Annual
REPORT&
ACCOUNTS
2014/15
Greater Manchester West Mental Health NHS Foundation Trust
Annual Report and Accounts 2014/15
Presented to Parliament pursuant to Schedule 7, paragraph 25 (4) (a) of the National Health Service Act 2006
Contents Page Strategic Report .......................................................................................................... 6 Risks ........................................................................................................................ 14 Our Environment .................................................................................................. 16 Social, Community & Human Rights Issues .......................................................... 17 Directors’ Report and Management Commentary ............................................. 20 Enhanced Quality Governance Reporting ............................................................. 23 Statement of Directors’ Responsibilities in Respect of the Accounts ............ 28 Register of Interests ................................................................................................... 30 Remuneration Report ................................................................................................ 32 How we Work .............................................................................................................. 36 Council of Governors ................................................................................................. 39 Membership of the Board of Directors .................................................................. 42 Committees .................................................................................................................. 48 Foundation Trust Membership ................................................................................ 54 Quality Report ............................................................................................................. 56 Staff Survey .................................................................................................................. 58 Regulatory Ratings Report ....................................................................................... 61 Financial Review ......................................................................................................... 63 Accounting Officer’s Responsibilities ..................................................................... 71 Annual Governance Statement ............................................................................... 73 Independent Auditor’s Report ................................................................................. 80 Appendix 1 – NHS FT Code of Governance ............................................................ 84 Appendix 2 – Annual Accounts ................................................................................ 92
Annual Report 2014/15
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Strategic Report
ue and respect • we work together • we go dly • we are caring and kind • we value and reater Manchester a mile • we are welcoming and friendlyWest • weMental Health NHS Foundation Trust formally a foundation trust in we work together • we go(GMW) the extra milebecame • We provide wide range of NHS services across g and kind • we value2008. and respect • we awork a large •and geographical coming and friendly wedisparate are caring and kind footprint covering Greater Manchester, North West and beyond. we go the extra mile • the we wider are welcoming ue and respect • we work together • we go dly • we are caring and kind • we valueand and Services provided include community inpatient mental health services, adult and adolescent forensic mental health services, adolescent psychiatry services, mental health a mile • we are welcoming and friendly • we and deafness services, community and inpatient alcohol and drugs services, and offender we work together we go mileservice • portfolio, we operate within a complex health•services. As athe resultextra of our diverse commissioning framework. partnership working with commissioners and other g and kind • we value and respectEffective • we work providers is critical to managing this and to ensuring that we remain at the forefront of coming and friendly • we are caring and kind local planning. we go the extra mile • we are welcoming Our vision remains to deliver ‘Improved Lives and Optimistic Futures for People Affected ue and respect we work together we go by • Mental Health and Substance•Misuse Problems’. Our vision is underpinned by six strategic objectives: dly • we are caring and kind • we value and To promote recovery by providing high quality care and delivering excellent outcomes ra mile • we• are welcoming and friendly • • To work with service t • we work together • we gousers the and carers to achieve their we are caring goals and kind • we value e extra mile• •Towe areinwelcoming engage effective working ue and respect partnership • we work together invest in our g and friendly• •Towe are caring and environments r • we go the extra mile • we are • To enable staff to reach d • we value and respect weinnovate work their potential•and coming and friendly • we are caring • To achieve sustainable financial be • ogether • we go the strength extra and mile well-governed g and kind • we value and respect • we are welcoming and friendly • t • we work together • we go the We work together to achieve our values we are caring and kind • we value Greater Manchester West Mental Health NHS Foundation Trust extra mile • Page we6 are welcoming and friendly
G
And, our values, which articulate what we stand for as an organisation and how we will work together to achieve the best for our staff and patients: • We are welcoming and friendly • We are caring and kind • We value and respect • We work together • We go the extra mile
extra mile • we are welc caring and kind • we v Strategic Goals and Initiatives We have made significant progress in together • we go the ext delivering the strategic development and Plan friendly • we are ca plans set out in our ‘Strategic for 2014 to 2019’ and our respect ‘Operational•Planwe work togeth for 2014 to 2016’. Progress is tracked via we are welcoming local project groups or•routine meetings, as well as via our robust annual business and kind • we value and r planning process. The business planning we for go the extra mile process provides opportunity previous year’s achievements tofriendly be acknowledged • we are caring an and outstanding priorities (that remain • be we together • w relevant and feasible) to carried work forward. are welcoming and friendly The Trafford Aim launch event Key achievements in 2014/15 include: and we value respect • we extra acute mile • we are welc • Implementing a redesigned care pathway in Bolton, Salford and Trafford: including the provision of more effective Treatment services; strengthened caring and kindHome-based • we value and respect • we work together • bed management, improved interfaces across inpatient, home- and community-based are welcoming friendly • of we are caring and kind • we services; and the commencement of work and to develop a ‘Centre Excellence’ for older people. This work will conclude in 2015/16 together • we go the extra mile • we are welcoming and frie • Continuing to develop our rapid access psychiatric liaison services in Bolton, Salford and • we value and respect • we work together • we go the ex Trafford acute hospital settings and friendly we are caring and kind we value and respect • Embedded new designated and fit for•purpose place of safety facilities for•individuals admitted on a Section 136extra in Boltonmile and Salford the • we are welcoming and friendly • we are ca • Expanding our Memory Assessment Treatment Service • forwe people dementia, respect • weand work together gowith the extra mile • we are and their carers, in Salford are caring and kind • we value and respect • we work togeth • Continuing to consolidate and improve our Improving Access to Psychological Therapies services we are welcoming and friendly • we are caring and kind • we • Implementing new services following a successful together • we go thetender: extra mile • we are welcoming and frie • Salford Integrated Drug andvalue Alcoholand Recovery Services•for Adult and Young People. • we respect we work together • we go the ex Operating as prime provider with sub-contracting arrangements developed with and • weProject, are caring andNHS kind • we value organisations such as Greatfriendly Places, Thomas Salford Royal Foundation Trust and respect and Early Break the extra mile • we are welcoming and friendly • we are ca • HMP New Hall Personality Disorder Services for women respect • we work together • we go the extra mile • we are • Trafford Drug and Alcohol Detoxification Services are caring and kind • we value and respect • we work togeth • Successfully tendering to provide mental health and substance misuse services at HMP are welcoming andSecure friendly • we areand caring and kind • we Hindley and mentalwe health services at Barton Moss Children’s Centre St. Catherine’s Children’s Centre – implementation to follow in 2015/16 together • we go the extra mile • we are welcoming and frie • we value and respect • we work together • we go the ex Page 7 Annual Report 2014/15 and friendly • we are caring and kind • we value and respect
• Providing additional capacity in our adolescent inpatient service (Junction 17) to respond to national demand • Investing in capital development: • Provision of new medium secure accommodation to replace old accommodation • Commencing work to re-provide our existing male low secure wards and build an education and training facility, which will provide a central ‘hub’ for our Recovery Academy and enable the re-location of Trust Headquarters • Continuing to expand our low secure and ‘locked’ inpatient care, in Widnes through a contractual Joint Venture with Priory • Progressing the implementation of a new clinical information system • Actively contributing to the development and implementation of an integrated Primary and Acute Care System to meet all health and social care needs in Salford –working in partnership with Salford CCG, Salford City Council, Salford Royal NHS Foundation Trust and Salix via an alliance contracting model and backed by NHS England as one of its vanguard sites. New integrated care system to be piloted in 2015/16.
Government and Regulatory Context We have developed an ‘Operational Plan for 2015/16’, reviewed our five-year ‘Strategic Plan for 2014 to 2019’ and our two-year ‘Operational Plan for 2014 to 2015’. We have also analysed the national (government and regulatory) context, specifically taking into account: • ‘Everyone Counts: Planning for Patients 2014/15 – 2018/19’ • ‘NHS Five Year Forward View’ • ‘The Forward View into Action: Planning for 2015/16’ • ‘The Mandate for the NHS 2015/16’ • ‘Closing the Gap: Priorities for Essential Change in Mental Health’ • Winterbourne, Berwick, Francis and Keogh inquiries and reports • Changes in regulatory policy including the Care Quality Commission’s new inspection regime • The National Tariff and our choice of the Enhanced Tariff Option ‘Everyone Counts: Planning for Patients 2014/15 to 2018/19’ established a requirement for NHS organisations to shift their focus from short-term incremental improvements to longer-term planning. Our existing ‘Strategic Plan’ responded to this by setting out plans for transforming our services over a fiveyear period, and this Plan continues to support that vision.
We are committed to improving access to therapies
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The ‘NHS Five Year Forward View’ emphasises that major system changes are required to protect high quality, sustainable
Greater Manchester West Mental Health NHS Foundation Trust
care for patients now and into the future. Our plans represents a credible strategy for change that will enable delivery of the required levels of performance into the long-term. Our plans also meet all operational and financial requirements in 2015/16 and we have contingencies in place to address any short-falls or unexpected difficulties. ‘The Forward View into Action: Planning for 2015/16’ (published December 2014) describes the approach organisations should start to take in 2015/16 in order to fulfil the vision set out in the ‘NHS Five Year Forward View’. The ‘Forward View into Action’ specifically identifies ‘achieving parity for mental health’ as a priority for 2015/16. This is alongside priorities for improving quality and outcomes, improving patient safety and meeting NHS constitutional standards. The introduction of access and waiting time standards in mental health in 2015/16 is one approach identified in ‘The Forward View into Action’ as a means of achieving parity. New access and waiting time standards will be implemented in the following areas and monitored via Monitor’s Risk Assessment Framework and local contracts: • Early Intervention in Psychosis – £40 million additional investment has been made available to support this • Improving Access to Psychological Therapies – £10million additional investment has been made available centrally and will be targeted towards those areas facing the greatest challenge in achieving the standards ‘The Forward View into Action’ also identifies further investment for the development of adequate and effective liaison psychiatry services, for all ages, in a greater number of acute hospitals. Targeted investment of £30million will be made available in 2015/16 for this purpose. A further £30million targeted investment will be used to support the establishment of community-based specialist teams for children and young people with eating disorders. We welcome the news that, as an outcome of the ‘NHS Five Year Forward View’ and the current impetus to significantly improve mental health services, a new taskforce has been launched to develop a new five-year strategy for mental health for people of all ages. We will take every opportunity to contribute to the work of this Taskforce. The approach to achieving parity in mental health outlined in ‘The Forward View into Action’ does not change the ambitions set out for mental health in ‘The Mandate’ to NHS England for 2015/16. As such, we will continue to deliver against pre-existing mandate objectives - including improving access to psychological therapies standards and improving diagnosis, treatment and care for people with dementia - whilst also focusing on achieving the new access and waiting time standards for mental health services. ‘Closing the Gap’ sets out 25 priorities for essential change in mental health and details how changes in local service planning and delivery will make a profound difference to the lives of people with mental health problems. We have developed local responses to these priorities and will continue to implement these in 2015/16. We remain committed to quality assuring all of Annual Report 2014/15
Closing the Gap sets out local service planning and delivery
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our activities based on the findings of the Winterbourne, Berwick, Francis and Keogh inquiries and reports, and to take steps to strengthen our systems of internal control. In 2015/16, we are planning to participate in a ‘Governance Review’ led by Monitor to assess our performance against its ‘Well-led Framework’ and determine the robustness of our governance arrangements and organisational development agenda. We are also focused on the Care Quality Commission’s new Registration Regulations, and associated fundamental standards of quality and safety, and are actively preparing for the new inspection regime. We are taking steps to strengthen our assurance process and have also commenced a regular programme of internal inspections, which will continue into 2015/16, to this end.
Quality Goals As planned, we continued to drive forward quality improvements in 2014/15. We achieved all targets set nationally for mental health providers in 2014/15, delivered our Commissioning for Quality and Innovation schemes and secured all associated income, and made significant progress against our Quality Improvement Priorities as set out in our annual Quality Account.
National and Local Commissioning Priorities We recognise the particular challenges faced in, and across, our local health economies and our plans align with our commissioners’ intentions as set out in their long-term strategic plans and associated needs assessments and strategies. We continue to work closely with our commissioners to understand the health needs of our populations and to develop and deliver services that best meet those needs within the available resources. Our main commissioners are: • Bolton, Salford and Trafford CCGs for our district services • NHS England (Cheshire and Merseyside Sub-Regional Team) for specialised services • NHS England Health and Justice Team for North West (hosted by Lancashire and Greater Manchester Sub-Regional Team) for offender health services • A number of local authorities (including, Salford, Central Lancashire, Cumbria and Wigan and Leigh) for substance misuse services District Services - CCGs have explicitly been asked to ensure that spend on mental health services rises in real terms in 2015/16 and grows at least in line with the CCG’s overall allocation growth. Our CCGs’ commissioning intentions cover the following themes: • Early intervention and prevention • Recovery – enabling the best possible outcomes for patients • Delivering an integrated approach to care to support patients’ physical, mental and social care needs • Improving Access to Psychological Therapies • Improving children and young people’s mental health • Rapid and convenient access to services • Emergency and unplanned care - continued development of psychiatric liaison or RAIDtype services
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Greater Manchester West Mental Health NHS Foundation Trust
• Supporting people with dementia to live healthier lives • Implementing redesigned acute inpatient services and community services • Positive or improved experience of care We continue to address these themes in our strategic priorities for 2015/16, which are supported by our commissioners.
Supporting people with dementia to live healthier lives
Offender Health/Health and Justice - In terms of offender health, NHS England are part-way through their fourtranche programme of re-procurement for health and social care services in prisons and healthcare in secure children’s homes across the North West. In partnership with Bridgewater Community Healthcare NHS Trust, we have participated in procurement exercises in Greater Manchester and Merseyside to date and have been awarded contracts in HMP Hindley and Barton Moss Secure Children’s Centre in Greater Manchester and St. Catherine’s Secure Children’s Centre in Merseyside. Procurement for tranche 3 (Cheshire) and tranche 4 (Lancashire) will follow in early 2015/16 and these opportunities will be assessed when the tenders are published. Specialised Services – NHS England’s review of CAMHS (Child and Adolescent Mental Health) Tier 4 services, and adult medium and low secure mental health services, will continue in 2015/16. The review will focus particularly on whether the right services are being provided in the right place and providing the required capacity. We will be an active participant in this work and recognise that changes in the way services are commissioned and delivered may follow. Substance Misuse Services – The market for alcohol and drugs services continues to be the area where we are most subject to commissioners ‘market testing’ services with a view to driving up quality and value for money. This market is fast-moving, subject to political scrutiny and occupied by a range of competing NHS and third sector providers. Commissioners are issuing requests for tenders at regular intervals (usually, three to five years). As such, opportunities for expansion, and equally risks of losing existing business, arise frequently.
Devolution We are active participants in planning for the devolution of health and social care responsibilities to CCGs and local councils in Greater Manchester during the build-up year (2015/16) and from April 2016 onwards. We are members of the mental health workstream of ‘Devo Manc’ and fully support the principles guiding this development. We recognise that mental health services may be re-shaped as this agenda progresses in order to better meet the interests and outcomes of patients and people in Greater Manchester.
Annual Report 2014/15
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Manchester Mental Health Improvement Programme We understand the long-standing challenges facing providers of mental health services in Manchester and continue to be engaged in the Manchester Mental Health Improvement Programme (MHIP). This programme of work is focused on reducing fragmentation across Manchester and enabling a more integrated approach; improving outcomes and quality; improving access; and delivering care and treatment based on assessed needs and good practice. We are committed to working with other key stakeholders to redesign services in Manchester and implement new care pathway specifications. We will continue to engage with Monitor and the CQC as this work progresses and in the event that any potential transactions would result in a material or significant change to this organisation.
Competition As more opportunities arise outside the alcohol and drugs field – for example, in health and justice and psychological therapies services - we are taking steps to share our experience across the wider organisation. We have necessarily developed a formal process for bidding/tenders, which includes market shaping, assessments and strategy and defined roles and responsibilities. Within this process, we also focus on relationship management and reputation management, and maintain a knowledge base of the local health economy, commissioner requirements and changing agendas. We will continue to seek to improve our bid maturity in 2015/16. We have also grasped opportunities to deliver services in new ways and by using different contracting models, such as prime provider models, contractual joint ventures and alliance agreements, and will continue to innovate in this regard in future years.
Summary of Board Strategic Intentions In light of this strategic context, we recommit to pursuing the direction set out in our fiveyear strategic plan for 2014 to 2019. This plan resonates with the expectations set out for mental health services in ‘The Five Year Forward View’, ‘The Forward View into Action’ and the NHS Mandate. We welcome the identification of ‘parity for mental health’ as a key priority and the introduction of access and waiting time standards, and respond to these in our plans for 2015/16.
Performance Monitoring Performance against our key priorities is monitored via a number of mechanisms. For example, our approach to business planning allocates responsibility for monitoring, supporting and performance managing the achievement of business plan priorities, throughout the year, to identified individuals (namely, Network Directors and Heads of Service). For those priorities which require resource allocation, and have therefore been developed into a business case, the individual business cases also outline how performance will be monitored. This includes via agreed performance targets; systems to record and report performance; implementation plans, including key milestones and timescales; and the approach to evaluation and evaluation criteria.
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Greater Manchester West Mental Health NHS Foundation Trust
Financial Plans The Trust has had a successful year financially, achieving a net surplus of £7.8m, and an overall Financial Risk Rating of 4. Whilst 2014/15 has been a successful year for the Trust, the coming years will continue to represent an increasing challenge to both the Trust and to the Public Sector. The NHS faces an unprecedented financial dilemma; the supply of funding is struggling to match the growing demand for healthcare. The need to deliver 4 per cent efficiency savings until 2016 is of immediate concern. Savings of a similar amount are likely to be needed after 2017. Along with all NHS organisations, we will need to identify and deliver 4 to 5% efficiency savings on an annual basis. This means an estimated £5m per year must be saved on a recurrent basis whilst we maintain the quality of services. Our Trust has an excellent track record for making efficiencies but this must continue in the forthcoming years, to ensure that we remain a financially secure organisation. ‘The Five Year Forward View’ highlighted that major system changes are required to protect high-quality sustainable care for patients now and into the future. Additional investment of £1.98bn in mental health services was announced in the autumn 2014 statement, including £150m from NHS England. We welcome this investment and will work with commissioners to ensure that the increase in funding is invested to meet the new standards for early intervention in psychosis services, access standards relating to adult Improving Access to Psychological Therapies services and liaison psychiatry services. The Trust has developed its 2015/16 operational plan in light of the challenging economic backdrop and a clear expectation that the funding provided to the NHS will need to be supplemented by making efficiencies to deal with the rising demand from an ageing population and the increased costs of new technology.
