Annual Report 2008/09 by The Clatterbridge Cancer Centre

The Centre

for cancer care 2008/09

Annual Report AND ACCOUNTS

2008/09

Annual Report AND ACCOUNTS Presented to Parliament pursuant to Schedule 7, paragraph 25(4) of the National Health Act 2006.

Contents Annual Report Chairman’s Statement Directors’ Report Operating & Financial Review (OFR) Patient Care Developing our services Governance

5 7 8 12 15 19

Quality Report Quality Strategy priorities Priorities and initiatives for 2009/10 Quality Overview

36 38 40

Annual Accounts Foreward to the Accounts Statement of accounting officer’s responsibilities Statement of Directors’ responsibilities Independent Auditors Report Statement of Internal Control Notes to the Accounts Remuneration Report

45 46 47 48 50 64 70

Introduction Chairman’s Statement Reaching the end of the financial year 2008/09 is an opportune time to reflect on the work of the Trust during the course of the year. I am pleased to report that Clatterbridge Centre for Oncology (CCO) continues to provide the highest quality clinical care possible and in recognition of this the Healthcare Commission has awarded the Trust its ‘excellent’ rating for both the quality of services and for the use of resources; the two areas it inspects for the year 2007/08 and we are confident that we will receive a similarly high rating for 2008/09. In addition, the Foundation Trust Regulator has awarded the organisation the highest ratings possible for the two key issues he monitors ie governance and finance. CCO is achieving all the required NHS targets including 62 day waiting time target (urgent referral to treatment for all cancers) and the 18 week waiting time target (point of initial referral up to the start of any treatment). Infection control continues to present particular difficulties for this Centre because virtually all our patients are referred from other hospitals but I am pleased to report that MRSA bacteraemia infections have remained at zero throughout the year. Furthermore, the Trust has achieved a strong balance sheet with a surplus of £4.45m, which has enabled us to develop a £3m investment programme to upgrade facilities and services at the centre. In December 2008 Cherie Blair, who has agreed to champion our fundraising appeal, officially opened the new Out-Patient Department. The first completed phase of the investment plan. The new department includes state-of-the-art clinic rooms and patient waiting areas. A conservatory has also been built out into a landscaped water garden as an extension to the patient waiting area. The conservatory was funded by the Melanie Beattie Appeal, for which we are most grateful. Construction work has now started on the second phase to completely remodel Sulby Ward to include more single room and en-suite facilities and the development of a dedicated Teenage and Young Adult Unit. This four-bedded facility, which is on schedule to be completed by the end of July 2009, will accommodate patients aged 16-24 years, offering privacy and independence - as well as additional space for overnight stays by family members. The Centre is working in partnership with the Teenage Cancer Trust on the project. We pride ourselves on leading the way when it comes to technological advances in modern radiotherapy treatments and it is a core value of the Trust to ‘put patients first’. In December we became the first cancer facility in the UK to offer patients a revolutionary radiotherapy treatment known as Rapidarc. The treatment significantly reduces patient treatment times. We are also the only Trust in the UK to provide low energy proton treatments for eye cancers. New forms of proton treatment are now available to deal with other types of tumours and we are currently in discussion with the Department of Health seeking to negotiate a financial

arrangement to provide and operate a very expensive proton treatment machine which will enable CCO to be the first Centre in the UK to provide these types of treatment. Proton therapy has significant benefits particularly for children and young people. One of the key drivers for the Trust Board has been to try and deliver our services as near as possible to the patient. We already have seven chemotherapy clinics located in acute hospitals throughout Cheshire and Merseyside but all our radiotherapy is undertaken at the Clatterbridge site. With this in mind we will in the near future commence building a Satellite Radiotherapy Centre ‘Clatterbridge Cancer Centre – Liverpool’ on the Walton/Aintree Hospital site in North Liverpool. The cost of the project will be met by the Trust with the help of charitable funds. Our colleagues from the Marina Dalglish Appeal are working hard to raise a significant proportion of the money required to ensure that this facility opens at the end of 2010. Needless to say we are most grateful for all their hard work. Clearly 2008/09 has been a productive year for the Trust. I am confident that with the support of our Governors and Members and the commitment and hard work of our Staff 2009/10 will prove to be equally demanding and successful.

Alan White - Chairman, Clatterbridge Centre for Oncology NHS Foundation Trust

Directors’ Report Background Information Clatterbridge Centre for Oncology was licensed as a Foundation Trust from 1st August 2006. Our vision as an NHS Foundation Trust is to provide ‘world class cancer care.’ Fundamental to our success in achieving our vision has been our focus on delivering our strategic objectives. These are: x x x x

To be the provider of choice for non-surgical (solid tumour) cancer services to the population of Cheshire and Merseyside. This is our core service. To develop key partnerships that will further strengthen core business To remain the employer of choice for staff both within the local, general employment market, and nationally for staff with specific expertise in cancer services To become an organisation that is fully responsive and accountable to its membership

Trust profile Clatterbridge Centre for Oncology is one of the largest cancer centres in the UK – registering over 8,300 new patients each year and providing more than 131,000 attendances for treatment. In addition to the facilities provided on the main Clatterbridge site, many of our outpatient and treatment clinics are run in the surrounding general hospitals of Merseyside, Cheshire and the Isle of Man where we serve a population of 2.3 million. We employ over 650 staff and volunteers and spend approximately £56m per year on all aspects of cancer treatment, diagnosis and care. The cancer centre is located on the Clatterbridge Hospital site in Bebington, Wirral. Within the centre we provide a range of radiotherapy and chemotherapy treatments in out-patient and in-patient settings. We also provide out-patient consultations and support services. 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. Research and development, including participation in national and international clinical trials, is an important feature of the cancer centre.

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

Outcome

Planned income & expenditure surplus of £1.98m Earnings Before Interest, Tax, Depreciation and Amortisation (EBITDA) of £5.88m I&E surplus margin of 3.4% EBITDA margin of 10.1% Return of Assets employed of 7.8% Liquid ratio of 92.8 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 5. (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 £12.7m Private Patient Income Cap: Under the terms of authorisation as a Foundation Trust private patient income must not exceed 2.2% of total clinical income

Achieved actual surplus of £4.45m Achieved actual EBITDA of £8.44m Achieved margin of 8.0% Achieved margin of 13.8% Achieved return of 15.0% Achieved ratio of 88.1 days Achieved Financial Risk Rating of 5.

CCO has not taken out any loans in 2008/09, therefore net debt is nil. The Trust is within the PBL. Private Patient income of £0.27m represents approximate 0.5% of total Trust clinical income. Therefore the Trust has remained within the Private Patient Income Cap.

It should be noted that the additional recurrent surplus generated in 2008/09 provides the opportunity to meet the additional running costs of the new radiotherapy treatment facility, the Clatterbridge Cancer Centre Liverpool, adjacent to the Walton Centre in North Liverpool. The surplus also helps generate cash balances to make a significant contribution to the capital cost of the investment. Once the facility is operational (towards the end of 2010) the Trust’s revenue surplus and cash balances will fall significantly but to sustainable levels. Key Financial Risks Each year the Trust faces a number of short-term financial risks that are considered and addressed in the annual financial planning round. The majority (89%) 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. Approximately 23% of the Trust’s clinical income is 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, largely because most of the costs it incurs are fixed or semi-fixed for its foreseeable activity levels. However the Trust is able to mitigate in part against this risk by: x x x x

Employing contract tolerances to reduce in-year income volatility Agreeing local tariffs with commissioners for 77% of clinical income that are not, therefore, subject to the same degree of price volatility as the nationally determined tariffs within Payment by Results. Agreeing cancer drug developments to ensure drug funding based on actual drug usage. Setting a prudent level of financial reserves and maintaining strong levels of liquidity

Another key financial risk is the delivery of the Trustâ&#x20AC;&#x2122;s cost improvement programme (CIP) and improvements in unit efficiency. However the target was achieved in 2008/09 and 75% of the 2009/10 programme has been identified. In addition to the above, there are also a number of medium term risks that need to be kept under review, with appropriate action plans being developed and executed to manage any adverse consequences. It is becoming increasingly clear that the difficult economic outlook and the consequences for NHS funding, in particular beyond 2010/11, will pose a significant challenge to the Trust and its Commissioners as it seeks to deliver more and higher quality treatments in the future. The Trust will increase its efforts to deliver continuous improvements in its efficiency. The risk is increased to the extent that a significant part of the financial headroom will be removed due to the trustâ&#x20AC;&#x2122;s commitment in respect of the development of the Clatterbridge Cancer Centre Liverpool described above. Finally the policy direction of the Department of Health is to widen the scope of activity subject to national rather than local tariffs. Although it is unlikely that tariffs will be set for radiotherapy and the majority of chemotherapy before 2011/12 this may be a source of future income volatility. Activity As noted above, the majority of the Trustâ&#x20AC;&#x2122;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 2008/09 the Trust has continued to experience steady growth for most of its services, with the exception of Proton Therapy. However the latter is a national service providing complex treatment for specific rare tumours and activity is difficult to predict for low volume services (actual activity of 600 attends equates to circa 100 patients, or 8 a month, whereas the plan was for 10 patients a month).

Activity Chemotherapy attends Radiotherapy attends Proton therapy attends In-patient spells Out-patient consultations

2008/09 Actual

2008/09 Plan

% Variance

% Growth Forecast 2009/10

29,670 98,945 600 4,723 56,418

27,869 98,686 729 4,570 53,378

6.5% 2.6% -17.7% 3.3% 5.7%

3% 1.5% 0% 1% 1%

Forecast growth is related to the increase in estimated numbers of our catchment population that are over 50 years of age, and is based on the same assumptions that underpin the Trust’s 5 year Service Development Strategy and 3 year Forward Plan. 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 11% 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 just under £2 million in new and replacement capital equipment and building refurbishment in 2008/09. The main schemes were: x

£0.9m for Clatterbridge Cancer Centre – Liverpool. As noted under Post Balance Sheet Events above the total cost of this scheme is forecast to be £17.5m, and the new Centre is expected to open in December 2010. It will increase the Trust’s capacity to deliver radiotherapy treatments to meet increasing forecast demand as well as providing access to services closer to a significant proportion of the Trust’s population.

£0.5m to improve outpatient facilities, increase accommodation and maintain the good physical condition of the Trust’s estate.

£0.2m commencing works for Sulby ward refurbishment. The Trust is committed to spend a further £1.25m in 2009/10 to complete the project, which includes the construction of a dedicated Teenage and Young Adult unit (see note 20 in the Trust’s Annual Accounts).

£0.2m to replace a Cobalt source for Cobalt treatment machine.

All of the above 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. In addition to completing the Sulby / Teenage & Young Adult Unit and continuing with the Clatterbridge Cancer Centre – Liverpool, the Trust is planning further capital expenditure in 2009/10 to commence the next phase of the ward refurbishment programme, and continue with its on-going equipment replacement programme. Capital investment will be made to enable the expansion of the stereotactic radio-surgery service in partnership with the Walton

Centre for Neurology & Neurosurgery NHS Trust. A number of projects are also planned to improve Information Management and Technology services and systems at the Trust. In the longer term the Trust’s plans for capital investments include: x x x

x x

Refurbish the remaining wards on the Clatterbridge site Rationalise the estate to reduce the number of modular buildings , improve storage & office capacity To evaluate the case for a second radiotherapy treatment centre in Liverpool, in conjunction with the Cancer Network, commissioners and the Royal Liverpool University & Broadgreen Hospitals NHS Trust. This may take the form of a Trust response to a tender for radiotherapy services led by Liverpool PCT Working in partnership with the Royal Liverpool University Hospital and the University of Liverpool to develop an Academic Oncology Centre Develop an evaluation of the Trust’s options in respect of providing a high-energy proton therapy service if the Department of Health seek to establish such a facility in England.

Accounting Policies There have been no significant changes to the Trust’s accounting policies from those in 2007/08. A comprehensive list of the accounting policies are included as part of the Annual Accounts. Charitable Funding The Board of CCO are also the Corporate Trustee of Clatterbridge Centre for Oncology Charitable Funds. During 2008/09, £142,949 has been spent by the charity in support of the Foundation Trust. The main areas of expenditure were: x x x x

Contribution to capital - refurbishment of outpatients department £35,000 Research & development - £104,876 Improving patients welfare - £1,110 Improving staff welfare - £1,963

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.

Patient Care Using our freedoms as an NHS Foundation Trust The principle way that the Trust has sought to exploit the opportunities afforded to it as a Foundation Trust is through the development of its plans to build a satellite radiotherapy unit adjacent to the Walton Centre for Neurology & Neurosurgery NHS Trust on the Aintree Hospital campus in North Liverpool. The proposed investment is for the establishment of an ambulatory radiotherapy treatment facility at an estimated capital cost of some ÂŁ17.5m. A decision by the Board to proceed is anticipated in early May 2009. The facility is expected to be operational by the end of 2010. It will provide accessible services to a significant proportion of the Trust's catchment population North of the River Mersey, who currently have to travel to the Wirral. The service will continue to provide high quality treatment services and a patient experience (e.g. adjacent free car parking, pleasant environment) equivalent to that in place at CCO. Foundation Trust freedoms have been critical to the proposal in a number of ways. These include; the ability to generate significant revenue surpluses to finance a significant proportion of the investment and retain the cash generated until it is required and access to the Foundation Trust Financing Facility to obtain a loan. However the most significant issue is the autonomy that the Trust is able to exercise in deciding that this is a high priority investment. Due to the size of the proposed investment relative to the organisation's turnover the Regulator will need to assess the impact on the Trust's Financial Risk Rating. However Monitor will not pass judgement on the service need for the investment. This is a matter for the Board. This degree of oversight/approval processes is in contrast that the Trust would have been subject to before achieving FT status. Performance against key targets 2008/09 As of January 1st 2009, the Cancer Reform targets were introduced which changed the reported performance levels for both the 31 day and 62 day cancer waiting times targets, in order to align them with the 18 week pause model. That is, the majority of usable adjustments, such as patient thinking time, time out for patient holidays, medical suspensions, were removed. The impact of this was that reported performance was seen to drop significantly, even though in reality patients were being seen and treated just as quickly as before. Since the target rationales were changed in the last quarter, with as yet no criteria set for the new targets, the following is the performance related to the first three quarters of the year, upon which it is expected that performance achievement will be considered: x x x

All patients who had suspected cancer and were referred urgently by their G.P.â&#x20AC;&#x2122;s were seen within 14 days. 99.8% of patients were treated within 31 days from the time of decision to treat (target threshold 98%). 93.3% of patients were treated within 62 days from the date of urgent GP referral (target threshold 93%).

x x

No patient has waited longer than 6 weeks (target 13 weeks) for Imaging (CT and MRI at CCO). We have had no incidence of a MRSA bacteraemia (our target is no more than 2).

The following is the performance for the full year: x

As at March 2009 97.3% of new admitted patients were seen within 18 weeks from there initial GP referral to being admitted for their treatment, this compares very favourably against the national requirement against this target of 90% . (This measure includes the entire pathway that the patient goes through e.g. outpatients, diagnostic tests and inpatient treatment). For non admitted patients 98.5% of newly referred patients were seen within 18 weeks, again this compares very favourably with the national standard for this target which stands at 95%.

