future economic benefits embodied in the grant are to be consumed in a manner specified by the donor, in which case, the donation/grant is Statement of Directors' responsibilities respecttooffuture the Accounts 107 that the deferred within liabilities and is carriedinforward financial years to the extent condition has not yet been met. Independent Report to the Board 108manner as The donatedAuditor's and grant funded assets are subsequently accounted for in the same other items or property, plant and equipment. Statement of Comprehensive Income Private Finance Initiative (PFI) transactions

110

PFI transactions which meet the IFRIC 12 definition of a service concession, as interpreted in Statement of Financial HM Treasury’s FReM,Position are accounted for as ‘on-Statement of Financial Position’ 111 by the Trust. The underlying assets are recognised as property, plant and equipment at their fair value. An equivalent financial liability is recognised in accordance with IAS 17. Statement of Changes in Taxpayers Equity 112 The annual contract payments are apportioned between the repayment of the liability, a finance cost and the charges for services. The finance charge is calculated using the Statement of Cashrate Flows 114 effective interest for the scheme. The service charge is recognised in operating expenses and the finance cost is charged to Accounting Policies 116 Finance Costs in the Statement of Comprehensive Income. Notes the Accounts 1.4 toIntangible assets

130

Recognition Intangible assets are non-monetary assets without physical substance which are capable of being sold separately from the rest of the trust’s business or which arise from contractual or other legal rights. They are recognised only where it is probable that future economic benefits will flow to, or service potential be provided to, the trust and where the cost of the asset can be measured reliably, and is at least £5000. Where internally generated assets are held for service potential, this involves a direct contribution to the delivery of services to the public.

121 104

123

The The Clatterbridge Centre for Oncology NHSNHS Foundation Trust Clatterbridge Centre for Oncology Foundation Trust st st Accounts for the year ended 31 March 2012 Accounts for the year ended 31 March 2012 Internally generated intangible assets

Contents Internally generated goodwill, brands, mastheads, publishing titles, customer lists and similar items are not capitalised as intangible assets. Expenditure on research is not capitalised.

Page

Expenditure Forewordontodevelopment the Accountsis capitalised only where all of the following can be demonstrated:

105

of the Chief Executive's as the accounting xStatement the project is technically feasible responsibilities to the point of completion and willofficer result of in an 106 Clatterbridge Centre Oncology intangible asset forfor sale or use; NHS Foundation Trust x the trust intends to complete the asset and sell or use it; Statement of Directors' responsibilities in respect of the Accounts x the trust has the ability to sell or use the asset;

107

Auditor'sasset Report the Board 108 xIndependent how the intangible willtogenerate probable future economic or service delivery benefits e.g. the presence of a market for it or its output, or where it is to be used for internal use, the usefulness of the asset; Statement of Comprehensive Income 110 x adequate financial, technical and other resources are available to the trust to complete the development and sell or use the asset; and Statement of Financial Position 111 x the trust can measure reliably the expenses attributable to the asset during development. Statement of Changes in Taxpayers Equity 112 Software Statement of Cash Flows 114 Software which is integral to the operation of hardware e.g. an operating system is capitalised as part of the relevant item of property, plant and equipment. Software which is Accounting Policies not integral to the operation of hardware e.g. application software, is capitalised as an116 intangible asset. Notes to the Accounts Measurement

130

Intangible assets are recognised initially at cost, comprising all directly attributable costs needed to created, produce and prepare the asset to the point that it is capable of operating in the manner intended by management. Subsequently intangible assets are measured at fair value. Revaluations gains and losses and impairments are treated in the same manner as for Property, Plant and Equipment. Increases in asset values arising from revaluations are recognised in the revaluation reserve, except where, and to the extent that, they reverse an impairment previously recognised in operating expenses, in which case they are recognised in operating income. Decreases in asset values and impairments are changed to the revaluation reserve to the extent there is 122 104

124

TheClatterbridge ClatterbridgeCentre Centrefor forOncology OncologyNHS NHSFoundation FoundationTrust Trust The st st Accounts for the year ended 31 March 2012 Accounts for the year ended 31 March 2012 an available balance for the asset concerned, and thereafter are charged to operating expenses. Contents Gains and losses recognised in the revaluation reserve are reported in the Statement of Comprehensive Income as an item of “other comprehensive income”. Intangible assets held for sale are measured at the lower of their carrying amount of ‘fair Page value less costs to sell’. Foreword to the Accounts 105 Amortisation Intangibleofassets are amortised their expected economicofficer lives in Statement the Chief Executive'sover responsibilities as useful the accounting of a manner 106 consistent with the consumption economic or service Clatterbridge Centre for Oncology of NHS Foundation Trust delivery benefits. 1.5 Revenue Government and other grantsof the Accounts Statement of Directors' responsibilities in respect

107

Government grants are grants from Government bodies other than income from primary care trusts or NHS trusts for the provision of services. Where the grant is used to fund revenue Independent Auditor's Report to the Board 108 expenditure it is taken to the Statement of Comprehensive Income to match that expenditure. Statement of Comprehensive Income 1.6 Inventories

110

Inventories valuedPosition at the lower cost and net realisable value. The cost of inventories is Statement of are Financial 111 measured using the First In, First Out (FIFO) method, or the weighted average cost method. Statement of Changes in Taxpayers Equity 1.7 Financial instruments and financial liabilities

112

Recognition Statement of Cash Flows

114

Financial assets and financial liabilities which arise from contracts for the purchase or sale of non-financial items (such as goods or services), which are entered into in accordance Accounting Policies 116 with the Trust’s normal purchase, sale or usage requirements, are recognised when, and to the extent which, performance occurs i.e. when receipt or delivery of the goods or services is made. Notes to the Accounts 130 Financial assets or financial liabilities in respect of assets acquired or disposed of through finance leases are recognised and measured in accordance with the accounting policy for leases described below. All other financial assets and financial liabilities are recognised when the Trust becomes a party to the contractual provisions of the instrument.

123 104

125

The Clatterbridge Centre for Oncology NHS Foundation Trust for the yearfor ended 31st March 2012 The Accounts Clatterbridge Centre Oncology NHS Foundation Trust st Accounts for the year ended 31 March 2012 De-recognition

Contents All financial assets are de-recognised when the rights to receive cash flows from the assets have expired or the Trust has transferred substantially all of the risks and rewards of ownership. Page Financial liabilities are de-recognised when the obligation is discharged, cancelled or expires. Foreword to the Accounts 105 Classification and measurement Financial assetsofare as: Statement thecategorised Chief Executive's responsibilities as the accounting officer of Clatterbridge Centre for Oncology NHS Foundation Trust x ‘Fair value through Income and Expenditure’; x Loans and receivables; or of Directors' responsibilities xStatement ‘Available-for-sale financial assets’. in respect of the Accounts

106

107

Financial liabilities are classified as: Independent Auditor's Report to the Board 108 x ‘Fair value through Income and Expenditure’; or x ‘Other Financial liabilities’. Statement of Comprehensive Income 110 Financial assets and financial liabilities at ‘Fair Value through Income and Expenditure’ Statement of Financial Position 111 Financial assets and financial liabilities at ‘fair value through income and expenditure’ are financial assets or financial liabilities held for trading. A financial asset or financial liability is Statement Changesif in Taxpayers Equity for the purpose of selling in the short-term. 112 classified in thisofcategory acquired principally Derivatives are also categorised as held for trading unless they are designated as hedges. Derivatives which are embedded in other contracts but which are not ‘closely-related’ to Statement Cash Flows those contractsofare separated-out from those contracts and measured in this category.114 Assets and liabilities in this category are classified as current assets and current liabilities. Accounting Policiesand financial liabilities are recognised initially at fair value, with 116 These financial assets transaction costs expenses in the income and expenditure account. Subsequent movements in the fair value are recognised as gains or losses in the Statement of Comprehensive Notes to the Accounts 130 Income. Loans and receivables Loans and receivables are non-derivative financial assets with fixed or determinable payments with are not quoted in an active market. They are included in current assets. The Trust’s loans and receivables comprise: current investments, cash and cash equivalents, NHS debtors, accrued income and ‘other debtors’.

124

104

126

TheClatterbridge ClatterbridgeCentre Centrefor forOncology OncologyNHS NHSFoundation FoundationTrust Trust The st st Accountsfor forthe theyear yearended ended3131 March March2012 2012 Accounts Loans and receivables are recognised initially at fair value, net of transactions costs, and are measured subsequently at amortised costs, using the effective interest method. The Contents effective interest rate is the rate that discounts exactly estimated future cash receipts through the expected life of the financial asset or, when appropriate, a shorter period, to the net carrying amount of the financial asset. Page Interest on loans and receivables is calculated using the effective interest method and credited to the Statement Foreword Accounts of Comprehensive Income. 105 Available-for-sale financial assets Statement of the Chief Executive's responsibilities as the accounting officer of 106 Available-for-sale assetsNHS are non-derivative financial assets which are either Clatterbridge Centrefinancial for Oncology Foundation Trust designated in this category or not classified in any of the other categories. They are included in long-term assets unless the trust intends to dispose of them within 12 months of the StatementofofDirectors' Financialresponsibilities Position date. in respect of the Accounts Statement 107 Available-for-sale financial assets are recognised initially at fair value, including transaction costs, and measured subsequently at fair value, with gains or losses recognised108 in reserves Independent Auditor's Report to the Board and reported in the Statement of Comprehensive Income as an item of ‘other comprehensive income’. When items classified as ‘available-for-sale’ are sold or impaired, the accumulated fair value of adjustments recognised are transferred from reserves and recognised 110 in ‘Finance Statement Comprehensive Income Costs’ in the Statement of Comprehensive Income. Other financial liabilities Statement of Financial Position

111

All other financial liabilities are recognised initially at fair value, net of transaction costs incurred, and measured subsequently at amortised cost using the effective interest Statement of Changes in Taxpayers Equity 112method. The effective interest rate is the rate that discounts exactly estimated future cash payments through the expected life of the financial liability or, when appropriate, a shorter period, to the net carrying amount of the financial liability. Statement of Cash Flows 114 They are included in current liabilities except for amounts payable more than 12 months after the Statement of Financial Position date, which are classified as long-term liabilities. Accounting Policies 116 Interest on financial liabilities carried at amortised cost is calculated using the effective interest method and charged to Finance Costs. Interest on financial liabilities taken Notes to the Accounts 130 out to finance property, plant and equipment or intangible assets is not capitalised as part of the cost of those assets. Determination of fair value For financial assets and financial liabilities carried at fair value, the carrying amounts are the full value of cash in the balance sheet, and are determined from quoted market prices/independent appraisal/discounted cash flow analysis.

125 104

127

Impairment of financial assets

Contents At the Statement of Financial Position date, the trust assessed whether any financial assets, other than those held at ‘fair value through income and expenditure’ are impaired. Financial assets are impaired and impairment losses are recognised if, and only if, there is objective evidence of impairment as a result of one or more events which occurred after the initial Page recognition of the asset and which has an impact on the estimated future cash flows of the asset. Foreword to the Accounts 105 For financial assets carried at amortised cost, the amount of the impairment loss is measured as the difference asset’s carrying amount and theaccounting present value of the Statement of between the Chiefthe Executive's responsibilities as the officer of revised 106 future cash flows discounted at the asset’s effective Clatterbridge Centre for Oncology NHSoriginal Foundation Trustinterest rate. The loss is recognised in the Statement of Comprehensive Income and the carrying amount of the asset is reduced through the use of an allowance account/bad debt provision. Statement of Directors' responsibilities in respect of the Accounts 107 Where an allowance account/bad debt provision is used, the accounting policies should include the criteria for determining when an asset’s carrying value is written down directly and whenIndependent the allowance account is used, andBoard the criteria for writing off amounts charged to108 the Auditor's Report to the allowance account against the carrying amount of the financial asset. Trade Receivables Statement of Comprehensive Income

110

A provision for impairment against a trade receivable is established when the Trust considers it willStatement not be able collect all amounts due according to the original terms of the contract. of to Financial Position 111 The Trust will take the following factors into consideration when determining a trade receivable to be impaired: of Changes in Taxpayers Equity 112 xStatement Significant financial difficulties of the debtor; x Probability that the debtor will enter bankruptcy or financial reorganisation; and x Default or delinquency in payment (more than 60 days overdue) Statement of Cash Flows 114 The carrying amount of the asset is reduced through the use of an allowance account for the trade receivables (Bad Debt Provision), and the amount of the loss is recognised in the Accounting Policies Statement of Comprehensive Income. If the trade receivables become uncollectible, it116 is written off against the Bad Debt Provision. Any subsequent recoveries of amounts previously written off are credited to the Statement of Comprehensive Income. Notes to the Accounts 130 1.9

Leases

Finance leases Where substantial risks and rewards of ownership of a leased asset are borne by the NHS foundation trust, the asset is recorded as property, plant and equipment and a corresponding liability is recorded. The value at which both are recognised is the lower of the fair value of the asset or the present value of the minimum lease payments, discounted using the interest rate implicit in the lease. The implicit interest rate is that which produces a constant periodic rate of interest on the outstanding liability. 126 104

128

TheClatterbridge ClatterbridgeCentre Centrefor forOncology OncologyNHS NHSFoundation FoundationTrust Trust The st st Accountsfor forthe theyear yearended ended3131 March March2012 2012 Accounts The asset and liability are recognised at the commencement of the lease. Thereafter the asset is account for an item of property plant and equipment. Contents The annual rental is split between the repayment of the liability and a finance cost so as to achieve a constant rate of finance over the life of the lease. The annual finance cost is charged to Finance Costs in the Statement of Comprehensive Income. The lease liability, is Page de-recognised when the liability is discharged, cancelled or expires. Foreword to the Accounts 105 Operating leases Other leases areChief regarded as operating leases and are charged Statement of the Executive's responsibilities as the the rentals accounting officer ofto operating 106 expenses onCentre a straight-line basisNHS over Foundation the term of the lease. Operating lease incentives Clatterbridge for Oncology Trust received are added to the lease rentals and charged to operating expenses over the life of the lease. Statement of Directors' responsibilities in respect of the Accounts 107 Leases of land and buildings Where a lease is for land andtobuildings, Independent Auditor's Report the Boardthe land component is separated from the 108building component and the classification for each is assessed separately. Leased land is treated as an operating lease. Statement of Comprehensive Income 110 1.10 Provisions Statement of Financial Position 111 The NHS Foundation Trust recognises a provision where is has a present legal or contractive obligation of uncertain timing or amount; for which is it probable that there will be a future outflow ofofcash or other resources; Equity and a reliable estimate can be made of the amount. The Statement Changes in Taxpayers 112 amount recognised in the Statement of Financial Position is the best estimate of the resources required to settle the obligation. Where the effect of the time value of money is significant, estimated Statement ofthe Cash Flows risk-adjusted cash flows are discounted using HM Treasury’s 114 discount rate of 2.2% in real terms, except for early retirement provisions and injury benefit provisions which both use the HM Treasury’s pension discount rate in real terms. Accounting Policies 116 Clinical negligence costs The NHS Notes to theLitigation AccountsAuthority (NHSLA) operates a risk pooling scheme under which 130the NHS Foundation Trust pays an annual contribution to the NHSLA, which, in return, settles all clinical negligence claims. Although the NHSLA is administratively responsible for all clinical negligence cases, the legal liability remains with the NHS foundation trust. The total value of clinical negligence provisions carried by the NHSLA on behalf of the NHS foundation trust is disclosed at note 22 but is not recognised in the NHS Foundation Trust’s accounts. Non-clinical risk pooling The NHS foundation trust participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both are risk pooling schemes under which the trust pays an annual contribution to the NHS Litigation Authority and in return receives assistance with the costs of 127 104