Achievements The last 12 months have been on of achievement and many successes have been awarded to us. Not only did the rapid access detoxification acute referral facility win Team of the Year at the Royal College of Psychiatrists, but GMW also won:
The Junction 17 building won the Design Project of the Year at the Design in Mental Health Network National Awards
• Design Project of the Year at the Design in Mental Health Network National Awards for GMW’s adolescent inpatient unit at Prestwich • Two Advancing Quality awards for Best Performing Trust Annual Report 2014/15
The Dementia Team with their Advancing Quality Award
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for Dementia and Best Performing Trust for First Episode Psychosis • Two awards at the Care Coordination Association for outstanding practitioners • A National Service User Award for the ‘Getting on The Psychosis Team with their Advancing Quality Award with People’ card game which is designed to help patients discuss their perception and experience of bullying
Risks Our Trust Board hold ultimate accountability for quality. The Board has established a subcommittee with delegated authority to set the strategy for quality and to ensure delivery against it. The Quality Governance Committee is chaired by a Non-Executive Director and includes other Trust Board members, lead clinicians from all clinical services and corporate leads with responsibility for risk and quality management. The structure and business of the Quality Governance Committee has been informed by an assessment against Monitor’s Quality Governance Framework, with guidance and advice from Deloitte. The Quality Governance Committee have an agreed Quality Governance Framework and leads on setting and measuring performance against the Trust’s quality priorities as set out in the annual Quality Account. Trust Board are visible within clinical services and undertake regular visits to services. This provides members with opportunities to triangulate evidence, speak to service users and staff about their experience and to ensure that there is an open and transparent culture within the Trust. The Trust Board’s Board Assurance Framework sets out the key strategic risks, which could affect delivery of our key strategic and quality priorities. The risks identified in the Board Assurance Framework are based on a collective assessment by the Trust Board of the operating environment. They are also informed by risks identified at Directorate/ service level, which are managed via local Risk Registers and reviewed at the Trust-wide Risk Management Strategy Group. Directorate risks are escalated to the Board Assurance Framework in the event that they could significantly impact upon the delivery of our strategic objectives. As quality is at the heart of all of our objectives, risks identified in the Board Assurance Framework have the potential to impact on service quality. Our current key strategic risks, and associated controls, are as follows. Where gaps in controls have been identified by the Trust Board, actions are being progressed to mitigate these. Key risks: • Acute Care Pathway – risk of the redesigned acute care pathway not being implemented effectively, which could result in quality, relationship, financial and workforce issues. Controls in place to mitigate this risk include oversight provided by the Steering Group and designated work-streams; robust business plan; and continuous engagement with CCGs and other key stakeholders during, and subsequent to, the consultation process • Implementation of the new clinical information system – risk of failure to effectively implement the new clinical information system which may impact on safety Page 14
Greater Manchester West Mental Health NHS Foundation Trust
and quality. Controls in place include oversight of the Project Board, robust business plan; engagement of Directors and clinicians in implementation and commitment of required resources • Workforce planning – risk of ineffective/insufficient workforce planning leading to inadequate resources to deliver services and lack of control over pay costs. Control in place include identification of workforce issues via annual business planning process; incorporation of key workforce indicators in monthly Directorate Performance Reports; annual development of Trust-wide Workforce Plan plus specific workforce plans for service redesigns; annual Training Needs Analysis; and cost improvement planning. • Sickness absence – risk of higher than planned sickness absence impacting on service delivery and incurring higher bank and agency expenditure. Controls in place include Sickness Management Policy; monthly Directorate sickness absence reports; designated HR Officer to support Directorates; Absence Management Training for all Line Managers; Occupational Health and Counselling service available to all staff; and monthly monitoring and assurance meetings. • Mandatory training – risk of lower than agreed compliance with mandatory training leading to inadequately trained staff. Controls in place include Induction and Mandatory Training Policy; monthly monitoring at Workforce and Education Governance Committee; adequate classroom and e-learning provision in place; resource built into staffing establishments to enable release of staff for training; and requirement to attend mandatory training made a requirement for pay progression with effect from 1 April 2014. • Compliance with targets – risk of failure to meet national and/or local targets, which may impact on patient care, Trust rating and could lead to financial penalties or intervention from regulators. Controls include Board and Directorate Performance Reports; Data Quality Reports and associated operating guidance; and scrutiny via Network Board, Performance Measures, Contract Monitoring and Quality Governance Committee meetings. • IT business continuity and disaster recovery – risk of lack of resilient IT infrastructure and business continuity/disaster recovery arrangements leading to a delay in the recovery of key clinical and consequently impacting on service delivery and patient safety. Controls include oversight of IM&T Strategy Group and investment in IT infrastructure. • Income (economic climate) – risk of uncertainty/insecurity of income as a consequence of national economic climate and commissioner intentions. Specific risk relate to competition and tendering of our existing services. Controls include financial reporting at Directorate level; signed contracts in place; Contract Monitoring meetings; annual and longer-term planning; contracts risk register; and market assessment of business development opportunities. • Devolution Greater Manchester - the implications of the framework for delegation and devolution of health and social care responsibilities in shadow and final form by April 2016 on commissioning arrangements across Greater Manchester. We are aware that from July 2015, GMW will be subject to an unannounced Care Quality Commission (CQC) ‘deep dive’ inspection where the following questions will be asked: • Are services safe? • Are services caring? • Are services responsible? • Are services effective? • Are services well-led?
Annual Report 2014/15
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As these visits will be very different from other CQC visits, over the coming months, senior executives will carry out a number of mock inspections in our services which will mirror what would be like if the CQC were to actually inspect the service. These mock inspections are a great way for us to be able to see when our teams are doing really well and when they need extra support. If improvements are needed, we can help staff make positive change.
Our Environment The pressures on the NHS have never been greater with efficiencies being sought from all services involved in the delivery of healthcare. The sustainability agenda is seen by the government as a primary enabler to achieve these efficiencies with the added benefit of releasing significant cost savings across a range of key areas of activity:
One of the many GMW buildings
• Energy and carbon management • Procurement and food • Transport and access • Water • Waste • Designing the built environment • Organisational and workforce development • Partnership and networks • Governance • Finance GMW has been at the forefront of the sustainability agenda throughout 2014/15 promoting and raising the profile of sustainability in its widest context. A number of major achievements in areas as diverse as procurement, energy, and waste have demonstrated GMW’s commitment to meet its sustainable objectives as outlined in the GMW Sustainability Strategy. The Hospital Food Standards Panel in late 2014, after working with organisations including royal colleges and nutritional experts developed a set of compulsory standards and recommendations for hospitals that encourage healthy eating, high-quality food production, sustainability and excellent nutritional care. The Department of Health advised ‘for the first time hospitals will have to meet mandatory food standards as part of a long-mooted drive to raise its standards of food across the country’. The new standards introduced for the first time the need to source food on a sustainable basis through reinforcing the need to reduce food miles and source locally whenever possible. Food Standards 1. Nutritious and appetising food and drink 2. A varied menu which includes meals suitable for all religious needs 3. Access to fresh drinking water at all times Page 16
Greater Manchester West Mental Health NHS Foundation Trust
4. Food and drink that is available at all times 5. Food that adheres to the Government Buying Standards for Food that is sustainable and locally produced where possible. The updated energy pack and video pod casts on the GMW Sustainability homepage are intended to make climate change a reality by bringing to everyone’s attention how their behaviour impacts on the environment. Engaging with service users, visitors and the GMW workforce remains as a key priority in the coming year as changing individuals’ behaviour so they become more carbon aware and consequently less carbon dependant will have the greatest impact on GMW’s fossil fuel consumption and consequently CO2 emissions. The sustainability agenda continues to gather momentum with 2015 being the next benchmark year for NHS organisations to demonstrate they have met their carbon reduction targets. The NHS is required achieve a 10% reduction in its carbon emissions when compared to the 2007 baseline. While it is anticipated that GMW will meet this target a number of energy initiatives have been incorporated into the 2015 capital programme to deliver further reductions in primary and secondary energy consumption. This ensures that our capital investment programme reflects GMW’s ongoing commitment to remaining at the forefront of low carbon technology with highly efficient infrastructure and new buildings. The NHS sustainability day on 26th March 2015 marked the start of the national publicity campaign aimed at promoting carbon reduction strategies and sustainable developments across the entire NHS. GMW was actively engaging and promoted sustainability with events centred at the Waterdale Restaurant and Conference centre. Local companies and suppliers were involved with GMW showcasing its sustainability plans for the coming year. Clinical services were involved for the first time promoting the role of local sustainability champions.
Social, Community and Human Rights Issues Greater Manchester West Mental Health NHS Foundation Trust is committed to improving the lives of our service users, carers, staff and the broader populations whom we serve. Our aspirations to achieve this corporate social responsibility are set out in “Committed to sustaining communities” within which, one of the key objectives is to implement a strategy that promotes social inclusion and the recovery model. Social inclusion and recovery are closely linked to the equality and diversity agendas, and this strategic plan incorporates the Trust’s Single Equality Scheme which sets out our arrangements for meeting our statutory duties in relation to race equality, disability equality and gender equality, as well as actions on age, sexual orientation and spirituality. Through implementation of “Equality, Inclusion, Recovery” we will continue to strive to be an organisation that: • Has the confidence and respect of service users, carers, communities, our staff and partner organisations • Provides high quality mental health and substance misuse services that meet the needs of all our diverse communities • Is fully representative of our diverse communities • Has equality and diversity embedded in its culture • Works with service users to maximise opportunities for full community engagement • Works to reduce stigma in mental health and substance misuse Annual Report 2014/15
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Supporting staff with disability
• Enhances the quality of life and challenge the exclusion of patients, carers and communities by delivering improved mental health and social care services and outcomes for individuals and communities in partnership with those communities and with our partner organisations. • Recruits, supports and retains a diverse and skilled workforce by providing training and guidance to deliver acceptable, valued and effective services with confidence. • Promotes partnership and networking with service users, carers, our workforce and partner organisations within and across the Trust’s services and geographical communities to support social inclusion and recovery. • Ensures services meet statutory obligations under relevant equalities legislation and the Human Rights Act (1998) • Engages with service users and their carers to ensure that they have equal access to a full range of housing, employment, training and leisure activities and to promote their family life The model of business for the trust is based on the following corporate objectives: • Promote recovery by providing high quality care and delivering excellent outcomes • Work with service users and carers to achieve their goals • Engage in effective partnership working • Invest in our environment • Enable staff to reach their potential and innovate • Achieve sustainable financial strength and be well-governed We recognise our responsibility to involve service users and carers in the planning and provision of services; development of proposals for change in the way services are provided; and other decisions affecting the operation of services. We take this responsibility seriously and have a strong track record of service user and carer involvement and engagements through a variety of mechanisms. A number of the established plans outlined respond to service user feedback. We will continue to work Page 18
Greater Manchester West Mental Health NHS Foundation Trust
with our service users and carers to ensure that plans remain on track and relevant to any changing priorities or needs. Our Council of Governors have actively contributed to the development and agreement of the plans. During 2014, we hosted a round of governor elections and recruited a number of new governors who have rich and varied backgrounds. Further details can be found under the Council of Governors section of this Annual Report. Where required, the views of Overview and Scrutiny Committees and commissioners have and will be sought on specific plans. We are particularly focused on enabling the following: • Market penetration – consolidate or strengthen our position in existing markets • Service development – provide a new type of service, which may or may not be an extension of existing services, in existing markets • Market development – providing a service in which we have experience (i.e. an existing service) in new markets • Diversification – providing a new type of service in new markets During the year 2014 – 2015, staff in post figures are 3136 headcount and 2897.14 WTE.
Table 1 Staff numbers according to gender As at 31 March 2015 Male
Female
TOTAL
Directors
9
5
14
Other Senior Managers
5
15
20
Employees
904
2198
3102
TOTAL
918
2218
3136
Data show number of staff Directors are Chief Exec. Chair, Executive and Non-Executive Directors Other Senior Managers are staff on Bands 8c and above, except those employed to provide clinical services eg. Psychologists Employeers are the remainder of the staff employed by the Trust in substantive posts ie. Bank and Locums excluded
The following accounts have been prepared under a direction issue by Monitor under the National Health Service Act 2006. 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.
Signed: Bev Humphrey, Chief Executive
Annual Report 2014/15
Date: 22nd May 2015
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Directors’ Report and Management Commentary
dly • we are caring and kind • we value and mile • we are welcoming and friendly • we e work together • we go the extra mile • and kind • we value and the respect • we work During 2014/15 following people were directors of Greater Manchester West Mental Health NHS Foundation: coming and friendly • we are caring and kind we go the extra mile Chair • we are welcoming Alan Maden, ue and respect • Bashford, we workNon-Executive together •Director we go Jon dly • we are caring and kind • we value and Anthony Bell, Non-Executive Director mile • we are welcoming and friendly • we Mike Chapman, Vice Chair and Senior Independent Director e work together • we go the extra mile • Malcolm Non-Executive and kind • we valueCowen, and respect • we Director work coming and friendly • weNon-Executive are caring and kind Kathy Doran, Director we go the extra mile •Non-Executive we are welcoming Julie Jarman, Director ue and respect • we work together • we go Professor Karen Luker, Non-Executive Director dly • we are caring and kind • we value and Terry McDonnell, Non-Executive Director mile • we are welcoming and friendly • we Brian•Slater, Non-Executive Director e work together we go the extra mile • and kind • we value and respect • we Director work Sunita Thomson, Non-Executive coming and friendly • we are caring and kind Bev Humphrey, Chief Executive we go the extra mile • we are welcoming Dr Steve Colgan, Medical Director ue and respect • we work together • we go Gill Green, Director of Nursing and Operations dly • we are caring and kind • we value and Ismail Hafeji, Director Finance,•Information Management and Technology mile • we are welcoming and of friendly we e work together • we go the extra mile Resources • Andrew Maloney, Director of Human and Governance and kind • we and respect • we Joevalue Peers, Director of Estates andwork Facilities coming and friendly • we are caring and kind Neil Thwaite, Deputy Chief Executive and Director of Business and Service we go the extra mile • we are welcoming Development ue and respect • we work together • we go dly • we are caring and kind • we value and Page 20 Greater Manchester West Mental Health NHS Foundation Trust ra mile • we are welcoming and friendly •
Greater Manchester West Mental Health NHS Foundation Trust recognises that equality of opportunity in employment will promote the full use of the skills and abilities of its entire workforce. Only with the help and commitment of present and future staff will the Trust be able to provide sensitive and effective health care to all its population. The Trust recognises that by developing and using the skills of the whole workforce and in recruiting from all sections of the community will it be best able to meet its core values extra mile • we are welcoming and friendly • we are caring an and objectives.
• we work together • we go the extra mile • we are welc
The Trust’s Equal Opportunity Policy aims to prevent covert acts of discrimination but caring and and kind •which, we although value and respect • weare work together • also to highlight requirements practices, possibly unintentional discriminatory in nature. intended to aidand the development employment areIt iswelcoming friendly of • good we are caring and kind • we practices in respect of present and future employees.