The 62-day cancer waiting time standard The Trust has worked particularly hard to deliver the 62-days Cancer Waiting time standard. This standard is a particular challenge for CCO as a tertiary provider of services. The improvement in performance is evidence of the effective management of the patient pathway and co-operation with secondary care Trusts that make referrals to CCO. The achievement of the 62 day waiting time standard has remained a high priority for the Trust, this target monitors the maximum waiting time for suspicion of cancer patients from the point of urgent GP referral to the start of treatment. Considerable effort has been put in across the Trust in achieving this target, similarly we have worked hard to build effective working relations with partner NHS Trusts who refer patients into the Trust, to help ensure that patients are referred to us as quickly as possible. The table below shows the improvements that have been made against the 62 day target over the first three quarters of the year. Yearly quarter

Trust performance 2007/08

Trust performance 2008/09

Q1 (April â&#x20AC;&#x201C; Jun) Q2 (July â&#x20AC;&#x201C; Sept) Q3 (Oct â&#x20AC;&#x201C; Dec) Q1-Q3

93.3% 95.4% 97.7% N/A

92.64% 90.61% 97.32% 93.31%

Healthcare Commission Assessment and Review Standards for Better Health Declaration 2008/09 The Trust has declared full compliance for all of the core standards.

Healthcare Commission Performance Ratings 2007/08 The Healthcare Commission performance ratings for 2007/08 were published in the autumn of 2008. The ratings are derived from a wide range of indicators and are summarised to a rating on two categories; quality of services and use of resources. Quality of Services:

Excellent

This rating ranks the Trust higher than the average in England. The overall rating is a consolidation of the following areas: Component

Rating

Meeting core standards Existing national targets New national targets

Fully Met Fully met Excellent

The rating for existing national targets reflects the particularly difficult challenge the Trust faced in respect of achieving a maximum waiting time of two months from urgent GP referral to treatment for all cancers. Use of Resources:

Excellent

The Trust achieved the best available ranking which is based on Monitor’s assessment of the Trust’s financial performance for the year. Healthcare Commission inspection: Hygiene Code In September 2008 Trust received a planned inspection from the Healthcare Commission in relation to compliance with the Hygiene Code. Overall the report was positive however a breach was identified against Duty 4: “The trust must provide and maintain a clean and appropriate environment for healthcare”. Immediate steps were taken and all areas were rectified. The Trust was then able to declare full compliance with the Hygiene Code in its application for registration with the care Quality Commission. Independent Risk Management Assessments Achievement of NHSLA level 3 In November 2007 the Trust was successfully assessed against NHSLA level 3 (the highest available) and became the second Trust in the country (not including the pilot Trusts) to gain this level of attainment. The assessment reflects the Trust’s robust risk management systems and processes and the extent to which a risk aware culture is embedded in the organisation. 14

Maintenance of ISO 9001:2000 Standard The ISO 9001:2000 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 2008/09.

Developing our services Radiotherapy Radiotherapy continues to be busy with 9 Linear Accelerators and a cobalt unit all operational. During 2008 CCO was the first UK centre to treat patients using RapidArc which has been installed on one of the Varian Linacs and enables some patients to be treated with a very fast Intensity Modulated Radiotherapy technique significantly reducing the time they have to spend on the treatment couch. The use of this technology is currently being expanded into other anatomical sites. The radiotherapy development on the Walton / Aintree site is progressing with detailed building plans having been developed with multi-disciplinary engagement. The business case having been accepted by the Trust Board in April 2009 is with Monitor for approval and it is anticipated that building works will begin very soon. It is anticipated that a radiotherapy service will commence at the end of 2010. The Therapy Radiography workforce at CCO is currently being re-structured with an emphasis on improving services for patients, the introduction of the 4 tier model and improving career progression for staff. Chemotherapy The Trust is committed to delivering chemotherapy treatments as close as possible to the patient. A significant proportion of the Trustâ&#x20AC;&#x2122;s chemotherapy service is already delivered by CCO from District General Hospitals in the cancer network. However the Trust is committed to building up capacity at these treatment clinics across Cheshire and Merseyside, addressing the tension inherent within the requirement to deliver a uniformly high quality of service whilst at the same time delivering this service as close to patients as possible. In support of enhancing our chemotherapy services, CCO has: x x

Nurse led clinics have been implemented across all clinics and across all major treatment pathways. The new role for Nurse Clinicians has been discussed, and training analysis for such post is underway, this will improve the patient pathway, and reduce pressures on Clinicians

x x x

x x x x x x x

Continued to work with Commissioners to ensure access to evidence based treatment regimes. Appointed to the new post of Chemotherapy Service Manager to lead on the development of the service Begun to implement new Service Level Agreements (SLAs) with our partner organisations to deliver increased treatment capacity, improved patient environment, appropriate staff facilities and support for our doctors and nurses working out-with the CCO centre. New chemotherapy satellite established at Halton, all North Cheshire patients are now treated in this purpose built/modeled unit, enhancing the patient experience. Repatriation of patients to local DGH satellite clinics has taken place, with additional provision planned at the Liverpool Womenâ&#x20AC;&#x2122;s Hospital and at the Liverpool Heart and Chest Hospital. Development of a stand alone Triage Service has commenced Telephone follow up service commenced for all new patients who receive a phone call within 24 hours of receiving first chemotherapy intervention Pre-assessment clinics commenced to reduce waiting times, and to improve communication and information giving to patients prior to chemotherapy. Links have been developed with Christie Hospital, and partnership working and collaboration is progressing well. Posters and presentations have been delivered at a number of events across the region and nationally, and more are planned to continue to raise the profile of CCO.

Diagnostic Imaging Diagnostic Imaging has continued to play a key role in providing a range of services to support the core services of radiotherapy and chemotherapy. Activity levels have generally remained consistent, although a worldwide shortage of radioisotopes between September 2008 and February 2009 resulted in a slight reduction in activity in Nuclear Medicine. Waiting times have consistently reached the national target of less than 6 weeks. A large number of patients taking part in clinical trials have undergone imaging investigations. A PET/ CT scanning service for patients across Cheshire and Merseyside commenced at CCO in April 2008, as part of the national agreement for provision of diagnostic services. Currently, a mobile facility provided by Alliance Medical Ltd (AML) visits once a week, although there are plans to increase the frequency of visits to meet the increasing demand for this service and consideration is being given to improving this service by provision of a static facility in the future. Clinicians across Cheshire and Merseyside have been able to refer their patients for PET/CT scans, which were not available in the North West beforehand. Trust staff have been working closely with AML staff to ensure that the service is well integrated, sharing some Trust patient facilities. It has been well received by patients, as demonstrated by the results of satisfaction surveys carried out by AML. Dr Christopher Romaniuk, one of our Consultant Radiologists plays a key role in the local team providing reporting services. He is also the Administration of Radioactive Substances Advisory Committee (ARSAC) certificate holder for CCO, offering advice and ensuring that safe practices are followed.

The third Consultant radiologist took up post in July 2008. Unfortunately, the full effect of this additional appointment has not been fully felt, as it coincided with additional commitments arising for the existing Consultant radiologists, such as PET/CT reporting. Requirements for the future are currently being considered. An agreement with Wirral Primary Care Trust has for provision of diagnostic imaging services has greatly improved access for patients referred by local General Practitioners and Intermediate Services. This agreement has resulted in some additional income being generated for the Trust. Early availability of diagnostic results has resulted in many more patients being cared for in the primary care setting and others being referred to secondary care, already having had a diagnosis made. Developing our Workforce The Trust has developed an organisational development strategy that set out our approach to issues such as leadership, workforce engagement and other aspects of how we manage and develop our people. Clear goals were outlined within the strategy and progress has been made in a number of areas. Work has continued, and significant progress made, on embedding the core values that have been developed through engagement with our workforce. The values now play a core part in Trust processes and inform decisions made around recruitment, induction, staff awards and internal communication channels. The Trust was selected by the Department of Health as one of five organisations to feature in a promotional DVD on ‘Values led organisations’. The Trust has become a member of the NHS Northwest Leadership Academy and has ensured participation in each development programme launched. We have reviewed and further developed our internally created and managed Key Skills for Managers programme and have now had a total of 68 first and second line management participants. The Trust has also begun a programme of initiatives around employee health & wellbeing, which has seen free health checks, nutritional advice, complementary therapies and a stress awareness campaign. Supporting a strategy to provide managers with the right tools to enable effective management of their people, the Trust successfully implemented the Electronic Staff Record and rapidly completed a subsequent assessment that demonstrated appropriate use of the system. HSJ Awards The Chief Executive and Director of HR travelled to London with 8 other members of the Clatterbridge team on 2nd March to accept the Trust’s place in the HSJ’s Top 100 Healthcare employers list. The list has been compiled to identify the top healthcare providers to work for in the UK and was open to both NHS and independent healthcare providers. Out of the 100 companies short listed for the awards Clatterbridge Centre for Oncology ranked 40th in the overall list.

Service improvements following staff or patient surveys or comments and Healthcare Commission reports 55% of CCO staff responded to the 2008 staff survey, which noted that the Trust scored in the top 20% of all acute specialist trusts nationally in 22 of the 36 key areas. The Trust continually reviews the survey results and implements service improvements accordingly. Such developments have included a review of the Performance & Development Review process (leading to a significantly increased completion rate), the development of a Stress working group and the introduction of trained ‘mentors’ to support anyone who has concerns about unacceptable behavior in the workplace. In the 2008 Healthcare / Care Quality Commission in-patient survey the Trust scored in the top 20% of all acute Trusts nationally in 53 out of the 62 key areas. For 10 areas we scored the top score achieved by any Trust. The Trust will continue to monitor patients experience throughout the year and aim to continually improve on current performance. CCO has also put into place an internal survey where we offer all patients who complete a course of treatment or in-patient stay the opportunity to provide feedback in ‘real time’. Further information on the survey results are contained within the Quality Report. As a result of the information obtained in these surveys we have greatly improved our processes for ensuring that patients and their GPs receive appropriate discharge information, whilst we are aiming to minimise patient waiting times within the departments we have put in place free tea and coffee through our volunteer service to improve the patients experience whilst waiting. We have also increased the availability of our hand and foot massage service to patients in the radiotherapy department and have revised what refreshments are on offer in our coffee bar facilities and have improved the environment in relation to privacy and dignity for radiotherapy patients. Improvements in patient/carer information Throughout 2008/09 we have continued the programme of review of our patient information in order to improve the design and accessibility of information to patients, carers and their families. The Trust has also joined a pilot project facilitated by the Merseyside and Cheshire Cancer Network to implement the national Cancer Patient Information Pathways: a project led by the National Cancer Action Team in conjunction with Macmillan and CRUK. Complaints handling The Trust continues to have a low number of complaints (11 in 2008/09). 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 Governance 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 roadshows held in public areas of the Trust. A new complaints policy was approved in March 2009 ready for implementation from 1st April 2009.

Partnerships and alliances As a Foundation Trust we recognise the need to continue to develop a broad range of partnerships to support the delivery of our plans. Over the last year we have achieved our plans for evolving partnership arrangements with: x x x

Continued working with the independent sector to deliver PET:CT services Continued partnership with the University of Liverpool to develop an Academic Unit of Oncology and associated research developments. Close working relationships with Aintree University Hospitals NHS FT and The Walton Centre for Neurology and neurosurgery NHS Trust in the development of our plans for a satellite radiotherapy centre.

We have also developed key partnerships to support: x x x

The further implementation of our distributed chemotherapy service model with host provider Trusts Improvement to performance against Cancer Waiting Times targets where we are dependent upon the actions of others. Working in partnership with the teenage Cancer Trust to develop our new Teenage and Young Adults unit.

Governance NHS Foundation Trust Code of Governance The Monitor Foundation Trust Code of Governance includes a code provision (C.2.1 â&#x20AC;&#x153;â&#x20AC;Ś.All [other] Executive Directors should be appointed by a committee of the Chief Executive, the Chairman and Non-Executive Directors and subject to re-appointment at intervals of no more than five years). The Board considered this code provision at its meeting in March 2007 and was informed that with an employment contract of any type, there is only one way to terminate without incurring a financial penalty and that is by following due process, i.e. clear and documented performance management. The financial penalty associated with ending a rolling contract could be significantly higher than a standard contract. The Board therefore agreed that it would not comply with this code provision. All other requirements of the 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 Governorsâ&#x20AC;&#x2122; views are understood and that they receive appropriate support.

The Chief Executive prepares a report with updates on performance, strategic and operational issues for each of the Council of Governors meetings. Both Executive Directors and Non-Executive Directors attend the Council of Governors’ meetings and its committees. In addition to attendance at these meetings, the Board uses opportunities to work with the Governors, as it did at the event held on 27th March which focused on the strategic development of the organisation. The Senior Governor and Chair’s of the Council of Governors meetings have with the Chairman throughout the year to ensure Governors are kept up to date on any developments within the Trust. 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 quarterly in public and fulfils its legal obligations as outlined in the constitution. In addition to Council meetings, there are three Committees – Membership, Communications and Fundraising, Patient Experience and Strategy The Council of Governors has approved its standing orders which includes the development of its sub committees. Each of these committees has identified an Executive and a NonExecutive Director for advise 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.

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

Michael Ashley Trevor Benn (from September 2008) Peter Benson Andrea Chambers MichĂ¨le Christopherson Stuart Clutton (from September 2008) John Cocker (until May 2008) Alan Comyns (from September 2008) Kerry Connon Nicola Cook Reg Cox Mary Doddridge

Elected public Elected public

3 2

Elected public Elected public

Warrington & Halton Wirral, Wales and the rest of England Non Staff Manx Cancer Help Association Sefton Warrington & Halton

Nominated Elected public

John Earis

Nominated

Doug Errington Peter Fearnhead (until August 2008) Deborah Ferns Tom Fisher

Elected staff Elected staff

Denys Floyd June Holland (until August 2008) Joanne Martin (until August 2008) Philip Mayles Ray Murphy

Elected public Elected public

Ruth Murray (until August 2008) Ernie Natrass Gill Oliver*

Elected public

Kate Perkins Cherry Povall (from May 2008) Susan Ramsay

Elected staff Nominated

Kate Smith Margaret Warriner Alistair Watson Hilda Whitfield (until August 2008) Ewan Wilkinson Eleanor Williams (from September 2008)

Elected staff Elected public Nominated Elected public

Elected staff

Elected public Nominated Elected public Elected public

Elected staff Elected public

Elected public Elected staff Nominated

Elected public Elected public

Elected public

Nominated Elected public

*Senior Governor PE Patient Experience ST Strategy

Member of Committee See key

Year Terms ends

2 2

ST PE

2010 2011

3 3 3 2

PE ST PE MCF

2011 2010 2009 2011

Metropolitan Borough of Wirral

2008

Chester, Ellesmere Port & Vale Royal Sefton Macmillan Cancer Support Liverpool Liverpool

MCF

2011

3 3 3 3

3 1 2 3

2010 2009 2009 2010

Aintree University Hospitals NHS Foundation Trust Doctor Non Clinical

ST ST MCF ST, MCF (Chair), Nom

3 1

2 0

PE, ST, Nom

2010 2008

Non Clinical Wirral, Wales and the rest of England St Helens & Knowsley Wirral, Wales and the rest of England Wirral, Wales and the rest of England Other Clinical Cheshire & Merseyside Cancer Network Task Force Chester, Ellesmere Port and Vale Royal Liverpool Chester, Ellesmere Port and Vale Royal Radiographer Metropolitan Borough of Wirral

0 3

MCF PE, Nom

2011 2011

3 1

2 1

MCF PE

2011 2008

3 3

3 2

ST, MCF ST

2010 2009

2008

3 3

2 3

MCF MCF

2010 2009

3 2

2 1

2009 2011

Wirral, Wales and the rest of England Nurse St Helens & Knowsley University of Liverpool Warrington & Halton

2010

3 3 3 1

3 3 1 1

PE (Chair) PE, MCF PE

2009 2010 2009 2008

Liverpool PCT Wirral, Wales and the rest of England

3 2

2 2

ST (Chair) PE

2009 2011

MCF Nom

Meetings held

Meetings attended

2009

2008

Membership, Communication & Fundraising Nomination

We would like to express our thanks to former public Governors Joanne Martin, June Holland, Ruth Murray, Hilda Whitfield, staff Governor Peter Fearnhead and former nominated Governor John Cocker. Each served as a Governor during 2008/09 for a period of time, but they have since resigned from their roles or not been re-elected.