129

The The Clatterbridge Centre for Oncology NHSNHS Foundation Trust Clatterbridge Centre for Oncology Foundation Trust st st Accounts for the ended 31 31 March 20122012 Accounts for year the year ended March claims arising. The annual membership contribution, and any ‘excesses’ payable in respect of particular claims are charged to operating expenses Contentswhen the liability arises. 1.11

Contingencies

Page Contingent assets (that is, assets arising from past events whose existence will only be confirmed by one or more future events not wholly within the entity’s control) are not 105 Foreword to the Accounts recognised as assets, but are disclosed in note 26 where an inflow of economic benefits is probable. Statement of the Chief Executive's responsibilities as the accounting officer of 106 Contingent liabilities are not but Foundation are disclosed in note 26, unless the probability of Clatterbridge Centre for recognised, Oncology NHS Trust a transfer of economic benefits is remote. Contingent liabilities are defined as: Directors'arising responsibilities respect of theexistence Accountswill be confirmed107 xStatement possible of obligations from pastinevents whose only by the occurrence of one or more uncertain future events not wholly within the entity’s control; or Independent Auditor's Report to the Board 108 x present obligations arising from past events but for which it is not probable that a transfer of economic benefits will arise or for which the amount of the obligation cannot Statement of Comprehensive 110 be measured with sufficientIncome reliability. of Financial Position 1.12Statement Public dividend capital

111

Public dividend capital (PDC) is a type of public sector equity finance based on the excess of Statement of Changes Taxpayers Equity of the predecessor NHS trust. HM 112 assets over liabilities at the in time of establishment Treasury has determined that PDC is not a financial instrument within the meaning of IAS 32. Statement of Cash A charge, reflecting the Flows cost of capital utilised by the NHS foundation trust, is payable 114 as public dividend capital dividend. The charge is calculated at the rate set by HM Treasury (currently 3.5%) on the average relevant net assets of the NHS Foundation Trust during the Accounting Policies net assets are calculated as the value of all assets less the value 116 of financial year. Relevant all liabilities, except for (i) donated assets (including lottery funded assets), (ii) net cash balances held with the Government Banking Services (GBS), excluding cash balances held Notes to the Accounts 130 in GBS accounts that relate to a short-term working capital facility, and (iii) any PDC dividend balance receivable or payable. In accordance with the requirements laid down by the Department of Health (as the issuer of PCD), the dividend for the year is calculated on the actual average relevant net assets as set out in the ‘pre-audit’ version of the annual accounts. The dividend thus calculated is not revised should any adjustment to net assets occur as a result the audit of the annual accounts. 1.13

Value Added Tax

Most of the activities of the NHS Foundation Trust are outside the scope of VAT and, in general, output tax does not apply and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or included in the 128 104

130

TheClatterbridge ClatterbridgeCentre Centrefor forOncology OncologyNHS NHSFoundation FoundationTrust Trust The st st Accountsfor forthe theyear yearended ended3131 March March2012 2012 Accounts capitalised purchase cost of fixed assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net Contents of VAT. 1.14

Corporation Tax

Page The NHS Foundation Trust is a Service Body within the meaning of s519A ICTA 1988 and accordingly is exempt from taxation in respect of income and capital gains tax within Foreword to the Accounts 105 categories covered by this. There is a power by the treasury to disapply the exemption in relation to specified activities of a Foundation Trust (s519A (3) to (8) ICTA 1988). Accordingly, theChief TrustExecutive's is potentially within the scope of corporation in respect of activities, Statement of the responsibilities as the accounting tax officer of 106 which are not related or ancillary to,Foundation the provision of healthcare, and where the profits Clatterbridge Centre forto, Oncology NHS Trust therefore exceed £50,000 per annum. If the NHS Foundation Trust has determined that it is has no corporation tax liability then the basis for that decision should be disclosed. Statement of Directors' responsibilities in respect of the Accounts 107 1.15 Foreign exchange Independent Auditor's Report to the Board The functional and presentational currencies of the trust are sterling.

108

A transaction which is denominated Statement of Comprehensive Income in a foreign currency is translated into the functional 110 currency at the spot exchange rate on the date of the transaction. Where the has assets or liabilities denominated in a foreign currency at the111 Statement of Statement oftrust Financial Position financial Position date: Statement Changesitems in Taxpayers Equity 112through x ofmonetary (other than financial instruments measured at ‘fair value income and expenditure’) are translated at the spot exchange rate on 31 March; Statement Cash Flows assets and liabilities measured at historical cost are translated 114 x ofnon-monetary using the spot exchange rate at the date of the transaction; and Accounting 116using the x Policies non-monetary assets and liabilities measured at fair value are translated spot exchange rate at the date the fair value was determined. Notes to the gains Accounts 130 or on Exchange or losses on monetary items (arising on settlement of the transaction re-translation at the Statement of Financial Position date) are recognised in income or expense in the period in which they arise. Exchange gains or losses on non-monetary assets and liabilities are recognised in the same manner as other gains and losses on these items. 1.16

Third party assets

Assets belonging to third parties (such as money held on behalf of patients) are not recognised in the accounts since the NHS Foundation Trust has no beneficial interest in 129 104

131

The The Clatterbridge Centre for Oncology NHSNHS Foundation Trust Clatterbridge Centre for Oncology Foundation Trust st st Accounts for the ended 31 31 March 20122012 Accounts for year the year ended March them. However, they are disclosed in separateContents note to the accounts in accordance with the requirements of HM Treasuryâ&#x20AC;&#x2122;s FReM. 1.17

Losses and special payments

Page

Losses and special when it Foreword to thepayments Accounts are items that Parliament would not have contemplated 105 agreed funds for the health service or passed legislation. By their nature they are times that ideally should not arise. They are therefore subject to special control procedures compared with Statement the generality of payments. They are divided into different categories, whichofgovern of the Chief Executive's responsibilities as the accounting officer 106the way Clatterbridge that individualCentre cases for areOncology handled. NHS Losses and special payments are changed to the Foundation Trust relevant functional headings in expenditure on an accruals basis, including losses which would have been made good through insurance cover had NHS trusts not been bearing their own Statement risks (with of insurance premiums then being included as normal revenue expenditure). Directors' responsibilities in respect of the Accounts 107 However the losses and special payments note is compiled directly from the losses and compensations which reports onBoard an accrual basis with the exception of provisions Independentregister Auditor's Report to the 108 for future losses. Statement of Comprehensive Income

110

2. Operating segments Statement of Financial Position 111 The Trust considers that all of its activities fall within the single category of the provision of healthcare services. This is an aggregate of all the speciality services provided by the Trust, bothStatement at its mainofClatterbridge and at Equity clinics held at other hospitals in the region. The Changes in site, Taxpayers 112 large majority of the Trust's income originates from within the UK Government. The main expenses incurred are the cost of staff involved in the production or support of healthcare services, together with the related supplies and overheads necessary to establish this 114 Statement of Cash Flows production. The business activities which earn revenue and incur expenses are therefore of one broad combined nature and because of this, it is considered appropriate to aggregate these activities into the single segment of Healthcare. Accounting Policies 116 The Trust's operating results are reviewed on a monthly basis by its Board of directors which is chaired Notes by to the the Chairman Accounts and includes executive directors as well as senior professional 130 non-executive directors. The Trust Board reviews the financial position of the Trust as a whole - rather than any individual components included in the totals - in its roles of making decisions and allocating resources. This process implies a single operating segment under IFRS 8. The monthly finance report prepared for the Trust Board contains detailed performance and activity information together with expenditure reports covering all areas of the Trust. All of this information is summarised into single Income & Expenditure, Balance Sheet and Cash Flow reports for the whole Trust. The Board acting in its role as Chief Operating decision maker therefore only considers one segment of healthcare in its decision - making process.

130 104

132

TheClatterbridge ClatterbridgeCentre Centrefor forOncology OncologyNHS NHSFoundation FoundationTrust Trust The st st Accountsfor forthe theyear yearended ended3131 March March2012 2012 Accounts The single segment of healthcare has therefore been identified consistent with the core Contents principle of IFRS 8 which is to enable users of the financial statements to evaluate the nature and financial effects of business activities and economic environments. Page

2.1 Income from Activities Foreword to the Accounts Income from activities comprises:

105 2010/11 2011/12 £ 000s £ 000s Statement of the Chief Executive's responsibilities as the accounting officer of 106 Elective income 3,370 3,306 Clatterbridge Centre for Oncology NHS Foundation Trust Non-elective income 3,215 3,151 Outpatient income 9,140 7,680 A & E income 0 Statement of Directors' responsibilities in respect of the Accounts 1070 Other NHS clinical income 48,552 45,373 64,277 59,510 Income from Activities Private patients 639 217 Independent Auditor's Report to the Board 108 Other non-protected clinical income * 2,439 2,687 67,355 62,414 * Other non-protected income covers income from Non-English commissioners 110 Statement of Comprehensive Income (e.g. Wales, Scotland) The figures quoted forPosition both years above are based upon income received in respect Statement of Financial 111 of actual activity undertaken within each category. The Terms of Authorisation set out the mandatory goods and services that the Trust is required to provide - protected services. All of the income from activitiesinshown aboveEquity is derived from the provision of protected services. Statement of Changes Taxpayers 112 Statement of Cash Flows 2.2 Private Patient Income Accounting Policies

2011/12 £ 000s

Private patient income Notes to the Accounts Total patient related income Proportion as a percentage

639 67,355 0.95%

2010/11 £ 000s

114 Base Year 2002/03 116 £ 000s

217 62,414 0.35%

1,108 130 24,284 4.56%

Section 44 of the National Health Services Act 2006 requires that the proportion of private patient income to the total patient related income of NHS Foundation Trusts should not exceed its proportion whilst the body was an NHS Trust in 2002/03 (Private Patient Cap). The proportion in 2002/03 was 4.6% and the above note shows that the Trust was compliant in 2011/12.

2.3 Operating lease income There was no operating lease income. 131 104

133

Contents

2011/12 £ 000s

2010/11 £ 000s

NHS Foundation Trusts 428 307 NHS Trusts 0 3Page Strategic Health Authorities 0 0 Primary Care Trusts 63,849 58,026 105 Foreword to the Accounts Local Authorities 0 0 Department of Health - grants 0 0 Department of Health - other 0 officer of 0 106 Statement of the Chief Executive's responsibilities as the accounting NHSClatterbridge Other 0 1,174 Centre for Oncology NHS Foundation Trust Non NHS - Private patients 639 217 Non NHS - Overseas patients 0 0 NHSStatement injury scheme 0 107 of Directors' responsibilities in respect of the Accounts 0 Non NHS:Other 2,439 2,687 67,355 62,414 Total income from activities * NonIndependent NHS Other covers incomeReport from nontoEnglish UK Auditor's the Board 108 commissioners

Statement of Comprehensive Income

110

2.5 Other Operating Income Statement of Financial Position Research and Development Statement Changes in Taxpayers Equity Education andof Training Charitable and other contributions to expenditure Non-patient care services to other bodies Statement of Cash Flows Other Total

2011/12 £ 000s 2,323 1,467 123 0 4,028 7,941

2010/11 £ 000s 344 1,349 3,199 0 4,489 9,381

111 112 114

In 2010/11 Other Income included income for the R&D Cancer Network (£1,303k) and National Cancer 116 Accounting Policies Analysis Team (£616k), for 2011/12 all R&D related income has been reclassified under Research & Development.

the Accounts OtherNotes Incometoincludes income from drug sales (£605k) IT recharges (£322k), clinical excellence awards130 (£235k) and income from recharges to charities and other organisations (£926k)

132 104

134

The TheClatterbridge ClatterbridgeCentre Centrefor forOncology OncologyNHS NHSFoundation FoundationTrust Trust stst Accountsfor forthe theyear yearended ended31 31 March March2012 2012 Accounts 3. Operating Expenses 3.1 Operating expenses comprise:

Contents

2010/11 2011/12 ÂŁ 000s ÂŁ 000s Services from NHS Foundation Trusts 5,278 4,806 Page Services from NHS Trusts 2,066 1,776 Servicestofrom PCTs 0 0 Foreword the Accounts 105 Services from other NHS bodies 3 0 Purchase of healthcare from non NHS bodies 0 0 Executive Directors' costs 496 468 Statement of the Chief Executive's responsibilities as the accounting officer of 106 Non Executive Directors' costs NHS Foundation Trust 119 115 Clatterbridge Centre for Oncology Staff costs 31,194 29,596 Drugs costs 18,586 15,653 Supplies and services clinical (excluding drug Statement of Directors' responsibilities in respect of the Accounts 107 costs) 2,931 2,649 Supplies and services - general 385 202 Establishment 1,046 995 Independent Auditor's Report to the Board 108 Research and Development 0 0 Transport 50 25 Premisesof Comprehensive Income 3,566 2,537 Statement 110 Increase / (decrease) in provision for impairment of receivables 6 (129) Other impairment of financial assets 0 0 Statement of Financial Position 111 Depreciation on property, plant and equipment 3,325 2,958 Amortisation of intangible assets 0 5 Impairments of property, plant & equipment 50 2,690 Statement of Changes in Taxpayers Equity 112 Audit fees - statutory audit 70 48 Audit fees - regulatory reporting 0 0 Other Auditors remuneration: further assurance Statement of Cash Flows 114 services 76 0 Other Auditors remuneration: other services 77 92 Clinical negligence 121 126 Accounting Policies 116 Legal fees 65 67 Consultancy costs 139 252 Training, and conferences 205 276 Notes to thecourses Accounts 130 Patients travel 123 116 Car parking & Security 5 2 Hospitality 25 0 Publishing 0 41 Insurance 88 101 Other services, eg external payroll 152 65 Losses, ex gratia & special payments 17 45 Other 608 318 70,872 133 104

135

65,895

The Clatterbridge for Oncology NHS Foundation Trust The Clatterbridge Centre forCentre Oncology NHS Foundation Trust st st forended the year March 2012 AccountsAccounts for the year 31 ended March312012 Audit Remuneration Internal audit services Other services

Contents 2011/12 £ 000s 68 85

2010/11 £ 000s 71 21

153

Foreword to the Accounts 3.2 Arrangements containing an operating lease

Page 105

2010/11 2011/12 Statement of the Chief Executive's responsibilities as£the accounting £officer 000s of 000s Clatterbridge Centre for Oncology NHS Foundation Trust Minimum lease payments 703 619 Contingent rents 0 0 Directors' responsibilities in respect of the Accounts LessStatement sub-leaseofpayments 0 0 703