together • w welcoming and kind • work togeth • we are we caring and • we work t mile • we a we are cari respect • w the extra m friendly • w value and re go the ext All staff are treated equally and fairly and friendly we value and respect • we work together • we go the ext Everyone who works in the Trust, or applies to work in the Trust, should be treated fairly and valued equally. Allfriendly conditions of service andcaring job requirements should fit with and • we are and kind • we value and respect the needs of the service and those who work in it, regardless of age, disability, race, the extra mile • we are welcoming and friendly • we are ca nationality, ethnic or national origin, gender, religion, beliefs, sexual orientation, domestic respect • westatus, work together • we go the extra mile • we are circumstances, social and employment marriage and civil partnership, pregnancy and maternity, HIV status, gender reassignment or political affiliation or trade union are caring and kind • we value and respect • we work togeth membership. we are welcoming and friendly • we are caring and kind • we Equality of opportunity means that•an individual’s diversity is viewed and,welcoming and frie together we go the extra milepositively • we are in recognising that everyone is different, valuing equally the unique contribution that we value respect individual experience,•knowledge andand skills can make. • we work together • we go the ext and friendly • we are caring and kind • we value and respect In September 2014, the Health Service Journal announced that GMW was in the top 100 mile • we are and friendly • we are ca NHS trusts to work for.the Out extra of the 250 NHS trusts who hadwelcoming taken part in the annual NHS staff survey, GMW wasrespect showcased one of the together best to work • for. • as we work we go the extra mile • we are are caring and kind • we value and respect • we work togeth we are welcoming and friendly • we are caring and kind • we together • we go the extra mile • we are welcoming and frie • we value and respect • we work together • we go the ext Page 21 and respect Annual Report 2014/15 and friendly • we are caring and kind • we value
extra mile • we are welcoming and friendly • we are caring and kind • we value and respect • we work together • we go the extra mile • we are welcoming a n d friendly • we are c a r i n g and kind • we value the extra m are caring a together • w and friendly respect • we we are welc • we value the extra m are caring a together • w and friendly Staff Health and Wellbeing is of upmost Importance respect • we The Health and Safety at Work Act (1974) places a duty on every employer to prepare, we are welc and as often as may be appropriate, revise a written health and safety policy and to • relevant we value and respect • we work together • w bring it and any revision to the notice of all persons. GMW has a robust policy encompassing all employees, bank and agency patients users, students, and staff, friendly • and weservice are caring and kind • we valu volunteers, visitors, contractors and members of the public. It encompasses all activities, the extra mile • we are welcoming and friend premises and services of the Trust. The policy sets out the arrangements for health respect • wethework together • we go the extra and safety management within the Trust and determines responsibility for health and safety at all levels and the methods ofare communication required caring and kindfor• the weeffective value and respect • we management of health and safety. The purpose of this policy is to provide a framework we are welcoming and friendly • we are caring around which a safe and healthy work environment can be maintained by promoting we go the to extra mile good working practices and encouraging together involvement • and commitment this policy at • we are welc all levels of the Trust. Whilst legislation exists to enforce and • we valuegood andstandards respectof•health we work together • w safety, the Trust aims not only to adhere to these standards but to improve on them. and friendly • we are caring and kind • we value the extra mile • we of are welcoming and friendl The promotion and maintenance of the physical and mental wellbeing all staff is vitally important to the Trust. This is why we have access to a dedicated Occupational Health respect • we work together • we go the extra team of doctors and practitioners to advise the organisation on how best to manage and are caring and kind • we value and respect support an employee who is experiencingwe illness. mile • we are welcoming and friendly • we ar Due to the geographical spread of our locations, we have to rely mainly on electronic • we work together • we go the extra mile • communications which is why we send a weekly e-bulletin to all staff and rely on our kind •Over wethe value and respect • we wo website and intranet to provide staff withcaring the latestand information. next 12 months, the Marketing and Communications are seeking and to improve online • we are caring an areTeam welcoming friendly availability of information for staff at our together various sites. • we go the extra mile • we are welco • we value and respect • we issues work These communication methods routinely include trust performance and financial to together • w reassure staff of the current position of the trust. and friendly • we are caring and kind • we val go the extra mile • we are welcoming and fri Page 22 Greater Manchester West Mental Health NHS Foundation Trust and respect • we work together • we go the e
d y
Enhanced Quality Governance Reporting
and respect • we work together • we go mile • we are welcoming and friendly • we and kind • we value and respect • we work we go the extra mile • we are welcoming GMW isand a highkind performing achieving all its mandatory targets set by y • we are caring • weorganisation, value and Commissioners, the Care Quality Commission and Monitor. As well as also achieving our e work together • we go the extra mile • financial targets and cost improvement efficiencies, we compare well with other similar coming and friendly • we are the caring and kind organisations in both national staff surveys and community patient survey when compared to other organisations. The findings and respect • we work together • we go from the 2014 Community Mental Health for GMW were published by the Care Quality Commission (CQC). Service users mile • we areSurvey welcoming and friendly • we were asked what they thought about different aspects of the care and treatment they and kind • wereceived valueatand GMW.respect • we work we go the extra mile • we are welcoming GMW’s results are comparable to most other trusts that participated in the survey and y • we are caring and kind • we value and findings were that the vast majority of respondents gave positive answers allowing GMW e work together • we go the • on the following aspects of care: to score higher than mostextra Trusts inmile England coming and friendly • we are caring and kind • Respondents felt they were always treated with dignity and respect we go the extra mile • we are welcoming • Respondents felt involved in decisions about medication ue and respect • we work together • we go • They felt care and services were organized well and that they were seen often enough dly • we are caring and kind • we value and to meet their needs mile • we are welcoming and friendly • we • A large number felt that they were listened to carefully and were given enough time to e work together • we the mile • discuss theirgo needs andextra treatment and kind • we value and respect • we work • Many felt that they knew how to contact their care coordinator if they had concerns coming and friendly • we are caring and kind • Three quarters rated their overall experience of GMW as good or very good we go the extra mile • we are welcoming • Almost two thirds of respondents e and respect •knew we work together we in go who to contact out of•hours a crisis and kind • we value and ly • we are caring a mile • we are welcoming and friendly • As always there is room for improvement t • we work together • we go the and this includes providing betterextra on medication purposes and re caring andinformation kind • we value and respect side effects. We will also aim to improve • we are welcoming and friendly • we are service users’ knowledge of who their ork together •care wecoordinator go theisextra • we and howmile they can be nd kind • we accessed. value and respect • we work oming and friendly • we are caring and kind It is also imperative that all service users we go the extra mileto•an we welcoming have access outare of hour’s mental health support telephone number lue and respect • we work together •and we We work closely with Carers iendly • we are caring and kind • we value Page 23 Annual Report 2014/15 extra mile • we are welcoming and friendly
extra mile • we are welcoming and friendly • we are ca • we work together • we go the extra mile • we a we are committed to making this a realityand under the new home-based treatment services caring kind • we value and respect • we work toget during 2015. welcoming and friendly • we are caring and kind • we va Although our Carers Charter has been across the Trust, it is vital enough we fully go embedded the extra mile • we arethat welcoming and friendl information is given to families and carers as they play such an important role in the recovery andWe respect • we together we go the extra mi and ongoing support of service users. will ensure carerswork and families remain a•significant priority over 2015 – 16 and beyond. we are caring and kind • we value and respect • we wo However, alongside the annual • community health survey, users •are now we are mental welcoming andservice friendly we are caring and ki able to give feedback on their experiences of care and treatment provided by GMW since together • we go extra we are welcoming January 2015. Mental Health and Community Health arethe the latest two mile areas to•start gathering information from thousands of patients across the country – a move comes • we value and respect • we workthat together • we go t after the Family and Friends Test went live across all 8,000 GP practices in England where and friendly • we are caring and kind • we value and r up to one million people see their doctor every day. the extra mile • we aretowelcoming and friendly • we GMW mental health inpatients are given an electronic questionnaire complete on discharge rating how likely they are to recommend to theirtogether friends and family. respect • we us work • weThe gomajority the extra mile • of our community mental health service users receive a text message asking them the same areacaring and kindareas • we andwillrespect • we work question. Some services will also have post box in reception andvalue service users be encouraged to complete a postcard to say how likely they are to recommend us. we are welcoming and friendly • we are caring and kin However, the real strength of the FFT lies in the rich feedback servicemile users are together • we go thethat extra • we are welcoming able to give direct to our staff in near real time. The free-text comments offer a real • weisvalue • we work together opportunity to find out quickly what workingand well respect and what can be improved, making • we go the our services better for everyone.friendly • we are caring and kind • we value and respe Another development has beenextra the newmile feature•ofwe theare ‘Achieve’, Salford recovery welcoming and friendly • we are ca service which will work intensively with all family members to explore the impact of • we • patterns we goof the extra mile • we a alcohol misuse and equip them with thework tools totogether break harmful behaviour. A specialist young person’s teamcaring will work withkind teenagers and youngand adultsrespect at a time • we work toget and • we value when people can be particularly vulnerable to developing longer term problems or using welcoming and friendly • we caring and kind • we v alcohol in a way which will impact on their future life chances, health andare wellbeing. • we go th and friendly and respect extra mile we are carin we work tog are welcom kind • we va we go the Photo from the Achieve Salford Recovery Service Launch Event friendly • w During 2014, GMW became the first UK mental health trust to implement and demonstrate respect • we work together • we go the extra mile • all ten Safeward interventions on a pilot inpatient ward. The interventions involve forming better relationships between staff andcaring patients, and managing patient’s closely are kind • wemoods valuemore and respect • we work and creating discharge messages whereby patients who are being discharged leave positive areabout welcoming and • ward. we are caring and kin messages for current and future we patients their care and timefriendly spent on the Safeward principles comprise of planning, compromise, positive and•reducing together • we go theenvironments extra mile we are welcoming incidents which fall in line with GMW’s CQUIN targets and quality account priorities. The value and respect • we work together • we go t Safewards project will roll out to•allwe inpatient wards by 2016. and friendly • we are caring and kind • we value and r Page 24 Greater Manchester West Mental Health NHS Foundation Trust the extra mile • we are welcoming and friendly • we
aring and kind • we value and respect It isand important that we• hold are welcoming friendly weourselves are accountable to external organisations to demonstrate our openness, transparency and that we are doing the very best for our ther • we go the mile we are serviceextra users and their • families and carers. We have positive, well established relationships with GP colleagues in clinical commissioning groups (CCGs) and third sector organisations alue and respect • we work together • and are committed to working together for the good of the local health and social care economies. By working with different partners, we can ensure that mental health, ly • we are caring and kind • weclosely value drug and alcohol services remain top of the health agenda. ile • we are welcoming and friendly • have a strong relationship with the Local Authority Overview and Scrutiny ork together •We we go the extra mile Committees (OSCs) in Bolton, Salford and Trafford, as well as the newly established ind • we value and respect • we Healthwatch and the local work Health and Wellbeing Boards. We place a high value on their involvement and are glad they share our commitment to provide high quality mental and friendly •health we are caring and kind services for the communities we serve. the extra mile • we are welcoming Safeguarding children and vulnerable adults is also one of our top priorities and we work respect • we with work together • we go local safeguarding boards to make sure all partners involved in the care of children and adults communicate regularly. e are caring and kind • we value and The Boardand of Directors publicly scrutinises key performance and quality indicators at the • we are welcoming friendly • we public meetings of the Trust Board. As well as at Board level, our performance against together • we extra mile • indicators is subject to internal scrutiny at individual localgo andthe national targets and quality level and nd • we valueDirectorate and respect • Trust-wide we workat Network Boards and the Performance Measures Group. We are also monitored by external organisations including our Commissioners and friendly •through we are caring kind contract andand quality groups, the Care Quality Commission (CQC) and Monitor. e extra mile The • we are welcoming CQC have inspected our and services regularly during the last 12 months and our registration with the CQC is without ect • we work together • we go the any conditions, showing full compliance with the essential standards of quality and safety. aring and kind • we value and respect Our Business Intelligence Team has established robust structures and processes to enable are welcoming and friendly • we are review and reporting against our performance requirements and other contractual commitments. These processes enable us to demonstrate our compliance with standards, ther • we go the extra mile • we are as well as identifying areas for further improvement. value and respect • we work together Our Quality Account also provides he extra mile • we are welcoming assurance about the quality of services provided bykind GMW.•The Quality y • we are caring and we value Governance Committee, a formal t • we work sub-committee together •ofwe go the the Board monitors in detail performance against e • we are welcoming and friendly • key milestones and improvement ng and kind •priorities. we value and respectof•our We take advantage foundation trust status by hosting gether • we go the extra mile • we the Dragons Den initiative, which is chaired Trustcaring Chair. This has ming and friendly • by wetheare and funded small innovative projects alue and respect • our weservices, work which together across help us• our quality account priorities. extra mile •achieve we are welcoming and Dragons Den Panel Front line staff and service users and we are caring and kind • we value and carers have pitched their ideas to the Dragons, and resulting in over 30 • we are welcoming friendly • projects we being funded. These work streams have helped us demonstrate improvement in areas such as physical healthcare, carers and service user’s together • we go the extra mile • dual diagnosis and dementia care. Some examples of experience, psychological therapies, the initiatives the Dragons have funded can be found in the Quality Account. nd • we value and respect • we work Trust is committed to ensuring and friendly •The we are caring and kind that service users, carers, staff and the general public who access our services have a safe, effective and positive experience. In delivering this the extra mile • we are welcoming commitment, the Trust recognises and supports the need for care to be delivered in safe respect • we work together • we go Page 25 Annual Report 2014/15 e are caring and kind • we value and
environments with minimal risk to service users and staff and that care delivery is personcentred, evidence based, efficient and effective. We acknowledge and appreciate that Quality and Governance is everyone’s responsibility and all staff must contribute to the organisational values by: • Working within National Guidance, Trust policies and local service guidelines • Adhering to multiagency safeguarding procedures, including Prevent to protect children, young people and vulnerable adults from all forms of abuse • Identifying and managing potential risks and reporting incidents in order to protect service users, carers and staff and support lessons learnt from such events • Demonstrating transparency, openness and a duty of candour • Valuing and respecting diversity and treating service users, carers and colleagues with dignity, respect and compassion • Actively contributing to and supporting positive practice and innovation • Addressing and managing evidence of poor standards of care or negligence or abuse of service users by reporting such incidents as per Trust policy • Keeping up to date with research, developments and evidence based practice • Delivering a robust clinical audit programme and acting on results as appropriate • Supporting data collection for the monitoring and reporting of service quality to external regulators i.e. Monitor, Health and Safety Executive, Care Quality Commission, Clinical Commissioning Groups, NHS England and the NHS Litigation Authority in order to provide organisational compliance assurance The safety of service users, carers, staff and the general public is of the utmost importance. We continue to use and expand our web-based patient safety and risk management system, which are linked with our electronic medical records systems to ensure service user records can be accessed quickly and securely. These systems have continued to improve the timely management and lessons learnt from incidents and identify potential risks. As a result of our web-based patient safety and Safety is very important to us risk management system we continue to see a reduction in clinical and non-clinical claims. We have had independent verification that our incident management and risk management arrangements are strong and robust enough to ensure that patient safety is first-rate. Our Customer Care Team support and facilitate the management of complaints and compliments. When we receive a complaint, we aim to address it in a timely manner and provide individuals with all the evidence available to show that we have dealt with their concerns using a clear and transparent approach. Service users and carers are involved with meetings and projects in order to share their experiences so that we may further understand the needs of our local communities and respond by adopting our services accordingly.
Page 26
Greater Manchester West Mental Health NHS Foundation Trust
To further facilitate lessons learnt, safety and evidence based practice we have an annual internal audit calendar. This audit calendar is produced and agreed by the Nice Implementation & Audit Group which reports to the Board of Directors. This audit calendar captures the national, clinical and directorate audits that we undertake in order to demonstrate that we do take the provision of patient centred, equitable, safe, high quality, and evidence based care very seriously. Any weaknesses highlighted from the audit outcomes are then addressed and reassessed by repeating the audit cycle. Further assurance is provided, as required, through the procurement of Mersey Internal Audit Agency who undertook independent audits within the Trust and produced a level of assurance and recommendations for improvement. This assurance is further enhanced through our Quality Accounts. We continue to monitor our performance under the Mental Health Act to ensure that our practice is lawful and in accordance with the Code of Practice and we continue to strengthen our Trust-wide Mental Health Act management arrangements to help us achieve consistently high standards in our administration of the Act. Whilst we are recognised for already providing good quality care, demonstrated by our compliance with external regulators, we recognise that there is always room for improvement. As an organisation with a culture for continuous learning, we encourage all our staff and service users to make suggestions for quality improvement and be involved in implementing the great ideas that are adopted, in order to further enhance safe, effective and positive experiences for users of our services.
Annual Report 2014/15
Page 27
Statement of Directors’ Responsibilities in Respect of the Accounts
riendly • we are caring and kind • we value xtra mile • we are welcoming and friendly • • we work together • we go the extra mile g and kind • we value and respect • we work coming and friendly • we are caring and kind The directors the NHS Act 2006 and under a direction issued by we go the extra mileare• required we areunder welcoming Monitor, to prepare accounts for each financial year. In preparing those accounts, the ue and respect • weare work together we go directors required to ensure • that: dly • we are caring and kind • are weaware, value and • So far as the directors there is no relevant audit information* of which are aware; a mile • we areauditors welcoming and friendly • we • The•directors have taken all of the steps • that they ought to have taken as a director in we work together we go the extra mile order to make themselves aware of any relevant audit information* and to establish g and kind • wethat value and respect the auditors are aware•ofwe thatwork information. coming and friendly • we caring and * “Relevant auditare information” meanskind information needed by the auditor in connection with preparing their report. we go the extra mile • we are welcoming A director is regarded as having •taken the steps that they ought to have taken as a ue and respect • we work together weallgo director in order to do the things mentioned above, if they have: dly • we are caring and kind • we value and • Made such enquiries of their fellow directors and of the NHS Foundation Trust’s a mile • we are welcoming and friendly • we auditors for that purpose, and we work together • we go the extra mile • • Taken such other steps (if any) for that purpose, as are required by their duty as a the NHS foundation trust to exercise reasonable care, skill and diligence. g and kind • wedirector valueofand respect • we work coming and friendly • we are caring and kind we go the extra mileenquiries, • we are welcoming After making the directors have a reasonable expectation that the NHS Foundation Trust has adequate resources to continue in operational existence for the ue and respect • we work together • we go foreseeable future. For this reason, they continue to adopt the going concern basis in preparingand the accounts. dly • we are caring kind • we value and a mile • we are and friendly • we Thewelcoming directors confirm to the best of their knowledge and belief they have complied with the above requirements in preparing the we work together • we go the extra mileaccounts. • g and kind • we value policies and respect • we Accounting for pensions and work other retirement benefits are set in note 7 to the accounts and that details of senior employees can be found in page 27 of the coming and friendly • we are caring and kind remuneration report. we go the extra mile • we are welcoming ue and respect • we work together • we go dly • we are caring and kind • we value and Page 28 Greater Manchester West Mental Health NHS Foundation Trust ra mile • we are welcoming and friendly •
By order of the Board.