Elections An election process was completed in August 2008 and the outcomes were announced at the Annual Members Meeting on 14th September 2008. In addition to this a further election process was completed in March 2009 for the vacant staff Governor seat – Non Clinical Declaration of Interests A copy of the Register of Interests is available via the Trust website www.ccotrust.nhs.uk, alternatively you can contact Andrea Leather on 0151 482 7799 to request a copy.

Board of Directors Board of Directors’ roles and responsibilities and working arrangements The Board of Directors has responsibility for setting the strategic direction of the Trust and for understanding and managing significant risks. The Board also receives assurance that the Trust is fulfilling its responsibilities including compliance with standards and targets. The Board delegates specific functions to its committees identified within their terms of reference. 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. The Trust recognises that the Board of Directors should provide a portfolio of skills and expertise to reflect the business, patient care and clinical requirements of a high performing and effective organisation. The board members provide a breadth of public and private sector expertise at executive level and provide a mix of gender and age profiles. These requirements are periodically reviewed. Board of Directors – Composition, backgrounds and interests 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 and three elected Governors (A White, T Fisher, D Errington, M Doddridge). 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. The Nominations Committee followed the re-appointment process described in the Trust’s constitution for the re-appointment of Graham Morris in October 2008. These reappointments were approved by the Council of Governors at its meeting in November 2008. The Senior Independent Director – Douglas Buchanan was appointed as such on 5th April 2006.

The Board has reviewed all Non Executive Directors and considers them all to be Independent Directors.

Board Members Alan White – Chairman Re-appointed by the Council of Governors (2nd term of office, 3 years) until November 2010. 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. Darren Hurrell – Chief Executive Darren was appointed as Chief Executive in July 2007. He started his career in the NHS in 1990, prior to this he worked for Newcastle University as well as spending some time living in Canada. He has undertaken a number of managerial posts in the NHS including gaining experience in managing mental health services, community services, acute care and specialist cancer care. He took up the post of Chief Executive in July 2007. Executive Directors Andrew Cannell – Deputy Chief Executive / Director of Finance Andrew was appointed as Director of Finance in July 2003 and the Deputy Chief Executive role from February 2008. He is a IPFA qualified accountant who has worked almost exclusively in the NHS since 1983. Before joining the Trust he worked in a senior role as a “Link Accountant” at the North West Regional Office and Greater Manchester SHA. Prior to that he worked for a number of years as Deputy Director of Finance and then Acting Director of Finance at the Manchester Children’s Hospital NHS Trust. Andrew fulfilled the role of Acting Chief Executive until the commencement of the new substantive Chief Executive, Darren Hurrell, on 30th July 2007. In January 2008 the Board re-established the post of Deputy Chief Executive – Andrew was appointed with affect from 1st February 2008.

Dr David Husband – 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 23

Clatterbridge to train in Clinical Oncology in 1985 and was appointed Consultant in Clinical Oncology in 1992. He is an Honorary Lecturer in the Department of Medicine, University of Liverpool. During a varied career David has worked in some 20 Hospitals. Dawn Jennings – Director of Human Resources (non voting) Dawn joined the Trust in December 2005. She is a graduate of the Chartered Institute of Personnel & Development and has held a variety of Human Resources (HR) posts in both the public and private sector. Immediately prior to taking up this post, Dawn was Associate Director of HR at the Christie Hospital in Manchester. Prior to her NHS experience, Dawn worked within various business areas of the Automobile Association, including Insurance and Retail. Dawn has also held a variety of voluntary posts, including Trustee and Treasurer of a local Pre-school, Secretary of the Mid-Cheshire branch of the National Childbirth Trust and Governor of the Primary school. She is now a Parent Governor at her local high school. Silas Nicholls – Director of Operations & Performance Silas is an experienced general manager with fifteen years of experience in a range of health care management posts both in the NHS and in the private sector. Silas joined the Trust in February 2008 from Bolton Hospitals NHS Trust where he was the Divisional General Manager for Surgery & Anaesthesia. Helen Porter – Director of Nursing & Quality Helen has been a cancer nurse for over 20 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. Non Executive Directors Douglas Buchanan – Vice Chairman, Senior Independent Director Re-appointed by the Council of Governors (3rd term of office, 3 years) until January 2011. Douglas has been a Non-Executive Director since 1995 and was appointed as Vice Chairman in April 2004. He is a retired surgeon whose medical career started in Edinburgh in 1966. He enjoyed a successful 11 years working as a surgeon for the mining industry in Zambia and latterly as their Chief Medical Officer. On return to the UK in 1986, Douglas joined the British Council where in 1990 he was appointed to the post of Director of the Health Work of the Council. During his work at the British Council, Douglas visited 35 countries working with health professionals up to ministerial level. In 1996 he organised a seminar on the UK NHS reforms held at the World Bank in Washington. The UK team included Sir Alan Langlands, the CEO of the NHS and Sir Nigel Crisp, then CEO of the Oxford Radcliffe Hospital. 24

Carol Eastwood Appointed by the Council of Governors (1st term of office, 3 years) until January 2010. In September 2007 Carol retired as a Vice President in Corporate Information Services in AstraZeneca, 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. Louise Martin Re-appointed by the Council of Governors (2nd term of office, 3 years) until November 2010. 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 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. Following his return from America, Graham helped set up a joint venture company Selectusonline Ltd – a procurement consultancy that can harmonise specifications and aggregate volumes within the utilities sector. As an elder and treasurer of Upton by Chester United Reformed Church he also has extensive involvement in charity and community activities, including being on the executive of the local pre-school association. In July 2006 he was elected on to the Finance Committee of the United Reformed Church at a national level. Vicky Tagart Re-appointed by the Council of Governors (2nd term of office, 3 years) until November 2010. After a degree in Biochemistry from Somerville College, Oxford, Vicky gained a Ph.D. in immunology from the University of Bristol. This was followed by two postdoctoral research positions, the first at the Clinical Research Centre, Harrow, Middlesex, and the second at Johns Hopkins University, Baltimore. On return to the UK Vicky joined the UK affiliate of the American pharmaceutical company Eli Lilly. Vicky then moved to the Head Office Personnel Department. In 1991 Vicky took the position of Head of Human Resources with Degussa Ltd., the UK affiliate of a large German chemical company. Since December 2000 she has been a Non-Executive Director. 25

Declaration of Interests The Chairman has no other significant commitments. A copy of the Register of Interests is available via the Trust website www.ccotrust.nhs.uk, alternatively you can contact Andrea Leather on 0151 482 7799 to request a copy. Board meetings & Committees Appropriate Board Roles and Structure The Board has reviewed the Integrated Governance Handbook and has developed an Integrated Governance Development Plan to ensure that the Trust continues to develop and comply with best practice in its governance arrangements. The Board has approved a revised committee structure which reflects this model. The revised structure is: x x x x x x

Monthly Board meetings (all meetings are closed to the public) Quarterly Integrated Governance Committee Audit Committee (5 times per year) Nominations Committee (Ad hoc) Remuneration Committee (Ad hoc) Four â&#x20AC;&#x2DC;task and finishâ&#x20AC;&#x2122; Board committees (IM&T, Research & Development, Vision 2020 and Investment).

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 and Corporate Governance Manual (standing orders and standing financial instructions) and updated to reflect changes in the operating environment and best practice. 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. In 2006, in preparation for Foundation Trust status, the Board commissioned Whitehead Mann consultants to provide an independent assessment of the effectiveness of the Board and of how it functions. It also reported on the roles and experience of individual Board members. The output of this review has been used to inform the Board development programme. Learning Review A learning review has been carried out with the Board. A number of the learning review outcomes that were subsequently agreed at the Board had a direct link to Board development, specifically that we would: x x

take the opportunity to work as a board to develop CCOâ&#x20AC;&#x2122;s long term strategy use the whole board to develop and nurture key external relationships

proactively stimulate and challenge our thinking, using external speakers to assist with this where appropriate.

These recommendations also support principles contained within the Department of Healthâ&#x20AC;&#x2122;s Integrated Governance Handbook, specifically that healthcare boards should work together as whole teams in their development to ensure greater integration and corporacy. The recommendations also support requirements contained within the Monitor Code of Governance to ensure the continuing development of Board Directors.

Audit Committee The Audit Committee â&#x20AC;&#x201C; 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. During this year the Audit Committee undertook the following pieces of work to ensure the effective discharge of its responsibilities: x x x x x x x x

Committee review of the financial statements of exchequer and charitable funds. Review of the findings of the Healthcare Commission in the acute hospitals portfolio. Setting and reviewing progress of the annual internal audit plan using a risk-focused approach, linked to the controls assurance framework. Receiving regular reports from both Internal Audit and External Auditors. Agreeing and reviewing the work of the Trustâ&#x20AC;&#x2122;s counter fraud officer. Undertaking a self assessment of its work and effectiveness, and identifying any training needs. Reviewing and updating its terms of reference. Approving bad debt write offs and contract extensions.

Integrated Governance Committee The role of the Integrated Governance Committee is: x To provide strategic oversight to all areas of governance within the Trust, by giving carefully consideration to the Clinical, Organisational and Performance arrangements in place. x To ensure organisation-wide co-ordination and prioritisation of risk management issues, encouraging and fostering a greater awareness and ownership of Objectives, Risks and Controls. x To oversee on behalf of the Boards, the management of healthcare and organisational risk. During this year the Integrated Governance Committee delivered against its terms of reference in particular focusing on:

x x x x x x x

Maintaining an overview of the strategies within its remit (e.g. Clinical Governance, Risk Management, Patient and Public Involvement, Infection Control) ensuring structures and systems are in place to ensure effective governance and to receive performance reports related to these strategies. Implementing and monitoring the Trusts integrated Governance development plan. Ensuring compliance with Standards for Better Health Receiving assurance that the Trust meets all relevant statutory and regulatory obligations Receiving assurance of the adequacy of systems for quality assurance, managing risk and control of the environment. Ensuring that the Trust has an effective corporate risk register Keeping the Board fully informed of all significant risks which may impact on the Trusts strategic direction and business planning process and to report to the Board on the management of significant risks. Ensuring that the Trust has structures, processes and controls in place to assure and demonstrate the continued quality of its services and to monitor their performance

Remuneration Committee The Remuneration Committee of the Chairman and other Non-Executive Directors, decides the terms and conditions of office including the remuneration and allowances of all the Directors, including pension rights and any compensation payments. The Committee met on 1 occasion, all members were in attendance. 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 2008-09 there were no new Executive Director appointments.

Attendance at Board of Directors and Board Committee meetings For the period 1st April 2008 to 31st March 2009 the Board of Directors held 12 Trust Board meetings which are non public. Board of Directors

Audit

Integrated Governance

Remuneration

Information Management & Technology

Research & Development

Vision 2020

No. of meetings held for 2008/09

Darren Hurrell Andrew Cannell Helen Porter Silas Nicholls David Husband Dawn Jennings (non voting)

11 11 10 12 10 11

EXECUTIVE DIRECTORS 2 3 3 4 2 4

4 4 4 2

2 3 2 3 2 -

3 3 2 3 3 3

Alan White Louise Martin Vicky Tagart Douglas Buchanan Carol Eastwood Graham Morris

12 9 11 11 11 10

5 6 4 6 5

NON EXECUTIVE DIRECTORS 1 3/4 1 3/3 1 3/4 1 1 0/1 1

1/1 1/1 3/3 4/4 2/3

3 3 3 -

1/2 3/3 -

NB. x The Investment Committee was not required to meet during 2008/09. x All meetings were quorate. x *The Non Executive Director membership of these Committees changed in January 2009. Attendance has been shown with the number of meetings held whilst the individual was a member of the relevant Committee.

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 opted in. 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 by email andrea.leather@ccotrust.nhs.uk There is a ‘members only’ section available on the CCO website.

Public Constituency Staff Constituency 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

2008/09 (plan)*

2008/09 (actual)

2009/10 (estimated)

42 136 208 118

48 156 225 120

134 121

137 172

1614

1679

1717

700 681 522 619 599

830 1105 563 668 632

225 across all constituencies

Staff constituency members as of March 31, 2009 totalling 759 Public constituency members as of March 31, 2008 totalling 5477

* The Trust set a target within its Annual Plan to increase its membership by 10% in the Liverpool and Sefton constituencies and under 50’s across all areas. In addition to this, to increase its ethnic minority membership, representative of the Liverpool constituency. As outlined in the table above, the number of public members has continued to grow with 742 new members joining the Trust. A large proportion of our members come from our patient population. The number of public members identified as ‘leaving’ are predominantly due to members dying (131 out of 300) rather than opting to stop being a member. The remaining 169 have been picked up as being members who have moved home without notifying the Trust. Membership strategy The Membership and Communications committee is responsible for reviewing and implementing the Membership Strategy. 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). Staff open forums are held with the Chief Executive to address staff directly when any service changes are proposed (e.g. our plans for a satellite radiotherapy development). In addition the Trust Board engages staff through a visible leadership programme 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.

The Trust is committed to delivering on its single equality scheme and to the development of anti-discriminatory practices and the provision of equal opportunities. Training on equality and diversity is included in the Trust’s mandatory training programme. The Trust Board has participated in equality and diversity training. All new policies are impact assessed for any potential discrimination. The Trust retained it’s ‘Two Ticks’ accreditation, annually reviewing the five commitments and what has been achieved including planning ways to improve our service and letting employees know about our progress on future plans. Clatterbridge Centre for Oncology is committed to Diversity in Employment. We utilise the involvement of an external employment service to assess, evaluate and implement practical support to employees with a declared disability who have requested assistance in the workplace eg. the supply of ergonomic keyboards and assistance with transport to work. The Trust has in place counter fraud policies and a local counter fraud service. The Trust has a joint staff side and management health and safety committee. During 2007/08 this committee has developed a range of health and safety policies and monitors health and safety issues such as slips, trips and falls, advising the Trust on any actions required. Health and safety training is mandatory for all staff and specific additional training has been provided to the Board and to senior managers to ensure that they are aware of their specific responsibilities. The Trust provides a comprehensive occupational health service via a service level agreement with Wirral University Hospital NHS Foundation Trust. Patient and Public Involvement Activity The Trust has contacted all its OSCs in relation to the declaration against Standards for Better Health. The Trust continues to engage widely with its patients, governors, staff, PPI forum with regards to the Satellite Radiotherapy Centre. The Trust has in place a PPI strategy and actively engages with its patients and public through a number of mechanisms. These have included for 2008/09: Working closely with the Council of Governors and its Committees e.g. x x

The Patient Experience Committee has raised funds to furnish the ‘quiet room’ for patients. The Membership and Communications Committee is leading the development of plans to proactively engage with existing members and attract more members. They have also introduced a scheme to link elected governors with a member of staff in a service area of interest – to improve understanding about each other’s roles The Fundraising Committee is supporting the work of the newly established fundraising team at the Centre

A Strategy Committee is reviewing and supporting us in our service development plans.