Independent Auditor's Report to the Board 3.3 Statement Arrangements containing anIncome operating lease of Comprehensive Future minimum lease payments Statement of Financial Position due: Not later than one year Later than one year and not later than five years Later than five of years Statement Changes in Taxpayers Equity

Notes to the Accounts

107

619

108 110

2010/11 £ 000s

2011/12 £ 000s 699 1,492 8,925

Total Statement of Cash Flows Total of future minimum sublease lease payments to be received at the balance sheet date Accounting Policies

106

111 629 1804 9000 112

11,116

11,433

114 116 130

134

104

136

137

Band of the Highest Paid Directors Median Remuneration (£000) Ratio

113 135

115-20 29 6.19

115-120 0 090-95 025-30 090-95 050-55 015-20 05-10 0 0 040-45 015-20 010-15 010-15 05-10 010-15 0 0-5 0 0-5 0 0 -434 7,385

0 0 0155-160 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

4,856 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 434 23,345

Public Revaluation Donated Other Income & dividend reserve asset reserves expenditure 2010/11 2011/12 capital reserve Other reserve Other Benefits Benefits £ 000s £ 000s £ 000s £ 000s £ 000s £ 000s Salary remuneration in kind Salary remuneration in kind 46,558 21,245 6,881 2,554 0 (bands of (bands of (bands (bands of (bands of (bands of15,878 561 £5,000) 0 of £100) 938 0 £100) 2,177 £5,000) £5,000) -2,554£5,000) £000 47,119 £000 21,245 £00 7,819£000 0 £000 0 £00 18,055

Total

Taxpayers' Equity at 1 April 2010 - as previously stated Prior period adjustment Name and titleat 1 April 2010 - restated Taxpayers' Equity Executive Directors A Cannell -for Chief 115-120 4,856 Surplus/(deficit) the Executive year 0 Y Bottomley Deputy Chief Executive & Finance Director 90-95 Transfers between reserves 0 0 Impairments 0 155-160 0 D Husband - Medical Director 25-30 Revaluations plant and equipment 0 0 H Porter--property, Director of Nursing & Quality 90-95 Revaluations - intangible 0 0 S Nicholls - Director assets of Operations 0 Revaluations Financial assets 0 0 A Constantine - Acting Director of Operations 0 AssetRdisposals 0 0 Smith - Director of Operations 85-90 Share of comprehensive income from associates and joint ventures 0 0 Movements arising from classifying non current assets as Assets Held for Sale 0 0 Non Executive Directors Fair Value gains/(losses) 0 0 A White - Chairman on Available-for-sale financial investments 40-45 Recycling gains/(losses) on Available-for-sale financial investments 0 0 G Morris - Non Executive Director 15-20 OtherDrecognised lossesDirector 0 0 Buchanan gains - Non and Executive 0 Actuarial gains/(losses) on defined benefit pension schemes 0 0 L Martin - Non Executive Director 10-15 PublicV Dividend Capital received 0 0 Tagart - Non Executive Director 0 PublicCDividend Capital repaid 0 0 Eastwood - Non Executive Director 5-10 Public Dividend Capital written off 0 0 J Burns - Non Executive Director 10-15 Other movements in PDC in year 0 0 J Kingsland - Non Executive Director 10-15 Reserves eliminated on dissolution 0 0 A Hastings - Non Executive Director 0-5 Other reserve movements 0 0 51,975 21,245 Taxpayers' Equity at 31 March 2011 Banded remuneration of the highest paid director and the ratio between this and the median remuneration of all staff

3.4 Remuneration Report STATEMENT OF CHANGES IN TAXPAYERS EQUITY Salary and Allowances

The TheClatterbridge ClatterbridgeCentre Centrefor forOncology OncologyNHS NHSFoundation FoundationTrust Trust st Accounts Accountsfor forthe theyear yearended ended31 31stMarch March2012 2012

138 136

As Non-Executive members do not receive pensionable remuneration, there are no entries in respect of pensions for Non-Executive members. 113

The Trust is required to disclose the relationship between the remuneration of the highest paid director median remuneration In the Total Public and the Revaluation Donatedof the Trusts Otherworkforce. Income & financial year 2011/12 the highest paid director was in the banding £180-£185k. This was 6.19dividend times the median remuneration of the workforce. reserve asset reserves expenditure capital reserve reserve The aggregate amount of remuneration and other benefits received by Directors£during the financial year was £530,395 Employer contributions to a pension 000s £ 000s £ 000s £ 000s £ 000s £ 000s scheme in respect of Directors was £59,374. 46,558 21,245 6,881 2,554 0 15,878 Taxpayers' Equity at 1 April 2010 - as previously stated Prior 1) period adjustment 561 0 938 -2,554 0 2,177 All Board members are appointed by the Board on permanent contracts. 47,119 21,245 7,819 0 0 18,055 Taxpayers' Equity at 1 April 2010 restated 2) All non Executive Board members are appointed by the Council of Governors for an initial period of 3 years which is renewable subject to satisfactory performance. Surplus/(deficit) for the year 4,856 0 0 0 0 4,856 3) The following changes have occurred since 1st April 2011:a) Creserves Eastwood left the board as a Non Executive Director on 31.12.11 Transfers between 0 0 0 0 0 0 Impairments b) A Hastings joined the board as a Non Executive Director on 01.01.12 0 0 0 0 0 0 Revaluations - property, plant and equipment 0 0 0 0 0 0 Revaluations - intangible assets 0 0 0 0 0 0 3.5 Pension entitlements Revaluations - Financial assets 0 0 0 0 0 0 Asset disposals 0 0 0 0 0 0 Real Real Share of comprehensive income from associatesincrease and joint ventures 0 0 0 0 0 0 Lump sum Total accrued Lump sum Cash Cash increase Employer's Movements arising from classifying non current in assets as Assets Held for Sale 0 0 0 0 0 0 pension at investments at aged 60 pension at age 0 at aged 60 0 Equivalent 0 Equivalent 0 in Cash Fair Value gains/(losses) on Available-for-sale financial 0 contribution 0 to Recycling gains/(losses) on Available-for-sale financial investments 0 0 0 0 0 0 age 60 related to 60 at 31March related to Transfer Other recognised gains and losses 0 0 0 Transfer 0Equivalent 0 stakeholder 0 2012 Value at Actuarial gains/(losses) on defined benefit pension schemes real increase 0 accrued pension 0 0 Value at 0 Transfer 0 pension 0 in pension 31 March Public Dividend Capital received 0 at 31 March 0 0 31 March 0 Value 0 (rounded to 0 (bands of (bands of (bands of 2012 Public Dividend Capital repaid 0 2012 (bands of0 0 2011 0 0 nearest £00) 0 £2,500) £2,500) £5,000) £5,000) Public Dividend Capital written off 0 0 0 0 0 0 Name and title £000 £000 £000 £000 £000 £000 £000 £00 Other movements in PDC in year 0 0 0 0 0 0 Reserves eliminated on dissolution 0 0 0 0 0 0 Cannellmovements - Chief Executive 0-2.5 2.5-5 40-45 120-125 0 710 -434 592 0 OtherAreserve 0 0 102 0 434 Y Bottomley - Deputy CEO & Finance 51,975 21,245 7,385 0 0 23,345 Taxpayers' Equity at 31 March 2011 Director 0-2.5 0-2.5 0-5 0-5 37 15 21 0 D Husband - Medical Director 0-2.5 0-2.5 75-80 230-235 1,778 1,730 48 0 H Porter - Director of Nursing & Quality 0-2.5 2.5-5 30-35 95-100 583 494 75 0 R Smith - Director of Operations 0-2.5 0-2.5 20-25 65-70 350 295 47 0

The Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31stNHS March 2012 The Clatterbridge Centre for Oncology Foundation Trust st Accounts for the year ended 31 March 2012 STATEMENT OF CHANGES IN TAXPAYERS EQUITY

139

Total

113 137

Revaluations - Financial assets 0 0 0 0 0 0 Asset disposals 0 0 0 0 0 0 Share of comprehensive 0 0 0 0 0 0 Real Increase in income CETV from associates and joint ventures Movements arising from classifying non current assets as Assets Held for Sale 0 0 0 0 0 0 Fair Value gains/(losses) on Available-for-sale financial investments 0 0 0 0 0 0 This reflects the increase in CETV effectively funded by the employer. It takes account of0 the increase0 in accrued 0pension due to Recycling gains/(losses) on Available-for-sale financial investments 0 0 0 inflation, contributions paid by the employee (including the value of any benefits transferred from another scheme 0or arrangement) and Other recognised gains and losses 0 0 0 0 0 uses common market valuation factors for the start and end of the period. Actuarial gains/(losses) on defined benefit pension schemes 0 0 0 0 0 0 Public Dividend Capital received 0 0 0 0 0 0 Public Dividend Capital repaid 0 0 0 0 0 0 Public Dividend Capital written off 0 0 0 0 0 0 Other movements in PDC in year 0 0 0 0 0 0 Reserves eliminated on dissolution 0 0 0 0 0 0 Other reserve movements 0 0 -434 0 0 434 51,975 21,245 7,385 0 0 23,345 Taxpayers' Equity at 31 March 2011

former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the disclosure and 4,856 Surplus/(deficit) for the yearof the pension scheme, not just their service in a senior 4,856capacity to which 0 0 applies. The 0 CETV figures 0 the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has Transfers between reserves 0 0 0 0 0 0 transferred to the NHS pension scheme. They also include any additional pension benefit Impairments 0 0 accrued to 0the member 0as a result0of their 0 Revaluations - property, plant and equipment 0 0 calculated0 within the guidelines 0 0 0 purchasing additional years of pension service in the scheme at their own cost. CETVs are and Revaluations - intangible assetsby the Institute and Faculty of Actuaries. 0 0 0 0 0 0 framework prescribed

Public Revaluation Donated Other Income & dividend reserve asset reserves expenditure capital A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension schemereserve benefits accrued by a reserve £ 000s £ 000s £ 000s £ 000s £ 000s £ 000s member at a particular point in time. The benefits valued are the member's accrued benefits and any contingent spouse's pension 46,558 21,245 6,881 2,554 0 15,878 Taxpayers' Equity at 1 April 2010 - as previously stated payable from the scheme. A CETV figure is a payment made by a pension scheme or arrangement to secure pension benefits in Prior period adjustment 561 0 938 -2,554 0 2,177 anotherEquity pension arrangement when the member leaves a scheme 47,119 and chooses 21,245 to transfer 7,819 the benefits0 accrued in0 their 18,055 Taxpayers' at 1 scheme April 2010or - restated

STATEMENT OF CHANGES IN TAXPAYERS EQUITY Cash Equivalent Transfer Values

The Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2012

Clatterbridge Centre for Oncology Foundation Trust The The Clatterbridge Centre for Oncology NHSNHS Foundation Trust st st Accounts for year the year ended March Accounts for the ended 31 31 March 20122012 3.6 Remuneration Committee and Terms of Service Contents The Remuneration Committee is made up of the Chairman and Non-Executive Directors only. Acting in accordance with Department of Health Guidelines, the committee determines the remuneration of Senior Managers and Executive Directors. The Chief Executive of the Page Trust joins the Committee when the remuneration of other Executive Directors is being reviewed. The Chief Executive and Executive Directors are employed under permanent Foreword to the Accounts 105 contracts of employment and (apart from the Medical Director) they have been recruited under national advertisements. The position of Medical Director is an internal appointment open to competition between senior medical staff. The employment of Senior Managers and Statement of themay Chief as the accounting officer 106 Executive Directors beExecutive's terminated responsibilities with three months notice as a result of a of disciplinary Clatterbridge Centre for Oncology NHS Foundation Trust process, if the Trust is dissolved as a statutory body, or if they choose to resign. None have contracts of service, and none has a contract that is subject to any performance conditions. The position of Chair and Non-Executive Directors are recruited through national Statement ofAppointments Directors' responsibilities respect the Accounts 107 advertisements. are made oninfixed termofcontracts (normally for three years), which can be renewed on expiry. Terms of appointment and remuneration for Non-Executive Directors are set by the Council of Governors. Independent Auditor's Report to the Board 108 Details of the remaining terms of the Chair and Non-Executive Directors are as follows: Name First Income Statement of Comprehensive Appointed Alan White 23.08.1999 Statement Graham Morrisof Financial Position 01.12.2005 Louise Martin 01.04.2001 Carol Eastwood 01.02.2007 of Changes in Taxpayers Equity JanStatement Burns 01.02.2011 James Kingsland 01.02.2011 Alison Hastings 01.01.2012 Statement of Cash Flows

Extended To

30.11.2002 30.11.2009 31.03.2005 31.01.2010 31.01.2014 31.01.2014 31.12.2015

31.07.2013 30.11.2012 31.07.2013 31.12.2011

110 111 112 114

The Remuneration Committee will be responsible for agreeing remuneration and terms of employment for Policies the Chief Executive and other Directors in accordance with: Accounting 116 1) Legal requirements 2) The principles of probity Notes to the Accounts 3) Good people management practice 4) Proper corporate governance

130

The membership of the Remuneration Committee, number of meetings held and attendance can be found on pages 43 and 44 of the Annual Report.

Signed Andrew Cannell Chief Executive

Date 30th May 2012

138

104

140

Contents

2010/11 2011/12 £ 000s £ 000s Salaries and wages 26,128 24,987 Page Social Security costs 1,896 1,719 Employer contributions to NHS Pension scheme 2,992 2,819 Foreword the-Accounts 105 0 Pensiontocost other contributions 0 Other post employment benefits 0 0 Other employment benefits 0 0 Statement of the Chief Executive's responsibilities as the accounting officer of 106 0 Termination benefits 0 Clatterbridge forstaff Oncology NHS Foundation Trust Agency andCentre contract 674 539 4.1 Staff costs

31,690 Employee benefits expense Statement of Directors' responsibilities in respect of the Accounts

30,064 107

All employer pension contributions in 2011/12 were paid to the NHS Pensions Agency.

Independent Auditor's Report to the Board 4.2 Average number of persons employed Medical and dental Statement of Comprehensive Income Ambulance staff Administration and estates Healthcare assistants & other support staff Statement Financial&Position Nursing, of midwifery health visiting staff Nursing, midwifery & health visiting learners Scientific, therapeutic and technical staff Statement of Changes in Taxpayers Equity Social care staff Bank and agency staff Other Statement of Cash Flows Total

2011/12 72 0 234 67 140 0 211 1 0 0 791

108 2010/11 67 110 0 196 70 111138 0 214 112 0 0 22 114 707

Accounting Policies 116 have In 2010/11 'Other' included Executive Directors and Heads of Department. In 2011/12 these employees been assigned to the appropriate occupational categories above.

4.3 Employee Benefits Notes to the Accounts

130

None (2010/11 - None) 4.4 Retirements due to ill-health This note discloses the number and additional pension costs for individuals who retired early on ill-health grounds during the year. There were 3 retirements, at an additional cost of £329k in 2011/12 (2010/11 - none). This information has been supplied by the NHS Pensions Agency.