extra mile • we are welcoming and friendly • we are caring an
Signed:
• we work together • we go the extra mile • we are welc Signed:
caring and kind • we value and respect • we work together • w
B e v H u m p h r e y I s m a i l H a•f ewe ji welcoming and friendly are caring and kind • we value and Chief Executive
Director
of
Finance
and
IM&T
we go the extra mile • we are welcoming and friendly • we a
D a t e : 22 n d M a y 2015
Date: 22nd May 2015
and respect • we work together • we go the extra mile • we
we are caring and kind • we value and respect • we work toge
Our Board of Directors•operate to the highest corporate we are welcoming and governance friendly •standards. It we are caring and kind • we is responsible for all aspects of the performance of the Trust, including financial performance, clinical and service quality, and performance. together • wemanagement go the extra mile • we are welcoming and frie The Board is legally accountable for the services provided thework Trust and their key • we value and respect • by we together responsibilities include:
• we go the ext
and friendly • we are caring and kind • we value and respect
• Setting the strategic direction, having taken into account the Council of Governors’ the extra mile • we are welcoming and friendly views • Ensuring that our services provide safe, clean and personal care for go patients respect • we work together • we the
• we are ca
extra mile • we are
• Ensuring robust governance arrangements are in place
are caring and kind • we value and respect • we work togeth
• Ensuring rigorous performance management so that we achieve all local and national targets we are welcoming and friendly • we are caring
and kind • we
• Ensuring that we are always compliant with our Terms of Authorisation
together • we go the extra mile • we are welcoming and frie
The Board has decided that certain decisions may only be exercised or made in formal • we value and respect • we work together • we go the extra Board sessions. These are set out in the reservation of powers to the Board and the Scheme of Delegation.friendly • we are caring and kind • we value and respect • we
extra mile • we are welcoming and friendly • we are caring an
we work together • we go the extra mile • we are welc Declaration•of Interests
caring and kind • we value and respect • we work together • w
The Board of Directors undertakes an annual review of its Register of Declared Interest. At welcoming and friendly • we are kind • we value and each meeting of the Board of Directors, a standing agenda item alsocaring requiresand all Executive and Non-Executive Directors to make known an interest in relation to the agenda and we go the extra mile • we are welcoming and friendly • we a changes to their declared interests. The Register of Declared Interests for the Board of Directors is held by theand Trustrespect Secretary and is available for public inspection. Members of • we work together • we go the extra mile • we the public can gain access by contacting Steph Neville, Head of Corporate Affairs, Trust Headquarters, Greaterwe Manchester West Mental Health•NHS Trust, Bury New are caring and kind weFoundation value and respect • we work toge Road, Prestwich, M25 3BL
• we are welcoming and friendly • we are caring and kind • we
together • we go the extra mile • we are welcoming and frie
• we value and respect • we work together • we go the extra Annual Report 2014/15
Page 29
friendly • we are caring and kind • we value and respect • we
Register of Interests
e extra mile • we are welcoming and friendly • ct • we work together • we go the extra mile As an NHS Foundation Trust, Greater Manchester West Mental Health NHS Foundation is required by its Terms of Authorisation to comply with the principles of best ring and kindTrust • we value and respect • we work practice applicable to corporate governance in the NHS/health sector and with any welcoming andrelevant friendly are in caring and code •ofwe practice, particular thekind NHS Foundation Trust Code of Governance • we go the extra mile • we are welcoming The expectations of the NHS in respect of standards of corporate conduct are set out in value and respect • we work go guidance issued by thetogether Department•ofwe Health and the NHS Appointments Commission, the ‘Code of Conduct Code of Accountability in endly • we are caring and kind • we value andthe NHS’ and Monitor’s ‘The NHS Foundation Trust Code of Governance’. tra mile • we are welcoming and friendly • we The Code of Conduct for the Board of Directors of Greater Manchester Mental Health • we work together • weTrust go (the theTrust) extra mile with • this guidance and seeks to expand NHS Foundation is consistent and value complement Constitution forwork Greater Manchester West Mental Health NHS ing and kind •onwe andthe respect • we Foundation Trust (the Constitution). welcoming and friendly • we are caring and kind Under the provisions of the Constitution, the Trust shall have a Register of Interests to we go the extra mile • we are welcoming and record formally declarations of interests of Board of Directors. In particular, the Register e and respect will • we work together • we go the relevant material interests, which both include details of all directorships and other Executive and Non-Executive Board Directors have declared. • we are caring and kind • we value and respect of the Board Directors • must ile • we are Members welcoming and of friendly wedeclare are on appointment any interests, which might place, or be seen to place them in a potential conflict of interest between their work togetherpersonal • we go the interest extraand mile • arising we are or private those from their membership of the Board of Board Directors are alsotogether required to declare any conflict of interest that arises in ind • we valueDirectors. and respect • we work • the course of conducting Trust Business, specifically at each meeting of the Board. and friendly • we are caring and kind • we value The Register of Interests will be maintained by the Head of Corporate Affairs and shall be e extra mile •available we are welcoming and friendly • for inspection by members of the public on request. ct • we work together • we go the extra mile The Register will be subject to annual review by the Board. ring and kind • we value and respect • we work welcoming and friendly • we are caring and kind we go the extra mile • we are welcoming and e and respect • we work together • we go the • we are caring and kind • we value and respect ile • we are welcoming and friendly • we are work together • we go the extra mile • we are ind • we value and respect • we work together • and friendly •Page we30are caring and kind • we value Greater Manchester West Mental Health NHS Foundation Trust e extra mile • we are welcoming and friendly
Chair Alan Maden
Trustee Pension Fund – St Ann’s Hospice
Non Executive Directors Jon Bashford
Director of Research and Development TiFCi Senior Partner, Community Innovations Enterprise LLP Undertakes contract work across NHS & LAs across England
Anthony Bell
extra mile • we are welcoming and friendly • we are caring
Non- Executive Director, Guinness Partnership
• we work together • we go Non-Executive Director, Carriocca Enterprises
the extra mile • we are w
caring and kind Institute • we value and respect • we Vice-Principal, The Grimsby of Further & Higher Education Mike Chapman Malcolm Cowen
work together •
No welcoming directorships or significant interests to and friendly • declare we are caring and kind • we value No directorships of significant interests to declare
Kathy Doran
weand goacting theVice-Chair extraofmile • we are welcoming and Trustee The Reader Organisation Non Executive Director of Your Housing Group
Julie Jarman
Trustee of MIND in Salford (delivers IMHA services with GMW)
Karen Luker
University nominated Non-Executive Head of School we are caring and kindDirector • wepost value and respect • we work to of Nursing, Midwifery and Social Work, Queen’s Nursing Institute of Professor Community Nursing, The University of Manchester • weofare welcoming and friendly • we are caring and kind •
Terry McDonnell
No directorships or significant interests to declare
Brian Slater
No directorships or significant interests to declare
Sunita Thomson
Director of Goal Development Consultancy • we value and respect • we
Chief Executive Bev Humphrey
friendly • w
and respect • we work together • we go the extra mile •
together • we go the extra mile • we are welcoming and work together • we go the
and friendly • we are caring and kind • we value and respe extra mile •interest we are welcoming No the directorship or significant to declare
Executive Directors
and friendly • we are
respect • we work together • we go the extra mile • we
Stephen Colgan
caring and kind • we value No are directorships or significant interests to declare
and respect • we work toge
Gill Green
No we directorships or significant interests declare are welcoming and to friendly
• we are caring and kind •
Ismail Hafeji
No directorships or significant interests to declare
Andrew Maloney
•significant we gointerests the extra mile No together directorships or to declare
Joe Peers
No • directorships or significant interests•towe declare we value and respect work
Neil Thwaite
No directorships or significant interests to declare
• we are welcoming and
together • we go the ext
friendly • we are caring and kind • we value and respect •
extra mile • we are welcoming and friendly • we are caring
• we work together • we go the extra mile • we are w
caring and kind • we value and respect • we work together • welcoming and friendly • we are caring and kind • we value
we go the extra mile • we are welcoming and friendly • w and respect • we work together • we go the extra mile •
we are caring and kind • we value and respect • we work to
• we are welcoming and friendly • we are caring and kind • together • we go the extra mile • we are welcoming and Annual Report 2014/15
31 • we value and respect • we work togetherPage • we go the ext
Renumeration Report
dly • we are caring and kind • we value and mile • we are welcoming and friendly • we Table 2 Remuneration of Board Members e work together • we go the extra mile • 2014/15 2014/15 2013/14 2013/14 Taxable Taxable and kind • we value and respect • we work Name Title Salary Total Salary Total Benefits* Benefits* and Fees Salary and Fees Salary coming and friendly • we are caring and (Bands kindof To nearest (Bands of (Bands of To nearest (Bands of £5,000) £100) £5,000) £5,000) £100) £5,000) £’000 £ £’000 £’000 £ £’000 we go the extra mile • we are welcoming Chair 40-45 40-45 40-45 40-45 A Maden ue and respect • we work together • we go Non Executive Director (retired July 0-10 0-10 15-20 15-20 M Chapman 2014) dly • we are caring and kind • we value and Non Executive Director (retired July 0-10 0-10 10-15 10-15 J Bashford 2014) mile • we are welcoming and friendly • we Non Executive Director 10-15 10-15 10-15 10-15 Prof K Luker e work together • weNongo the extra Executive Director (retired Julymile • 0-10 0-10 1015 10-15 B Slater 2014) and kind • we value and respect Non Executive Director • we work 1520 15-20 15-20 15-20 T McDonnell Non Executive Director 15-20 15-20 15-20 15-20 M Cowen coming and friendly • we are caring and kind Non Executive Director- new in 0-10 0-10 A Bell post 14/15 we go the extra mile • we are welcoming Non Executive Director- new in 0-10 0-10 Post 14/15together • we go ue and respectK Doran • we work Non Executive Director- new in 0-10 0-10 J Jarman Post kind 14/15 dly • we are caring and • we value and Chief Executive 160-165 3,300 165-170 160-165 3,400 160-165 B Humphrey mile • we areG Green welcoming and friendly •110-115 we 110-115 110-115 Director of Operations &Nursing 1,100 110-115 Finance and IM&T 110-115 115-120 110-115 1,800 110-115 I Hafeji• weDirectorof e work together go the extra mile • 3,100 115-120 1 Directorof HR & Governance 110-115 1 3,700 2,800 115-120 A Maloney 110-115 1 and kind • we value and respect • we work Medical Director 95-100 95-100 95-100 95-100 S Colgan coming and friendly • we are caring and kind Director of Estates & Facilities 120-125 3,300 120-125 110-115 3,000 115-120 J Peers Director of Service & Business we go the extra mile • we are welcoming 110-115 3,400 115-120 110-115 3,000 115-120 N Thwaite Development ue and respect • we work together • we go * Benefits in kind relate to the provision of lease cars to Board Members. ** There were no annual performance or long-term dly • we are caring and kind • werelated value and performance-related bonuses paid to Board Members during 2013/14 or 2014/15 mile • we are welcoming and friendly • we e work together • we go the extra mile • and kind • we value and respect • we work coming and friendly • we are caring and kind we go the extra mile • we are welcoming ue and respect • we work together • we go dly • we are caring and kind • we value and Page 32 Greater Manchester West Mental Health NHS Foundation Trust ra mile • we are welcoming and friendly •
Table 3 Pension Benefits as at 31 March 2015
Name
Title
Total Accrued Pension and Related Lump Sum at Age 60 at 31 March 2015
Cash Equivalent Transfer Value at 31 March 2015
Cash Equivalent Transfer Value at 31 March 2014
Real increase in Cash Equivalent Transfer Value
(Bands of £2,500) £’000
(Bands of £5,000) £’000
£’000
£’000
£’000
7.5-10are welcoming 255-260 1,241 and friendly 1,166 75 extra mile • we • we are caring an
Bev Humphrey
Chief Executive
Neil Thwaite
Director of Service and Business Development
Ismail Hafeji
Directorof Finance and IM&T
Gillian Green
Director of Operations and Nursing
Andrew Maloney
Director of HR and Governance
Joseph Peers
Real Increase in Pension and Related Sum at Age 60
5-7.5 423 36 • we work together •120-125 we go459the extra mile • we are welc 5-7.5
175-180
893
841
52
5-7.5
107-110
379
352
27
10-12.5 185-190 907• we work 86 caring and kind • we value and993respect together • w
and5-7.5 friendly • we are caring • we value and Director of welcoming Estates and Facilities 225-230 0 1,276and kind -1,276
we do gonotthe extra mile remuneration, • we are welcoming and friendly • we a As non-executive directors receive pensionable there are no entries in respect of pensions for non-executive directors.
and respect • we work together • we go the extra mile • we
A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the we are caring and kind • we value and respect • we work toge pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member’s accrued and anyand contingent spouse’s pension • we arebenefits welcoming friendly • we arepayable caring and kind • we from the scheme. A CETV is a payment made by a pension scheme, or arrangement to secure pension benefits in another • pension scheme arrangement theare member together we go theorextra milewhen • we welcoming and frie leaves a scheme and chooses to transfer the benefits accrued in their former scheme. • werelate value and respect • individual we work The pension figures shown to the benefits that the hastogether accrued as a • we go the ext consequence of their total membership of the pension scheme, notjust their service in a and • we The areCETV caring and kind • we value and respect senior capacity to which the friendly disclosure applies. and the other pension figures, include the value of any pension benefits in another scheme or arrangement which the thetoextra we are and friendly • we are ca individual has transferred the NHS mile pension•scheme. Theywelcoming also include any additional pension benefit accrued to the member as a result of their purchasing additional years mile • we are respect • we work together • we go the extra of pension service in the scheme at their own cost. CETV5 are calculated within the guidelines and framework by thekind Institute and value Faculty of Actuaries. are prescribed caring and • we and respect • we work togeth
Real Increase in CETV -This the increase inand CETV.friendly It takes account the increase we reflects are welcoming • weofare caring and kind • we in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred another schememile or arrangement) uses togetherfrom • we go pension the extra • we areand welcoming and frie common market valuation factors forth e start and end of the period.
• we value and respect • we work together • we go the extra
Table 4 Governors and Directors Expenses
friendly • we are caring and kind • we value and respect • we 2014/15
2013/14
Governors Directors and Governors Directors extra mile • we are welcoming friendly • we are caring an Total Numberin Office during the year Number Receiving Expenses
33
17
27
14
0
6,900
200
6,600
• we work together0 • we go the extra mile • we are welc 12 3 11
Aggregate Expenses Sum Paid (to the nearest £000)
caring and kind • we value and respect • we work together • w
Three non executive directors retired part way through the financial year 2014/15 with welcoming and friendly • we are caring and kind • we value and three new non executives subsequently joining the Board Govenor elections took place during the year due towe 2 resignations one govenor to the end of term of theirfriendly • we a go the and extra mile •coming we are welcoming and office. 9 new governors were elected to office in July 2014, and 1 in February 2015.
and respect • we work together • we go the extra mile • we
we are caring and kind • we value and respect • we work toge
• we are welcoming and friendly • we are caring and kind • we
together • we go the extra mile • we are welcoming and frie Annual Report 2014/15
Page 33 • we value and respect • we work together • we go the extra
Table 5 Hutton Review of Fair Pay - Disclosure Information
Band of Highest Paid Directors Total * Mid-point of Highest Paid Director
2014/15
2013/14
£’000
£’000
165-170
160-165
167.5
162.5
2014/15
2013/14
£26,822
£26,822
6.24 times
6.06 times
* - The highest paid director represents the Chief Executive.
Staff Median Total Remuneration * Ratio **
* - The calculation is based on full-time staff as at 31st March 2015 and is calculated on an annualised basis. ** - Ratio represents the median remuneration of staff compared to the mid-point of the highest paid director.
Table 6 Off-Payroll Engagements For all off-payroll engagements as of 31 Mar 14 to 1 Apr 15, for more than £220 per day and that last for longer than six months”
2014/15
2013/14
Number that have existed for less than one year at the time of reporting
1
1
Number that have existed for between one and two years at the time of reporting
3
0
No. of existing engagements as of 31 Mar 2016 Of which:
Number that have existed for between two and three years at the time of_reporting Number that have existed for between three and four years at the time of reporting Number that have existed for four or more years at the time of reporting
The Trust can confirm that all existing off payroll engagements, outlined above, have been subject to a risk based assessment as to whether assurance is required that the individual is paying the correct amount of tax. The Trust can confirm that the For all new off-payroll engagements, or those that reached six months in duration, between 1 Apr 2014 and 31 Mar 2015, for more than £220 per day and that last for longer than six months
2014/15
2013/14
No. Of Engagements
No. Of Engagements
Number of new engagements, or those that reached six months induration between 01 Apr 2014 and 31 Mar 2015
1
0
Number of the above which include contractual clauses giving the trustthe right to request assurance in relation to income tax and national insurance obligations
1
0
Number for whom assurance has been requested
1
0
Number for whom assurance has been received
1
0
Number for whom assurance has not been received*
0
0
Number that have been terminated as a result of assurance not being received
1
0
Of which:
Page 34
Greater Manchester West Mental Health NHS Foundation Trust
For any off-payroll engagements of board members, and/or senior officials with significant financial responsibility, between 1 Apr 2014 & 31 Mar
2014/15 Number of engagements
Number of off-payroll engagements of board members, and/or, senior officials with significant financial responsibility, during the financial year. Number of individuals that have been deemed ‘board members and/or senior officials with significant financial responsibility�. This figure should include both off-payroll and on-payroll engagements.
0 0
Sickness Absence Information In accordance with FReM (Government Financial Reporting Manual) guidance the sickness absence figures have been calculated on a calender year basis for 2014/15 (January to December 2014). They are based on data from ESR Data Warehouse. The sickness absence rate is calculated by dividing the sum total sickness absence days (including non workingdays) by the sum total available days per month for each staff member). Average of 12 months (2014 calender year)
Average Full Time Equivalent 2014
6.50%
2,646
Full Time Equivalent days Available 595,415
Full Time Equivalent days Lost to Sickness Absence 38,633
Average Sick Days per Full Time Equivalent 14.6
Signed: Bev Humphrey, Chief Executive
Annual Report 2014/15
Date: 22nd May 2015
Page 35
How We Work
dly • we are caring and kind • we value and mile • we are welcoming and friendly • we Greater Manchester Westextra Mental Health e work together • we go the mileNHS • Foundation Trust has applied the principles of the NHS Foundation Trust Code of Governance on a comply or explain basis. The NHS and kind • we value and respect • we work Foundation Trust Code of Governance, most recently revised in July 2014, is based on the principles of the UK Corporate Governance Code issued in 2012. coming and friendly • we are caring and kind The Board of Directors have welcoming established governance policies to make sure we comply with we go the extra mile • we are the Code of Governance. These include: ue and respect • we work together • we go • Corporate Governance Framework Manual incorporating the Standing Orders of the dly • we are caring and kind • we value and Board of Directors, Standing Orders of the Council of Governors, Scheme of Reservation mile • we areand welcoming and friendly • weFinancial Institutions Delegation of Powers and Standing • Governance Strategy Plan mile • e work together • we go theand extra • Established rolerespect of Senior Independent Director and kind • we value and • we work • Regular•private meetings between the Chair and Non-Executive Directors coming and friendly we are caring and kind • Non-Executive Director Performance Appraisal Process developed and agreed by the we go the extra mile • we are welcoming Council of Governors ue and respect • we induction work together we go • Formal programme•for Non-Executive and Executive Directors dly • we are caring and kind • we value and • Attendance records for Directors and Governors at key meetings mile • we are welcominginduction and friendly • we • Comprehensive programme for Governors e work together • we go theof extra • and Senior Staff • Register of Interests Directors,mile Governors • Establishment the role of and kind • we value andofrespect • Lead we Governor work • Comprehensive Assurance Briefing Report to all meetings of Council of Governors coming and friendly • we are caring and kind • Effective Council of Governors’ sub-committee structure we go the extra mile • we are welcoming • Council of Governors’ agenda setting process ue and respect • we work together • we go • Membership Development Strategy, Implementation Plan and Key Performance dly • we are caring and kind • we value and Indicators mile • we are welcoming and friendly • weof Service Committee of the Board of Directors • Nominations, Remuneration and Terms e work together • we goRemuneration the extra • Nominations, andmile Terms • of Service Committee of the Council of Governors and kind • we value and respect • we work • Agreed recruitment process for Non-Executive Directors coming and friendly • we are caring and kind • High quality reports to the Board of Directors and Council of Governors we go the extra mile • we are welcoming • Board evaluation and development plan ue and respect • we work together • we go • Council of Governors’ presentation of performance and achievement at Annual dly • we are caring and kind • we value and 36 Manchester West Mental Health NHS Foundation Trust ra mile • wePage are welcoming and friendly Greater •
Members’ Meetings • Code of Conduct for Governors • Going Concern Report • Robust Audit Committee arrangements • Governor-led appointment process for External Auditor • Whistle-blowing Policy and Counter Fraud Policy and Plan
extra mile • we are welcoming and friendly • we are caring an
The sub-committees of the Board are: • Audit Committee
• we work together • we go the extra mile • we are welc
caring and kind • we value and respect • we work together • w
• Remuneration and Terms of Service Committee
welcoming and friendly • we are caring and kind • we value and • Remuneration and Terms of Office Committee • Quality Governancewe Committee go the
extra mile • we are welcoming and friendly • we a
• Charitable Funds Committee
and respect • we work together • we go the extra mile • we
• Nominations Committee
we are caring and kind • we value and respect • we work toge
GMW is compliant of the NHS Foundation Trust Code of Governance. All other requirements are listed theare tablewelcoming in Appendix 1 of this friendly Annual Report, with page • inwe and • we are caring references of where to find these matters which are in the public interest.
and kind • we
together • we go the extra mile • we are welcoming and frie
Table 7 - Board of Directors attendance:Alan Maden (Chair)
• we value and respect • we work together • we go the ext 10/10
Mike Chapman
and friendly • we are caring and kind •3/3we value and respect
Malcolm Cowen
9/10 the extra mile • we are welcoming and friendly • we are ca
Anthony Bell
7/7
Kathy Doran
respect • we work together • we go the 7/7 extra mile • we are
Julie Jarman
7/7 are caring and kind • we value and respect • we work togeth
Karen Luker
7/10
Terry McDonnell
we are welcoming and friendly • we are caring and kind • we 10/10
Brian Slater Jon Bashford
together • we go the extra mile • we 3/3 are welcoming and frie
Bev Humphrey
9/10 • we go the extra • we value and respect • we work together
Andrew Maloney
3/3
10/10
Neil Thwaite
friendly • we are caring and kind • we10/10 value and respect • we
Steve Colgan
9/10 extra mile • we are welcoming and friendly • we are caring an
Joe Peers
7/10
Ismail Hafeji
• we work together • we go the extra 10/10 mile • we are welc
Gill Green
caring and kind • we value and respect •9/10 we work together • w
The use of appraisal for Directors is good practice and supports the principle in • we value and welcoming and friendly • we are caring outlined and kind the NHS Foundation Trust Code of Governance that an effective Board of Directors should lead every NHS Foundation Trust. we go the extra mile • we are welcoming and friendly • we a
During 2014, the Trustand continued its Chair andwork Non-Executive appraisal. The process, respect • we together • we go the extra mile • we led by the Nominations Committee on behalf of the Council of Governors introduced we are caring kind wepeer value and respect a structured, competency-based approachand including self•and assessment from the • we work toge Director. The Chair conducted the Chief Executive’s performance evaluation who in turn • Executive we areDirectors. welcoming and friendly • we are caring and kind • we conducted those of the
together • we goDirector the extra mile we areatwelcoming and frie The outcome of the Chair and Non-Executive appraisals were • considered a
• we value and respect • we work together • we go the extra Annual Report 2014/15
37 friendly • we are caring and kind • we valuePage and respect • we
Council of Governors meeting during 2014. All Directors have agreed objectives and • wehasare and friendly personal development plans for theextra followingmile year, which beenwelcoming developed alongside the Trust’s strategic objectives.