Encouraging local residents to show their support for its work by registering to become a Foundation Trust member. Members receive regular news updates about the hospital and are invited to take part in consultation plans aimed at improving services. 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 patients 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. The Trust has an active patient Council who regularly undertake specific pieces of focused PPI activity such as surveys, and interviews with patients. This year amongst others they have looked at patient’s perspective around single sex accommodation and refreshment availability. Local Involvement Network (LINk) The Centre has established relationships with the local LINk groups, in particular Liverpool and Wirral and is looking forward to strengthening this relationship as the groups develop. Sickness Absence Data A new attendance management policy and procedure was launched in July 2008. The documents were written in partnership with staffside and the focus on proactive management of attendance rather than retrospectively dealing with sickness absence issues. The trigger points for dealing with frequent and persistent absences were tightened so that problems could be addressed at an earlier stage. The creation of an HR Advisor role, separate from the Medical Staffing Advisor post, has meant that line managers are receiving the support to identify and address sickness absence issues quickly and effectively. Yearly quarter

Trust performance 2008/09

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

4.16% 3.49% 4.61% 4.80% 4.16%

Serious Untoward Incidents During 2008/09 the Trust has had no serious untoward incidents involving data loss or confidentiality breach (required as part of NHS Information Governance rules).

Cost allocation and charging requirements In 2008/09 the Trust has complied with the cost allocation and charging requirements set out in HM Treasury and Office of Public Sector Information Guidance. Remuneration Report The Remuneration Report can be found at note 5.3/1 in the enclosed Trust Accounts for the period 1st April 2008 to 31st March 2009. Remuneration of senior managers See note 5.3/1 in the Annual Accounts Salary See note 5.3/1 in the Annual Accounts Other remuneration See note 5.3/1 in the Annual Accounts Golden hellos See note 5.3/1 in the Annual Accounts Compensation for loss of office See note 5.3/1 in the Annual Accounts Benefits in kind See note 5.3/1 in the Annual Accounts Pension disclosures See note 5.3/2 in the Annual Accounts Statement of accounting officerâ&#x20AC;&#x2122;s responsibilities See page 46 of the Annual Accounts Statement on internal control See page 50 of the Annual Accounts

2008/09

Quality Report

An Introduction from the Chief Executive â&#x20AC;&#x153;This last year the Trust set a new clear direction for the continued improvement of Quality in the management of patient care at CCO. The framework for this has been the development of our first Quality Strategy which the Trust Board approved in July 2008. This Quality Strategy has provided a clear focus in setting out steps to improve Patient Safety, Patient Experience and Patient Outcomes (Clinical effectiveness). Having set out this framework we will be working with all of our staff to embed the range of challenging quality initiatives that we have set ourselves. Quality is at the heart of what all of our staff aim to achieve for patients and I would like to thank our staff for the achievements that we have made this year and for their continuing commitment to deliver quality patient care for the futureâ&#x20AC;?

Andrew Cannell Acting Chief Executive Clatterbridge Centre for Oncology NHS Foundation Trust.

Quality Strategy priorities The Trust’s Quality Strategy, approved by the Board in July 2008, defines three key strategy aims: A. Improving Patient Safety This is divided into two steps: x Identification of avoidable harm x Reduction of avoidable harm B. Improving Patient Experience This is divided into three steps: x Understanding what impacts on the patient experience x Understanding the patient experience x Improving patient reported experience C. Improving patient outcomes (clinical effectiveness) This is divided into three sections: x Understanding our outcomes x Understanding how we compare x Improving our outcomes Priorities and initiatives for 2008/09 The main priorities for 2008/09 agreed within our Quality Strategy were: x Patient safety: Going further to reduce Healthcare Associated Infections x Patient experience: Embedding a ‘real time’ patient survey programme with clear performance metrics x Patient outcomes (clinical effectiveness): Investment in a programme to improve the care of the acutely ill patient Progress against each of these areas is outlined below. Improving Patient Safety A key target for this year was to reduce Healthcare Associated Infections such as MRSA bacteraemia and Clostridium Difficule. Our MRSA bacteraemia rate is the lowest in the country with no attributable cases being reported for 2008/09. We have also achieved the C Diff target with only 7 attributable cases this year against a maximum threshold of 19 cases. Initiatives that we have introduced this year included: i.

Investment in our infection control team with an additional infection control nurse and an increased investment with the provision of an antimicrobial pharmacist.

ii. iii. iv. v.

A proactive hand hygiene campaign - the success of which has been demonstrated in our national patient survey results which for two consecutive years have shown the highest scores for doctors washing their hands. The introduction of MRSA screening for all admissions ahead of the national guidance The introduction of the Productive Ward Review and change of our cleaning products.

Improving Patient Experience At CCO we have set an objective to build on our current high reported levels of patient satisfaction with the aim to provide the best patient experience at what can be a very traumatic time for our patients. Having an understating of what our patients think is key to this. We participate in the national patient survey programme, however, this only provides a picture of a small percentage of our patients. It does however provide a useful benchmark to compare with other organisations including other cancer centres. Initiatives we have introduced this year include the implementation of a Patient Survey Programme. In order to obtain ‘real time’ reporting we introduced a bespoke patient survey which was rolled out to cover all patient departments. The survey programme enables all patients who finish a course of treatment or intervention to complete a simple patient survey form based on the questions contained within the national survey. Results are monitored by the Trust Board monthly and are fed back to departmental heads for information and action. Overall the survey has yielded positive results, however we have set our selves some challenging targets. These include: x

x x x x x

Improving the patient experience to ensure a first-class personalised service in which at least 80% of patients rate as excellent through the national Healthcare Commission Survey when asked ‘Overall, how would you rate the care you received? (the results for 2008/09 show 63.4% report as excellent) At least 80% of patients rate as ‘always’ in the local patient survey programme when asked ‘I was treated with courtesy and respect’ (the overall results for 2008/09 are 98%) At least 80% of patients rate as ‘always’ in the local patient survey programme when asked ‘Was the ward / department clean’ (the overall results for 2008/09 are 95%) At least 70% of patients rate as ‘never’ in the local patient survey programme when asked ‘If they had to wait’ (the overall results for 2008/09 are 17%) 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’ (the overall results for 2008/09 are 90%) At least 80% of patients rate as ‘always’ in the local patient survey programme when asked if ‘the staff washed their hands’ (the overall results for 2008/09 are 92%)

Improving patient outcomes The profile of patients receiving inpatient care at CCO has changed over the last few years with an increasing number of patients becoming acutely ill and requiring level 2 (HDU) type interventions. This may be attributed to treatment toxicity or to the co-morbidities that patients 37

present with. A review of compliance against recent NICE guidance and expert clinical advice from within the Trust supported by an external review enabled us to identify this as a priority area for us. The areas of work that we have been able to deliver in 2008/09 include: x x x x x x

Investment in a Critical Care Nurse Specialist to provide expert advise and support to ward staff Agreement to access Wirral Hospital NHS Foundation Trust Critical Care Outreach service. Investment in capital equipment including replacing all IV pumps and syringe drivers, replacing all cardiac arrest trolleys Improved staff training in CPR, and ILS and ALERT courses. Further work will continue in this area over 2009/10 to provide level 2 care to patients at CCO and reduce the numbers of patients being transferred out of the hospital to A+E services. Obtained support from the Cancer Network to support these developments

Priorities and initiatives for 2009/10 Improving Patient Safety Our Quality strategy outlines a number of priorities and initiatives for 2009/10. These include: x

x x

The establishment of Patient Safety Leadership Rounds involving all Trust Board members in line with the guidance from the National Patient Safety Initiative. Improvements in quality and safety will be monitored through our Trust Board as part of our regular quality reporting The implementation of the Global Trigger Tool for case note / mortality reviews. Results of GTT reviews will be reviewed by the Trust Board through our Trust Board as part of our regular quality reporting The implementation of the North West Advancing Quality nursing metrics. These will enable us to monitor improvements within the Trust and to be able to benchmark with other North West NHS Trusts.

Patient experience From the introduction of our â&#x20AC;&#x2DC;real timeâ&#x20AC;&#x2122; patient survey in 2008/09 our performance in the areas relating to waiting times within departments is well below our target. We will be developing a focused action plan to ensure that we reduce waiting times to further improve the patients experience. Performance against the patient reported metrics will be closely monitored by our Trust Board as part of our Quality report. Targeted improvement in key indicators in patient survey programme focusing in particular on the waiting times in the departments. Patient outcomes Our patient survey provides valuable information form patients on their experience of using our service. It does not however provide validated information on patient reported outcomes (PROMS) in relation to the delivery of our core treatments (chemotherapy and radiotherapy).

Unfortunately we are unable to use the national PROMS tools as they are not relevant to our patient population. During 2009/10 we aim to develop validated cancer specific PROMS tools and to proactively monitor patient reported outcomes using these tools and to develop action plans to further improve patient reported outcomes.

Reports from our regulators and other external bodies Healthcare Commission inspection: Hygiene Code In September 2008 Trust received a planned inspection from the Healthcare Commission in relation to compliance with the Hygiene Code. Overall the report was positive however a breach was identified against Duty 4: â&#x20AC;&#x153;The trust must provide and maintain a clean and appropriate environment for healthcareâ&#x20AC;?. Immediate steps were taken and all areas were rectified. The Trust was then able to declare full compliance with the Hygiene Code in its application for registration with the care Quality Commission.

Independent Risk Management Assessments Achievement of NHSLA level 3 In November 2007 the Trust was successfully assessed against NHSLA level 3 (the highest available) and became the second Trust in the country (not including the pilot Trusts) to gain this level of attainment. 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 9001:2000 Standard The ISO 9001:2000 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 have achieved 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 2008/09. Monitor Throughout the year all of our ratings from Monitor have been the highest rating possible as follows: x x x

Governance: green Mandatory services and assets: green Finance: 5

Quality Overview The Trust 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. However, this does mean that data is predominantly internally generated and may not be subject to benchmarking at this stage. Trust performance against selected metrics: Patient safety

MRSA bacteraemia cases / 10,000 bed days C Diff cases / 1,000 bed days â&#x20AC;&#x2DC;Never Eventsâ&#x20AC;&#x2122; that occur within the Trust Chemotherapy medication errors* (number of errors per 1,000 doses) Radiotherapy treatment errors (number of errors per 1,000 fractions of radiotherapy) Falls / injuries / 1,000 inpatient admissions

2008/09

2007/08

0 0.2 0 0.1

0 0.6 0 0.05

0.76

1.17

2008/09

2007/08

39.3 0.4% 8.9% 0.9% 17.1%

42 1.4% 7.4% 1.2% 19.5%

All indicators: x Data source: CCO Clinical Outcome (clinical effectiveness)

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

HSMR:

Data source Dr Foster

Mortality rate: x Data definition: unadjusted mortality rate as a percentage of all cases treated in that category. x Data source: CCO

Patient reported experience measures

At least 80% of patients rate as ‘always’ in the local patient survey programme when asked ‘I was treated with courtesy and respect’ At least 80% of patients rate as ‘always’ in the local patient survey programme when asked ‘Was the ward / department clean’ At least 70% of patients rate as ‘never’ in the local patient survey programme when asked ‘If they had to wait’ 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’ At least 80% of patients rate as ‘always’ in the local patient survey programme when asked if ‘the staff washed their hands’

2008/09

2007/08 (Sept to March)

98%

97%

95%

17%

15%

90%

92%

90%

Patient survey: x Data source: data collected from in-house survey x Survey questions based on annual Healthcare 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

Performance in 2008/09 against key national priorities and the Department of Health’s National Core Standards As of January 1st 2009, the Cancer Reform targets were introduced which changed the reported performance levels for both the 31day and 62 day cancer waiting times targets, in order to align them with the 18 week pause model. Since the target rationales were changed in the last quarter, with as yet no criteria set for the new targets, the following is the performance related to the first three quarters of the year, upon which it is expected that performance achievement will be considered:

2008/09

2007/08

Standards for Better Health declaration

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

C Diff target

7 ( target no more than 19)

MRSA target

0 (target no more than 2)

Declared full compliance with all standards except one throughout year and full compliance at year end 26 (target no more than 11 cases) 0 (target no more than 2) 100%

2 week wait 31 day 62 day 18 week (admitted) 18 week (non admitted)

100%

99.8% (target threshold 98%). 93.3% (target threshold 93%). As at March 2009, 97.3% (target of 90%) 98.5% (target 95%).

99.8% (target 98%) 94.7% (target 93%) 95.9% (target 85%) 96% (target 90%)

2008/09

Annual Accounts for the 12 Months ended 31st March 2009

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009

Contents Foreword to the Accounts

Statement of the Chief Executive's responsibilities as the accounting officer of Clatterbridge Centre for Oncology NHS Foundation Trust.

Statement of Directors' responsibilities in respect of the Accounts

Independent Auditor's Report to the Council

48-49

Statement of Internal Control

50-54

Accounting Policies

55-63

Income and Expenditure Account

Balance Sheet

Statement of Total Recognised Gains and Losses

Cash Flow Statement

Notes to the Accounts

64-92

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009

Foreword to the Accounts Clatterbridge Centre for Oncology NHS Foundation Trust The accounts for the 12 months ended 31 March 2009, have been prepared by the Clatterbridge Centre for Oncology NHS Foundation Trust in accordance with paragraph 24 and 25 of Schedule 7 of the National Health Services Act 2006 in the form which Monitor has, with the approval of the Treasury directed.

Date 8th June 2009

Andrew Cannell Acting Chief Executive

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009

Statement of Chief Executive's Responsibilities as the Accounting Officer of Clatterbridge Centre for Oncology 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, 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 officers' Memorandum issued by the Independent Regulator of NHS Foundation Trusts (â&#x20AC;&#x153;Monitorâ&#x20AC;?). Under the National Health Services Act 2006, Monitor has directed the Clatterbridge Centre 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 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. 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: -

observe the Accounts Direction issued by Monitor, including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent basis;

make judgements and estimates on a reasonable basis;

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

prepare the financial statements on a going concern basis

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 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.

8th June 2009

Andrew Cannell Acting Chief Executive

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009

Statement of Directors' Responsibilities in Respect of the Accounts 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 required to;

select suitable accounting policies, as described on pages 55-63, and them apply them consistently

make judgements and estimates on a reasonable basis;

state whether applicable accounting standards have been followed, subject to any material departures disclosed and explained in the accounts;

prepare accounts on the going concern basis unless it is inappropriate to presume that the Trust will continue in business.

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 ensure that the accounts comply with requirements outlined in the above mentioned direction 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 irregularities. The Directors confirm to the best of their knowledge and belief that they have complied with the above requirements in preparing the accounts. By Order of the Board

Andrew Cannell Acting Chief Executive

8th June 2009

John Andrews Acting Director of Finance

8th June 2009

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009

Auditors’ Report to the Council of Governors of Clatterbridge Centre for Oncology NHS Foundation Trust We have audited the financial statements of Clatterbridge Centre for Oncology NHS Foundation Trust for the year ended 31 March 2009 under the National Health Service Act 2006. These comprise the Income and Expenditure Account, the Balance Sheet, the Cash flow Statement, the Statement of Total Recognised Gains and Losses and the related notes. These financial statements have been prepared under the accounting policies relevant to NHS Foundation Trusts set out therein. This report is made solely to the Council of Governors of Clatterbridge Centre for Oncology NHS Foundation Trust (‘the Trust’), as a body, in accordance with 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 it in an auditor’s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Trust and the Trust's Governors as a body, for our audit work, for this report, or for the opinions we have formed.