104 139

141

Contents Past and present employees are covered by the provisions of the NHS Pensions Scheme. Details of the benefits payable under these provisions can be found on the NHS Pensions website at www.pensions.nhsbsa.nhs.uk. The scheme is an unfunded, defined benefit Pagethe scheme that covers NHS employers, General Practices and other bodies, allowed under direction of the Secretary of State, in England and Wales. The scheme is not designed to be Foreword to the Accounts 105 run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the scheme is accounted for as if it were a defined contribution scheme: the cost to the NHS Body of participating in the scheme is taken as Statement of the Chiefpayable Executive's the accounting officer of 106 equal to the contributions to theresponsibilities scheme for theasaccounting period. Clatterbridge Centre for Oncology NHS Foundation Trust The scheme is subject to a full actuarial valuation every four years (until 2004, every five years) and an accounting valuation every year. An outline of these follows: Statement of Directors' responsibilities in respect of the Accounts 107 a) Full actuarial (funding) valuation The Independent purpose of this valuation is to to assess the level of liability in respect of the benefits108 due Auditor's Report the Board under the scheme (taking into account its recent demographic experience), and to recommend the contribution rates to be paid by employers and scheme members. The last suchStatement valuation, of which determined current Comprehensive Income contribution rates was undertaken as at 31 March 110 2004 and covered the period from 1 April 1999 to that date. Statement of Financial Position 111 The conclusion from the 2004 valuation was that the scheme had accumulated a notional deficit of ÂŁ3.3 billion against the notional assets as at 31 March 2004. However, after taking into account theofchanges benefit and contribution structure effective from 1 April112 2008, Statement Changesininthe Taxpayers Equity the scheme actuary reported that employer contributions could continue at the existing rate of 14% of pensionable pay. On advice from the scheme actuary, scheme contributions may be varied from timeoftoCash timeFlows to reflect changes in the schemeâ&#x20AC;&#x2122;s liabilities. Up to 31 March 2008, Statement 114 the vast majority of employees paid contributions at the rate of 6% of pensionable pay. From 1 April 2008, employees contributions are on a tiered scale from 5% up to 8.5% of their pensionable payPolicies depending on total earnings. Accounting 116 b) Accounting valuation Notes to the Accounts 130 A valuation of the scheme liability is carried out annually by the scheme actuary as at the end of the reporting period by updating the results of the full actuarial valuation. Between the full actuarial valuations at a two-year midpoint, a full and detailed member dataset is provided to the scheme actuary. At this point the assumptions regarding the composition of the scheme membership are updated to allow the scheme liability to be valued. The valuation of the scheme liability as at 31 March 2008, is based on detailed membership data as at 31 March 2006 (the latest midpoint) updated to 31 March 2008 with summary global member and accounting data.

140

104

142

The TheClatterbridge ClatterbridgeCentre Centrefor forOncology OncologyNHS NHSFoundation FoundationTrust Trust st st Accounts Accountsfor forthe theyear yearended ended3131 March March2012 2012 The latest assessment of the liabilities of the scheme is contained in the scheme actuary Contents report, which forms part of the annual NHS Pension Scheme (England and Wales) Resource Account, published annually. These accounts can be viewed on the NHS Pensions website. Copies can also be obtained from The Stationery Office. c) Scheme provisions

Page

The scheme is Accounts a “final salary” scheme. Annual pensions are normally based on 105 1/80th of the Foreword to the best of the last 3 years pensionable pay for each year of service. A lump sum normally equivalent to 3 years pension is payable on retirement. Annual increases are applied to pension payments at rates definedresponsibilities by the Pensions Act 1971, based on Statement of the Chief Executive's as (Increase) the accounting officerand of are106 changes in retail prices in the twelve ending 30 September in the previous calendar Clatterbridge Centre for Oncology NHSmonths Foundation Trust year. On death, a pension of 50% of the member’s pension is normally payable to the surviving spouse. Statement of Directors' responsibilities in respect of the Accounts 107 Early payment of a pension, with enhancement, is available to members of the scheme who are permanently incapable of fulfilling their duties effectively through illness or infirmity. A death gratuity of twiceReport final year’s pay for death in service, and five 108 times their Independent Auditor's to thepensionable Board annual pension for death after retirement, less pension already paid, subject to a maximum amount equal to twice the member’s final year’s pensionable pay less their retirement lump sum for those who die after retirement, is payable. Statement of Comprehensive Income 110 For early retirements other than those due to ill health the additional pension liabilities are not funded byofthe scheme. The full amount of the liability for the additional costs is charged to the Statement Financial Position 111 statement of comprehensive income at the time the Trust commits itself to the retirement, regardless of the method of payment. Statement of Changes in Taxpayers Equity 112 The scheme provides the opportunity to members to increase their benefits through money purchase additional voluntary contributions (AVCs) provided by an approved panel of life companies. UnderFlows the arrangement the employee/member can make contributions Statement of Cash 114 to enhance an employee's pension benefits. The benefits payable relate directly to the value of the investments made. Accounting Policies 116 Notes to the Accounts

130

104 141

143

Contents

2011/12 £ 000s 0 0 0 0

2010/11 £ 000s 0 0 Page 0 0 105

Interest on loans and receivables Interest on available for sale financial assets Interest on held-to-maturity financial assets Other gains (investment properties) Foreword to the Accounts Available for sale financial assets and liabilities held at fair value through income and expenditure account - fairStatement value gains 0 of the Chief Executive's responsibilities as the accounting officer of - fairClatterbridge value losses Centre for Oncology NHS Foundation Trust 0 Net gains / (losses) on available for sale financial assets through income and expenditure 0 Other (e.g. bankofinterest) 79 Statement Directors' responsibilities in respect of the Accounts 79 Independent Auditor's Report to the Board 6.1 Finance Costs - Interest expense

0 95 107 95 108

Statement of Comprehensive Income Loans from the Foundation Trust Financing Facility Commercial loans Statement of Financial Position Overdrafts Finance leases Interest on late of payment of in commercial Statement Changes Taxpayersdebt Equity Other

2011/12 £ 000s 209 0 0 16 0 0 225

Statement of Cash Flows 6.2 Impairment of assets (PPE & Intangibles) Accounting Policies

2010/11 110 £ 000s 238 0 111 0 21 0 112 0 259 114 116

Notes to the Accounts Loss or damage from normal operations Changes in market price Other

142

0 106 0

104

144

2011/12 £ 000s

2010/11 £ 000s 130

0 0 1,231 1,231

0 0 2,690 2,690

Contents

Better Payment Practice Code - measure of compliance 2011/12 Number £000

2010/11 Page Number £000

Foreword to the Accounts 105 Total Non-NHS trade invoices paid in the year 7,300 13,832 7,241 19,705 Total NonofNHS trade invoices paidresponsibilities within Statement the Chief Executive's as the accounting officer of 106 target 5,333 16,592 Clatterbridge Centre for Oncology NHS Foundation 6,389 Trust 12,691 Percentage of Non-NHS trade invoices paid within target 87.5% 91.8% 73.7% 84.2% Statement of Directors' responsibilities in respect of the Accounts Total NHS trade invoices paid in the year 1,126 26,681 Total NHS trade invoices paid within target 900 23,777 Percentage Auditor's of NHS trade invoices Independent Report to the paid Board within target 79.9% 89.1%

107 1,574 26,536 1,194 24,141 108 75.9% 91.0%

The Better Payment Practice Code requires the Trust to aim to pay all undisputed invoices by the due date

or within 30of days of receipt of goods or a valid invoice, whichever is later. Statement Comprehensive Income

110

6.4 The late payment of commercial debts (interest) Act 1998: Statement of Financial Position 2011/12 £ 000s Amounts of included within other interest payable arising Statement Changes in Taxpayers Equity from claims made under this legislation 0 Compensation paid to cover debt recovery costs under Statement of Cash Flows this legislation 0 Accounting Policies

111 2010/11 £ 000s 112 114 116

0 0

No interest or compensation has been paid under the Late Payment of Commercial Debts (Interest) Act 1998 during 2011/12 or 2010/11.

Notes to the Accounts 6.5 Management costs

130

Management costs Income Management costs as % of Income

2011/12 £000 3,088

2010/11 £000 2,975

75,296

71,795

4.1%

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

104 143

145

146

£ 000s

Software Licenses

0 0 0 0 0 0 0 0

0 0 0 0

- Donated at 1st April 2011

Total at 1st April 2011

- Purchased at 31st March 2012 - Donated at 31st March 2012

Total at 31st March 2012

Total

113 144

0 0

0 00 00 00 00 00 00 00 00 00 0 0 0 51,975

0 4,856 0 00 00 00 00 00

Licenses and £ 000s Trademarks 46,558 £ 000s 561 0 47,119

Share of comprehensive income from associates and joint ventures Amortisation at 1st April 2011 as previously stated Movements arising from classifying non current assets as Assets Held for0Sale Prior Period adjustments 0 Fair Value gains/(losses) on Available-for-sale financial investments Provided during the year 0 Recycling gains/(losses) on Available-for-sale financial investments Impairments 0 Other recognised gains and losses Reversal of Impairments 0 Actuarial gains/(losses) on defined benefit pension schemes 0 PublicReclassifications Dividend Capital received in yearCapital revaluation 0 PublicOther Dividend repaid PublicDisposals Dividend Capital written off 0 OtherAmortisation movements as in PDC inMarch year 2012 at 31st 0 Reserves eliminated on dissolution book movements value OtherNet reserve - Purchased at 1st 2011 2011 0 Taxpayers' Equity at April 31 March

Prior Period adjustments Impairmentsfor the year Surplus/(deficit) Reclassifications Transfers between reserves Other in year revaluation Impairments Additions -–property, purchasedplant and equipment Revaluations Additions -–intangible donated assets Revaluations Disposals Revaluations - Financial assets AssetGross disposals cost 31st March 2012

Taxpayers' Equity at 1 April 2010 - as previously stated Prior period adjustment Gross Cost at 1 at April 2011 as previously stated Taxpayers' Equity 1 April 2010 - restated

7.1 Intangible fixed assets 2011/12

STATEMENT OF Fixed CHANGES IN TAXPAYERS EQUITY 7. Intangible Assets

0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 21,245

0 0 0 0 0 0 0

0 0

00 0 00 00 00 00 00 00 00 00 00 0 -434 7,3850

0 00 00 00 00 00 00

Public Revaluation dividend reserve capital Patents Development £ 000s £ 000s Expenditure 21,245 6,881 £ 000s £ 000s 938 0 0 21,245 7,8190

The TheClatterbridge ClatterbridgeCentre Centrefor forOncology OncologyNHS NHSFoundation FoundationTrust Trust Accounts Accountsfor forthe theyear yearended ended31 31ststMarch March2012 2012

0 0

00 0 00 00 00 00 00 00 00 00 00 0 0 00

0 00 00 00 00 00 00

Donated asset reserve Goodwill £ 000s 2,554 £ 000s -2,554 00

0 0

00 0 00 00 00 00 00 00 00 00 00 0 0 00

0 00 00 00 00 00 00

0 £ 000s 0 00

Other £ 000s

Other reserves

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 434 0 23,345

0 0

0 04,856 0 0 0 0 0 0 0 0 0 0

Income & expenditure reserve Total £ 000s 15,878 £ 000s 2,177 0 18,055

147

33,564 0 33,564 649 0

0 464 0 0

£ 000s

464

£ 000s

Buildings excluding dwellings

33,219

2,489

325

30,405

145

4,856 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 51,975 0

£ 000s 0 46,558 0 561 0 47,119

£ 000s

Total

Dwellings

0 0 (1,975) 0 0 0 0 0 55 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,975 0 0 0 0 0 21,245 1,975

£ 000s 1,975 21,245 0 0 1,975 21,245

Assets under Public construction and dividend payments on account capital £ 000s

0 0 0 0 0 0 0 0 28,495 0 17,744 0 0 0 0 17,744 0 1,818 0 0 0 0 0 0 0 0 0 19,562 0 0 5,867 0 0 3,209 -434 9,0767,385

8,933

2,865

6,068

1,675

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

628

902

2,723

773

1,950

3,351

419

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

2,535

43,387

5,379

325

37,683

(1,181)

4,856 0 0 0 0 0 (27) 0 67,050 0 20,299 0 0 0 20,299 0 3,325 0 50 0 0 0 0 0 (11) 0 23,663 0 0 0 39,257 505 0 5,662 434 23,345 45,424

Total Income & reserve asset reserves expenditure reserve reserve £ 000s £ 000s £ 000s £ 000s £ 000s £ 000s £ 000s £ 000s £ 000s 26,820 48 2,852 0 65,723 6,881 2,554 0 15,878 0 0 0 0 0 938 -2,554 0 2,177 26,820 48 2,852 0 65,723 7,819 0 0 18,055

Plant & Transport Information Furniture Revaluation Donated Other machinery equipment technology & fittings

113 A revaluation of the refurbishments of a ward and office accommodation was undertaken in 2011/12 by qualified external valuers (DTZ Ltd.).

464

Total at 31st March 2012

Finance Lease

464

Donated

Purchased

Net book value at 31st March 2012

Surplus/(deficit) Impairments for the year 0 (1,181) Transfers between reserves Reclassifications 0 1,556 Impairments Revaluation surpluses 0 0 Revaluations Disposals - property, plant and equipment 0 (27) Revaluations - intangible assets Cost / valuation at 31 March 2012 464 34,561 Revaluations - Financial assets 0 596 AssetAccumulated disposals depreciation at 1st April 2011 as previously stated Prior period adjustments 0 Share of comprehensive income from associates and joint ventures0 Movements arising from classifying non as current assets as Assets Held for Sale Accumulated depreciation at 1st April 2011 restated 0 596 Fair Value gains/(losses) Provided during the year on Available-for-sale financial investments 0 707 Recycling gains/(losses) on Available-for-sale financial investments0 Impairments 50 OtherReclassifications recognised gains and losses 0 0 Actuarial gains/(losses) Revaluation surpluses on defined benefit pension schemes 0 0 PublicDisposals Dividend Capital received 0 (11) PublicAccumulated Dividend Capital repaid depreciation at 31st March 2012 0 1,342 PublicNet Dividend Capital written off book value at 31st March 2011 OtherPurchased movements in PDC in year 464 30,049 Reserves eliminated on dissolution Finance Lease 0 505 OtherDonated reserve movements 0 2,414 Taxpayers' Equity at 2011 31 March 2011 Total at 31st March 464 32,968

Additions – donated

Taxpayers' Equity at 1 April 2010 - as previously stated Prior period adjustments Prior Cost period adjustment or valuation at 1 April 2011 as restated Taxpayers' at 1 April 2010 - restated AdditionsEquity – purchased

Cost / valuation at 1st April 2011 as previously stated

Land

8.1 Property, plant and equipment 2011/12 STATEMENT OF CHANGES IN TAXPAYERS EQUITY

The TheClatterbridge ClatterbridgeCentre Centrefor forOncology OncologyNHS NHSFoundation FoundationTrust Trust stst Accounts for the year ended 31 March 2012 Accounts for the year ended 31 March 2012