• we are caring and kind • we value and respect • we The Board of Directors held dedicated development sessions throughout the year to mile • we are work together • we go the extra enable detailed analysis of areas of corporate strategy. The Board received internal welcoming and friendly • we are and caring and kind • audit opinion on the robustness of the Trust’s processes including self-accreditation Core Standards Assessment and Registration processes and Code of Compliance against we value and respect • we work together • we go Monitor guidance has been received. the extra mile • we are welcoming and friendly • we are caring and kind • we value and respect • we together • weand go the extra mile • we are Board of Directors work – appointment removal welcoming and friendly • we are caring and kind • w of chair and other non-executive directors • we go the extra mile • we are welcoming and frie The Council of Governors at a general meeting of the Council of Governors shall appoint respect • we work together • we or remove the chair of the trust andand the other non-executive directors. The Council of go the extra Governors shall appoint the Chair and other directors we arenon-executive caring and kind in • accordance we valuewith and respect • we the following procedures: • we are welcoming and friendly • we are caring and • The Council of Governors shall appoint a Nominations Committee, chaired by the Chair together • the wevice-chair, go the extra mile •iswe are welcomin of the trust (or when a chair is being appointed, unless the vice-chair standing for appointment, in which case another director Chairtogether is • we value non-executive and respect • weif the work • we g absent) and comprising some or all of its members. and friendly • we are caring and kind • we value an • The Nominations Committee shall seek the views of the Board of Directors as to their recommended criteria and processthe for selection candidates and, having regard to and friendly • extraofmile • we are welcoming those views, shall then seek, short-list and interview such candidates as the committee respect • we work together • we go the extra mile considers appropriate. caring and kindto •thewe value and respect • we wo • The Nominations Committee shallare make recommendations Council of Governors as to potential appointments as non-executive directors and shall advise the Board of we are welcoming and friendly • we are caring and Directors of those recommendations. • we go theand extra mile • we are welcomin • The Nominations Committee shalltogether have such terms of reference powers as agreed by the Council of Governors. The terms reference shallrespect have effect if incorporated • weofvalue and • as we work together • we g into the Standing Orders of the Council of Governors. and friendly • we caring and kind • Removal of the chair or another non-executive director shallare require the approval of • we value an not less than three-quarters of thethe members of the Council Governors. extra mile • of we are welcoming and friendly • respect • we work together • we go the extra mile are caring and kind • we value and respect • we wo we are welcoming and friendly • we are caring and together • we go the extra mile • we are welcomin • we value and respect • we work together • we g and friendly • we are caring and kind • we value an the extra mile • we are welcoming and friendly • respect • we work together • we go the extra mile are caring and kind • we value and respect • we wo we are welcoming and friendly • we are caring and together • we go the extra mile • we are welcomin • we value and respect • we work together • we g Page 38 Greater Manchester West Mental Health NHS Foundation Trust and friendly • we are caring and kind • we value an
•
• e e we value and respect • we work together endly • we are caring and kind • we value The Trust has a Council Governors•responsible for representing the views and interests mile • we are welcoming andoffriendly of the members and partner organisations. Governors are local people, service users, work together • we go who thehave extra carers and staff beenmile elected by their constituency members to represent their views. They also have formal duties which include the appointment of the Trust’s Chair d kind • we value and respect • we work and Non-Executive Directors and their termination, approval of the appointment of the Chief providingand their kind views to the Board of Directors on Trust plans, to review ng and friendly • Executive, we are caring the membership development strategy and to make recommendations for the Trust’s go the extraconstitution. Being mile • we are welcoming a Governor is a demanding, yet incredibly important and fulfilling role. They remain our ‘critical friend’ who offer support, guidance and challenges and nd respect • we work together • we go work closely with us to build local relationships with key stakeholders. Governors present us with for and us to learn from service users and carers, the public and we are caring andanother kind opportunity • we value key stakeholders to improve the services we offer. e • we are welcoming and friendly • we to the close working relationship between the Council of Governors and the Board ork together •Due we go the extra mile • of Directors, conflicts or disagreements are aired and resolved quickly. The Lead Governor and Senior play a crucial role in this. They also have regular one-tod kind • we value andIndependent respect • Director we work ones with the Chair. ng and friendly • we are caring and kind other foundation trusts, there is frequent and regular attendance by go the extraUnlike milemany • we are welcoming members of the Board of Directors at Council of Governor meetings. There is also an annual joint together meeting held•between the Board of Directors and Council of Governors. nd respect • we work we go we are caring and kind • agree we value anddirection of travel during the Trust’s Annual Governors help to the strategic Member’s Meetings. Not only do they reflect on the previous year’s performance, e • we are welcoming and friendly • we they also agree priorities and objectives for the coming twelve months. Minutes of canextra be foundmile on the • Trust’s website, where there is also the facility for ork together •these wemeetings go the Governors and members to provide feedback to the Trust. d kind • we value and respect • we work ng and friendly • we are caring and kind go the extra mile • we are welcoming nd respect • we work together • we go we are caring and kind • we value and e • we are welcoming and friendly • we ork together • we go the extra mile • d kind • we value and respect • we work ng and friendly • we are caring and kind go the extra mile • we are welcoming Page 39 Annual Report 2014/15 nd respect • we work together • we go
Council of Governors
extra mile • we are welcoming and friendly • we are caring a
• we work together • we go the extra mile • we are we
Table 8 - Council of Governors attendance Name Les Allen, Public: Bolton
caring and kind • we value and respect • we work together • w Attendance
welcoming and friendly • we are caring2/3and kind • we value an
Peter Baimbridge, Public: Salford
3/5
Fareed Bashir: Staff: Medical
3/5
we go the extra mile • we are welcoming and friendly • we
Rob Beresford: Other North West and respect
• we work together • we 4/5 go the extra mile • w
Desmond Bradley: Public: Bolton
3/3
we are caring and kind • we value and5/5respect • we work tog Anne Broadhurst (Lead Governor), Service User & Carer Paul Butcher: Public: Trafford • we
are welcoming and friendly • we5/5 are caring and kind • w
Jennifer Carlisle, Staff: Nursing
5/5
together • we go the extra mile • we Hazel Carter, Public: Trafford 4/5are welcoming and fr Steve Coen, Appointed: Salford Counciland • weCity value Ann Cunliffe, Appointed: Bolton
and Jonathan Elster, Public: Salford
0/5 respect • we work together • we go the e 2/4
friendly • we are caring and kind1/1 • we value and respec
Iris Emery, Service User & Carer
3/3 the extra mile • we are welcoming and friendly • we are c
William Gallagher, Public: Bolton
respect • we Andrew Greenhalgh, Service User & Carer
1/5
work together • we go the 3/3 extra mile • we ar
Paul Ingham, Service User & Carer
1/5 are caring and kind • we value and respect • we work toget
Eileen Killeen, Service User & Carer
we areProfessionals welcoming and friendly Leah Madnick, Staff: Allied Health (resigned in 2014)
0/5
• we are 2/2 caring and kind • w
Sarah McDonald, Staff: Non-Clinical
1/3
John McLellan, Public: Salford
3/5
together • we go the extra mile • we are welcoming and fr
Alan Mitchell, Appointed:•Trafford we value
5/5 and respect • we work together • we go the extr
Eddie Murdoch, Staff: Non-Clinical
2/3
friendly • we are caring and kind • we3/5value and respect • w Paul Pandolfo, Appointed: Inspiring Change Manchester Margaret Riley, Service User & Carermile extra Philip Saxton, Public: Other North West
4/5 • we are welcoming and friendly • we are caring a 3/5
• we work together • we go the extra mile • we are we Sylvia Seddon, Public: Trafford 3/5 Julie Turner, Staff: Non-Clinical caring
and kind • we value and respect2/3 • we work together • w
Tony Warne, Appointed: University of Salford
0/5
welcoming and friendly • we are caring2/3and kind • we value an Margaret Willis, Service User & Carer Joanne Wilson, Service User & Carere
0/5 we go the extra mile • we are welcoming and friendly • we
Sally Claydon, Appointed: Cloughside College (resigned in 2014)
and respect we Andrew Morgan, Public: Bolton (resigned in•2014)
2/2
work together • we 1/1 go the extra mile • w
Mike Hulmes, Staff: Non-Clinical (retired in 2014)
we are caring and kind • we value and0/2respect • we work tog
Wilf Davison, Appointed: Cloughside College
0/1
• we are welcoming and friendly • we are caring and kind • w
All Governors are required to comply with the Trust’s Code of Conduct and declare any interests that may resulttogether in a potential•conflict in their as a Governor the are Trust.welcoming and fr we go therole extra mile •ofwe
• we value and respect • we work together • we go the extr
friendly • we are caring and kind • we value and respect • w
extra mile • we are welcoming and friendly • we are caring a
• we work together • we go the extra mile • we are we
caring and kind • we value and respect • we work together • w
welcoming and friendly • we are caring and kind • we value an Page 40
Greater Manchester West Mental Health NHS Foundation Trust
we go the extra mile • we are welcoming and friendly • we
and kind • we value and respect
The register of interests is maintained and is available via:
elcoming and friendly • we are
Steph Neville Head of Corporate we go the extra mile • weAffairs are Greater Manchester West Mental Health Trust NHS Foundation Trust nd respect • we together • Burywork New Road Prestwich e are caring and kind • we value Manchester M25 3BL
we are welcoming and friendly •
gether • we go the extra mile
we value andThe respect • we work Elections
riendly • we are caring and kind
During 2014, a round of elections took place to fill the following vacancies:
extra mile • we are welcoming
• Public – Bolton (two seats)
ct • we work • together • we go Public – Salford (one seat)
caring and kind • we value(one andseat) • Public – Trafford
Service users and • carers re welcoming• and friendly we (three seats) • Staff – Allied health professionals (one seat)
ther • we go the extra mile •
• Staff – Non –clinical (two seats)
we value and • respect • we work Staff – Nursing (one seat)
riendly • we are caring and kind
ra mile • we are welcoming The Trafford and theand Nursing staff seats were uncontested, however, the member of nursing staff – Joanne Howcroft - left the Trust shortly after taking the role, so this seat
we work together we go thestood for the seat in Salford, however, the Council has co-opted a remains•vacant. No one Governor into that seat. The new governors are as follows:
and kind • we value and respect
– Bolton: Les Allen and Desmond Bradley elcoming andPublic friendly • we are
Public – Salford: Jonathan Elster we go the extra mile • we are
Service users and carers: Iris Emery, Andrew Greenhalgh and Margaret Willis nd respect • we work together •
Staffkind – Allied professionals: Leah Madnick e are caring and • health we value
Staff – and Non-clinical: Sarah•McDonald, Eddie Murdoch and Julie Turner we are welcoming friendly
gether • we go the extra mile
we value and respect • we work
riendly • we are caring and kind
ra mile • we are welcoming and
we work together • we go the
and kind • we value and respect
elcoming and friendly • we are
we go the extra mile • we are
nd respect • we work together • Annual Report 2014/15
e are caring and kind • we value
Page 41
Membership of the Board of Directors
and kind • we value and respect • we work oming and friendly • we are caring and kind e go the extra mile • we are welcoming e and respect • we work together we goChair (current terms ends December Alan•Maden, 2015) y • we are caring and kind • we value and Alan was previously mile • we are welcoming and friendly • we a Non-Executive Director at the Trust from February 2005 to September 2009 when he was formally made work together • we go the extra • Chair of mile the Trust. He is a retired Senior Partner of a local practice of solicitors but also has a wealth of NHS experience. He was and kind • we value and respect • we work Chair of the Bury and Rochdale Health Authority from 1994 to oming and friendly • we are caring kind 2002 and and was a Non-Executive Director and Vice Chair of the Manchester Strategic Health Authority in April 2002. At e go the extra mile • we areGreater welcoming the Strategic Health Authority’s request he was also Acting Chair of the•Manchester e and respect • we work together we go Mental Health and Social Care Trust from February 2002 to September 2004, in a turnaround role. y • we are caring and kind • we value and mile • we are welcoming and friendly • we Jon Bashford, work together • we go the extra mile •Non-Executive Director (term of office came to an end in July 2014) and kind • we value and respect • we work Jon became a Non-Executive Director in 2005. He has over 20 oming and friendly • we are caring kindin the statutory and voluntary sectors in the years’and experience of drugs, alcohol and mental health both as a clinician e go the extra mile • we arefields welcoming and a senior manager. Jon has a research interest in equality e and respect • we work together • we and gohis PhD was in the area of race equality and and diversity organisational change. Jon is a senior partner with Community y • we are caring and kind • we value and Innovations Enterprise (CIE) and undertakes work across the public sector including the NHS on equality, human rights, a mile • we are welcoming and friendly • community engagement and needs assessment. • we work together • we go the extra e caring and kind • we value and respect • we are welcoming and friendly • we are rk together • we go the extra mile • we d kind • we value and respect • we work oming and friendly • we are caring and kind e go the extra mile • we are welcoming e and respect • we work together • we go y • we are caring and kind • we value and Page 42 Greater Manchester West Mental Health NHS Foundation Trust a mile • we are welcoming and friendly •
Anthony Bell, Non-Executive Director (current terms ends July 2018)
Anthony joined GMW in 2014 and is a qualified accountant. He is part-time vice principal of commercial activities at the Grimsby Institute of Further and Higher Education and non-executive director at the Guinness Partnership - a large housing association. Anthony has over 20 years of experience at board level in the education and social housing sectors, and has also had senior roles in the private sector. He is deputy chair of a managed extra milecomplex • we are welcoming and developing friendly • we are caring and workspace company, which supports business. Anthony has also previously been a board member • we together we goorganisation the extra mile • we are welco andwork treasurer of a training•placement for minority groups, and an education trust which supports disadvantaged caring and kind • we value and respect • we work together • we groups.
welcoming and friendly • we are caring and kind • we value and
we go the extra mile • we are welcoming and friendly • we ar Mike Chapman, Vice Chair and Senior Independent officetogether came to an end in 2014) andDirector respect(term • weofwork • we goJuly the extra
mile • we a
Head Teacher for 27 years, Mike was appointed Non-Executive weA are caring and kind • we value and respect • we work toget Director of GMW in 2002. He has also acted as Executive Head Teacher to supportand schools with problems, as a and kind • we • we are welcoming friendly • weworked are caring
Workforce Remodelling Consultant to schools and represented teachers • and head teachers on a range of issues, as well being together we go the extra mile • we are as welcoming and frien a member of the Local Strategic Partnership for several years. • we value and respect • we workandtogether He has served on Bolton Health Authority, was Chair of• we go the extr Bolton Community Health Council and Non-Executive Director of andBolton friendly • we are Authority. caring and kind • we value and Wigan Health In 2011, he was awarded an and respect • services to Health Care and Education by theHonorary extraDoctorate mile •for we are welcoming and friendly • we are cari the University of Bolton.
respect • we work together • we go the extra mile • we are w
areMalcolm caring and kind • we value • we work togethe Cowen, Vice Chair (fromand Julyrespect 2014) and
Director (current term weNon-Executive are welcoming and friendly • weends areDecember caring and kind • we v 2016)
together go the extrawith mile are welcoming and frien Malcolm •is we a qualified accountant over • 30we years private
sector experience and 16 years public sector experience, including • we value and respect • we work together • we go the extra m ten years as a Director of Finance for a large hospital trust. He also works closely with local interest, patient•and groups friendly • we are caring and kind wecarer value and respect • we and recently retired from the National Offender Management
Service with • budgetary financial control 14 North West extra mile we areand welcoming andforfriendly • we are caring and prisons. Malcolm became a Non-Executive Director in 2009.
• we work together • we go the extra mile • we are welco
caring and kind • we value and respect • we work together • we welcoming and friendly • we are caring and kind • we value and
we go the extra mile • we are welcoming and friendly • we ar
and respect • we work together • we go the extra mile • we a
we are caring and kind • we value and respect • we work toget • we are welcoming and friendly • we are caring and kind • we
together • we go the extra mile • we are welcoming and frien Annual Report 2014/15
Pagego 43 the extra m • we value and respect • we work together • we
Kathy Doran OBE, Non-Executive Director (current term ends July 2018) Kathy joined GMW in 2014 and has 37 year’s public sector experience across central government and NHS providers and commissioners. For 11 years until 2013, Kathy worked in primary care and as cluster primary care trust executive. She is a former member of the National Institute of Health Research Advisory Board and is currently an advisor to NHS Employers, where she is a member of the negotiating teams for GP and dentist pay. Kathy is a non-executive director of Your Housing Group – a large North West housing association. Kathy is also a trustee and vice chair of The Reader Organisation, a Liverpool-based charity.
Julie Jarman, Non-Executive Director (current term ends July 2017) Julie joined GMW in 2014 and is currently the Programme Manager for Church Action on Poverty with responsibility for managing a programme of anti-poverty projects and national campaigning work. Julie has over 17 years’ experience of senior management in the voluntary sector both in the UK and in international development. She also works as a management coach and mentor. Julie is a trustee of two charities: MIND in Salford and HomeWorkers Worldwide.
Professor Karen Luker, Non-Executive Director (current term ends January 2016) Karen is the Head of the School of Nursing, Midwifery and Social Work at the University of Manchester and was previously the Head of the School of Health Sciences at the University of Liverpool. She was also a Non-Executive Director of the former Ashworth Hospital Authority from 1998 to 2002 and was NonExecutive Director for the former Sefton FSHA between 1992 and 1996. She became a Non-Executor Director for GMW in 2004.