Respective responsibilities of directors and auditors As described on page 46, the Accounting Officer is responsible for the preparation of the financial statements in accordance with directions issued by Monitor. Our responsibilities, as independent auditors, are established by statute, the Code of Audit Practice issued by Monitor and our profession’s ethical guidance. We report to you our opinion as to whether the financial statements give a true and fair view of the state of affairs of the Trust and its income and expenditure for the year ended 31 March 2009. We review whether the statement on internal control on pages 50 to 54 reflects compliance with Monitor’s guidance issued in the NHS Foundation Trust Financial Reporting Manual. We report if it does not meet the requirements specified by Monitor or if the statement is misleading or inconsistent with other information we are aware of from our audit of the financial statements. We are not required to consider, nor have we considered, whether the directors’ statement on internal control covers all risks and controls. We are also not required to form an opinion on the effectiveness of the Trust’s corporate governance procedures or its risk and control procedures. Our review was not performed for any purpose connected with any specific transaction and should not be relied upon for any such purpose. We read the information contained in the Annual Report and consider the implications for our report if we become aware of any apparent misstatements or material inconsistencies with the statement of accounts. Basis of audit opinion We conducted our audit in accordance with the National Health Service Act 2006 and the Code of Audit Practice issued by Monitor, which requires compliance with relevant auditing standards issued by the Auditing Practices Board. An audit includes examination, on a test basis, of evidence relevant to the amounts and disclosures in the financial statements. It also includes an assessment of the significant estimates and judgements made by the Directors in the preparation of the financial statements, and of whether the accounting policies are appropriate to the Trust's circumstances, consistently applied and adequately disclosed.

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009 We planned and performed our audit so as to obtain all the information and explanations which we considered necessary in order to provide us with sufficient evidence to give reasonable assurance that the financial statements are free from material misstatement, whether caused by fraud or other irregularity or error. In forming our opinion we also evaluated the overall adequacy of the presentation of information in the financial statements.

Opinion In our opinion: x

the financial statements give a true and fair view, in accordance with the accounting policies directed by Monitor as being relevant to NHS Foundation Trusts in England, of the state of the Trustâ&#x20AC;&#x2122;s affairs as at 31 March 2009 and of its income and expenditure for the year then ended; and

the part of the Remuneration Report to be audited has been properly prepared in accordance with the requirements of the NHS Foundation Trust Financial Reporting Manual.

Certificate We certify that we have completed the audit of the accounts in accordance with the requirements of the National Health Service Act 2006 and the NHS Foundation Trust Audit Code of Practice issued by Monitor.

Trevor Rees (Senior Statutory Auditor) for and on behalf of KPMG LLP, Statutory Auditor Chartered Accountants KPMG LLP St Jamesâ&#x20AC;&#x2122; Square Manchester M2 6DS 3 June 2009

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009

Statement of Internal Control 1. 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 Trust’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. In my role of Chief Executive I account to the Chairman and Board of Clatterbridge Centre for Oncology NHS Foundation Trust for all matters pertaining to the delivery of strategic and operational objectives of the Trust. I hold key responsibilities for ensuring financial duties are met, clinical governance systems are robust and the development of effective partnerships with external organisations and bodies and internally with staff. To support this role there are clear systems of accountability with each Executive Director having delegated areas of operational responsibility. In order to achieve my responsibilities a governance and management framework has been established. x Central to the organisation’s strategic management of risk identification and control is the Service Development Strategy and Annual Plans. In addition, the Trust Board regularly reviews performance monitoring and management of the Trust’s strategic objectives. x Personal objectives are agreed for all directly managed staff ensuring direct linkage to the Trust’s Service Development Strategy. x The Trust has in place a Corporate Governance Manual supported by a detailed Scheme of Reservation and Delegation, outlining statutory and operational responsibilities. x A review of the workings and membership of the Board, including the role and function of the sub-committees is undertaken, in line with guidance on integrated governance. This supports the strategic direction of the Trust and the management of risk through the Assurance Framework. x Ensuring managers’ awareness and compliance with policies and procedures takes place, including NHS codes of conduct. x The Foundation Trust operates under a formal Foundation Trust constitution. The Trust’s principal commissioning partners are Wirral PCT who acts as co-ordinating commissioner for the other PCTs in our catchment area, supported by the Cheshire and Merseyside Specialised Commissioning Team. 2. 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, 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 2009 and up to the date of approval of the annual report and accounts.

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009 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. 3. 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: infection control, clinical care, radiation protection, Standards for Better Health, 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. 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. 4. The Risk and Control Framework The key elements of the Trustâ&#x20AC;&#x2122;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 co-ordination 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 is aware of their roles and responsibilities and outlines the structures and processes through which risk is assessed, controlled and managed. Risks are identified through feedback from many sources, such as, formal risk assessment, incident reporting, audit data, complaints, legal claims, patient and public feedback, stakeholder/partnership feedback and internal/external assessment. The Trust Board 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 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 Trustâ&#x20AC;&#x2122;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. The cascading of these processes to directorates has commenced the embedding of these principles across the organisation. This assists with the development of an organisation wide risk aware culture.

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009 The Trust has appointed an Executive Director as the Senior Information Risk Officer. Risks relating to data are assessed through the completion of the Department of Health’s Information Governance Toolkit. The Trust has assessed itself as securing a score of 89% (a “Green” rating) against the Department of Health’s Information Governance Toolkit in 2008/09; 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) Committee of the Trust Board. In respect of public involvement the Trust has both a Patient & Public Involvement Strategy and a Membership Strategy. The latter has been implemented and in excess of 5,400 public members have been recruited to date. Elections for places within the Council of Governors are undertaken each year in conjunction with the Electoral Reform Services and the governance infrastructure was in place to enable the trust to operate effectively as an NHS Foundation Trust from 1st August 2006. This work strengthens the input of patients, the public and staff into the strategic decision making of the Trust. The risk and control framework continues to be reviewed and developed. In 2009/10 this will include:

x x x x x x x x

Continued departmental embedding of the Assurance Framework, to ensure systematic mapping of risks to objectives throughout the organisation. Review the approved Trust Board committee structure in line with the principles of Integrated Governance to ensure its continued effectiveness. Continue to develop the operation of the Trust’s Risk Register Continue to maintain full compliance with the Standards for Better Health Core Standards The Trust continues to work with 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 will be made in 2009/10 in order to meet the new “going further on cancer waits” cancer waiting time standards. Work towards compliance with the new regulations for health and social care required by The Health and Social Care Act (2008) There are a number of new or emerging risks which have been considered in 2008/09 that will be kept under review. These include; risks in respect of Vision 20:20, the Trust’s response to the emerging shared services agenda (including the potential risks associated with a change to payroll provider and general ledger), maintaining income flows and key relationships with commissioners and implications of Payment by Results for specific cancer related services and the development of the proposed Satellite Radiotherapy Centre at Walton/Aintree.

5 Review of economy, efficiency and effectiveness and 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: o Setting and monitor the delivery of strategic and operational objectives Monitoring and review of organisational performance Delivery of efficiency savings

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009 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 Trust’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 6

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

Review of Effectiveness As the 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 and the executive managers within the NHS Foundation Trust who have responsibility for the development and maintenance of the internal control framework, and 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 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: x Waiting times are a critical indicator of success in terms of improving access for patients. The targets have been revised for Quarter 4. The achievement under the original methodology for the first three quarters has been 99.8% (operational target 98%) for the 31 day from decision to treat to first treatment and 93.3% (operational target 93%) against the 62-day urgent referral to first treatment target. The key issue to the Trust in continuing to achieve the 62-day target in the future is the timely referrals of patients from other hospitals. x The Trust is monitoring performance against the new cancer waiting time targets methodology introduced in quarter 4. The Trust achieved 98.7% against the 31 day subsequent treatment measure and 78.0% against the 62 day measure. Operational targets are still awaited from the Department of Health for these new measures of waiting time performance. x A “green” rating by Monitor for each quarter in 2008/09 for governance x A “green” rating by Monitor for each quarter in 2008/09 for the provision of mandatory services. x Achievement of all key financial duties and a Monitor financial risk rating of 5 for each quarter in 2008/09. x Internal Audit concluded that the systems and processes in place regarding the Assurance Framework are designed and operated to meet the requirements of the Statement of Internal Control. High Assurance has been received for this. They have also provided significant assurance regarding the systems and processes underpinning the Standards for Better Health

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009

x x x x x x

declaration, and significant assurance overall across a range of individual opinions arising from risk based audit assignments reported throughout the year. Accreditation for National Health Service Litigation Authority for Trusts (NHSLA) level 3. Maintaining a special quality management accreditation (ISO9001:2000) across the whole Trust from the British Standards Institute (BSI) Incorporation of feedback from Cancer Peer Review into action plans and corporate objectives. Regular audit committee review to ensure up to date and relevant financial policies and procedures are maintained. Compliance with Standards for Better Health core standards throughout 2008/09. The Trust has been granted full registration without conditions as a service provider from the Care Quality Commission in March 2009.

In conclusion, the Trust has a sound system of Internal Control in place, which is designed to manage the key organisational objectives and minimise the Trust exposure to risk. No significant internal control issues have been identified.

Name:

ANDREW CANNELL Acting Chief Executive

Signature: Date:

8th June 2009

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009

1. Accounting policies and other information Monitor has directed that the financial statements of NHS foundation trusts shall meet the accounting requirements of the NHS Foundation Trust Financial Reporting Manual which shall be agreed with HM Treasury. Consequently, the following financial statements have been prepared in accordance with the 2008/09 NHS Foundation Trust Financial Reporting Manual issued by Monitor. The accounting policies contained in that manual follow UK generally accepted accounting practice for companies (UK GAAP) and HM Treasury’s Financial Reporting Manual to the extent that they are meaningful and appropriate to NHS foundation trusts. The accounting policies have been applied consistently in dealing with items considered material in relation to the accounts.

1.1 Accounting convention

These accounts have been prepared under the historical cost convention modified to account for the revaluation of tangible fixed assets at their value to the business by reference to their current costs. NHS foundation trusts, in compliance with HM Treasury’s Financial Reporting Manual, are not required to comply with the FRS 3 requirements to report “earnings per share” or historical profits and losses.

1.2 Acquisitions and discontinued operations

Activities are considered to be ‘discontinued’ where they meet all of the following conditions: a. the sale (this may be at nil consideration for activities transferred to another public sector body) or termination is completed either in the period or before the earlier of three months after the commencement of the subsequent period and the date on which the financial statements are approved; b. if a termination, the former activities have ceased permanently; c. the sale or termination has a material effect on the nature and focus of the reporting NHS foundation trust’s operations and represents a material reduction in its operating facilities resulting either from its withdrawal from a particular activity or from a material reduction in income in the NHS foundation trust’s continuing operations; and d. the assets, liabilities, results of operations and activities are clearly distinguishable, physically, operationally and for financial reporting purposes. Operations not satisfying all these conditions are classified as continuing. Activities are considered to be ‘acquired’ whether or not they are acquired from outside the public sector.

1.3 Income recognition

Income is accounted for applying the accruals convention. The main source of income for the trust is under contracts from commissioners in respect of healthcare services. Income is recognised in the period in which services are provided. Where income is received for a specific activity which is to be delivered in the following financial year, that income is deferred. The NHS foundation trust changed the form of its contracts with NHS commissioners to follow the Department of Health’s Payment by Results methodology in 2008/09.To phase in the impact of PBR. Such income is shown net of transitional relief adjustments, which are calculated by the Department of Health. NHS Foundation Trust contracts may either receive or pay back transitional relief.

1.4 Expenditure

Expenditure is accounted for applying the accruals convention.

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009

1.5 Tangible fixed assets Capitalisation Tangible assets are capitalised if they are capable of being used for a period which exceeds one year and they: x

individually have a cost of at least ÂŁ5,000; or

form a group of assets which individually have a cost of more than ÂŁ250, collectively have a cost of at least ÂŁ5,000, where the assets are functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal dates and are under single managerial control; or

form part of the initial setting-up cost of a new building or refurbishment of a ward or unit, irrespective of their individual or collective cost.

Valuation Tangible fixed assets are stated at the lower of replacement cost and recoverable amount. On initial recognition they are measured at cost (for leased assets, fair value) including any costs, such as installation, directly attributable to bringing them into working condition. The carrying values of tangible fixed assets are reviewed for impairment in periods if events or changes in circumstances indicate the carrying value may not be recoverable. The costs arising from financing the construction of the fixed asset are not capitalised but are charged to the income and expenditure account in the year to which they relate. All land and buildings are revalued using professional valuations in accordance with FRS 15 every five years. A three yearly interim valuation is also carried out. Valuations are carried out by professionally qualified valuers in accordance with the Royal Institute of Chartered Surveyors (RICS) Appraisal and Valuation Manual. The valuations are carried out primarily on the basis of depreciated replacement cost for specialised operational property and existing use value for non-specialised operational property. The value of land for existing use purposes is assessed at existing use value. For non-operational properties including surplus land, the valuations are carried out at open market value. Additional alternative open market value figures have only been supplied for operational assets scheduled for imminent closure and subsequent disposal. 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. Residual interests in off-balance sheet private finance initiative (PFI) properties are included in assets under construction within tangible fixed assets at the amount of unitary charge allocated for the acquisition of the residual with an adjustment. The adjustment is the net present value of the change in the fair value of the residual as estimated at the start of the contract and at the balance sheet date. Operational equipment (including IT equipment), is carried at depreciated replacement cost. Equipment surplus to requirements is valued at net recoverable amount. Depreciation, amortisation and impairments Tangible fixed assets are depreciated at rates calculated to write them down to estimated residual value on a straight-line basis over their estimated useful lives. No depreciation is provided on freehold land, and assets surplus to requirements.

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009 Assets in the course of construction and residual interests in off-balance sheet PFI contract assets are not depreciated until the asset is brought into use or reverts to the trust, respectively. Buildings, installations and fittings are depreciated on their current value over the estimated remaining life of the asset as assessed by the NHS foundation trustâ&#x20AC;&#x2122;s professional valuers. Leaseholds are depreciated over the primary lease term. Equipment is depreciated on current cost evenly over the estimated life, which are as follows: Engineering plant and equipment

5-15 years

Medical and other equipment

5-15 years

Office equipment, furniture and soft furnishings

5-10 years

IT Equipment

5-8 years

Vehicles

7 years

Fixed asset impairments resulting from losses of economic benefits are charged to the income and expenditure account. All other impairments are taken to the revaluation reserve and reported in the statement of total recognised gains and losses to the extent that there is a balance on the revaluation reserve in respect of the particular asset.

1.6 Intangible fixed assets Intangible assets are capitalised when they are capable of being used in a trust's activities for more than one year; they can be valued; and they have a cost of at least ÂŁ5,000. Intangible fixed assets held for operational use are valued at historical cost and are amortised over the estimated life of the asset on a straight line basis. The carrying value of intangible assets is reviewed for impairment at the end of the first full year following acquisition and in other periods if events or changes in circumstances indicate the carrying value may not be recoverable. Purchased computer software licences are capitalised as intangible fixed assets where expenditure of at least ÂŁ5,000 is incurred and amortised over the shorter of the term of the licence and their useful economic lives.

1.7 Donated fixed assets Donated fixed assets are capitalised at their current value on receipt and this value is credited to the donated asset reserve. Donated fixed assets are valued and depreciated as described above for purchased assets. Gains and losses on revaluations are also taken to the donated asset reserve and, each year, an amount equal to the depreciation charge on the asset is released from the donated asset reserve to the income and expenditure account. Similarly, any impairment on donated assets charged to the income and expenditure account is matched by a transfer from the donated asset reserve. On sale of donated assets, the net book value of the donated asset is transferred from the donated asset reserve to the Income and Expenditure Reserve.

1.8 Liquid Resources Deposits and other investments that are readily convertible into known amounts of cash at or close to their carrying amounts are treated as liquid resources in the cashflow statement.

1.9 Government grants Government grants are grants from Government bodies other than income from primary care trusts or NHS trusts for the provision of services. Grants from the Department of Health, including those for achieving three star status, are accounted for as Government grants as are grants from the Big 57

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009 Lottery Fund. Where the Government grant is used to fund revenue expenditure it is taken to the Income and Expenditure account to match that expenditure. Where the grant is used to fund capital expenditure the grant is held as deferred income and released to the income and expenditure account over the life of the asset on a basis consistent with the depreciation charge for that asset.