148

Buildings excluding dwellings £ 000s 0 0 0

Dwellings

Revaluations - property, plant and equipment Revaluations - intangible assets Revaluations - Financial assets Asset disposals Share of comprehensive income from associates and joint ventures Movements arising from classifying non current assets as Assets Held for Sale Fair Value gains/(losses) on Available-for-sale financial investments Recycling gains/(losses) on Available-for-sale financial investments Other recognised gains and losses Actuarial gains/(losses) on defined benefit pension schemes Public Dividend Capital received Public Dividend Capital repaid Public Dividend Capital written off Other movements in PDC in year Reserves eliminated on dissolution Other reserve movements Taxpayers' Equity at 31 March 2011

Taxpayers' Equity at 1 April 2010 - as previously stated Prior period adjustment £ 000s £ 000s Taxpayers' Equity at 1 April 2010 - restated Net book value at 31st March 2012 Protected assets 464 33,219 Surplus/(deficit) for the year Unprotected assets 0 0 Transfers between reserves Total at 31st March 2012 464 33,219 Impairments

Land

STATEMENT OF CHANGES TAXPAYERS 8.2 Analysis of TangibleINfixed assets EQUITY

113 146

4,856 55 0 0 55 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 51,975 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 21,245

0 8,933 0 8,933 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 -434 7,385

0 25 0 25 0

Total Public Revaluation Assets under dividend Plant & Transport reserve construction capital machinery equipment and £ 000s £ 000s £ 000s payments 46,558 on 21,245 6,881 account 561 0 938 £ 000s £ 000s £ 000s 47,119 21,245 7,819

The TheClatterbridge ClatterbridgeCentre Centrefor forOncology OncologyNHS NHSFoundation FoundationTrust Trust Accounts Accountsfor forthe theyear yearended ended31 31ststMarch March2012 2012

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 628 0 628 0

0 63 0 063 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 434 23,345

33,683 4,856 9,704 0 43,387 0

Donated Other Income & Information Furniture expenditure Total asset reserves technology & fittings reserve reserve £ 000s £ 000s £ 000s 2,554 0 15,878 -2,554 0 2,177 £ 000s £ 000s £ 000s 0 0 18,055

Maximum Life Years

Page

Land to the Accounts Infinite Infinite Foreword Buildings excluding dwellings 2 89 Dwellings 0 0 Assets under 0 accounting0officer of Statement of theConstruction Chief Executive's responsibilities as the Plant & Machinery 1 10 Clatterbridge Centre for Oncology NHS Foundation Trust Transport Equipment 1 2 Information Technology 4 5 Furnitureof& Directors' Fittings responsibilities in respect of the 4Accounts 5 Statement

105

8.4 PropertyAuditor's Valuations Independent Report to the Board

108

106

107

The refurbishments of a ward and office accommodation has been revalued in 2011/12, by a professional valuer, on the Modern accounted for Statement of Comprehensive IncomeEquivalent Asset basis. The revaluation was 110 in year. The alternative site method was not used. Further details of the valuation approach are included under note 1.3 (Accounting policies). Statement of Financial Position

111

8.5 Non-Property Valuations Statement of Changes in Taxpayers Equity 112 Plant and equipment (including IT equipment) used in the Trust tends to be highly specialised in nature with no reliable means of ascertaining a market value. In accordance with IAS 16, these assets are carried Statement of Cash Flows at Depreciated Replacement Cost (DRC) and are not subject 114 to revaluation Accounting Policies

116

Notes to the Accounts

130

104 147

149

150

Buildings excluding dwellings

Accumulated depreciation at 31st March 2012 0

Fair Value gains/(losses) on Available-for-sale financial investments Recycling gains/(losses) on Available-for-sale investments Accumulated depreciation at 1st April 2011 asfinancial previously stated 0 Other recognised gains and losses Prior period adjustments 0 Actuarial gains/(losses) on defined benefit pension schemes depreciation at 1st April 2011 as restated 0 PublicAccumulated Dividend Capital received during the year 0 PublicProvided Dividend Capital repaid 0 PublicImpairments Dividend Capital written off of Impairments 0 OtherReversal movements in PDC in year Reclassifications 0 Reserves eliminated on dissolution surpluses 0 OtherRevaluation reserve movements Disposals 0 Taxpayers' Equity at 31 March 2011

318

164 0 164 165 0 0 0 0 (11)

£ 000s £ 000s Cost / valuation at 1st April 2011 as previously stated 0 670 Prior period adjustments 0 0 Surplus/(deficit) for the year Cost or valuation at 1 April 2011 as restated 0 670 Transfers between reserves Additions – purchased 0 0 Impairments Additions -–property, donated plant and equipment 0 0 Revaluations Impairments 0 0 Revaluations - intangible assets Reclassifications 0 0 Revaluations - Financial assets 0 0 AssetRevaluation disposals surpluses 0 (27) ShareDisposals of comprehensive income from associates and joint ventures Cost / valuation at 31classifying March 2012 Movements arising from non current assets as Assets 0Held for Sale 643

Taxpayers' Equity at 1 April 2010 - as previously stated Prior period adjustment Taxpayers' Equity at 1 April 2010 - restated

Land

Public

Revaluation

Donated

Other

Income &

113 148

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 51,975

0 0

£ 000s 47,119 0 0 4,856 0 0 0 0 0 0 0 0 0 0 0 0 0 0

561

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 21,245

0 0

£ 000s21,245 £ 000s 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 -434 07,385

0 0 0 0 0 0 0 0 0

938 7,819£ 000s

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

-2,554 £0000s

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

£0 000s

0 0 0 0 0 0 0 0 0

318

0 0 164 0 0 0 164 0 165 0 0 0 0 0 0 0 0 434 (11) 23,345

643 0

£2,177 000s 18,055 670 0 4,856 670 0 0 0 0 0 0 0 0 0 0 0 (27) 0

Assets under Plant & Transport Information Furniture Total dividend reserve asset reserves expenditure construction machinery equipment technology & fittings capital reserve reserve and £ 000s £ 000s £ 000s £ 000s £ 000s £ 000s payments on 46,558 account 21,245 6,881 2,554 0 15,878

Total

Dwellings

STATEMENT OF value CHANGES IN TAXPAYERS EQUITYleases 2011/12 9. Net book of assets held under finance

The TheClatterbridge ClatterbridgeCentre Centrefor forOncology OncologyNHS NHSFoundation FoundationTrust Trust Accounts Accountsfor forthe theyear yearended ended31 31ststMarch March2012 2012

151

506 0

0 0

Surplus/(deficit) the year Total at 31stfor March 2011 0 506 Transfers between reserves Impairments Net book value at 31st March 2012 Revaluations - property, plant and equipment Purchased 0 325 Revaluations - intangible assets Donated 0 0 Revaluations - Financial assets Total at 31st March 2012 0 325 Asset disposals Share of comprehensive income from associates and joint ventures Movements arising from classifying non current assets as Assets Held for Sale Fair Value gains/(losses) on Available-for-sale financial investments Recycling gains/(losses) on Available-for-sale financial investments Other recognised gains and losses Actuarial gains/(losses) on defined benefit pension schemes Public Dividend Capital received Public Dividend Capital repaid Public Dividend Capital written off Other movements in PDC in year Reserves eliminated on dissolution Other reserve movements Taxpayers' Equity at 31 March 2011

Donated

Taxpayers' Equity at 1 April 2010 - as previously stated Prior Net period adjustment book value at 31st March 2011 Taxpayers' Equity at 1 April 2010 - restated Purchased

Buildings excluding dwellings

Land

149

113

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 51,975

04,856

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 21,245 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 -434 7,385 0

0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0

4,856 506 0 0 0 325 0 0 0 325 0 0 0 0 0 0 0 0 0 0 0 0 434 23,345

Public Revaluation Donated Other Income & dividend reserve asset reserves expenditure Dwellings Assets under Plant & Transport Information Furniturereserve Total capital reserve £ 000s construction £ 000s machinery £ 000s equipment £ 000stechnology £ 000s& fittings£ 000s and payments 46,558on account 21,245 6,881 2,554 0 15,878 561 0 938 -2,554 0 2,177 47,119 21,245 7,819 0 0 18,055 0 0 0 0 0 0 506

Total

STATEMENT OF value CHANGES IN TAXPAYERS EQUITYleases 2011/12 (cont.) 9. Net book of assets held under finance

The TheClatterbridge ClatterbridgeCentre Centrefor forOncology OncologyNHS NHSFoundation FoundationTrust Trust st Accounts Accountsfor forthe theyear yearended ended31 31stMarch March2012 2012

Clatterbridge Centre Oncology NHS Foundation Trust TheThe Clatterbridge Centre for for Oncology NHS Foundation Trust st st Accounts year ended March 2012 Accounts for for thethe year ended 31 31 March 2012 10.1

Non-current assets for sale and assets in disposal groups 2011/12 Contents

There are none. 10.2

Non-current assets for sale and assets in disposal groups 2010/11

There were none. Foreword to the Accounts 10.3

105

Liabilities in disposal groups 2011/12

Statement of the Chief Executive's responsibilities as the accounting officer of There are none. Clatterbridge Centre for Oncology NHS Foundation Trust 10.4

Page

106

Liabilities in disposal groups 2010/11

Statement of Directors' responsibilities in respect of the Accounts There were none.

107

11.1 Investments - Carrying amount Independent Auditor's Report to the Board

108

There are none. Statement of Comprehensive Income 11.2 Investment Property expense

110

There are none. Statement of Financial Position

111

11.3

Investment property income

Statement of Changes in Taxpayers Equity There are none.

112

12.1 Fair value of investments in associate (and joined controlled operations) Statement of Cash Flows 114 There are none. Accounting Policies 116 12.2 Disclosure of aggregate amounts for assets and liabilities of jointly controlled operations Notes to the Accounts There are none.

130

104 150

152

The Clatterbridge Centre forfor Oncology NHS Foundation Trust The Clatterbridge Centre Oncology NHS Foundation Trust st st Accounts forfor thethe year ended 3131March 2012 Accounts year ended March 2012 Contents Total Total 31st 31st March March 2011 2012 £ 000s £ 000s Foreword Drugs to the Accounts 718 457 Work-in-Progress 0 0 Consumables 0 3 Statement Energy of the Chief Executive's responsibilities as 0 the accounting 0 officer of Clatterbridge Centre for Oncology NHS Foundation Trust Inventories carried at fair value less costs to sell 0 0 Other 0 0 Statement of Directors' responsibilities in respect of the Accounts Total 460 718 13.1 Inventories

Page 105 106

107

Independent Auditor's Report toin theexpenses Board 13.2 Inventories recognised

108

There are none. Statement of Comprehensive Income 14.1 Trade and other receivables

110

Statement of Financial Position Statement of Changes in Taxpayers Equity NHS Receivables - Revenue NHS Receivables - Capital Other receivables related parties Statement of Cash with Flows Revenue Other receivables with related parties Capital Accounting Policies Provision for impaired receivables Deposits and Advances Prepayments (Non-PFI) Notes to the Accounts PFI Prepayments Prepayments - Capital contributions Prepayments - Lifecycle replacements Accrued income Interest Receivable Corporation tax receivable Finance Lease Receivables Operating lease receivables PDC dividend receivable VAT receivable Other receivables Other receivables - Capital

Current Total Total 31st 31st March March 2011 2012 £ 000s £ 000s 2,689 2,970 0 0

Total current trade and other receivables

350

0 (208) 0 1,369

0 (202) 0 1,310

0 0 0

0 0 206 0 0 0 0 101 204 661 0

0 0 426 0 0 0 0 0 0 1,181 0

0 0 0 0 0 0 0 0 0 0 0

5,372

5,685

104 151

153

Non - current Total Total 111 31st March 31st 2011 March 2012 112£ 000s £ 000s 0 0 0 0 0 114 0 0

116 130

0 0 0

2010/11 £ 000s

202 166 0 (160) 208

331 189 0 (318) 202

Balance at 1st April 2011 Increase in provision Amounts utilised Unused amounts reversed Foreword to the Accounts Balance at 31st March 2012

Statement of the Chief Executive's responsibilities as the accounting officer of for Oncology NHS Foundation Trust 14.3Clatterbridge Analysis ofCentre impaired receivables 2010/11 2011/12 £ 000s £ 000s Statement Directors'receivables responsibilities in respect of the Accounts Ageing ofofimpaired 0 - 30 days 35 0 30-60 Days 0 45 Independent 60-90 days Auditor's Report to the Board 41 0 90- 180 days 56 94 over 180 days 76 63 Statement of Comprehensive Income Total 208 202 Ageing of non-impaired receivables Statement of Financial Position 0 - 30 days 30-60 Days 60-90 days Statement of Changes in Taxpayers Equity 90- 180 days over 180 days Total Statement of Cash Flows

2,272 38 0 0 0 2,310

14.4Accounting Finance lease receivables Policies

0 264 26 13 5 308

Page 105 106

107 108 110 111 112 114 116

There are none. Notes to the Accounts

130

15. Other assets There are none.

152

104

154

Trade and other payables

155 153

113

4,856 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 51,975

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 21,245

843 0 2,514 0 0 0 192 1,760 295 0 355 621 1,147 0 0 7,727 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 -434 7,385

625 0 2,998 0 0 16 860 365 271 0 353 451 1,301 0 0 7,240

Public Current Revaluation dividend reserve Total Total capital 31st March 31st March £ 000s £ 000s £ 000s 2012 46,558 21,245 2011 6,881 £ 000s 561 0 £ 000s 938 47,119 21,245 7,819

Early retirement detail included in NHS payables above.