Terry McDonnell, Senior Independent (from July 2014) Non-Executive Director (current term ends December 2016) Terry was Chief Executive for one of the largest hospices in the UK which offered the full range of services for end-of-life care and was regulated by the Care Quality Commission. He initially trained as a Psychiatric Social Worker but has held roles which have included management posts in local authority, the NHS and voluntary sectors for over 25 years. He was also Chair of North West Hospice Managers Group and the North West Representative of the UK Hospices Advisory Council. Terry became a Non-Executive Director in 2009. Terry is currently the chair of the Quality Governance and Post-Incident Review committees.
Page 44
Greater Manchester West Mental Health NHS Foundation Trust
Brian Slater, Non-Executive Director (term of office came to an end in July 2014) Brian has been a Non-Executive Director since 2007. He is a qualified accountant and is a retired board director of Brother UK. He has an expansive career history in large private sector businesses, with experience in business strategy, workforce design and financial improvement, including working for Deloitte and Touche. Brian is also a proprietor of a wills and estate planning company.
Sunita Thomson, Non-Executive Director (resigned September 2014) Sunita is currently the director/owner of Goal Development Consultancy and formerly had boardroom experience at Novartis Pharmaceuticals. In 2010 Sunita was regional director on a five month project delivering workshops in leadership and management in the NHS. She is also an honorary lecturer at Bolton University in patient care and equality and diversity. Sunita is a specialist member on the panel for mental health tribunals.
Executive Directors Bev Humphrey, Chief Executive Bev has been Chief Executive of the Trust from October 2006. She was previously Chief Executive for The Walton Centre for Neurosciences NHS Trust in 2004. Other NHS experience includes being Director of Performance for Cumbria and Lancashire Strategic Health Authority in 2002 and Director of Specialist Services Commissioning for Lancashire and South Cumbria in 2000. Prior to this, Bev held various managerial posts in both acute and community services in Merseyside, Essex and Lancashire, having started her career in the NHS in 1983. Bev chairs the North West Mental Health Chief Executives Group and that she is an elected Board Member of the national Mental Health Network of the NHS Confederation.
Dr Steve Colgan, Medical Director Steve was a Research Fellow at the University of Manchester for three years and has a Masters and Doctorate in Psychological Medicine. He was appointed as Consultant General Psychiatrist for the City of Salford in 1992, with responsibility for drug services. He was also Chair of the Medical Staffing Committee in 1996. Steve was appointed medical director in 1999 and continues to lead on clinical governance in addition to research and development’. More recently he has overseen the implementation of systems for medical revalidation and the revised acute care pathway
Annual Report 2014/15
Page 45
Andrew Maloney, Director of Human Resources and Governance With over fifteen years of senior HR management experience, Andrew has worked across a range of NHS sectors. From 2000 to 2004 he worked as the Assistant Director of HR for Sefton Health Authority and Sefton Primary Care Trust working on HR change management projects that supported the establishment of PCTs across Sefton. In 2004 Andrew joined The Walton Centre NHS Trust as Director of HR and in 2009 Andrew joined GMW as Director of HR and Governance in August 2009.
Joe Peers, Director of Estates and Facilities Joe is a Chartered Surveyor; he started his career in the NHS in 1976 as a Building Officer at Wigan Area Health Authority. He has worked at several NHS organisations including the East Lancashire Hospitals NHS Trust where between 1990 and 2007, he was based at Queen’s Park Hospital, Blackburn initially as Assistant Director before being appointed as Head of Estates. In 2007, he joined the Trust as Director of Estates and Facilities.
Neil Thwaite, Director of Development and Performance / Deputy Chief Executive Neil started his career in the NHS in 1993 and has worked across many NHS sectors including acute care, primary care, Cancer Network and a Strategic Health Authority. Neil joined GMW in 2006 and was the Executive lead for the successful Foundation Trust application. During 2014, Neil became Deputy Chief Executive of GMW.
Ismail Hafeji, Director of Finance, Information Management and Technology Ismail joined the Trust in February 2011. He has been working as an accountant in the NHS at Trusts, former Health Authorities and PCTs around the North West. His last role, before joining the Trust, was as Director of Finance, IT and Information at NHS Bolton. Ismail also has Assistant Director of Finance experience at Strategic Health Authority level and previous to this, worked as Acting Director of Finance for West Lancashire and Chorley and South Ribble PCTs.
Gill Green, Director of Nursing and Operations Gill joined the Trust in August 2011 and previously was at South West Yorkshire Partnership Foundation NHS Trust as Acting Director of Nursing, Compliance and Innovation. Previous to this she was Assistant Director of Health Services at the trust which included operational service development whilst delivering quality improvement programmes.
Page 46
Greater Manchester West Mental Health NHS Foundation Trust
Board of Director Meetings The Board of Directors meet monthly (with the exception of August). The Board comprises of the Chair of the Trust and six other Non-Executive Directors plus the Chief Executive and six Executive Directors. Part one of the meetings are held in public and part two is held in private. A quorum of seven is required for the meeting to take place. All Non-Executive Directors are considered to be independent and the Chair has no significant commitments.
Annual Report 2014/15
Page 47
Nominations Committee
ly • we are caring and kind • we value and mile • we are welcoming and friendly • we The Nominations Committee identifies suitable candidates for vacant Chair and None work together • we go the extra mile • Executive Director posts and present recommendations to the Council of Governors for at arespect general meeting. The Committee seeks the views of the Board of and kind • weappointment value and • we work Directors as to their recommended criteria and process for selection of candidates and, oming and friendly • wetoare caring andthen kind having regard those views, shall seek, short-list and interview such candidates as the Committee considers appropriate. They’ll we go the extra mile • we are welcoming evaluate the balance of skills, knowledge and experience on the Board and, in light of this evaluation, agree a description of the e and respectrole • we together • we go and work capabilities required for any particular appointment of Non-Executive Directors including the Chair. The Committee then makes recommendations to the Council of ly • we are caring and kind • we value and Governors as to potential appointments as Non-Executive Directors and shall advise the mile • we areBoard welcoming friendly • we of Directorsand of those recommendations. e work together • we go the extra mile • In 2014/15, the Nominations Committee, with advice from the Board of Directors, balance, competencies and appropriateness and appointed four Nonand kind • wereviewed value the and respect • we work Executive Directors with experience of financial and commercial sectors and partnership oming and friendly are caring kind working•atwe board-level in largeand charity and third-sector organisations. we go the extra mile • we are welcoming Table 9 - Nomination Committee attendance e and respect • we work together • we go Alan Maden 3/3 ly • we are caring and kind • we value and Alan Mitchell 2/3 mile • we areSylvia welcoming and friendly • we Seddon 3/3 Jennifer Carlisle 3/3 e work together • we go the extra mile • Anne Broadhurst 3/3 and kind • we value and respect • we work oming and friendly • we are caring and kind we go the extra mile • we are welcoming Audit Committee report e and respect • we work together • we go All Foundation Trust • Boards establish ly • we are caring and kind we must value and an audit committee. The Committee must be composed of at least three members who are all independent non-executive directors. At mile • we areleast welcoming wehave ‘recent and relevant financial experience.’ one memberand of thefriendly committee•must e work together • we go the extra mile • The committee’s terms for reference provide more explanation of the committee’s key and kind • werole value respect • we workand maintenance of an effective system of whichand is to review the establishment integrated governance, risk management oming and friendly • we are caring and kindand internal control across the whole of the organisation’s activities (both clinical and non-clinical), that supports the achievement we go the extra • we objectives. are welcoming of themile organisation’s This is evidenced by an effective Board Assurance Framework. e and respect • we work together • we go ly • we are caring and kind • we value and Page 48 Greater Manchester West Mental Health NHS Foundation Trust a mile • we are welcoming and friendly •
The main role and responsibilities are outlined in Monitors’ code of governance and include the following: • Monitor the integrity of the FT’s financial statements • Review internal financial controls, internal controls and risk management
extra mile • we are welcoming and friendly • we are caring and
• Monitor and review the effectiveness of the FT’s internal audit function
• the weeffectiveness work together we • Monitor and review of external•audit
go the extra mile • we are welco
• Monitor and review the effectiveness of • counter fraud and respect • we work together • we caring and kind we value
• Develop and implement policy on and using friendly external auditors supply non-audit welcoming • wetoare caring andservices kind • we value and
• Report to the council of governors any matters where action or improvement is needed we go the extra mile we are welcoming and friendly • we a and making recommendations as to the steps to be•taken • Review the effectiveness of the arrangements for whistle blowing and respect • we work together • we
go the extra mile • we
• Make recommendations to the council of governors on the appointment, rewe are caring and kind • we value and respect appointment and removal of external audit
• other we are welcoming friendly • we • Review the work of committees includingand quality governance andare risk management
• we work toget
caring and kind • we
together • we go the extra mile • we are welcoming and frien
The existence of an independent audit committee is a central means by which the board we value respectare • in we work together • we ensures that effective•internal controland arrangements place. In addition the audit committee provides an independent check on the executive arm of the board.
go the extr
and friendly • we are caring and kind • we value and respect •
Table 10 - Committee and • attendance the members extra mile we are welcoming
and friendly • we are car
Malcom Cowen - Chairman
5/5
Terry McDonnell
5/5
respect • we work together • we go the extra mile • we are
Anthony Bell – appointed 2014 areJuly caring
2/3 • we work togethe and kind • we value and respect
Jon Bashford – resigned June 2014
2/2
we are welcoming and friendly • we are2/2caring and kind • we Brian Slater – resigned June 2014 Sunita Thomson – appointed July 2014 / resigned 2014 mile together • we go September the extra
1/1 welcoming and frien • we are
The external auditors, audit,and counter fraud are also work invited to attend the• we go the extra m • internal we value respect • we together meetings. Other attendees include, the Director of Finance and IM&T, Director of Human friendly we areand caring and kind • we value and respect • we Resources and Governance, Chief•Executive the Head of Corporate Affairs.
extra mile • we are welcoming and friendly • we are caring and
• we work together • we go the extra mile • we are welco Work of the committee in 2014/15 and kind • we value financial and respect • we The Committee met caring on five occasions during the 2014/15 year. There waswork together • we
a change in membership as a result of Non-executive Directors resignations and welcoming friendly • we internal are caring kind • we value and appointments. The meetings focusedand on financial reporting, controland processes, and the work of Internal and External audit, policy and procedure updates.
we go the extra mile • we are welcoming and friendly • we a
The minutes of the audit committee meeting are included on the agenda of the Trust and respect • we work together • we go the extra Board.
mile • we
we are caring and kind • we value and respect • we work toget
• we are welcoming and friendly • we are caring and kind • we
together • we go the extra mile • we are welcoming and frien
• we value and respect • we work together • we go the extra m Annual Report 2014/15
Page 49
friendly • we are caring and kind • we value and respect • we
1. Financial reporting The Audit Committee meeting held on the 24th April 2015, included a review of the Trust’s performance as outlined in the 2014/15 annual financial statements and a commentary on the reasons for the main changes compared to the financial statements for 2013/14. Management brought to the attention of the audit committee the significant movements with regards to the accounts for the year ended 31 March 2015. The committee reviewed the Trust’ financial statements for the financial year 2014/15, in detail with a particular focus on: • Compliance with financial reporting standards • Areas requiring significant judgements in applying accounting policies • The accounting policies • Whether the accounts and annual report are a fair reflection of the Trust’s performance The Committee considered the financial statements audit risks including the areas where the Trust has applied judgement in the treatment of revenues and costs to ensure that annual accounts represented a true position of the Trust’s finances. The External Audit Plan 2014/15 highlighted two main risk issues relating to the valuation of land and buildings and recognition of deferred income and creditors. The Audit Committee discussed the approach taken by the Trust in the valuation of land and buildings. The Trust undertakes a full revaluation of its assets every three years and the next revaluation is due at the end of the 2015/16 financial year. For 2014/15, the Trust revalued the main buildings and capital works that were completed to ensure any impairment is correctly accounted for in the financial year. The Audit Committee also discussed the risk referring to the recognition of deferred income and creditors. The Trust outlined the process of classification and confirmed that the criteria used was related to the timings of the projects spending plans. As a result some items were classed as Creditors; due within one year, and other items included as liabilities extending to a longer time period.
2. Internal control In accordance with the Committee’s role, and in addition to the Director of Finance, other officers of the Trust were called to attend the Committee to provide updates regarding progress on implementation of recommendations following audit and other assurance reviews.
3. Internal Audit and Counter Fraud The Internal Audit service is provided by Mersey Internal Audit Agency (MIAA), an independent NHS organisation. The key conclusion from their work for 2014/15 as provided in the Director of Audit Opinion and Annual Report was that ‘Significant Assurance’ was given that there were generally sound systems of internal control to meet the organisation’s objectives and that controls are generally being applied consistently.
Page 50
Greater Manchester West Mental Health NHS Foundation Trust
Counter Fraud As with the Internal Audit Service, Counter Fraud is provided by the Counter Fraud Service and is hosted through Mersey Internal Audit Agency. As requested by the Committee to meet mandated requirements an Annual Report was provided outlining the delivery of the fraud plan.
4. External Audit The provision of External Audit services is delivered by the KPMG. Their work is mainly related to audit the financial statements and provide and audit opinion. The appointment of a Foundation Trusts External Auditors remains one of the important statutory duties of the Council of Governors, supported by the Audit Committee. KPMG were appointed as external auditors in December 2010, following a tender process. They were appointed for a period of three years. The guidance issued in August 2013 stated that the Audit Committee should run the process with the final decision on appointment/ re-appointment resting with the council of governors. In accordance with the guidance the Audit Committee agreed the process in 2013, for the appointment / re-appointment of external audit. The Committee reviewed the work of External Audit over the three year period since their appointment and focused on the effectiveness and value for money of the audit services over the last three years and their overall performance. The Council of Governors, at its March 2014 meeting, agreed a recommendation to extend the term with KPMG for a further two years and that the service be tendered in December 2016. The Audit Committee met with External Audit on regular occasions throughout the year to discuss their findings and the detail content of their reports. The external audit and Audit Committee members also met in private to discuss matters of a confidential nature. The Committee approved the External Audit Plan and have received regular updates from KPMG on technical issues briefings of developments in the NHS. During the course of the year the Audit Committee discussed the performance of External Audit and reviewed its effectiveness and output for the services provided and the annual cost. The total audit fee for the financial year 2014/15 was £64,825. It was made of two elements. For the ‘Accounts opinion and Resource conclusion,’ there was a cost of £50,575 and for the ‘Quality Accounts Opinion,’ a cost of £14,250. An unqualified opinion on the accounts for 2013/14 was given to the Trust. The work on the 2014/15 accounts commenced in April 2015 and will conclude with a report anticipated in May. Other matters: • The committee also provided oversight on a number of financial matters including Losses and Special Payments, Treasury management and waivers of Standing Financial Instructions • During the course of the year the Audit Committee reviewed the work and performance of both Internal and External audit by completing the audit committee handbook self-assessment checklists and feedback from committee members. • The committee also undertook a review of its own effectiveness. • The Committee also reviewed its terms of reference which were presented to the Trust Board and also agreed the audit committee work plan for the year. • During the year the committee met privately with external audit, internal audit and counter fraud. Annual Report 2014/15
Page 51
• The head of internal audit, external audit and the counter fraud specialist have direct access to the chair of the committee. Malcolm Cowen, Chair of the Audit Committee
Quality Governance Committee The Quality Governance Committee monitored quality and was the accountable committee for all risk management activity, charged with developing, implementing and evaluating a systematic approach for identifying areas of clinical and non-clinical risks in services. It reflects Monitor’s Quality Governance Framework and its focus is on strategy, capabilities, process, structures and measurement.
Table 11 - Quality Governance Committee Attendance Terry McDonnell (Chair)
5/6
Karen Luker
4/6
Mike Chapman
2/2
Kathy Doran
3/4
Julie Jarman
4/4
Bev Humphrey
3/6
Gill Green
6/6
Steve Colgan
6/6
Andrew Maloney
6/6
Neil Thwaite
5/6
Charitable Funds The aim of the Charitable Funds Committee is to ensure that the Board of Directors properly discharges its responsibilities in relation to its role as Corporate Trustee of the Charitable Funds. It does so in accordance with the NHS Acts, Charities Acts and good practice to ensure that decisions on the use or investment of funds are restricted to the explicit conditions or purpose of each donation, bequest or grant. It also makes decisions involving the use of charitable funds for investments with reference to appropriate legislation.
Table 12 - Charitable Funds Attendance Malcolm Cowen (Chair)
2/2
Jon Bashford
1/1
Anthony Bell
1/1
Ismail Hafeji
2/2
Gill Green
1/2
Remuneration and Terms of Service Committee The Remuneration and Terms of Office Committee makes recommendations to the Board on the remuneration, allowances and terms of service of other officer members to ensure they are fairly rewarded for their individual contribution to the organisation – having proper regard to the organisation’s circumstances and performance and to the provisions of any national arrangements where appropriate. It is also responsible for monitoring and evaluating the performance of individual officer members and advises Page 52
Greater Manchester West Mental Health NHS Foundation Trust
on and oversees appropriate contractual arrangements for such staff including the proper calculation and scrutiny of termination payments taking account of such national guidance as is appropriate.
Table 13 - Remuneration and Terms of Service Committee attendance Jon Bashford
1/1
Brian Slater
1/1
Mike Chapman
1/1
Terry McDonnell
1/1
Malcolm Cowen
1/1
Remuneration and Terms of Office Committee The Remuneration and Terms of Office Committee shall consider the remuneration and allowances, and the other terms and conditions of office, of the Chair and the other NonExecutive Directors taking into account benchmarking against other similar Foundation Trusts and taking specialist advice. It will recommend to the Council of Governors the remuneration and allowances, and the other terms and conditions of office, of the Chair and the other Non-Executive Directors and shall advise the Board of Directors of those recommendations. The committee did not meeting during 2014/15.