1.10 Private Finance Initiative (PFI) transactions The NHS follows HM Treasury’s Technical Note 1 (Revised) “How to Account for PFI transactions” which provides definitive guidance for the application of application note F to FRS 5. Where the balance of the risks and rewards of ownership of the PFI property are borne by the PFI operator, the PFI payments are recorded as an operating expense. Where the trust has contributed land and buildings, a prepayment for their fair value is recognised and amortised over the life of the PFI contract by charge to the income and expenditure account. Where, at the end of the PFI contract, a property reverts to the trust, the difference between the expected fair value of the residual on reversion and any agreed payment on reversion is built up over the life of the contract by capitalising part of the unitary charge each year, as a tangible fixed asset. Where the balance of risks and rewards of ownership of the PFI property are borne by the trust, it is recognised as a fixed asset along with the liability to pay for it which is accounted for as a finance lease. Contract payments are apportioned between an imputed finance lease charge and a service charge.

1.11 Stocks and work-in-progress Stocks and work-in-progress are valued at the lower of cost and net realisable value. Work-inprogress comprises goods and services in intermediate stages of production.

1.12 Cash, bank and overdrafts Cash, bank and overdraft balances are recorded at the current values of these balances in the NHS foundation trust’s cash book. These balances exclude monies held in the NHS foundation trust’s bank account belonging to patients (see “third party assets” below). Account balances are only set off where a formal agreement has been made with the bank to do so. In all other cases overdrafts are disclosed within creditors. Interest earned on bank accounts and interest charged on overdrafts is recorded as, respectively, “interest receivable” and “interest payable” in the periods to which they relate. Bank charges are recorded as operating expenditure in the periods to which they relate.

1.13 Research and development Expenditure on research is not capitalised. Expenditure on development is capitalised if it meets the following criteria: x x x x

there is a clearly defined project; the related expenditure is separately identifiable; the outcome of the project has been assessed with reasonable certainty as to its technical feasibility and its resulting in a product or services that will eventually be brought into use; and adequate resources exist, or are reasonably expected to be available, to enable the project to be completed and to provide any consequential increases in working capital.

Expenditure so deferred is limited to the value of future benefits expected and is amortised through the income and expenditure account on a systematic basis over the period expected to benefit from the project. It is revalued on the basis of current cost. Expenditure which does not meet the criteria for capitalisation is treated as an operating cost in the year in which it is incurred. Where possible, NHS foundation trusts disclose the total amount of research and development expenditure charged in the 58

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009 Income and Expenditure account separately. However, where research and development activity cannot be separated from patient care activity it cannot be identified and is therefore not separately disclosed. Fixed assets acquired for use in research and development are amortised over the life of the associated project.

1.14 Provisions The NHS foundation trust provides for legal or constructive obligations that are of uncertain timing or amount at the balance sheet date on the basis of the best estimate of the expenditure required to settle the obligation. Where the effect of the time value of money is significant, the estimated riskadjusted cash flows are discounted using HM Treasury’s discount rate of 2.2% in real terms.

1.15 Contingencies 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 recognised as assets, but are disclosed in note 22 where an inflow of economic benefits is probable. Contingent liabilities are provided for where a transfer of economic benefits is probable. Otherwise, they are not recognised, but are disclosed in note 22 unless the probability of a transfer of economic benefits is remote. Contingent liabilities are defined as: Possible obligations arising from past events whose existence will be confirmed only by the occurrence of one or more uncertain future events not wholly within the entity’s control; or 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 be measured with sufficient reliability.

1.16 Clinical negligence costs The NHS Litigation Authority (NHSLA) operates a risk pooling scheme under which the 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 17.

1.17 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 claims arising. The annual membership contributions, and any ‘excesses’ payable in respect of particular claims are charged to operating expenses when the liability arises.

1.18 Pension costs Past and present employees are covered by the provisions of the NHS Pensions Scheme. The Scheme is an unfunded, defined benefit scheme that covers NHS employers, General Practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The scheme is not designed to be 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

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009 defined contribution scheme: the cost to the NHS Body of participating in the Scheme is taken as equal to the contributions payable to the Scheme for the accounting period. The Scheme is subject to a full actuarial investigation every four years. The main purpose of which is to assess the level of liability in respect of the benefits due 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 such investigation, on the conclusions of which scheme contribution rates are currently based, had an effective date of 31 March 2004 and covered the period from 1 April 1999 to that date. Between the full actuarial valuations, the Government Actuary provides an annual update of the scheme liabilities for FRS17 purposes. The latest assessment of the liabilities of the Scheme is contained in the Scheme Actuary report, which forms part of the NHS Pension Scheme (England and Wales) Resource Account, published annually. These accounts can be viewed on the Business Service Authority - Pensions Division website at www.nhspa.gov.uk. Copies can also be obtained from The Stationery Office. The conclusion of the 2004 investigation was that the scheme had accumulated a notional deficit of £3.3 billion against the notional assets as at 31 March 2004. This is after making some allowance for the one-off effects of pay modernisation, but before taking into account any of the scheme changes which come into effect on 1 April 2008. Taking into account the changes in the benefit and contribution structure effective from 1 April 2008, employer contributions could continue at the existing rate of 14% of pensionable pay. On advice from the actuary, scheme contributions may be varied from time to time to reflect changes in the scheme’s liabilities. Up to 31 March 2008 employees paid contributions at the rate of 6% (manual staff 5%) of their pensionable pay. From 1 April 2008, employees will pay contributions according to a tiered scale from 5% up to 8.5% of their pensionable pay.

1.19 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 capitalised purchase cost of fixed assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT.

1.20 Corporation Tax The Trust is a Health Service Body within the meaning of s519A ICTA 1988 and accordingly is exempt from taxation in respect of income and capital gains within categories covered by this. There is a power for the treasury to disapply the exemption in relation to specified activities of a Foundation Trust (s519A (3) to (8) ICTA 1988). Accordingly, the Trust is potentially within the scope of corporation tax in respect of activities, which are not related to, or ancillary to, the provision of healthcare, and where the profits there from exceed £50,000 per annum.

1.21 Foreign exchange Transactions that are denominated in a foreign currency are translated into sterling at the exchange rate ruling on the dates of the transactions. Resulting exchange gains and losses are taken to the income and expenditure account.

1.22 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 them. However, they are

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009 disclosed in a separate note to the accounts in accordance with the requirements of the HM Treasury Financial Reporting Manual.

1.23 Leases Where substantially all risks and rewards of ownership of a leased asset are borne by the NHS foundation trust, the asset is recorded as a tangible fixed asset and a debt is recorded to the lessor of the minimum lease payments discounted by the interest rate implicit in the lease. The asset and liability are recognised at the inception of the lease, and are de-recognised when the liability is discharged, cancelled or expires. The interest element of the finance lease payment is charged to the income and expenditure account over the period of the lease at a constant rate in relation to the balance outstanding. Other leases are regarded as operating leases and the rentals are charged to the income and expenditure account on a straight-line basis over the term of the lease.

1.24 Public dividend capital Public dividend capital (PDC) is a type of public sector equity finance based on the excess of assets over liabilities at the time of establishment of the original NHS trust. A charge, reflecting the forecast cost of capital utilised by the NHS foundation trust, is paid over as public dividend capital dividend. The charge is calculated at the real rate set by HM Treasury (currently 3.5%) on the average relevant net assets of the NHS foundation trust. Relevant net assets are calculated as the value of all assets less the value of all liabilities, except for donated assets and cash held with the Office of the Paymaster General. Average relevant net assets are calculated as a simple mean of opening and closing relevant net assets.

1.25 Financial instruments and financial liabilities Recognition Financial assets and financial liabilities which arise from contracts for the purchase or sale of nonfinancial items (such as goods or services), which are entered into in accordance with the Trustâ&#x20AC;&#x2122;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. 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 above. All other financial assets and financial liabilities are recognised when the Trust becomes a party to the contractual provisions of the instrument. De-recognition All financial assets are de-recognised when the rights to receive cashflows from the assets have expired or the Trust has transferred substantially all of the risks and rewards of ownership. Financial liabilities are de-recognised when the obligation is discharged, cancelled or expires.

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009 Classification and Measurement Financial assets are categorised as, ‘Fair Value through Income and Expenditure’, Loans and receivables or ‘Available-for-sale financial assets’. Financial liabilities are classified as ‘Fair value through Income and Expenditure’ or as ‘Other Financial liabilities’. Financial assets and financial liabilities at ‘Fair Value through Income and Expenditure’ 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 classified in this category if acquired principally for the purpose of selling in the short-term. 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 those contracts are separated-out from those contracts and measured in this category. Assets and liabilities in this category are classified as current assets and current liabilities. These financial assets and financial liabilities are recognised initially at fair value, with transaction costs expensed in the income and expenditure account. Subsequent movements in the fair value are recognised as gains or losses in the income and expenditure account. 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 at bank and in hand, NHS debtors, accrued income and ‘other debtors’. Loans and receivables are recognised initially at fair value, net of transactions costs, and are measured subsequently at amortised cost, using the effective interest method. The 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. Interest on loans and receivables is calculated using the effective interest method and credited to the income and expenditure account. Available-for-sale financial assets Available-for-sale financial assets are non-derivative financial assets which are either 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 balance sheet date. Available-for-sale financial assets are recognised initially at fair value, including transaction costs, and measured subsequently at fair value, with gains or losses recognised in reserves. When items classified as ‘available-for-sale’ are sold or impaired, the accumulated fair value adjustments recognised in reserves are included in the income and expenditure account. Other financial liabilities All financial liabilities are recognised initially at fair value, net of transaction costs incurred, and measured subsequently at amortised cost using the effective interest method. The effective interest

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009 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. They are included in current liabilities except for amounts payable more than 12 months after the balance sheet date, which are classified as long-term liabilities. Interest on financial liabilities carried at amortised cost is calculated using the effective interest method and charged to the income and expenditure account. 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.

1.26 Impairment of financial assets At the balance sheet date, the Trust assesses whether any financial assets, other than those held at ‘fair value through income and expenditure’ is 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 recognition of the asset and which has an impact on the estimated future cashflows of the asset. For financial assets carried at amortised cost, the amount of the impairment loss is measured as the difference between the asset’s carrying amount and the present value of the revised future cash flows discounted at the asset’s original effective interest rate. The loss is recognised in the income and expenditure account and the carrying amount of the asset is reduced.

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009

Income and Expenditure Account for the Year Ended 31st March 2009

NOTE

2009 £ 000s

2008 £ 000s

Income from activities

54,412

46,613

Other operating income

6,726

6,734

Operating expenses

(56,216)

(49,442)

4,922

3,905

4,922

3,905

556 0 0 0 0

582 0 0 0 0

SURPLUS / (DEFICIT) FOR THE FINANCIAL PERIOD

5,478

4,487

Public Dividend Capital dividends payable

(927)

(1,119)

RETAINED SURPLUS / (DEFICIT) FOR THE PERIOD

4,551

3,368

OPERATING SURPLUS / (DEFICIT) Profit / (loss) on disposal of fixed assets

SURPLUS / (DEFICIT) BEFORE INTEREST Finance income 9 Finance costs - interest payable Other net gains/(losses) on financial instruments Other finance costs - unwinding of discount Other finance costs - change in discount rate on provisions

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009

Balance Sheet as at 31st March 2009 31st March 2009 £ 000s

31st March 2008 £ 000s

10 11 12

9 31,217 0 31,226

14 33,076 0 33,090

13 14

404 2,343 0 18,171 20,918

332 3,376 0 11,998 15,706

(9,867)

(11,180)

NET CURRENT ASSETS / (LIABILITIES)

11,051

4,526

TOTAL ASSETS LESS CURRENT LIABILITIES

42,277

37,616

NOTE

FIXED ASSETS Intangible assets Tangible assets Investments CURRENT ASSETS Stocks and work in progress Debtors Investments Cash at bank and in hand

CREDITORS: Amounts falling due within one year

CREDITORS: Amounts falling due after more than one year

(561)

(958)

PROVISIONS FOR LIABILITIES AND CHARGES

(818)

(11)

40,898

36,647

21,245 5,503 1,721 0 12,429 40,898

21,245 5,804 2,021 0 7,577 36,647

TOTAL ASSETS EMPLOYED FINANCED BY: Public dividend capital Revaluation reserve Donated asset reserve Other reserves Income and expenditure reserve TOTAL FUNDS

18 18 18 18 18

The Financial Statements on pages 64 to 92 were approved by the Board on 27th May 2009 and signed on its behalf.

Signed: …………………………………………………………….Acting Chief Executive Date:

8th June 2009

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009

Statement of Total Recognised Gains and Losses for the 12 Months Ended 31st March 2009 2008/09 ÂŁ 000s

2007/08 ÂŁ 000s

5,478

4,487

Fixed asset impairment losses

Unrealised surplus / (deficit) on fixed asset revaluations / indexation

229

Net gains / losses on available for sale investments

(300)

(306)

Additions / (reductions) in "other reserves"

Other recognised gains and losses

Total gains and losses relating to the financial period

5,178

4,410

Total gains and losses recognised since last annual report

5,178

4,410

Surplus / (deficit) for the financial year before dividend payments

Increase in the donated asset reserve due to receipt of donated assets Reductions in the donated asset reserve due to depreciation

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009

Cash Flow Statement for the Year Ended 31st March 2009

NOTE

2008/09 £ 000s

2007/08 £ 000s

19.1

10,116

6,874

556 0 0

582 0 0

556

582

(3,572) 0 0 0 0 (3,572)

(3,383) 0 (14) 0 0 (3,397)

DIVIDENDS PAID

(927)

(1,119)

Net cash inflow / (outflow) before management of liquid resources and financing

6,173

2,940

MANAGEMENT OF LIQUID RESOURCES (Purchase) of current asset investments Sale of current asset investments Net cash inflow / (outflow) before financing

0 0 6,173

0 0 2,940

0 0 0 0 0 0 0 0 0

692 0 0 0 0 0 0 0 692

6,173

3,632

OPERATING ACTIVITIES Net cash inflow / (outflow) from operating activities

RETURNS ON INVESTMENTS AND SERVICING OF FINANCE: Interest received Interest paid Interest element of finance leases Net cash inflow / (outflow) from returns on investments and servicing of finance Taxation paid / received CAPITAL EXPENDITURE Payments to acquire tangible fixed assets Receipts from sale of tangible fixed assets Payments to acquire intangible fixed assets Receipts from sale of intangible fixed assets (Payments)/receipts for fixed asset investments Net cash inflow / (outflow) from capital expenditure

FINANCING Public Dividend Capital received Public dividend capital repaid Loans received from Foundation Trust Financing Facility Other loans received Loans repaid to Foundation Trust Financing Facility Other loans repaid Other capital receipts Capital element of finance lease rental payments Net cash inflow / (outflow) from financing Increase / (decrease) in cash

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009 2. Segmental Analysis The Trust considers that all of its activities fall within the single category of the provision of healthcare services

3. Income from Activities 3.1 Income from activities comprises:

2008/09 £ 000s 4,652 3,519 6,953 0 37,280 52,404 0 52,404 274 1,734 54,412

Elective income Non-elective income Outpatient income A & E income Other NHS clinical income * Total income at full tariff PBR claw back Income from Activities Private patients Other non-protected clinical income *

2007/08 £ 000s 4,291 3,732 5,774 0 34,888 48,685 (4,374) 44,311 391 1,911 46,613

The figures quoted for 2008/09 are based upon income received in respect 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 activities shown above is derived from the provision of protected services.

3.2 Income from activities comprises:

2008/09 £ 000s 274 54,412 0.50%

Private patient income Total patient related income Proportion as a percentage

2007/08 £ 000s 391 46,613 0.84%

Base Year 2002/03 £ 000s 520 23,697 2.19%

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 2.2%. The above note shows that the Trust was compliant in 2008/09.