There are none

16.2

NHS payables capital Surplus/(deficit) for the -year Transfers reserves NHSbetween payables - revenue Impairments NHS Payables - Early retirement costs payable within one year Revaluations - property, equipment Amounts due to plant otherand related parties - capital Revaluations intangible assets Amounts due to other related parties - revenue Revaluations - Financial assets- capital Other trade payables Asset disposals Other trade payables - revenue Share of comprehensive income from associates and joint ventures Social Security costs Movements arising from classifying non current assets as Assets Held for Sale VAT payable Fair Value gains/(losses) on Available-for-sale financial investments Other taxes payable Recycling gains/(losses) on Available-for-sale financial investments payables OtherOther recognised gains and losses Accruals Actuarial gains/(losses) on defined benefit pension schemes PDC dividend Public Dividend Capitalpayable received to liabilities held in disposal groups in year PublicReclassified Dividend Capital repaid PublicTotal Dividend Capital written off Other movements in PDC in year Reserves eliminated on dissolution Other reserve movements Taxpayers' Equity at 31 March 2011

Receipts in advance

Taxpayers' Equity at 1 April 2010 - as previously stated Prior period adjustment Taxpayers' Equity at 1 April 2010 - restated

16.1

Total

The TheClatterbridge ClatterbridgeCentre Centrefor forOncology OncologyNHS NHSFoundation FoundationTrust Trust st Accounts Accountsfor forthe theyear yearended ended31 31stMarch March2012 2012

STATEMENT OF CHANGES IN TAXPAYERS EQUITY

Trust 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 434 23,345

0 04,856 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Donated Other Income & Non-current asset reserves expenditure Total Total reserve reserve 31st March 31st March £ 000s £ 000s £ 000s 2012 2,554 0 2011 15,878 £ 000s -2,554 0 £ 000s 2,177 0 0 18,055

156

Current Non-current Total Public Revaluation Donated Total dividend Totalreserve Total asset Total 31st capital 31st 31st reserve 31st March £ 000sMarch £ 000s March£ 000s March£ 000s 46,558 21,2452012 6,881 2,554 2011 2011 2012 0 000s 938 £561 000s £ 000s -2,554 £ 000s £ 0 0 47,119 0 21,245 0 7,819 0 2,904 3,504 3,129 0 4,856 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 366 363 0 0 0 0 0 0 3,270 0 03,867 0 3,129 0 0 £ 000s 0 0 0

Other reserves

Income & expenditure reserve £ 000s 15,878 2,177 18,055

113 154

Surplus/(deficit) for the year 0 4,856 Deferred PFI credits Transfers between reserves 0 0 Lease incentives Impairments 0 0 Net Pension Scheme Liability Revaluations - property, plant and equipment 0 0 Total Revaluations - intangible assets 0 0 Revaluations - Financial assets 0 0 0 0 0 0 Asset disposals 0 0 0 0 0 0 Share of comprehensive income from associates and joint ventures 0 0 0 0 0 0 Movements arising from classifying non current assets as Assets Held for Sale 0 0 0 0 0 0 Fair Value gains/(losses) on Available-for-sale financial investments 0 0 0 0 0 0 Included within deferred income are specific allocations relating to hosted services, research & development and post graduate medical Recycling gains/(losses) on Available-for-sale financial investments 0 0 0 0 0 0 education. Funding is received annually for these services. Deferred income brought forward from the previous 0year is utilised in year Other recognised gains and losses 0 0 0 0 0 andgains/(losses) the annual incomes for the services are deferred if not required Actuarial on defined received benefit pension schemes 0 during the0 current year.0 0 0 0 Public Dividend Capital received 0 0 0 0 0 0 majority of repaid the remaining balance of deferred income relates to training current PublicThe Dividend Capital 0 and project0management; 0 the whole 0of the non 0 0 to project Publicelement Dividendrelates Capital written off management. 0 0 0 0 0 0 Other movements in PDC in year 0 0 0 0 0 0 Reserves eliminated on dissolution 0 0 0 0 0 0 Other reserve movements 0 0 -434 0 0 434 51,975 21,245 7,385 0 0 23,345 Taxpayers' Equity at 31 March 2011

Other Deferred income

Taxpayers' Equity at 1 April 2010 - as previously stated Prior period adjustment Taxpayers' Equity atgrants 1 April income 2010 - restated Deferred

STATEMENT OF CHANGES IN TAXPAYERS EQUITY 17. Other liabilities

TheClatterbridge ClatterbridgeCentre Centrefor forOncology OncologyNHS NHSFoundation FoundationTrust Trust The Accountsfor forthe theyear yearended ended31 31ststMarch March2012 2012 Accounts

157

Fair Value gains/(losses) on Available-for-sale financial investments Recycling gains/(losses) on Available-for-sale financial investments Other recognised gains and losses Actuarial gains/(losses) on defined benefit pension schemes Public Dividend Capital received Public Dividend Capital repaid Public Dividend Capital written off Other movements in PDC in year Reserves eliminated on dissolution Other reserve movements Taxpayers' Equity at 31 March 2011

0 0 0 0 0 0 0 0 0 0 51,975

155

113

Current Total Total Total 31st 31st £ 000s March March 46,558 Taxpayers' Equity at 1 April 2010 - as previously stated 2011 2012 Prior period adjustment 561 £ 000s £ 000s 47,119 Taxpayers' Equity at 1 April 2010 restated Bank overdrafts - Government Banking Service 0 0 Bank overdrafts - Commercial banks 0 0 Surplus/(deficit) for the year 4,856 Drawdown in committed facility 0 0 Transfers between reserves 0 Loans from Foundation Trust Financing Facility 250 250 Impairments 0 Loans from Department Health 0 Revaluations - property, plant and of equipment 00 Other Loans 0 Revaluations - intangible assets 00 Obligations under finance leases 121 107 Revaluations - Financial assets 0 lifecycle replacement received in advance 0 AssetPFI disposals 00 Obligations under PFI contracts (excl. lifecycle) 0 Share of comprehensive income from associates and joint ventures 00 Movements 0 371 357 Total arising from classifying non current assets as Assets Held for Sale

STATEMENT OF CHANGES IN TAXPAYERS EQUITY 18. Borrowings

0 0 0 4,250 0 0 0 0 0 190 0 0 0 0 0 0 4,440 0 0 0 0 0 0 0 0 0 0 21,245

0 0 0 4,500 0 0 0 00 305 0 00 0 0 0 4,805 0 0 0 0 0 0 0 0 0 -434 7,385

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Public Non-current Revaluation Donated Total Total dividend reserve asset 31st 31st capital reserve £ 000s £ 000s March March £ 000s 21,245 6,881 2,554 2011 2012 0 938 -2,554 £ 000s £ 000s 21,245 0 7,819 0 0

The Clatterbridge Centre Oncology NHS Foundation Trust The Clatterbridge Centre forfor Oncology NHS Foundation Trust st Accounts year ended 31March March 2012 Accounts forfor thethe year ended 31st 2012

£ 000s

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0

Other reserves

4,856 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 434 23,345

Income & expenditure reserve £ 000s 15,878 2,177 18,055

Prudential borrowing Limit

2011/12 £ 000s

Contents

Total long term borrowing limit set by Monitor Working capital agreed by Monitor Actual (contracted) working capital facility Total prudential borrowing Foreword to the Accountslimit

14,200 4,000 4,000 18,200

Borrowing (as defined in the Prudential Borrowing Statement officer of Code) at 1 Aprilof the Chief Executive's responsibilities as the accounting 5,162 Clatterbridge Centre for Oncology NHS Foundation Trust Net actual borrowing/(repayment) in year (351) Long term borrowing at 31 March 4,811 Statement Directors'atresponsibilities in respect of the Accounts Working capitalofborrowing 1 April Net actual borrowing/(repayment) in year working capital Independent Report the Board Working capital Auditor's borrowing at 31to March

2010/11 £ 000s 13,500 Page4,000 4,000 17,500 105 1065,554 (392) 5,162

107

0 0

108

0 0

The NHS Foundation Trust is required to comply and remain within a prudential borrowing limit. 110 ThisStatement is made upofofComprehensive two elements: Income -

the maximum cumulative amount of long-term borrowing. This is set by reference to the Statement Financial Position four ratiooftests set out in Monitor's Prudential Borrowing Code. The financial risk111 rating set under Monitor's Compliance Framework determines one of the ratios and therefore can impact on the long term borrowing limit; and Statement of Changes in Taxpayers Equity 112 the amount of any working capital facility approved by Monitor.

Cash Flows 114 The Statement Trust has aofprudential borrowing limit of £14.2 million in 2011/12 (2010/11 £13.5 million) and has borrowings of £4.8 million in 2011/12 (2010/11 £5.2 million). The Accounting Trust had a Policies Working Capital Facility of £4 million in place during 2011/12 (2010/11116 £4 million). This complies with the amount approved by Monitor. Notes to the Accounts 130 Further information on the NHS Foundation Trusts' Prudential Borrowing Code and Compliance Framework can be found on the website of Monitor, the Independent Regulator of Foundation Trusts. Financial Ratios Minimum dividend cover Minimum interest cover Minimum debt service cover Maximum debt service to revenue

Actual 8.4 33.9 13.1 0.79%

156

104

158

Approved >1 >3 >2 <2.5%

Actual Approved 7.2 >1 26.5 >3 10.1 >2 0.90% <2.5%

Finance lease obligations

Contents

Gross lease obligations of which liabilities are due:- Not later than one year - later than one year and not later than 5 years - later than 5 years Foreword to the Accounts Finance charges allocated to future periods

2011/12 ÂŁ 000s

2010/11 ÂŁ 000s

387

412

131 256 0 (76)

107 Page 305 0105 0

Net lease Statement ofliabilities the Chief Executive's responsibilities as the accounting311 officer of 412106 - Not later than onefor year 121 107 Clatterbridge Centre Oncology NHS Foundation Trust - later than one year and not later than 5 years 190 305 - later than 5 years 0 0 Statement of Directors' responsibilities in respect of the Accounts 107 21. PFI Obligations Independent Auditor's Report to the Board There are none

108

Statement of Comprehensive Income

110

Statement of Financial Position

111

Statement of Changes in Taxpayers Equity

112

Statement of Cash Flows

114

Accounting Policies

116

Notes to the Accounts

130

104 157

159

160

Provisions for liabilities and charges

0 0 10 0 523 533

0 0 4 4,856 0 0354 0 358

46,558 561 47,119

Total

21,245 0 21,245

Public

Current dividend 2010/11 capital 2011/12 £ 000s £ 000s £000 £000

Reclassified to liabilities held in disposal groups in year Reversed unused Unwinding of discount At 31st March 2012 0 0 0 0

158

113

0 0 0 0

0 0 0 10

0 0 0 0

0 (154) 0 523

(154) 0 533

4,856 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 434 23,345

Income & expenditure reserve £ 000s 15,878 2,177 18,055 0 0 0 0 0 0 0 0 0 Total 0 0 0 0 £ 000s 0 0358 0 0 0358 0 0 0533 0 (204)

Revaluation Donated Other reserveNon-current asset reserves 2010/11 2011/12 reserve £ 000s £ 000s £000 £ 000s £000 6,881 2,554 0 938 0 -2,554 0 0 7,819 0 0 0 0

Surplus/(deficit) for the year 0 0 0 0 0 Redundancy TransfersOther between reserves 0 0 0 *** 0 0 Impairments 0 0 0 0 Total 0 Revaluations - property, plant and equipment 0 0 0 0 Revaluations - intangible assets 0 0 0 0 Revaluations - Financial assets 0 0 0 0 *** Other includes provisions for expenditure that the Trust is committed to but the final value is not yet known with 100% certainty AssetThis disposals 0 0 0 0 expenditure does not fall into any of the other categories above. Share of comprehensive income from associates and joint ventures 0 0 0 0 Movements arising from classifying non current assets as Assets Held for Sale 0 0 0 0 Pensions Pensions Other Redundancy Other Fair Value gains/(losses) on Available-for-sale financial investments 0 0 0 0 relating to relating to0 Legal 0 Recycling gains/(losses) on Available-for-sale financial investments 0 0 former other staff0 claims 0 Other recognised gains and losses 0 0 directors Actuarial gains/(losses) on defined benefit pension schemes 0 0 0 0 £ 000s £ 000s 0 £ 000s 0 £ 000s 0 £ 000s0 Public Dividend Capital received 1st April 2011repaid 0 40 354 PublicAtDividend Capital 00 00 0 period adjustments 0 00 PublicPrior Dividend Capital written off 00 00 0 0 OtherAt movements PDC inas year 00 00 0 0 40 354 1st Aprilin2011, restated Reserves eliminated dissolution 00 00 0 0 Change in theondiscount rate 0 00 OtherArising reserve during movements 00 -4340 0 the year 0 10 0 523 51,975 21,245 7,385 0 Taxpayers' Equity at 31 March 2011 Utilised during the year 0 0 (4) 0 (200)

Other legal claims

Taxpayers' Equity at 1 April 2010 - as previously stated Prior period adjustment Pensions relating to former directors Taxpayers' Equity at 1 April 2010 - restated Pensions relating to other staff

22.

STATEMENT OF CHANGES IN TAXPAYERS EQUITY

The Clatterbridge Centre for Oncology NHS Foundation Trust The Clatterbridge Centre for Oncology stNHS Foundation Trust Accounts for the year ended 31 stMarch 2012 Accounts for the year ended 31 March 2012

161

0 0 0

£ 000s 46,5580 5610 47,1190

£ 000s 6,881 0 938 0 7,819 0

reserve

Donated Other Income & asset reserves expenditure reserve reserve £ 000s £ 000s £ 000s 2,554 0 15,878 523 533 -2,5540 0 0 2,177 00 0 0 18,055

159

113

Surplus/(deficit) 4,8560 0 0 4,856 0 100 00 523 533 Total for the year Transfers between reserves 0 0 0 0 0 0 Impairments 0 0 0 0 0 0 Legal claims consist of amounts The values Revaluations - property, plant and equipmentdue as a result of third party and employee 0 liability claims. 0 0 are based0 on information 0 0 provided by the NHS Revaluations - intangible assetsLitigation Authority. 0 0 0 0 0 0 Revaluations - Financial assets 0 0 0 0 0 0 Centre for Oncology NHS Foundation Trust is a member of the Authority negligence AssetClatterbridge disposals 0 NHS Litigation 0 0 (NHSLA) clinical 0 0 0 Sharescheme. of comprehensive income from associates and joint ventures 0 0 0 0 0 0 Movements arising from classifying non current assets as Assets Held for Sale 0 0 0 0 0 0 Fair Value gains/(losses) on Available-for-sale financial investments 0 NHSLA, consequently 0 0 Trust will 0have no provision 0 0 All clinical negligence claims are therefore recognised in the accounts of the the for Recycling gains/(losses) on Available-for-sale financial investments 0 0 0 0 0 0 such claims. The NHS Litigation Authority is carrying provisions as at 31st March 2012 in relation to ELS of £nil (2010/11 £nil) and in Otherrelation recognised gains and 0 0 0 0 0 to CNST of losses £120,000 (2010/11 £nil) making a total of £120,000 (2010/11 £nil) 0 Actuarial gains/(losses) on defined benefit pension schemes 0 0 0 0 0 0 Public Dividend Capital received 0 0 0 0 0 0 Public Dividend Capital repaid 0 0 0 0 0 0 Public Dividend Capital written off 0 0 0 0 0 0 Other movements in PDC in year 0 0 0 0 0 0 Reserves eliminated on dissolution 0 0 0 0 0 0 Other reserve movements 0 0 -434 0 0 434 51,975 21,245 7,385 0 0 23,345 Taxpayers' Equity at 31 March 2011

Taxpayers' Equity at 1 April 2010 - as previously stated Within 1 year Prior period 1 - 5 adjustment years Taxpayers' Equity at 1 April 2010 - restated Over 5 years

Expected timing of cashflows:

dividend capital £ 000s 21,245 10 00 21,245 0

The Clatterbridge Centre for Oncology NHS Foundation Trust The Clatterbridge Centre for Oncology Foundation Trust Accounts for the year ended 31stNHS March 2012 Accounts for the year ended 31st March 2012 STATEMENT OF CHANGES IN TAXPAYERS EQUITY 22. Provisions for liabilities and charges (cont.) Total Public Revaluation