Annual Report 2014/15
Page 53
Foundation Trust Governors and Membership
extra mile • we are welcoming and friendly • t • we work together • we go the extra mile ing and kind • we value and respect • we work elcoming andBeing friendly we are caring and kind financial freedoms, but it also allows us to an NHS•Foundation Trust gives us certain proactively involve service users, carers and the public in decisions about services, which is • we go the extra mile • we are welcoming a vital part of planning and improving the patient experience. Therefore we actively seek alue and respect • we work together • we gocommunity with whom we work on our to recruit an engaged and active membership developments and ensure we can act on the feedback they give us. endly • we are caring and kind • we value and be awelcoming member, people must either: • we ra mile • weTo are and friendly we work together we goWest the mile • • Live in •the North andextra be 14 years or older; ng and kind •• we andorrespect • the welast work Be avalue service user carer within five years; or Be a member of staff a permanent employment contract of more than 12 months elcoming and• friendly • we areon caring and kind we go the extra mile • we are welcoming and and respect • we work together • we go the Overview of membership • we are caring and kind • we value and respect le • we are welcoming andmembers friendly are We have over 8,000 and • to we ensure our membership is representative of the diverse area it covers, we organise our members into the following constituencies: work together • we go the extra mile • we are Staffrespect • we work together • nd • we value• and • Service andand carerskind • we value nd friendly • we are users caring Public extra mile •• we are welcoming and friendly • t • we work together • we go the extra mile alsovalue have appointed Governors whowork are not elected by members but are appointed ing and kind •Wewe and respect • we from a number of key organisations to ensure our membership has strong links with our elcoming andpartner friendly • we are caring and kind organisations. we go the extra mile • we are welcoming and The Trust has undertaken in-depth community profiling of the locations it serves and this informtogether a membership strategy. The and respect •data wewill work • we go theTrust Board is informed on a quarterly basis of the numbers and make-up of the membership profile. • we are caring and kind • we value and respect le • we are welcoming and friendly • we are work together • we go the extra mile • we are nd • we value and respect • we work together • nd friendly • we are caring and kind • we value Page 54 Greater Manchester West Mental Health NHS Foundation Trust e extra mile • we are welcoming and friendly
Table 14 - Membership size and movements Public constituency
Last year (2014/15)
At year start (April 1)
3,566
3,545
34
50
New members Members leaving At year end (March 31) Staff constituency At year start (April 1) New members
Next year (estimated) (2015/16)
55
30
3,545
3,565
Last year (2014/15)
Next year (estimated) (2015/16)
2,934 extra mile • we1,013 are welcoming and friendly • we are caring 2,934
50
Members leaving
• we work together 1,013 • we go the extra mile 100 • we are w
At year end (March 31)
caring and kind •2,934 we value and respect • we2,884 work together •
Patient constituency
Last year (2014/15)
Next year (estimated) (2015/16)
At year start (April 1)
welcoming and friendly • we are caring and1,592 kind • we value a 1,605
New members
14 20 we go the extra mile • we are welcoming and friendly • w
Members leaving At year end (March 31)
27
30
and respect • we1,592 work together • we go the 1,582extra mile • w
Analysis of current membership Public constituency
we are caring and kind • we value and respect • we work to Number of members
Eligible membership
Age (years):
• we are welcoming and friendly • we are caring and kind •
0-16
together • we go the extra mile • we are welcoming and f
17-21 22+ Unknown
0
1,422,553
96
459,101
3315 5,233,222 • we value and respect • we work together • we go the e 133
Total
and friendly • we are caring and kind •7,114,876 we value and respe 3,544
Ethnicity:
the extra mile • we are welcoming and friendly • we are
White
2,904
6,361,716
Mixed
respect • we work40together • we go the110,891 extra mile • we a
Asian or Asian British
213 • we value and respect 437,485 are caring and kind • we work toge
Black or Black British
122
97,869
Other
we are welcoming16and friendly • we are caring 44,216 and kind • w
Unknown
62,699 together • we go250 the extra mile • we are welcoming and f
Socio-economic groupings*: AB
• we value and respect • we work together • we go the ext 866 429,265
C1
672,341 friendly • we are 992 caring and kind • we value and respect •
C2 DE Unknown Gender analysis
735
460,181
67
4,892,815
extra mile • we are • we are caring 884 welcoming and friendly 660,274
• we work together • we go the extra mile • we are w
Male
caring and kind •1,222 we value and respect •3,504,687 we work together •
Female
welcoming and friendly • we are caring and kind • we value a 57 2
Unknown
2,266
3,610,187
we go the extra mile • we are welcoming and friendly • w
* Socio-economic data should be completed using profiling techniques (e.g. postcode) or other recognised methods.
and respect we work • Trust we please go the extra mile If any members would like to contact their•governor or a together director of the contact: Steph Neville, Head of Corporate Affairs, Greater Manchester West Mental we are caring and kind • we value and respect • we work Health Trust NHS Foundation Trust, Bury New Road, Prestwich, Manchester M25 3BL
•w
to
• we are welcoming and friendly • we are caring and kind •
Tel: 0161 772 3622, Email: steph.neville@gmw.nhs.uk Or visit our website: http://www.gmw.nhs.uk/contact-us together • we go the Annual Report 2014/15
extra mile • we are welcoming and f
• we value and respect • we work togetherPage • we go the ext 55
Quality Report
e extra mile • we are welcoming and friendly • ct • we work together • we go the extra mile ring and kindStatement • we value andon respect • we work Quality from the Chief Executive welcoming and friendly • we are caring and kind The Quality Account 2015/16 summarises some of the key improvements delivered by the • we go theTrust extra mile wechallenges are welcoming in 2014/15 and•the we have set ourselves for 2015/16. With the support of all our dedicated I am confident that we can meet these future challenges. value and respect • we workstaff, together • we go endly • we are andconfirms kind •that we and to achieve all targets set nationally Thecaring account also wevalue have continued mental health trustsand in 2014/15, delivered our CQUIN (Commissioning for Quality and tra mile • weforare welcoming friendly • we Innovation) schemes and retained our ‘registration without conditions’ with the Care • we work together • we go the extra mile • Quality Commission. ing and kind •Aswe and respect • we work Chiefvalue Executive of Greater Manchester West Mental Health NHS Foundation Trust, I can confirm that, to the best of my knowledge, welcoming and friendly • we are caring and kindthe information contained is the report is accurate. The ‘Statement of Directors Responsibilities’ summarises the steps we have we go the extra mile • we welcoming taken to develop the are Quality Account and and external assurance is provided in the forms of statements from our commissioners, local Healthwatch organisation and Joint Scrutiny e and respect • we work together • we go the Committee. The report of an external audit undertaken by KPMG, which gives assurance • we are caring and kindof• the weQuality valueAccount and respect on the content is also included. ile • we are welcoming and friendly • we are work togetherSigned: • we go the extra mile • we are ind • we value and respect • we work together • ev Humphrey, Chief Executive Dated: 29th May 2015 and friendly •Bwe are caring and kind • we value We have reviewed the quality of care offered by the Trust based on performance e extra mile •in we areagainst welcoming andoffriendly • clinical effectiveness and patient 2014/15 the indicators patient safety, experience. This can go be found Appendix 1. ct • we work together • we theinextra mile ring and kind • we value and respect • we work welcoming and friendly • we are caring and kind Statement Responsibilities in we go the extra mile • we of are Directors’ welcoming and the Quality Account e and respect Respect • we work of together • we go the • we are caring and kind • we value and respect The directors are required under the Health Act 2009 and the National Health Service ile • we are (Quality welcoming and friendly • we Quality are Accounts for each financial year. Accounts) Regulations to prepare work togetherMonitor • we has goissued the guidance extra mile • we are to NHS foundation trust boards on the form and content annual quality reports ind • we valueofand respect • we (which workincorporate togetherthe • above legal requirements) and on the and friendly • we are caring and kind • we value Page 56 Greater Manchester West Mental Health NHS Foundation Trust e extra mile • we are welcoming and friendly
arrangements that foundation trust boards should put in place to support the data quality for the preparation of the quality report. In preparing the quality report, directors are required to satisfy themselves that:
• The content of the quality report meets the requirements set out in the NHS Foundation Trust Annual Reporting Manual 2014/15; • The content of the Quality Report is not inconsistent with internal and external sources of information including: extra • we are welcoming o Board minutes and papers for mile the period April 2014 to June 2015 and friendly • we are caring o Papers relating to Quality reported the Board over the period to June • we worktotogether • we go April the2014 extra mile • we are w 2015 caring anddated kind • we o Feedback from the commissioners 22nd Mayvalue 2015 and respect • we work together • o Feedback from governors dated 22ndand May friendly 2015 welcoming • we are caring and kind • we value o Feedback from Local Healthwatch organisations dated 22nd May 2015 (Healthwatch Trafford) we go the extra mile • we are welcoming and friendly • w o The Trust’s complaints report published under regulation 18 of the Local Authority and respect • we work • we go the extra mile • Social Services and NHS Complaints Regulations 2009,together dated 30th April 2015 (draft) o The 2014 national patient survey dated 18th 2014value (date ofand publication on • we work to we are caring andSeptember kind • we respect CQC website) • we are welcoming o The 2014 national staff survey from 24th Februaryand 2015 friendly • we are caring and kind • o The Head of Internal together Audit’s annual theextra Trust’s control • opinion we goover the mileenvironment • we are welcoming and dated 30th April 2014. o CQC Intelligent Monitoring 2015.• we work together • we go the • weReport valuedated andOctober respect • The Quality Report represents a balanced picture of the NHS foundation trust’s and covered; friendly • we are caring and kind • we value and respe performance over the period • The performance information reportedmile in the Quality is reliable and accurate the extra • we Report are welcoming and friendly • we are • There are proper internal controls over the collection and reporting of measures of • we work together we gotothe extra mile • we performance included inrespect the Quality Report, and these controls•are subject review to confirm that they are working effectively in practice; are caring and kind • we value and respect • we work toge • The data underpinning the measures of performance in the Quality Report is robust and reliable, conforms to specified data quality and•prescribed we are welcoming andstandards friendly we are caring and kind • definitions, is subject to appropriate scrutiny and review; and the Quality Report has been prepared in accordance with reporting guidance (which together • Monitor’s we go annual the extra mile • we are welcoming and incorporates the Quality Accounts regulations) (published at www.monitor-nhsft. • we value respect we work together • we go the ext gov.uk/annualreportingmanual) as welland as the standards•to support data quality for the preparation of the Quality Report (available at www.monitor-nhsft.gov.uk/ friendly • we are caring and kind • we value and respect • annualreportingmanual)
extra • we areand welcoming and friendly The directors confirm to the best ofmile their knowledge belief that they have complied • we are caring with the above requirements in preparing the Quality Report.
• we work together • we go the extra mile • we are w
By order of the Board
caring and kind • we value and respect • we work together • welcoming and friendly • we are caring and kind • we value
Signed: Alan Maden, Chair Signed:
we go the extra mile • we are welcoming and friendly • w and respect • we work together • we go the extra mile • Date: 29th May 2015
we are caring and kind • we value and respect • we work to
• we are welcoming and friendly • we are caring and kind • together • we go the extra mile • we are welcoming and
Bev Humphrey, Chief Executive Annual Report 2014/15
Date: 29th May 2015
• we value and respect • we work together • we go the ext Page 57
friendly • we are caring and kind • we value and respect •
The NHS Staff Survey 2014
dly • we are caring and kind • we value and mile • we are welcoming and friendly • we Once • again, NHSextra Staff Survey has•provided us with a valuable insight into how e work together wethe go2014 the mile our staff feel about the work they do and how involved and appreciated they perceive to and kind • we respect • feedback we work be. value In theseand challenging times, such as this is more crucial than ever. coming and friendly we arepleased caring and kind We were • extremely to see that GMW scored higher than average in the area of staff feeling quality of work and patient care they are able to give. We we go the extra milesatisfied • wewith arethe welcoming understand how important it is for staff to feel able to do their best for their patients as ue and respect we this work together we go we•know is one of the main•reasons staff choose a career with us – to help people and make a difference to their lives. It is heartening dly • we are caring and kind • we value and to see we are achieving this. mile • we are welcoming and friendly • we is at 93% which is higher than average and Staff reporting errors, near misses or incidents shows that our reporting mechanisms are working well and that staff feel comfortable e work together • we go the extra mile • and confident in speaking up when something goes wrong. and kind • we value and respect • we work We also scored better than average in the areas of good communication between senior coming and friendly • we are caring management and staff, as well and as staffkind believing the Trust provides equal opportunities for career progression or promotion. We are pleased to see that staff feel like they we go the extra mile • we are welcoming can talk to senior management and that we will support their career aspirations and ue and respect • we work together • we go development. dly • we are caring and kind • we value and We also saw that staff agree that feedback from patients / service users is used to make informed decisions and in theirfriendly directorate•/ we department. This is incredibly reassuring as we mile • we are welcoming see patients, service users and their carers as some of the best experts we have within the e work together • we gotheir theinput extra mile • Trust and we use as a clear indication as to where our values should lie and how we should deliver their care. and kind • we value and respect • we work coming and friendly • we are and than kindaverage are the areas of work pressure felt by Other areas where wecaring scored higher staff, support from immediate managers and staff job satisfaction. This is pleasing as it we go the extra mile • we are welcoming indicates that overall, staff are happy in their work and feel supported to do their role to the•best their ability. ue and respect weofwork together • we go dly • we are caring and • we value As always, therekind are areas which need and improvement and over the next 12 months, we willwelcoming address areas where have not•performed as well. These include the number of mile • we are and we friendly we staff receiving their appraisal in the last 12 months as well as numbers of staff receiving e work together wesafety gotraining, the extra • health•and equalitymile and diversity training or job-relevant training, learning or development in the last 12 months. We recognise that it can be extremely and kind • we value and respect • we work challenging to release staff to go on training, especially ward-based staff, when times are coming and friendly • we we arehave caring busy. However, made and this a kind priority area for improvement and as such we have written to each manager across the Trust, encouraging them to use their leadership skills we go the extra mile • we are welcoming to ensure that these priorities are met. A small amount of time invested for training and development in the short term,•will reapgo longer term benefits and a meaningful annual ue and respect • we work together we dly • we are caring and kind • we value and 58 Manchester West Mental Health NHS Foundation Trust ra mile • wePage are welcoming and friendly Greater •
appraisal is the cornerstone of delivering the best service possible for our patients and service users. Realistic timelines have been put in place to ensure that every member of staff receives their annual appraisal.
We also scored higher than average in staff witnessing potentially harmful errors, near misses or incidents within the last month. Whilst this is one of our lowest ranking scores, it is reassuring to note that in the wake of the Francis Report, staff feel able to see such an incident and report it, leading to lessons being learned and an open, honest and extra • we are and • we are caring an accountable environment. Wemile feel proud that ourwelcoming staff feel able and safefriendly to speak up when they see something that causes them concern.
• we work together • we go the extra mile • we are welc
Overall we are pleased with staff survey results but we will continue to embed our Values caring and kind • weand value and respect • we asset work across the Trust to ensure we continue to support develop our Trusts’ greatest – together • w the people who work for GMW.