4. Other Operating Income Research and Development Education and Training Charitable and other contributions to expenditure Transfers from the donated asset reserve in respect of depreciation of donated assets Non-patient care services to other bodies Other Total

2008/09 £ 000s 357 1,115 0

2007/08 £ 000s 217 883 0

300 0 4,954 6,726

306 0 5,328 6,734

Other Income includes R&D Cancer Network £729k (2007/08 £668k), National Cancer Analysis Team £824k (2007/08 £524k), and Sales of drugs to private hospitals of 851£k (2007/08 1,076k)

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009 5. Operating Expenses 5.1 Operating expenses comprise: Services from NHS Foundation Trusts Services from other NHS Trusts Services from other NHS bodies Purchase of healthcare from non NHS bodies Executive Directors' costs Non Executive Directors' costs Staff costs Drugs costs Supplies and services - clinical (Excluding drug costs) Supplies and services - general Establishment Transport Premises Bad debts Other impairment of financial assets Depreciation and amortisation Fixed asset impairments Fixed asset reversal of impairments Audit services - statutory audit Other auditor's remuneration Clinical negligence Exceptional items Other

2008/09 £ 000s 4,408 1,822 66 0 578 118 24,848 14,452 2,291 203 1,158 6 2,067 (23) 0 3,184 483 0 40 21 54 0 440 56,216

2007/08 £ 000s 2,488 2,416 0 0 501 117 21,527 13,115 2,222 193 1,165 5 2,043 128 0 3,082 85 0 51 60 70 0 174 49,442

2008/09 £ 000s 2 650 652

2007/08 £ 000s 155 438 593

5.2 Operating leases 5.2/1 Operating expenses include: Hire of plant and machinery Other operating lease rentals

5.2/2 Annual commitments under non-cancellable operating leases are: Land and buildings 2007/08 2008/09 £ 000s £ 000s

Operating leases which expire: Within 1 year Between 1 and 5 years After 5 years

52 0 0 52

54 0 0 54

Other leases 2008/09 2007/08 £ 000s £ 000s 136 457 0 593

155 468 0 623

70 40-45 15-20 10-15 10-15 10-15 10-15

115-120 90-95 15-20 85-90 70-75 75-80

Salary (bands of £5,000) £000

160-165

2008/09 Other remuneration (bands of £5,000) £000 Benefits in kind (bands of £5,000) £000

40-45 15-20 10-15 10-15 10-15 10-15

65-70 85-90 15-20 80-85 65-70 10-15

Salary (bands of £5,000) £000

150-155

2007/08 Other remuneration (bands of £5,000) £000

Benefits in kind (bands of £5,000) £000

1) There have been no changes to the Board since 1st April 2008 2) All Board members are appointed by the Board on permanent contracts. 3) 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.

Non Executive Directors A White - Chairman G Morris - Non Executive Director D Buchanan - Non Executive Director L Martin - Non Executive Director V Tagart - Non Executive Director C Eastwood - Non Executive Director

Executive Directors D Hurrell - Chief Executive A Cannell - Director of Finance / Deputy Chief Executive D Husband - Medical Director H Porter - Director of Nursing & Quality D Jennings - HR Director S Nicholls - Director of Operations

Name and title

5.3/1 Salary and Allowances

5.3 Remuneration Report

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009

Lump sum at age 60 related to real increase in pension (bands of £2,500) £000 25-27.5 2.5-5 (0-2.5) 5-7.5 2.5-5 2-5.5

Real increase in pension at age 60 (bands of £2,500) £000 7.5-10 0-2.5 (0-2.5) 0-2.5 0-2.5 0-2.5

(bands of £5,000) £000 25-30 25-30 50-55 25-30 0-5 0-5

Total accrued pension at age 60 at 31 March 2009 (bands of £5,000) £000 75-80 80-85 160-165 75-80 5-10 10-15

Lump sum at age 60 related to accrued pension at 31 March 2009

£000 422 469 1,288 462 53 65

Cash Equivalent Transfer to Value at 31 March 2009

£000 217 345 939 328 30 37

Cash Equivalent Transfer to Value at 31 March 2008

£000 140 81 228 88 15 18

Real increase in Cash Equivalent Transfer Value

Employ er's contrib ution to stakeho lder pension Round to nearest £00) £00 0 0 0 0 0 0

Real Increase in CETV This reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period.

Cash Equivalent Transfer Values A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member's accrued benefits and any contingent spouse's pension payable from the scheme. A CETV figure is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies. The CETV figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries.

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

Name and title D Hurrell- Chief Executive A Cannell - Director of Finance / Deputy Chief Executive D Husband - Medical Director H Porter - Director of Nursing & Quality D Jennings - HR Director S Nicholls - Director of Operations

5.3/2 Pension entitlements

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009 5.3/3 Remuneration Committee and Terms of Service 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 Trust joins the Committee when the remuneration of other Executive Directors is being reviewed. The Chief Executive and Executive Directors are employed under permanent 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 Executive Directors may be terminated with three months notice as a result of a disciplinary 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 advertisements. Appointments are made on fixed term contracts (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. Details of the remaining terms of the Chair and Non-Executive Directors are as follows: Name

First Appointed

Extended To

Alan White Douglas Buchanan Graham Morris Louise Martin Vicky Tagart Carol Eastwood

23.08.1999 01.12.1995 01.12.2005 01.04.2001 01.12.2000 01.02.2007

30.11.2002 30.11.1997 30.11.2009 31.03.2005 30.11.2003 31.01.2010

31.07.2010 01.01.2011 30.11.2012 30.11.2010 30.11.2010

The Remuneration Committee will be responsible for agreeing remuneration and terms of employment for the Chief Executive and other Directors, in accordance with: 1) Legal requirements 2) The principles of probity 3) Good people management practice 4) Proper corporate governance The membership of the Remuneration Committee, number of meetings held and attendance can be found on page 29 of the Annual Report.

Signed

Acting Chief Executive

Date: 8th June 2009

7272

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009 6. Staff Costs and Numbers 6.1 Staff costs

2008/09 £ 000s 21,169 1,462 2,354 0 441 25,426

Salaries and wages Social Security costs Employer contributions to NHSPA Other Pension Costs Agency and contract staff

2007/08 £ 000s 18,330 1,262 2,080 0 356 22,028

All employer pension contributions in 2008/09 were paid to the NHS Pensions Agency. Accounting policies for pensions and other retirement benefits are set out in Note 1.18 on page 59 Details of senior employees’ remuneration can be found on page 70 of the Remuneration report

6.2 Average number of persons employed (Wte basis)

2008/09 Total Number 56 0 163 49 119 0 186 0 0 20 593

Medical and dental Ambulance staff Administration and estates Healthcare assistants & other support staff Nursing, midwifery & health visiting staff Nursing, midwifery & health visiting learners Scientific, therapeutic and technical staff Social care staff Bank and agency staff Other Total

2007/08 Total Number 52 0 153 48 116 0 184 0 0 16 569

6.3 Employee Benefits None 6.4 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 no such retirements, and therefore no additional cost (2007/08 – none). This information has been supplied by the NHS Pensions Agency. 6.5 Management costs

Management costs Income Management costs as % of Income

2008/09 £000

2007/08 £000

2,312

1,849

61,138

53,347

3.8%

3.5%

Management costs are defined as those on the management costs website at www.dh.gov.uk/PolicyAndGuidance/OrganisationPolicy/FinanceAndPlanning/NHSManagementCosts/fs/en..www.dh.gov. uk/policyandguidance/organisation policy/financeandplanning/nhsmanagementcosts/fs/en.

7373

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009 7. Better Payment Practice Code 7.1

Better Payment Practice Code - measure of compliance

2007/08 Number £000

2008/09 Number £000

Total Non-NHS trade invoices paid in the year Total Non NHS trade invoices paid within target Percentage of Non-NHS trade invoices paid within target

6,443 6,119 94.7%

9,870 9,276 94.0%

5,585 5,248 94.0%

10,571 9,599 90.8%

Total NHS trade invoices paid in the year Total NHS trade invoices paid within target Percentage of NHS trade invoices paid within target

1,049 1,001 95.4%

22,709 22,405 98.7%

728 672 92.3%

20,623 20,179 97.8%

The Better Payment Practice Code requires the Trust to aim to pay all undisputed invoices by the due date or within 30 days of receipt of goods or a valid invoice, whichever is later.

7.2 The late payment of commercial debts (interest) Act 1998: Amounts included within other interest payable arising from claims made under this legislation Compensation paid to cover debt recovery costs under this legislation

2007/08 £ 000s

2008/09 £ 000s 0 0

0 0

No interest or compensation has been paid under the Late Payment of Commercial Debts (Interest) Act 1998 during 2008/09 or 2007/08.

8. Profit / (Loss) on Disposal of Fixed Assets There has been no profit or loss on the disposal of tangible assets during 2008/09 or 2007/08 9.1 Finance Income

2008/09 £ 000s 556 0 0 0 556

Interest on loans and receivables Interest on available for sale financial assets Interest on held-to-maturity financial assets Other

9.2 Finance Costs - Interest expense There has been no interest expense during 2008/09 or 2007/08 9.3 Other net gains / (losses) on financial instruments There have been no gains / (losses) on financial instruments during 2008/09 or 2007/08

7474

2007/08 £ 000s 582 0 0 0 582

75 9

Total at 31st March 2009

Total at 1st April 2008 9 0

14 0

Net book value - Purchased at 1st April 2008 - Donated at 1st April 2008

- Purchased at 31st March 2009 - Donated at 31st March 2009

Accumulated depreciation at 31st March 2009

0 0

0 0 0 0 0 0 0

27 13 5 0 0 0 0 0

0 0 0 0 0 0 0

27 0 0 0 0 0 0

£ 000s

Amortisation at 1st April 2008 Provided during the year Impairments Reversal of Impairments Reclassifications Other in year revaluation Disposals

Gross Cost at 1 April 2008 Impairments Reclassifications Other in year revaluation Additions – purchased Additions – donated Disposals At 31st March 2009

Licenses and Trademarks

Software Licenses £ 000s

0 0

0 0 0 0 0 0 0

Patents

10.1 Intangible fixed assets at the balance sheet date comprise the following elements:

10. Intangible Fixed Assets

£ 000s

0 0

0 0 0 0 0 0 0

Development Expenditure

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009

£ 000s

0 0

0 0 0 0 0 0 0

Goodwill

£ 000s

Other

0 0

0 0 0 0 0 0 0

£ 000s

Total

9 0

14 0

13 5 0 0 0 0 0

27 0 0 0 0 0 0

76 3,200 0 3,200 3,200 0 3,200

- Purchased at 31st March 2009 - Donated at 31st March 2009 Total at 31st March 2009

0 0 0 0 0 0 0 0

16,705 1,651 18,356

16,475 1,727 18,202

0 883 0 0 0 0 0 883

18,202 560 0 (483) 960 0 0 19,239

£ 000s

3,200 0 0 0 0 0 0 3,200

£ 000s

Net book value - Purchased at 1st April 2008 - Donated at 1st April 2008 Total at 1st April 2008

Accumulated depreciation at 1st April 2008 Provided during the year Impairments Reversal of Impairments Reclassifications Other in year revaluation Disposals Accumulated depreciation at 31 March 2009

Cost / valuation at 1st April 2008 Additions – purchased Additions – donated Impairments Reclassifications Other in year revaluation Disposals At 31st March 2009

Buildings excluding dwellings

Land

£ 000s

0 0 0

0 0 0 0 0 0 0 0

Dwellings

1,243 0 1,243

960 0 960

0 0 0 0 0 0 0 0

960 1,243 0 0 (960) 0 0 1,243

£ 000s

Assets under construction & payments on account

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

11. Tangible Fixed Assets

6,908 71 6,979

8,574 295 8,869

12,827 1,890 0 0 0 0 (454) 14,263

21.696 0 0 0 0 0 (454) 21,242

£ 000s

Plant & machinery

£ 000s

0 0 0

0 0 0 0 0 0 0 0

Transport equipment

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009

1,439 0 1,439

1,845 0 1,845

757 406 0 0 0 0 0 1,163

2,602 0 0 0 0 0 0 2,602

£ 000s

Information technology

£ 000s

0 0 0

54 0 0 0 0 0 0 54

Furniture & fittings

29,495 1,722 31,217

31,054 2,022 33,076

13,638 3,179 0 0 0 0 (454) 16,363

46,714 1,803 0 (483) 0 0 (454) 47,580

£ 000s

Total

18,356

£ 000s

0 0

Dwellings

1,243

£ 000s

Assets under construction & payments on account

6,979

£ 000s

Plant & machinery

£ 000s

Transport equipment

1,439

£ 000s

Information technology

£ 000s

Furniture & fittings

31,217

21,556 9,661

£ 000s

Total

483

31st March 2009 £ 000s

31st March 2008 £ 000s

21,402

31st March 2009 £ 000s Unprotected

2008/09 Impairment arises from the District Valuer revaluation of new building projects as they become operational.

Changes in market price

11.6 Impairment of Assets

Freehold

31st March 2009 £ 000s Protected

31st March 2009 £ 000s

11.5 The net book value of land, buildings and dwellings at 31st March 2009 comprises:

11.4/1 No depreciation was charged to the income and expenditure in respect of assets held under finance leases and hire purchase contracts

11.4 No assets were held under finance leases and hire purchase contracts at the balance sheet date

11.3 Of the totals at 31st March 2009, £nil related to land valued at open market value and £nil related to buildings valued at open market value, £nil related to dwellings valued at open market value.

3,200

Total at 31st March 2009

18,356 0

£ 000s

3,200 0

Buildings excluding dwellings

Land

Net book value - Protected assets at 31st March 2009 - Unprotected assets at 31st March 2009

11.2 Analysis of Tangible fixed assets

All land and buildings are revalued using professional valuations in accordance with FRS 15 every five years. A three yearly interim valuation was carried out on 30 September 2007,by the Valuation Office Agency using the Exact Replacement (NHS Beacon) Basis method for revaluation. A valuation was carried out on two building projects that were completed in year:1) Refurbishment of Outpatients and 2) Construction of Research and Development offices. This evaluation exercise resulted in a building impairment of £483k, which has been charged to the income & expenditure account in 2008/09.

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009 12. There are no fixed asset investments 13. Stocks and Work in Progress

Raw materials and consumables Work-in-Progress Finished Goods Total 14. Debtors

Amounts falling due within one year:

31st March 2009 £ 000s 404 0 0 404

31st March 2008 £ 000s 332 0 0 332

31st March 2009 £ 000s

31st March 2008 £ 000s

NHS debtors Provision for irrecoverable debts Other prepayments and accrued income Other debtors and accrued income

469 (261) 1236 899

1,129 (283) 1,244 1,286

Sub Total

2,343

3,376

0 0 0 0 0

2,343

3,376

Amounts falling due after more than one year: NHS debtors Provision for irrecoverable debts Other prepayments and accrued income Other debtors Sub Total Total Debtors

15. There are no Current Asset Investments

78 78

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009 16.1 Creditors

31st March 2009 £ 000s

31st March 2008 £ 000s

Amounts falling due within one year: Bank overdrafts Payments received on account NHS creditors Taxation and Social Security Obligations under finance leases and HP contracts Capital Creditors Other creditors and accruals Deferred government grants Deferred income

0 463 2,886 517 0 625 2,771 397 2,208

0 345 2,470 452 0 2,394 1,769 397 3,353

Sub Total

9,867

11,180

0 0 561 561

0 0 958 958

10,428

12,138

Amounts falling due after more than one year: Obligations under finance leases and HP contracts NHS creditors Other Sub Total Total Creditors

Other Creditors include : -305K outstanding pension contributions at 31st March 2009 (2007/08 £261k) Accruals and deferred income include: Funding has been received from the Big Lottery Fund to purchase 3 Linear Accelerators and an MRI Scanner. These are deferred assets and funding will be released to the income and expenditure account over the life of the assets on a basis consistent with the depreciation charge for that assets. £397k will be released in less than 12 months and £561k will be released after more than one year. Loans At 31st March 2009, there are no outstanding loans (2007/08 –nil)

79 79

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009 16.2 Prudential borrowing Limit

31st March 2008 £ 000s

31st March 2009 £ 000s

Total long term borrowing limit set by Monitor Working capital facility

12,700 4,000

11,300 4,000

TOTAL PRUDENTIAL BORROWING LIMIT

16,700

15,300

0 0

Actual borrowing in year - long term Actual borrowing in year - working capital

The NHS Foundation Trust is required to comply and remain within a Prudential Borrowing Limit. This is made up of two elements: -

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

the amount of any working capital facility approved by Monitor.