162

0 0 0 0 0 0 0 0 0 0 0 51,975

160

113

Revaluation reserve Surplus/(deficit) for the year at 1 April 2011 Prior period adjustment Transfers between reserves Revaluation reserve at 1 April 2011 - restated Impairments At start -ofproperty, period for new Revaluations plant andFT's equipment Impairments Revaluations - intangible assets Revaluations Revaluations - Financial assets AssetTransfers disposals to other reserves disposals income from associates and joint ventures ShareAsset of comprehensive Fair Value gains/(losses) onnon Available-for-sale Movements arising from classifying current assets asfinancial Assets Held for Sale investments 0 Fair Value gains/(losses) on Available-for-sale financial investments Recycling gains/(losses) on Available-for-sale financial Recycling gains/(losses) on Available-for-sale financial investments 0 Otherinvestments recognised gains and losses Other recognised gains and losses 0 Actuarial gains/(losses) on defined benefit pension schemes reserve movements (1) PublicOther Dividend Capital received 6,036 reserve PublicRevaluation Dividend Capital repaidat 31 March 2012 Public Dividend Capital written off Other movements in PDC in year Reserves eliminated on dissolution Other reserve movements Taxpayers' Equity at 31 March 2011

Taxpayers' Equity at 1 April 2010 - as previously stated Prior period adjustment Taxpayers' Equity at 1 April 2010 - restated

Donated

0 0 0 0 0 0 0 0 0 0 0 0

Other

0 0 0 0 0 0 0 0 0 0 0 0

Income &

0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (1) 0 0 (434) 0 6,036 0 7,385 0 0 0 0 0 0 0 -434 21,245 7,385

0 0 0 0

0 0 0 0 0 0 0 (434) 0 7,385 0 0 0 0 434 23,345

2011/12dividend reserve asset 2010/11 reserves expenditure Total reserve Revaluation Revaluation Total Revaluationcapital Revaluation reserve Reserve, Reserve, £ 000s £ 000s £ 000s £ 000s £ 000s £ 000s Revaluation 2,554 Reserve Revaluation 46,558 Reserve Property 21,245 6,881 0 Property 15,878 Plant 561 0 & 938 -2,554 0 Plant & 2,177 Reserve Intangibles Reserve Intangibles Equipment 7,819 47,119 21,245 0 0Equipment18,055 £000 £000 £000 £000 £000 £000 7,385 0 7,385 6,881 0 6,8814,856 4,856 0 0 0 0 0 0 0 938 0 938 0 0 0 0 0 0 7,385 0 0 0 7,819 0 0 0 7,385 0 7,819 0 0 0 0 0 0 0 0 0 0 0 0 0 (1,181) 0 0 0 0 0 0 0 0 (1,181) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (165) 0 (165) 0 0 0 0 0 0 0 0 0 (2) 0 (2) 0 0 0 0 0

The Clatterbridge Centre for Oncology NHS Foundation Trust The Clatterbridge Centre for Oncology Foundation Trust Accounts for the year ended 31stNHS stMarch 2012 Accounts for the year ended 31 March 2012 STATEMENT OF CHANGES IN TAXPAYERS EQUITY 23. Revaluation Reserve Total Public Revaluation

163

Cash and cash equivalents

24,154

17,033

Public Revaluation dividend reserve capital 2010/11 2011/12 £ 000s £ 000s £ 000s £000 £000 46,558 21,245 6,881 561 17,033 0 24,065938 47,119 21,245 (7,032) 7,819 7,121

Total

Donated asset reserve £ 000s 2,554 -2,554 0 £ 000s

0 0 0

Other reserves

Income & expenditure reserve £ 000s 15,878 2,177 18,055

Contingent Assets and Liabilities

113 161

There is no contingent liability relating to the NHSLA Employer liability scheme (£1,000 in 2010/11).

26.

Surplus/(deficit) for the year 4,856 0 0 0 0 4,856 Transfers between reserves 0 0 0 0 0 0 Broken down into: Impairments 0 0 0 0 0 0 Commercial banks and cash in hand 16 0 75 0 Revaluations - property, plant and equipment 0 0 0 0 Cash with Government 24,138 0 16,958 0 Revaluations - intangible assets Banking Service 0 0 0 0 Other Current investments 0 0 0 0 Revaluations - Financial assets 0 0 0 0 24,154 0 17,033 0 and cash equivalents as in statement of financial position Asset Cash disposals 0 0 0 0 overdraft income from associates and joint ventures 0 0 Share Bank of comprehensive 0 0 0 0 0 Movements from classifying non current as Assets Sale 0 0 0 0 24,154 0 17,033 0 Casharising and cash equivalents as inassets statement of Held cashforflows Fair Value gains/(losses) on Available-for-sale financial investments 0 0 0 0 0 0 Recycling gains/(losses) on Available-for-sale financial investments 0 0 0 0 0 0 Other recognised gains and losses 0 0 0 0 0 0 25.1 Contractual Capital Commitments Actuarial gains/(losses) on defined benefit pension schemes 0 0 0 0 0 0 Public Dividend Capital received 0 0 0 0 0 0 Purchase orders for 203k have been raised for medical equipment (a replacement simulator and planning software upgrades) to be Public Dividend Capital repaid 0 0 0 0 0 0 in 2012/13. Publicdelivered Dividend Capital written off 0 0 0 0 0 0 Other movements in PDC in year 0 0 0 0 0 0 25.2 Post Balance Sheet Events Reserves eliminated on dissolution 0 0 0 0 0 0 Other reserve movements 0 0 -434 0 0 434 None.Equity at 31 March 2011 51,975 21,245 7,385 0 0 23,345 Taxpayers'

Balance at 31 March 2012

Taxpayers' Equity at 1 April 2010 - as previously stated Prior period adjustment Balance at 1 April 2011 Taxpayers' Equity April 2010 - restated Net changeatin1year

24.

TheThe Clatterbridge Centre for for Oncology NHS Foundation Trust Clatterbridge Centre Oncology NHS Foundation Trust st st Accounts for for thethe year ended 31 31 March 2012 Accounts year ended March 2012 27.

Related Party Transactions

Contents The Clatterbridge Centre for Oncology NHS Foundation Trust is a public interest body authorised by Monitor, the Independent Regulator for NHS Foundation Trusts. During the year none of the Board Members or members of the key management staff, or Page parties related to them, have undertaken any material transactions with Clatterbridge Centre for Oncology NHStoFoundation Trust. Foreword the Accounts 105 The Register of Interests for the Board of Governors for 2011/12 has been compiled in accordance with of theresponsibilities Constitution ofas Clatterbridge Centre for of Oncology Statement ofthe therequirements Chief Executive's the accounting officer 106 NHS Foundation Trust.Centre for Oncology NHS Foundation Trust Clatterbridge The Department of Health is regarded as a related party. During the year Clatterbridge Centre for Oncology Foundation Trust has had number material transactions with the StatementNHS of Directors' responsibilities in arespect ofof the Accounts 107 Department, and with other entities for which the Department is regarded as the parent Department. Independent Auditor's Report to the Board 108 In addition, the Trust has had a number of material transactions with other Government Departments and other central and local Government bodies. Most of these transactions have beenStatement with HM Revenue & Customs, Health Commission Wales (on behalf of the Welsh of Comprehensive Income 110 Assembly) and National Service Division (on behalf of the Scottish Assembly). The Statement Trust has also receivedPosition revenue payments from the Trusts charitable funds. The 111 of Financial Foundation Trust Board is the Corporate Trustee of the Charity. Statement of Changes in Taxpayers Equity

112

Statement of Cash Flows

114

Accounting Policies

116

Notes to the Accounts

130

104 162

164

165

£ 000s 46,558 561 47,119

Total

Public dividend capital £ 000s 21,245 0 21,245 67,542

8,581

PFI schemes deemed to be off-balance sheet 113

163

There are no PFI schemes deemed to be off-balance sheet (2010/11 - nil).

28.

Total balances with related parties at 31 March

4,197

3,486

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Revaluation 2011/12Donated reserve asset Income Expenditure reserve £000 £000 £ 000s £ 000s 0 0 0 6,881 0 2,554 938 -2,554 7,819 0 947 44

Surplus/(deficit) for the year 4,856 0 0 123 0 Charitable Funds Transfers between reserves / Joint Ventures 0 0 0 0 0 Subsidiaries / Associates Impairments 0 0 0 3,637 12,046 Other Revaluations property, plant and equipment 0 0 0 0 65 NHS Shared Business Services Revaluations - intangible assetswith related parties 0 0 Total value of transactions 72,249 0 20,736 Revaluations - Financial assets 0 0 0 Asset disposals 0 0 0 2011/12 Share of comprehensive income from associates and joint ventures 0 0 Receivables 0 Payables Movements arising from classifying non current assets as Assets Held for Sale 0 0 0 £000 £000 Fair Value gains/(losses) on Available-for-sale financial investments 0 0 0 0 0 Value of balances (other than salary) with board members at 31st March Recycling on than Available-for-sale investments 0 0 0 0 0 Valuegains/(losses) of balances (other salary) with keyfinancial staff members at 31 March OtherValue recognised gains andthan losses 0 0 0 0 of balances (other salary) with related parties in relation to doubtful debts at 31 March 0 Actuarial on defined benefit schemes 0 at 31 March 0 0 0 0 Valuegains/(losses) of balances (other than salary) withpension related parties in respect of doubtful debts written off in year PublicValue Dividend Capital received 0 0 0 of balances with other related parties at 31 March:PublicDepartment Dividend Capital repaid 0 0 0 3 14 of Health PublicOther Dividend Capital written off 0 0 0 3,640 2,450 NHS Bodies OtherCharitable movements in PDC in year 0 0 0 0 0 Funds Reserves eliminated on dissolution 0 0 0 0 0 Subsidiaries / Associates / Joint Ventures OtherOther reserve movements 0 0 554 -434 1,016 51,975 21,245 7,385 Taxpayers' Equity at 31 March 2011 0 6 NHS Shared Business Services

Other NHS Bodies

Taxpayers' at 1 April 2010 as previously stated Value ofEquity transactions with key staff- members Prior Value periodofadjustment transactions with other related parties:Taxpayers' Equity at 1 April 2010 - restated Department of Health

Value of transactions with board members

STATEMENT CHANGES Related partyOF transactions :- IN TAXPAYERS EQUITY

The TheClatterbridge ClatterbridgeCentre Centrefor forOncology OncologyNHS NHSFoundation FoundationTrust Trust st Accounts Accountsfor forthe theyear yearended ended31 31stMarch March2012 2012

2,970

2,998

11,715 0 4,856 0 0 0 7,262 0 44 19,021 0

0 0 02010/11 0 0 0 Receivables Payables 0 £000 0 £000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 42 0 0 0 2,928 2,998 0 0 0 0 0 0 0 0 0 0 0 434 0 0 023,345

64,276 0 0 0 0 527 0 0 0 65,821 0

Other 2010/11 Income & reserves expenditure Income Expenditure reserve £000 £000 £ 000s £ 000s 0 0 0 0 015,878 0 2,177 0 18,055 1,018 0

166

£ 000s 46,558 561 47,119

Total

Public dividend capital £ 000s 21,245 0 21,245

113 164

0 0 0 Total at 31 March 2012 plant and equipment Revaluations - property, 0 0 Revaluations - intangible assets 0 0 NHS Trade and other receivables excluding non financial assets (at 31 March 2011) Revaluations - Financial assets 0 0 Non-NHS Trade and other receivables excluding non financial assets (at 31 March 2011) Asset disposals 0 0 Other of Investments (at 31 March 2011) Share comprehensive income from associates and joint ventures 0 0 Other Financial Assets (atclassifying 31 March 2011) Movements arising from non current assets as Assets Held for Sale 0 0 NonValue current assets held foron sale and assets held infinancial disposal investments group excluding non financial assets (at 31 Fair gains/(losses) Available-for-sale 0 March 2011) 0 Cash and gains/(losses) cash equivalentson(atAvailable-for-sale bank and in hand (at 31 March 2011) Recycling financial investments 0 0 Total at 31 March 2011 Other recognised gains and losses 0 0 Actuarial gains/(losses) on defined benefit pension schemes 0 0 Public Dividend Capital received 0 0 Public Dividend Capital repaid 0 0 Public Dividend Capital written off 0 0 Other movements in PDC in year 0 0 Reserves eliminated on dissolution 0 0 Other reserve movements 0 0 51,975 21,245 Taxpayers' Equity at 31 March 2011

Other Investments (at 31 March 2012) Other Financial Assets 31 March 2012) Surplus/(deficit) for the(at year 4,856 Non current assets held for sale and assets held in disposal group excluding non financial assets (at 31 Transfers between reserves 0 March 2012) Cash and cash equivalents at bank and in hand (at 31 March 2012) Impairments 0

Assets as per Statement of Financial Position Taxpayers' Equity at 1 April 2010 - as previously stated NHS Trade and other receivables excluding non financial assets (at 31 March 2012) Prior period adjustment Non-NHS Trade and other receivables excluding Taxpayers' Equity at 1 April 2010 - restatednon financial assets (at 31 March 2012)

STATEMENT OF CHANGES IN TAXPAYERS EQUITY 29.1 Financial assets by category

0 0 0 29,526 0 0 2,970 0 2,715 0 0 0 0 0 0 0 17,033 0 22,718 0 0 0 0 0 0 0 -434 7,385

0 0 0 24,154

0 0 0 0 0 0 0

0 0 0 0

0 4,8560 00 00

2,970 2,715 0 0 0 17,033 22,718

29,526

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0

00 0 00 00 00 00 00 00 00 0 0 0 0 0 0 434 23,345

Donated Other Income & at asset Assets reserves expenditure Loans and Held toreserve Available reserve fair value Total Receivables Through I&E Maturity for sale £ 000s £ 000s £ 000s £ 000s £000 6,881 £000 £000 £000 £000 2,554 0 15,878 2,689 938 2,689-2,554 0 0 0 2,1770 2,6837,819 2,683 0 0 0 0 18,0550

Revaluation reserve

The TheClatterbridge ClatterbridgeCentre Centrefor forOncology OncologyNHS NHSFoundation FoundationTrust Trust Accounts Accountsfor forthe theyear yearended ended31 31ststMarch March2012 2012

167

£ 000s 46,558 561 47,119

Taxpayers' Equity at 1 April 2010 - as previously stated Prior period adjustment Liabilities as per Statement of Financial Taxpayers' Position Equity at 1 April 2010 - restated

165

113

Provisions under contract (at 31 March 2011) Liabilities in disposal groups excluding non-financial assets (at 31 March 2011) Total at 31 March 2011

Surplus/(deficit) for the year 4,856 Borrowings excluding Finance lease and PFI liabilities (at 31 March 2012) Transfers between reserves 0 Obligations under finance leases (at 31 March Impairments 0 2012) Revaluations property, plant and equipment 0 Obligations- under Private Finance Initiative contracts (at 31 March 2012) Revaluations intangible NHS Trade- and other assets payables excluding non financial assets (at 31 March 2012) 0 Revaluations Financial assets 0 Non-NHS Trade and other payables excluding non financial assets (at 31 March 2012) Asset disposals 0 Other financial liabilities (at 31 March Share of comprehensive income from associates and joint ventures 0 2012) Movements classifying current assets as Assets Held for Sale 0 Provisionsarising underfrom contract (at 31non March Fair Value gains/(losses) on Available-for-sale financial investments 0 2012) Recycling gains/(losses) on Available-for-sale financial investments 0 Liabilities in disposal groups excluding non-financial assets (at 31 March 2012) Other recognised gains2012 and losses 0 Total at 31 March Actuarial gains/(losses) on defined benefit pension schemes 0 Public Dividend Capital received 0 Borrowings excluding Finance lease and PFI liabilities (at 31 March 2011) Public Dividend Capital repaid 0 Obligations under finance leases (31 March 2011) Public Dividendunder Capital writtenFinance off 0 Obligations Private Initiative contracts (31 March 2011) Other movements in PDC in year 0 NHS Trade and other payables excluding non financial assets (31 March 2011) Reserves eliminated on dissolution Non-NHS Trade and other payables excluding non financial assets (31 March 2011)0 Other reserve movements 0 Other financial liabilities (31 March 51,975 Taxpayers' Equity at 31 March 2011 2011)

Total

STATEMENT OF CHANGES IN TAXPAYERS EQUITY 29.2 Financial liabilities by category Liabilities

204 0 16,791

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0

0 0 0 0 0

0 0 0

0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Revaluation Donated at Other reserveOther asset reserves reserve Total Financial fair value £ 000s £ 000s Through £ 000s 6,881 2,554 0 Liabilities I&E 938 -2,554 0 0£000 0 £000 7,819 £000

0 0 4,500 4,500 0 0 0 0 311 311 0 0 0 0 0 0 2,514 2,514 0 0 5,213 5,213 0 0 0 0 6,399 6,399 0 0 0 0 75 75 0 0 0 0 0 19,012 0 19,012 0 0 0 0 4,750 4,750 0 0 412 412 0 0 0 0 0 0 2,998 2,998 0 0 4,242 4,242 0 -434 21,245 7,385 4,185 4,185

Public dividend capital £ 000s 21,245 0 21,245

The Clatterbridge Centre Oncology NHS Foundation Trust The Clatterbridge Centre forfor Oncology NHS Foundation Trust st Accounts year ended March 2012 Accounts forfor thethe year ended 31st31March 2012

4,856 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 434 23,345

Income & expenditure reserve £ 000s 15,878 2,177 18,055

Fair Values

Contents Set out below is a comparison, by category, of book values and fair values of the Trust's financial assets and liabilities as at 31st March 2012. Book value £ 000s

Fair value

Page

Foreword to the Accounts £ 000s Fair value of financial assets at 31 March 2012 of the NonStatement current trade andChief otherExecutive's receivablesresponsibilities as the accounting officer of Clatterbridge Centre for Oncology NHS Foundation0 Trust excluding non financial assets 0 Other Investments 0 0 Other 0 0 Statement of Directors' responsibilities in respect of the Accounts 0 0 Total

105

Independent Auditor's Report to the Board Book value £ 000s of Comprehensive FairStatement value of financial liabilities Income at 31 March 2012 Non current trade and other payables Statement of Financial Position excluding non financial liabilities 0 Provisions under contract 0 Loans 4,500 Statement of Changes in Taxpayers Equity Other 0

Fair value

108

4,500

Total Statement of Cash Flows

£ 000s

0 0 4,500 0

106

107

110 111 112 114

30.1Accounting ChangesPolicies in the benefit obligation and fair value of plan assets during the 116 year for amounts recognised in the Statement of Financial Position There are none. Notes to the Accounts 30.2

130

Reconciliation of the present value of the defined benefit obligation and the present value of the plan assets to the assets and liabilities recognised in the balance sheet

There are none. 30.3

Amounts recognised in the Statement of Comprehensive Income

There are none.

104 166

168

Losses and Special Payments Contents

There were 20 cases of losses and special payments totalling £17k paid during 2011/12. (2010/11, 4 cases totalling £52k). There were no cases exceeding £250k in either year. Page Foreword to the Accounts 32. Discontinued operations

105

There are none. Statement of the Chief Executive's responsibilities as the accounting officer of Clatterbridge Centre for Oncology NHS Foundation Trust 33. Corporation tax

106

Statement responsibilities in respect of the Accounts There areofnoDirectors' surpluses subject to corporation tax.

107

Independent Report to the Board 34. OtherAuditor's Financial Assets

108

There are none. Statement of Comprehensive Income

110

35. Other Financial Liabilities Statement of Financial Position There are none.

111

Statement of Changes in Taxpayers Equity

112

Statement of Cash Flows

114

Accounting Policies

116

Notes to the Accounts

130

167 104

169

170

NHS receivables

Other receivables

Current

2,689

661

900 0 0

0 469 206 661

Amounts due to other related parties

Accruals and deferred income

Other payables

Non-current

Total

VAT, SS and other taxes payable

NHS payables

Current

14,126

3,129

650

1,933

0 10,962

0 0

0 3,129

Surplus/(deficit) forProvision the year (208) 0 Current for impaired receivables (208) Transfers between reserves 101 0 Current PDC dividend receivable 101 Impairments 0 0 Current VAT, SS and other taxes receivable 204 Revaluations - property, plant and equipment 0 0 Non-current NHS Receivables 0 Revaluations - intangible assets 0 0 Non-current Other receivables with related parties 0 Revaluations - Financial assets 0 0 Non-current Prepayments 0 AssetNon-current disposals Accrued income 0 0 0 ShareNon-current of comprehensive income from associates and joint ventures 0 0 Other receivables 0 Movements arisingTotal from classifying non current assets as Assets Held for Sale 1,101 5,372 1,229 Fair Value gains/(losses) on Available-for-sale financial investments Recycling gains/(losses) on Available-for-sale financial investments Non-WGA Other recognised gains and losses Payables Total FTs amounts Actuarial gains/(losses) on defined benefit pension schemes Public Dividend Capital received £000 £000 £000 Public Dividend Capital repaid 0 1933 Current NHS payables 2,514 Public Dividend Capital written off 0 0 Current Amounts due to other related parties 0 Other movements in PDC in year 4,051 0 Current Accruals and deferred income 4,051 Reserves eliminated on dissolution 2,939 0 Current Other payables 2,939 Other reserve movements 843 0 Current Receipts in advance 843 Taxpayers' Equity at 31 March 2011 0 0

£000

FTs £000 201

£000

Total

Taxpayers' EquityOther at 1receivables April 2010 - as previously stated 350 Current with related parties Prior period adjustment Current Prepayments 1,369 Taxpayers' at 1 April 2010 - restated Current Equity Accrued income 206

Current

Receivables

Non-WGA amounts

36.1 Information for WGA - Balances STATEMENT OF CHANGES IN TAXPAYERS EQUITY

113 168

389

46,558 0 0561 47,119 0

4,856 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 46 0 0 NHS 0 Trusts 0 0 £000 0 389 0 0 0 0 0 0 0 0 51,975 0

£000 000s 46

Trusts

NHS Total

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 129 3 0 0 Department 0 SHAs of Health 0 0 £000 £000 0 14 8 0 0 0 0 0 0 0 0 0 0 0 0 21,245 0 0 0

capital £000 £ 000s 3 129 21,245 0 0 0 0 0 21,245 0 0

£000

reserve£000 £000 £ 000s 0 0 £ 000s 0 0 2,554 0 -2,554 0 0 0 0 0 0 0

£000

150

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,310 0 0 0 Special 0 Health PCTs Authorities 0 0 £000 £000 0 20 150 0 0 0 0 0 0 0 0 0 -434 0 0 7,385 0 0 0

6,881 0 0 938 7,819 0

£000 £ 2310 000s

reserve £000 £ 000s 0 15,878 350 2,177 0 18,055 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NDPBs 0and Skipton 0 Fund 0 £000 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Local 0 Government 0 0 £000 0 0 0 0 0 0 0 0 0 0 0 0

650

4,856 0 0 0 0 204 0 0 0 0 0 0 0 0 0 0 0 554 0 0 Central 0 Government 0 0 £000 0 0 0 0 0 0 0 0 434 0 23,345 650

NDPBs Special and Other Local Income Central Department Public SHAsRevaluation Donated & PCTs Health Government Government of Health dividend reserve Authorities assetSkipton reserves expenditure Fund

TheClatterbridge ClatterbridgeCentre Centrefor forOncology OncologyNHS NHSFoundation FoundationTrust Trust The Accountsfor forthe theyear yearended ended31 31ststMarch March2012 2012 Accounts

171

63,849

639

£000

Non-WGA amounts

6,050

428

£000

FTs

Total

70,872

57,219

Surplus/(deficit) for the year Income from activities - Other 2,439 7 Transfers between reserves Research and development 2,323 316 3 Impairments Education and training 1,467 244 15 Revaluations - property, plant and equipment Income Other 4,151 3,116 62 Revaluations - intangible assets Total 75,296 4,322 508 Revaluations - Financial assets Asset disposals Share of comprehensive income from associates and joint ventures Movements arising from classifying non current assets as Assets Held for Sale Non-WGA Total FTs amounts Fair Value gains/(losses) on Available-for-sale financial investments Expenditure Recycling gains/(losses) on Available-for-sale financial investments £000 £000 £000 Other recognised gains and losses Services from NHS Foundation Trusts 5,278 5,278 Actuarial gains/(losses) on defined benefit pension schemes Services from NHS Trusts 2,066 Public Dividend Capital received fromCapital PCTs repaid 0 PublicServices Dividend Services from other NHS Bodies 3 Public Dividend Capital written off Expenses - Staffin year 31,194 26,080 219 OtherEmployee movements in PDC Drug costs 18,586 18,290 200 Reserves eliminated on dissolution Supplies and services clinical (excluding drug costs) 2,931 2,887 41 Other reserve movements Expenditure Other 10,814 9,962 312 Taxpayers' Equity at 31 March 2011

Income from activities - Private Patients

Income from activities - Primary Care Trusts

£000 Taxpayers' Equity at 1 April 2010 - as previously stated Income from activites Inter NHS Foundation Trusts 428 Prior period adjustment Income from activities - NHS Trusts 0 Taxpayers' Equity at 1 April 2010 - restated

Income

Total

STATEMENT OF CHANGES IN TAXPAYERS EQUITY 36.2 Information for WGA - Income and Expenditure

169

113

2,201

4,856 0 550 0 947 14 0 0 107 0 0 671 947 0 0 0 0 NHS Department Trusts of0Health 0 £000 £000 0 0 2,066 0 0 0 0 7 0 0 48 0 44 3 0 0 77 51,975 0 3

176

0 0 483 0 24 1,184 2 0 144 620 0 1,811 064,495 0 0 0 SHAs PCTs 0 0 £000 0 £000 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0 0 176 21,245

63,849

151

0 0 0 0 0 0 0 57 0 57 0 0 Special 0 Health 0 Authorities 0 £0000 0 0 0 0 0 0 0 0 0 -434 0 7,385151

£000

NDPBs and Skipton Fund

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Public Revaluation Donated NDPBs Special dividend reserve asset and NHS Department SHAs PCTs Health Skipton Trusts of Health capital Authorities reserve Fund £ 000s £ 000s £ 000s £ 000s £000 46,558 £000 £000 £000 £000 21,245 £000 6,881 2,554 561 0 938 -2,554 0 47,119 21,245 7,819 0

Total

132

0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 Local Government 0 0 £000 0 0 0 0 0 00 00 00 132 0

£000

£ 000s

Government

Other reserves Local

4,896

4,856 0 0 0 8 0 45 0 2,485 0 0 0 0 Central Government 0 0 £000 0 0 0 0 0 4,888 0 4 0 0434 4 23,345 2,432

Income & expenditure Central Government reserve £ 000s £000 15,878 2,177 18,055

Financial Instruments

Contents IFRS 7, IAS 32 and 39, Accounting for Derivatives and Other Financial Instruments, requires disclosure of the role that financial instruments have had during the period in creating or changing the risks an entity faces in undertaking its activities. Clatterbridge Centre for Oncology NHS Foundation Trust actively seeks to minimise its financial risks. In line Page with this policy, the Trust neither buys nor sells financial instruments. Financial assets and liabilities are generated by day-to-day operational activities rather than being held to change the risks Foreword to the Accounts 105facing the Trust in undertaking its activities. As allowed by IFRS IAS 32 and 39 debtors and creditors that are due to mature Statement of the7,Chief Executive's responsibilities as the accounting officer of or become 106 payable within 12Centre monthsforfrom the balance sheet date have Clatterbridge Oncology NHS Foundation Trustbeen omitted from all disclosures other than the currency profile. Liquidity risk of Directors' responsibilities in respect of the Accounts Statement

107

The Trust's income is negotiated under agency purchase contracts with local Primary Care Trusts, which are Auditor's financed Report from resources voted annually by Parliament. The Trust receives Independent to the Board 108 such contract income in accordance with Payment by Results (PBR), which is intended to match the income received in year to the activity delivered in that year by reference to a National / LocalofTariff unit cost. The Trust receives cash each month based on an annually Statement Comprehensive Income 110 agreed level of contract activity and there are periodic corrections made to adjust for the actual income due under the contract. The Trust's activity has remained broadly ahead of plan during 2011/12, whichofhas minimised any risk to its main source of income. Statement Financial Position 111 The Trust presently finances most of its capital expenditure from internally generated funds. In 2009/10 the Trust borrowedinÂŁ5 million from the Department of Health Financing Facility Statement of Changes Taxpayers Equity 112 specifically to finance part of the construction of the new Radiotherapy Centre at Aintree. Interest rate risk Statement of Cash Flows

114

The only asset or liability subject to fluctuation of interest rates is cash holdings at the Government banking service and at a UK High street bank. The ÂŁ5 million loan from the Accounting Policies 116 Department of Health Financing Facility has been taken on a fixed rate basis to avoid any risk from interest rate fluctuations. Clatterbridge Centre for Oncology NHS Foundation Trust is not, therefore, to significant interest rate risk. Notes 29.1 and 29.2 show the interest Notes exposed to the Accounts 130 rate profiles of the Trust's financial assets and liabilities. Foreign currency risk The Trust has negligible foreign currency income, expenditure, assets or liabilities. Credit Risk The Trust has considered credit risk under IFRS 7, and concluded that this note is not applicable to the Trust.

104 170

172

The Clatterbridge Centre Oncology NHS Foundation Trust The Clatterbridge Centre forfor Oncology NHS Foundation Trust st st Accounts year ended March 2012 Accounts forfor thethe year ended 3131March 2012 38.

Auditors Liability

39.

Third Party Assets

Contents The auditor’s liability for losses in connection with the external audit is limited to £1,000,000. Page

The Trusttoheld £nil cash at bank and in hand at 31st March 2012 (31st March 2011 Foreword the Accounts 105£nil) which relates to monies held by Trust on behalf of patients. Statement of the Chief Executive's responsibilities as the accounting officer of Clatterbridge Centre for Oncology NHS Foundation Trust

106

Statement of Directors' responsibilities in respect of the Accounts

107

Independent Auditor's Report to the Board

108

Statement of Comprehensive Income

110

Statement of Financial Position

111

Statement of Changes in Taxpayers Equity

112

Statement of Cash Flows

114

Accounting Policies

116

Notes to the Accounts

130

104 171

173

Clatterbridge Centre for Oncology NHS Foundation Trust Clatterbridge Road Bebington, Wirral CH63 4JY Telephone. 0151 334 1155 www.clatterbridgecc.nhs.uk

Large Print and Braille versions or translations available on request.