The Trust had a maximum long term borrowing limit of £12,700,000. The Trust has borrowed £nil in 2008/09.(2007/08 £nil) Further information on the NHS Foundation Trust Prudential Borrowing Code and Compliance Framework can be found on the website of Monitor, the independent regulator of foundation Trusts.

Financial Ratios Maximum debt / capital Minimum dividend cover Minimum interest cover Minimum debt service cover Maximum debt service to revenue

2008/09 Actual Approved

2007/08 Actual Approved

nil 10 n/a n/a nil

nil 7 n/a n/a nil

<25% >1 >3 >2 <3

<25% >1 >3 >2 <3%

Until such time as the Trust draws down a loan only the minimum dividend cover ratio is relevant. st

At 31 March 2009, the Trust does not have a working capital facility.(In 2007/08, the Trust had an approved working capital facility of £4 million against which £nil was drawn down)

80 80

Total

0 2 0

816

316 500 0

816

0 0 816 0 0 0

£ 000s

Other

818

316 502 0

11 0 818 (11) 0 0

£ 000s

Total

Clatterbridge Centre for Oncology NHS Foundation Trust is a member of the NHS Litigation Authority (NHSLA) clinical negligence scheme. All clinical negligence claims are therefore recognised in the accounts of the NHSLA, consequently the Trust will have no provision for clinical negligence claims. The NHS litigation Authority is carrying provisions as at 31st March 2009 in relation to ELS of £nil (2007/08 £nil) and in relation to CNST of £270,244 (2007/08 £80,308) making a total of £270,244

Legal claims consist of amounts due as a result of third party and employee liability claims. The values are based on information provided by the NHS Litigation Authority.

Other provisions arising during the year represents a reclassification of income received for junior medical staff (MADEL).This amount has Accrued over the past five years and the balance has previously been carried in Deferred income within the creditors section of the Balance Sheet

0 0 0

Within 1 year 1 - 5 years Over 5 years

Expected timing of cashflows:

At 31st March 2009

11 0 2 (11) 0 0

£ 000s

£ 000s 0 0 0 0 0 0

Legal claims

Pensions relating to other staff

0 0 0 0 0 0

Pensions relating to former directors £ 000s

At 1st April 2007 Change in the discount rate Arising during the year Utilised during the year Reversed unused Unwinding of discount

17. Provisions for Liabilities and Charges

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009 2008/09 ÂŁ 000s

2007/08 ÂŁ 000s

36,647 5,478 (927) 0

32,664 4,487 (1,119) 0

41,198

36,032

0 0 0 (300) 0

60 692 0 (137) 0

40,898

36,647

Public dividend capital at start of period New public dividend capital received Public dividend capital repaid in year Public dividend capital repayable (creditor)

21,245 0 0 0

20,553 692 0 0

Public dividend capital at 31 March 2009

21,245

18.1 Movements in Taxpayers Equity Taxpayers' equity at 1st April 2008 Surplus / (deficit) for the financial year Public Dividend Capital dividends Fixed Asset Impairments

Surplus/(deficit) from revaluations of fixed assets and current asset investments New Public Dividend Capital Public dividend capital repaid in year Additions/(reductions) in donated asset reserve Additions/(reductions) in other reserves (revaluation reserve) Taxpayers Equity at 31st March 2009 18.2 Movements in public dividend capital:

82 82

0 0

Surplus on other revaluations / indexation of fixed assets

Transfer of realised profits / (losses) to the income and expenditure reserve

Receipt of donated assets

Transfers to the income and expenditure account for depreciation, impairment and disposal of donated assets

At 31st March 2009

Movements on other reserves

1,721

5,503

(300)

(301)

Fixed Asset Impairments

Other transfers between reserves

2,021

£ 000s

£ 000s 5,804

Donated asset reserve

Revaluation reserve

Transfer from the income and expenditure account

At 1st April 2008

18.3 Movements on Reserves

£ 000s

Available for sale investments

£ 000s

Other reserves

12,429

301

4,551

7,577

£ 000s

Income and expenditure reserve

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009

19,653

(300)

4,551

15,402

£ 000s

Total

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009 19. Notes to the Cash Flow Statement 19.1 Reconciliation of operating surplus / (deficit) to net cash flow from operating activities

Total operating surplus / (deficit) Depreciation and amortisation charge Fixed Asset impairments Transfer from donated asset reserve Other movements (Increase) / decrease in stocks (Increase) / decrease in debtors Increase / (decrease) in creditors Increase / (decrease) in provisions Net cash inflow from operating activities 19.2 Reconciliation of net cash flow to movement in net debt Increase / (decrease) in cash in the period Cash inflow from new debt Cash outflow from debt repaid and finance lease capital payments Cash (inflow) / outflow from (decrease) / increase in liquid resources Change in net debt resulting from cashflows Non-cash changes in debt Net debt at 1st April 2008 Net funds / (debt) at start of period Net debt at 31st March 2009 19.3 Analysis of changes in net debt

Commercial cash at bank and in hand OPG cash at bank Bank overdrafts Debt due within one year Debt due after one year Finance leases Current asset investments Total

2008/09 £ 000s 4,922 3,184 483 (300) 0 (72) 1,033 59 807 10,116

2007/08 £ 000s 3,905 3,082 85 (306) 0 79 (565) 588 6 6,874

2008/09 £ 000s 6,173 0 0 0 6,173 0 11,998 0 18,171

2007/08 £ 000s 3,632 0 0 0 3,632 0 8,366 0 11,998

At 1st April 2008

Non Cash changes in year

Cash changes in year

At 31st March 2009

£ 000s

61 11,937 0 0 0 0 0 11,998

39 6,134 0 0 0 0 0 6,173

0 0 0 0 0 0 0 0

100 18,071 0 0 0 0 0 18,171

The Trust anticipates using a significant amount of the £18,171k cash balance held at 31st March 2009 to build a satellite radiotherapy centre in Liverpool. Construction will commence in 2009/10 under a procure 21 contract and the latest estimated costs are buildings £12,200k and equipment £5,300k

84 84

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009 20. Contractual Capital Commitments Commitments under capital expenditure contracts at the balance sheet date were £1,098k, (2007/08 £263k) which relate to building contracts entered into during 2008/09 which are due to be completed in 2009/10. 21. Post Balance Sheet Events There are no post balance sheet events. 22. Contingent Assets and Liabilities There are no contingent assets or liabilities at 31st March 2009 (2007/08 £Nil). 23.1 Related Party Transactions 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 parties related to them, has undertaken any material transactions with Clatterbridge Centre for Oncology NHS Foundation Trust. The Register of Interests for the Council of Governors for 2008/09 has been compiled in accordance with the requirements of the Constitution of Clatterbridge Centre for Oncology NHS Foundation Trust. The Department of Health is regarded as a related party. During the year Clatterbridge Centre for Oncology NHS Foundation Trust has had a number of material transactions with the Department, and with other entities for which the Department is regarded as the parent Department. 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 been with HM Revenue & Customs, Health Commission Wales (on behalf of the Welsh Assembly) and National Service Division (on behalf of the Scottish Assembly). The Trust has also received revenue payments from the Trusts charitable funds, all of the Trustees for which are also members of the NHS Trust Board. The Trust has also had a number of material transactions with the Clatterbridge Cancer Research (CCR), which is a recognised charity supporting Cancer research. The following related party transactions are in excess of 1% of turnover.

85 85

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009

Wirral University Teaching Hospital NHSFT Warrington & Halton Hospitals NHSFT (post 01/12/08) North Cheshire Hospitals NHS Trust (pre 01/12/08) North West Ambulance Service NHS Trust Royal Liverpool & Broadgreen University Hospitals NHS Trust HM Revenue & Customs NHS Pension Scheme (Employers) Department of Health Wirral PCT National Assembly for Wales North West Strategic Health Authority North West Specialised Commissioning Team (Hosted by Western Cheshire PCT) Total

2008/09 Income Expenditure £000 £000 18,909 445 570 562 827 1,544 2,354 2,129 631 1,694 1,089 49,715 55,258

25,211

2007/08 Income Expenditure £000 £000 17,084 1,045 745 236 1,411 2,077 (2,426) 822 1,911 1,187 45,780 47,274

23.2 Related Party Balances

The following related party balances are in excess of 1% of turnover:-

Wirral University Teaching Hospital NHSFT

2008/09 Debtors Creditors £000 £000 1,000

2007/08 Debtors Creditors £000 £000 1,516

24.1 PFI schemes deemed to be off-balance sheet There are no PFI schemes deemed to be off-balance sheet (2007/08 – NIL).

25. Financial Instruments FRS 25,26 and 29, 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 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 facing the Trust in undertaking its activities. As allowed by FRS 25,26 and 29 debtors and creditors that are due to mature or become payable within 12 months from the balance sheet date have been omitted from all disclosures other than the currency profile.

86 86

22,598

4 5 5 6 1 7

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009 Liquidity risk The Trust's income is negotiated under three year agency purchase contracts with local Primary Care Trusts, which are financed from resources voted annually by Parliament. The Trust receives 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 / Local Tariff unit cost. The Trust receives cash each month based on an annually agreed level of contract activity and there are periodic corrections made to adjust for the actual income due under the contract. The Trustâ&#x20AC;&#x2122;s activity hasremained ahead of plan during 2008/09 which has contributed to an increase in cash holdings such that the working capital facility which expired on 31st July 2008 has not needed to be renewed. The Trust presently finances its capital expenditure from internally generated funds. In addition, the Trust can borrow, both from the Department of Health Financing Facility and commercially to finance capital schemes. Financing is drawn down to match the spend profile of the scheme concerned and the Trust is not, therefore, exposed to significant liquidity risks in this area.

Interest rate risk The only asset or liability subject to fluctuation of interest rates are cash holdings at the OPG and a UK high street bank. Clatterbridge Centre for Oncology NHS Trust is not, therefore, exposed to significant interest-rate risk. Note 25.1 and note 25.2 show the interest 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 FRS29, and concluded that this note is not applicable to the Trust.

87 87

(261) 899 0 18,171

(261) 899 0 18,171 19,278

Total at 31 March 2009

0 1,286 0 11,998

0 1,286 0 11,998 14,413

Total at 31 March 2008

14,413

0 1,129

Fixed Asset Investments (at 31 Mar 2008) NHS Debtors (at 31 Mar 2008) Provisions for irrecoverable debts (at 31 March 2008) Other debtors & accrued income (at 31 March 2008) Current Asset Investments Cash at bank and in hand (at 31 March 2008)

19,278

0 469

£ 000s

Loans and Receivables

0 469

£ 000s

Total

Fixed Asset Investments (at 31 March 2009) NHS Debtors (at 31 Mar 2009) Provisions for irrecoverable debts (at 31 March 2009) Other debtors and accrued income (at 31 March 2009) Current Asset Investments Cash at bank and in hand (at 31 March 2009)

Assets as per balance sheet

25.1 Financial assets

0 0

Assets at fair value Through I&E £ 000s £ 000s

0 0

Held to Maturity

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009

£ 000s

0 0

Available for sale

2,481

11 2,481

Total at 31 March 2008

0 0 2,470 0 0

Bank Overdrafts (at 31 Mar 2008) Loans (at 31 Mar 2008) NHS creditors (at 31 March 2008) Other creditors (at 31 March 2008) Capital creditors (at 31 March 2008) Finance lease obligations (at 31 March 2008) Provisions under contract (at 31 March 2008)

818

818 6,015

6,015

0 0 1,801 2,771 625

£ 000s

Loans and Receivables

£ 000s 0 0 1,801 2,771 625

Total

Total at 31 March 2009

Bank Overdrafts (at 31 Mar 2009) Loans (at 31 Mar 2009) NHS creditors (at 31 March 2009) Other creditors (at 31 March 2009) Capital creditors (at 31 March 2009) Finance lease obligations (at 31 March 2009) Provisions under contract (at 31 March 2009)

Liabilities as per balance sheet

25.2 Financial Liabilities

0 0 0 0 0

Assets at fair value Through I&E £ 000s 0 0 0 0 0 £ 000s

0 0 0 0 0

Held to Maturity

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009

£ 000s

0 0 0 0 0

Available for sale

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009 25.3 Fair Values 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 2009.

Financial assets Cash Debtors over 1 year:

Book value

Fair value

ÂŁ 000s

0 0

Investments Total Financial liabilities Overdraft Creditors over 1 year: - finance lease obligations Provisions under contract Loans

818 0 0

Total

818

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009 26. Third Party Assets The Trust held £NIL cash at bank and in hand at 31st March 2009 (2007/08 £Nil) which relates to monies held by Trust on behalf of patients

27. Intra-Government and Other Balances (FTC 20)

Debtors: amounts falling due within one year

Debtors: amounts falling due after more than one year

Creditors: amounts falling due within one year

£000

Creditors: amounts falling due after more than one year £000

English NHS Foundation Trusts English NHS Trusts Department of Health English Strategic Health Authorities English Primary Care Trusts RAB Special Health Authorities NHS CGA bodies NHS WGA bodies

53 6 0 40 353 1 0 16

0 0 0 0 0 0 0 0

1,202 567 0 5 9 18 0 0

0 0 0 0 0 0 0 0

Total NHS debtors / creditors Other WGA bodies TOTAL DUE WITHIN ONE YEAR

469 41 510

0 0 0

1,801 721 2,522

0 0 0

469

1,801

0 469 0

0 0 0

0 1,801 0

0 0 0

0 0 0 0 0 41 510

0 0 0 0 0 0 0

0 0 517 0 204 0 2,522

0 0 0 0 0 0 0

NHS and other WGA Debtors and Creditors Due within one year

Analysis of NHS and Other WGA Debtors and Creditors due within one year Total NHS debtors / creditors Less amounts included in other categories: Loans Total NHS debtors / creditors Add back: amounts included in other categories Analysis of other WGA bodies Loans Corporation tax receivable / payable Other tax and social security costs Other debtors / creditors Other: NHS Pension Scheme (Employers) HM Customs & Excise (VAT) TOTAL DUE WITHIN ONE YEAR

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2009 28. Losses and Special Payments There were 31 cases of losses and special payments totaling ÂŁ33k paid during 2008/09. (2007/08 13 cases totaling ÂŁ4k). There were no cases exceeding ÂŁ250k in year. Note: The total costs included in this note are on a cash basis and will not reconcile to the amounts in the notes to accounts which are prepared on an accruals basis. 29. Auditors Liability The auditors liability for losses in connection with the external audit is not limited.

Clatterbridge Centre for Oncology Clatterbridge Road Bebington, Wirral CH63 4JY Telephone. 0151 334 1155 www.ccotrust.nhs.uk

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