welcoming and friendly • we are caring and kind • we value and
Table 15 - Staff Survey Table – top and bottom we go the extra mile • ranking we are scores welcoming and friendly • we a Trust Improvement /
2013/14 • we work 2014/15 and respect together • weDeterioration go the extra mile • we Response rate
National National Trust • we value and respect • we work toge weTrust are caring and kind Average Average
53% are welcoming 50% 46% 42% 7% • we and friendly • weDecrease are caring and kind • we 2013/14
Trust Improvement /
2014/15
Deterioration together • we go the extra mile • we are welcoming and frie National
National
Response rate
Trust Trust • we value and respect • we work together • we go the ext Average Average
Top 5 Ranking Scores
and friendly • we are caring and kind • we value and respect
Percentage of staff reporting errors, near misses or incidents witnessed in the last month Percentage of staff agreeing that feedback from patients/service users is used to make informed decisions in their directorate/ department Work pressure felt by staff Percentage of staff reporting good communication between senior management and staff Support from immediate managers
the mile • we and friendly • we are ca 94%extra 92% 93%are welcoming 92% Decrease 1%
respect • we work together • we go the extra mile • we are
are caring and kind • we value and respect • we work togeth N/A (additional theme for 2014)
N/A (additional theme for 2014)
N/A (additional theme we are welcoming and 59% friendly 53% • we are caring and kind • we for 2014)
together • we go the extra mile • we are welcoming and frie
• we value and respect • we work together • we go the extra 3.01 3.07 3.01 3.07 No change
friendly • we are caring and kind • we value and respect • we
31% mile31% 30% and friendly Increase 2%• we are caring an extra • we are33% welcoming
• we work together • we go the extra mile • we are welc 3.83
3.82
3.84
3.81
Increase 0.01
caring and kind • we value and respect • we work together • w Trust Improvement /
2013/14 welcoming and friendly2014/15 • we are caring and kind • we value and Deterioration Response rate
National
National
Trust Trust • we are welcoming and friendly • we a we go the extra mile Average Average
Bottom 5 Ranking Scores Percentage of staff witnessing potentially harmful errors, near misses or incidents in the last month
and respect • we work together • we go the extra mile • we
we31% are caring and kind • we26% value andIncrease respect • we work toge 26% 33% 2%
• we are welcoming and friendly • we are caring and kind • we
together • we go the extra mile • we are welcoming and frie Annual Report 2014/15
Page 59go the extra • we value and respect • we work together • we
Percentage of staff receiving health and safety training in the last 12 months
69%
Percentage of staff appraised in last 12 months
86%
Percentage of staff having well-structured appraisals in last 12 months
43%
Percentage of staff receiving job-relevant training, learning or development in last 12 months
82%
Page 60
extra mile • we are welcoming and friendly • we are caring and kind • we value and respect • we64% work together • we go the extra mile • 75% 73% Decrease 5% we are welcoming and friendly • we are caring and 72% kind • we value Decrease and respect • we work 87% 88% 14% together • we go the extra mile • we are welcoming and friendly • we are caring and 42% 35% 41% Decrease 8% kind • we value and respect • we work together • we go the extra mile • we are welcoming 82% and 79% 3% and kind • we friendly 82% • we areDecrease caring value and respect • we work together • we go the extra mile • we are welcoming and frien respect • we work together • we go the extra are caring and kind • we value and respect • w we are welcoming and friendly • we are caring together • we go the extra mile • we are we • we value and respect • we work together • and friendly • we are caring and kind • we val the extra mile • we are welcoming and frien respect • we work together • we go the extra are caring and kind • we value and respect • w we are welcoming and friendly • we are caring together • we go the extra mile • we are we • we value and respect • we work together • and friendly • we are caring and kind • we val the extra mile • we are welcoming and frien respect • we work together • we go the extra are caring and kind • we value and respect • w we are welcoming and friendly • we are caring together • we go the extra mile • we are we • we value and respect • we work together • and friendly • we are caring and kind • we val the extra mile • we are welcoming and frien respect • we work together • we go the extra are caring and kind • we value and respect • w we are welcoming and friendly • we are caring together • we go the extra mile • we are we • we value and respect • we work together • and friendly • we are caring and kind • we val theManchester extra West mile • Health we are welcoming and frien Greater Mental NHS Foundation Trust
d r g
Regulatory Ratings Report
o ndly • we are caring and kind • we value and a mile • we are welcoming and friendly • we Monitor’s Assessment Framework we work together • we goRisk the extra mile • g and kind • Risk weAssessment value and respect(RAF) • we work Framework requires the Trust to report against the “Continuity of Service Risk Ratings (CoSRR)”, and Governance elcoming and friendly • we are caring and kind Risk Rating. we go the extra mile • range we are The CoSRR ratings fromwelcoming 1 through to 4, with an overall rating of 4 being an indication of a low level of risk. lue and respect • we work together • we go Governance ratings arevalue Green, Amber ndly • we areThe caring and Risk kind • we and or Red, with a Green Governance Risk Rating being an indication that there is ongoing compliance with all the targets and a mile • we are welcoming friendly • we indicators as set out inand the Risk Assessment Framework. we work together • we go the extra mile • Prior to the 1st October 2013, all Foundation Trusts was required to report against g and kind • the weCompliance value and respectThe • Compliance we workFramework included the Risk ratings Framework. Monitor used as the primary basis for assessing risk of Trusts breaching their Terms of elcoming and friendly • we are caring and kind Authorisation. The Financial Risk rating had a range from 1 to 5 with a rating of 4 or 5 being anmile indication of low level risk. we go the extra • we are welcoming lue and respect • we work together • weare goincluded as a comparison for previous year’s The Compliance Framework Risk ratings ndly • we areperformance. caring and kind • we value and The Trusts risk ratingsand underfriendly the Risk assessment a mile • we are welcoming • we Framework and the Compliance framework are analysed in Table 1, which shows that the Trust has complied with all of we work together • we go the extra mile • Monitor’s compliance indicators g and kind • we value and respect • we work Table 16 - Under the Risk Assessment Framework – 2014/15 elcoming and friendly • we are caring and kind Annual Plan 2014-15 mile • we are welcoming Q1 2014/15 Q2 2014/15 Q3 2014/15 Q4 2014/15 we go the extra 2014/15 Continuity lue and respect • weofwork together • we go Service Risk 4 4 4 4 4 ndly • we are rating caring and kind • we value and Governance a mile • we are welcomingGreen and friendly • we Green Green Green Green Risk rating we work together • we go the extra mile • g and kind • we value and respect • we work elcoming and friendly • we are caring and kind we go the extra mile • we are welcoming lue and respect • we work together • we go ndly • we areAnnual caring Page 61 Report and 2014/15kind • we value and
Table 17 - Under the Compliance Framework – Quarters 1 and 2 2013/14 2013-14
Annual Plan 2013/14
Q1 2013/14
Financial Risk
5 5 we are caring and kind • we value and respect Rating Governance and friendly • we are • we are welcoming Green Green Risk rating
Q2 2013/14
Q3 2013/14
Q4 2013/14
5 Green
rk together • we go the extra mile • we are
d • we value and respect • we work together •
Table 18 - Under the Risk Assessment Framework – Quarter 3 and 4 d friendly • we2013/14 are caring and kind • we value
Annual Plan xtra mile • we2013-14 are welcoming and friendly Q1 2013/14• 2013/14
Q2 2013/14
Q3 2013/14
Q4 2013/14
4
4
Green
Green
• we work together • of we go the extra mile Continuity Service Risk
g and kind • we value and respect • we work rating
Governance coming and friendly • we are caring and kind Risk rating
we go the extra mile • we are welcoming
ue and respect • we work together • we go
dly • we are caring and kind • we value and mile • we are welcoming and friendly • we
e work together • we go the extra mile • and kind • we value and respect • we work
coming and friendly • we are caring and kind
e go the extra mile • we are welcoming and
nd respect • we work together • we go the
we are caring and kind • we value and respect • we are welcoming and friendly • we are
rk together • we go the extra mile • we are
d • we value and respect • we work together •
d friendly • we are caring and kind • we value
xtra mile • we are welcoming and friendly •
• we work together • we go the extra mile
g and kind • we value and respect • we work
coming and friendly • we are caring and kind
e go the extra mile • we are welcoming and
nd respect • we work together • we go the
Page 62 Greater Manchester West Mental Health NHS Foundation Trust we are caring and kind • we value and respect
Annual Report 2014/15 work together • we go the extra mile • we are welcom
and kind • we value and respect • we work together • w welcoming and friendly • we are caring and kind • we valu Financial Review • we go the extra mile • we are welcoming and friend value and respect • we work • we go the extr he following section provides an overview on together the financial friendly • we and kind • year, we value and respec performance of the Trust overare thecaring 2014/15 financial the extra milewithin • we are welcoming and friendly • we are highlighting points of interest the Annual Accounts respect •against we work • we go the extra mile • we and the Trust’s performance its together key financial targets. are caring and kind • we value and respect • we work tog we are welcoming and friendly • we are caring and kind • together • we go the extra mile • we are welcoming and 1. Introduction • we value and respect • we work together • we go the The Annual Accounts haveand been prepared International Financial friendlyin •accordance we arewith caring and kind • we value and resp Reporting Standards (IFRS), and are in line with guidance issued by Monitor, The theFoundation extra mile we arereport welcoming friendly • we are Independent Regulator of NHS Trusts.•The quality is includedand on pages 56 to 57. The financial statements start• on page 92. together • we go the extra mile • we respect we work are caring and kind • we value and respect • we work tog we are welcoming and friendly • we are caring and kind • 2. Summary of Financial Performance 2014/15 together • we go the extra mile • we are welcoming and • The overall income and expenditure position shows a net surplus of £8.04m after non• we value respect • we • we go the operating income and expenses, with anand underlying operating network surplustogether of £8.9m friendly • we 2015 are iscaring and kindfor • more we value and resp • The overall Financial Riskand Rating as at 31st March 4, (see note 3 below detail). the extra mile • we are welcoming and friendly • we are • The total Comprehensiverespect Surplus, after movements direct to reserves shows a surplus • we work together • we go the of extra mile • w £8.03m. we are caring and kind • we value and respect • we wo mile • we are welcoming and friendly • we are caring a 3. Financial Performance Monitor’s Regulatory Ratings (CoSRR)mile • we are w • we –work together • we go the extra The Trust is required to report against the Monitor of and Servicerespect Risk Ratings” caring and kind •“Continuity we value • we work togethe (CoSRR), and the Governance Risk Rating. The CoSRR ratings range from 1 through to are welcoming and friendly • we are caring and kind • w 4, with an overall rating of 4 being an indication of a low level of risk. The Governance Risk ratings are Green, Amber or Red, with a Green Riskmile Rating•being together • we goGovernance the extra we an are welcoming and indication that there is ongoing compliance with all the targets and indicators as set out in • we value and respect • we work together • we go the the Risk Assessment Framework (see pages 61 to 62 for the Regulatory Rating Report). and friendly • we are caring and kind • we value and resp 63 Annual Report 2014/15 the extra mile • we are welcoming andPage friendly • we are
T
The Trusts risk ratings under the Risk Assessment Framework are analysed in Table 1, which shows that the Trust has complied with all of Monitor’s indicators.
Under the Risk Assessment Framework 2014/15 Annual Plan 2014/15
Continuity of Service Riskextra Rating Governance Risk rating
Actual Rating 2014/15
4 mile • we are 4welcoming and friendly • we are caring Green
Green
• we work together • we go the extra mile • we are w
caring and kind • we value and respect • we work together •
4. Income and Expenditure Position welcoming and friendly • we are caring and kind • we value a
The following table summarises the actual performance as at the 31st March 2015 we go the extra mile • we are welcoming and friendly • w compared to the Annual Plan.
and respect • we work together • we go the extra mile • w For the year to 31st March 2015
we are caring and Plan kind • weActual value andVariance respect • we work to Clinical Income Other Income Total Income Operating Expenditure
£000’s £000’s £000’s • we are welcoming and friendly • we are caring and kind • 148,067
153,131
5,064
159,335
166,537
7,202
(148,645)
(152,340)
(3,695)
(2,811)
(3,226)
(415)
together • we go the extra mile welcoming and f 11,268 13,406• we are2,138
• we value and respect • we work together • we go the e
EBITDA
and friendly • we are caring and kind • we value and respe 10,690 14,197 3,507
Depreciation Interest Receivable
the extra mile • we 123 are welcoming and friendly • we are 192 69
Interest Expense
(209) (180) 29 mile • we a respect • we work together • we go the extra
Public Dividend Capital
(2,289)
(2,059)
230
are caring and kind • we value and respect •0we work toge Profit/(Loss) on disposal of assets 0 0 Surplus/(Deficit) before we Otherare Non-welcoming Operating Expenses
together Other Non-Operating Income
• we go the extra mile 0• we are welcoming and f 0 0
Impairment Losses (Reversals) net (on non PFI • we value and assets) Net Surplus/(Deficit)
and friendly8,924 • we are caring 5,504 3,420 and kind • w
(2,420) (885) respect • we work together1,535 • we go the ext
3,084 and kind 8,039 4,955and respect • friendly • we are caring • we value
Elements of Comprehensive Income
(6)
(6)
welcoming8,033 and friendly • we are caring Comprehensive Income extra mile • we are 3,084 4,949
• we work together • we go the extra mile • we are w
5. Trust Income
caring and kind • we value and respect • we work together •
and friendly • weThe are caring and kind • we value a The Trust received a totalwelcoming of £166.5 million income for 2014/15. majority of this income related to patient care (£153.1 million). Patient care income by commissioner and we go the extra mile • we are welcoming and friendly • w service is illustrated below.
and respect • we work together • we go the extra mile • w
we are caring and kind • we value and respect • we work to • we are welcoming and friendly • we are caring and kind •
together • we go the extra mile • we are welcoming and f Page 64
Greater Manchester•West Health NHS Foundation • we value and respect weMental work together • Trust we go the ext
g and kind • we value and respect
welcoming and friendly • we are
• we go the extra mile • we are
and respect • we work together •
we are caring and kind • we value
we are welcoming and friendly • NHS
ogether • we go the NHS extra mile Salford England CCG
we value andIncome respect48,888 • we work 33,378 (£’000s)
NHS Bolton CCG
NHS Trafford CCG
Other CCG’s
Local Authorities
Other
Total
22,098
16,625
6,631
22,263
2,282
152,165
friendly • we are caring and kind
The Trust received £14.3 million other income (non-patient care services), with the largest sourcewelcoming (£4.2 million) coming from NHS North West to support education and extra mile •single we are training. The Trust received income of £2.9 million to support research and development. ect • we workThe together • we go income of £6.5m to support the Trust’s capital programme. Trust released deferred
caring and kind • we value and
are welcoming • we 6. and Trustfriendly Expenditure
ether • we go the extra mile •
we value and respect • we work
friendly • we are caring and kind
tra mile • we are welcoming and we work together • we go the
g and kind • we value and respect
welcoming and friendly • we are
• we go the extra mile • we are
and respect • we work together •
we are caring and kind • we value
we are welcoming and friendly •
ogether • we go the extra mile we value and respect • we work
friendly • we are caring and kind
2014/15 tra mile • weAnnual are Report welcoming and
Page 65
Operating Expenses
Expenditure (£’000s)
Staff Costs
115,712
Premises & Transport
10,921
Supplies and Services - Clinical and General
5,969
Purchase of Healthcare from Non-NHS Bodies
5,212
Other
6,137
Drug Costs
2,453
Establishment
2,125
Research and Development Costs
2,855
Training, Courses and Conferences
957
Total Operating Expenditure
152,341
Depreciation
3,226
Impairments of Property, Plant and Equipment
885
Grand Total
156,452
The largest item of expenditure within the Trust relates to staff costs, (£115.7 million or 73.9% of operating expenses). The District Valuers valued the new buildings completed during the year, such as Eskdale Ward and the second substation on the Prestwich site. This resulted in an impairment of £885k
7. Capital Investment The Trust continued to invest in the development and improvement of its estate. The following table shows the schemes that have been undertaken during the year, totalling £13.0 million. This is a significant investment in the enhancement of patient and nonpatient facilities. Capital Expenditure Additional medium secure beds Edenfield New build Recovery Academy Additional beds at Woodlands site Low Secure Ward replacement Provision of Second Substations at Edenfield and Prestwich Meadowbrook Schemes Backlog Maintenance Schemes Relocation of Corporate Services Edenfield Schemes PARIS system Other Schemes Statutory Schemes Minor Schemes Ligature Audit Schemes Energy Improvement Scheme Vehicle replacements Total
Page 66
Expenditure to 31st March 2015 (£’000’s) 2,898 2,548 1,936 1,838 1,315 610 423 301 298 296 145 106 103 75 65 64 13,021
Greater Manchester West Mental Health NHS Foundation Trust
The major capital schemes include: i)
The scheme to build additional medium secure beds on the Edenfield site is progressing well and is due for completion in 2015.
ii)
The scheme to build the Recovery Academy, a purpose-built Education and Training Facility on the Prestwich site is on schedule to be completed and commissioned by Autumn 2015.
The new facility will accommodate existing education and training functions, including library services, and enable the relocation of our Trust Headquarters. iii) On the Woodland site, schemes to accommodate additional beds and improve facilities on Moss and Delamere wards, and the conversion of the former Day Hospital are progressing well. These are due to be completed and commissioned by September 2015. iv) Work commenced on the replacement of Low Secure wards on the Edenfield site. The scheme is progressing and is on target to be completed during 2016. In addition upgrades to the IT server room, the relocation of the finance department to Harrop House, and improvements at Meadowbrook were completed during the year. As in previous years the Trust has continued to invest in backlog maintenance, statutory works, reducing ligatures and energy performance improvements.
8. Liquidity and Short Term Investments The Trust has a cash balance of ÂŁ49.8 million as at the 31st March 2015, with interest receivable of ÂŁ0.2 million being re-invested in the delivery of services.
9. Better Payment Practice Code – Measure of Compliance
Annual Report 2014/15
Page 67
The Better Payment Practice Code (BPPC) requires the Trust to pay all NHS, and non-NHS trade creditors within 30 calendar days of receipt of goods or a valid invoice (whichever is later) unless other payment terms have been agreed. Where this involves a non-public sector organisation, the Trust ensures to make payments as quickly as possible.
10. Cost Allocation The Foundation Trust has complied with cost allocation and charging requirements set out in the HM Treasury Guidelines.
11. Accounting Policies The Trust has produced the Annual Accounts for 2014/15 following the NHS Foundation Trust Annual Reporting Manual 2014/15, and in-line with the requirements of International Financial Reporting Standards (IFRS). The accounting policies are approved by the Board for use in preparing the accounts and are reviewed annually to reflect any changing circumstances involving accounting regulation or guidance. Accounting policies for pensions and other retirement benefits are set out in note 1.3.2 of the accounts. Details of senior employees’ remuneration can be found on page 34 of the Annual Report.
12. Going Concern Following review by the Trust’s Board, the directors have a reasonable expectation that the Trust has adequate resources to continue to adopt the going concern basis in preparing the accounts.
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13. Looking Forward Whilst 2014/15 has been successful year for the Trust, the coming years will continue to represent an increasing challenge to both the Trust and to the Public Sector. The NHS faces an unprecedented financial dilemma; the supply of funding is struggling to match the growing demand for healthcare. The need to deliver 4 per cent efficiency savings until 2016 is of immediate concern. Savings of a similar amount are likely to be needed after 2017. Greater Manchester West, along with all NHS organisations will need to identify and deliver 4 to 5 per cent efficiency savings on an annual basis. For the Trust this means an estimated £5m per year must be saved on a recurrent basis whilst we maintain the quality of services. The Trust has an excellent track record for making efficiencies but this must continue in the forthcoming years, to ensure that the Trust remains a financially secure organisation. The Five Year Forward View highlighted that major system changes are required to protect high-quality sustainable care for patients now and into the future. The Trust has developed the 2015/16 operational plan in light of the challenging economic backdrop and a clear expectation that the funding provided to the National Health Service will need to be supplemented by making efficiencies to deal with the rising demand from an ageing population and the increased costs of new technology.
NHS Funding in 2015/16 Additional investment of £1.98bn was announced in the autumn 2014 statement, including £150m from NHS England through efficiencies and reprioritisation in its central budgets. This implies a real terms funding increases of 1.6%, in line with the funding ambitions outlined in the Forward view. The additional funding seeks to address a number of priorities. For mental health investment, there is a specific reference of the following additional resources: • £40m being made available to support the introduction of specialist early-interventionin-psychosis services, • £10m for access standards relating to adult IAPT services, • £30m for liaison psychiatry services In addition to the above, CCG Commissioners have been asked to: “ ensure that mental health spend will rise in real terms in every CCG and grow at least in line with the CCG’s overall allocation growth;”
Annual Report 2014/15
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extra mile • we are welcoming and friendly • we are caring and kind • we value and respect • we work together • we go the extra mile • Trust Future Financial Objectives we are welcoming and friendly • we are caring Our overall financial objectives for the future will allow the Trust to invest in our services and kind • we value and respect • we work and improve the Trusts buildings and ward environments. In specific terms the Trust plans: together • we go the extra mile • we are • To deliver an operational surplus of more than 1% of operating income to facilitate and friendly • we are caring and potential investment in the improvementwelcoming of services • we value and respect • To generate earnings before interest, tax,kind depreciation and amortisation of 5%,• we work together (EBITDA) • we go the extra mile • we are welcoming • To maintain a Continuity of Service Risk Rating (CoSRR) of 4 and friendly • we are caring and kind • we The financial outlook and main risks faced by the Trust over the next•two are together • we go value and respect weyears work summarised below: the extra mile • we are welcoming and frien • The main assumptions supporting the Trusts financial plan are based on the guidance respect • we work together • we go the extra in the document, “The NHS Forward View.” The national efficiency requirements arefactored caringinto and • plans. we value and respect • w of 3.5% and the changes in tariff have been the kind financial This includes the aforementioned efficiency requirement of 3.5% and assumes inflationary we are welcoming and friendly • we are caring uplift of 1.9%. For 2015/16 the efficiency challenge of circa 4% has been included with associated tariff changes. together • we go the extra mile • we are wel • The Trusts major challenge over the planning period is the second year implementation • we value and respect • we work together • of the Acute Care Pathway programme, including the enhancement of Community andof friendly are caring and kind • we val services and the development of the ‘Centre Excellence,’•atwe the Woodlands hospital. From a financial planning perspective, the cost of investment in the community and the the extra mile • we are welcoming and frien transition costs of moving services away from hospital locations have been included in respect • we work together • we go the extra the Trust’s plans. arethere caring kind • we value and respect • w o With regard to Drug and Alcohol services, are a and number of risks in 2015/16 as a result of services being subject to tendering processes and migration of the we are welcoming and friendly • we are caring commissioning of these services to Local Authorities. • we in go the extra o The CCG commissioning processes will together continue to develop 2015-16 and the mile • we are wel Trust needs to work with all partners, including the Local Authorities to ensure • we value and respect • we the work together • Commissioners requirements are met. Similarly, for Specialist Services the Trust will friendly • wethat arethecaring and kind • we val continue to develop relationships withand NHS England to ensure organisation continues to provide quality services whilst Trust • remains financially theensuring extrathe mile we are welcoming and frien robust and sustainable for the future. respect • we work together • we go the extra are caring and kind • we value and respect • w we are welcoming and friendly • we are caring together • we go the extra mile • we are wel • we value and respect • we work together • and friendly • we are caring and kind • we val the extra mile • we are welcoming and frien respect • we work together • we go the extra are caring and kind • we value and respect • w we are welcoming and friendly • we are caring together • we go the extra mile • we are wel • we value and respect • we work together • and friendly • we are caring and kind • we val the extra mile • we are welcoming and frien Page 70 Greater Manchester West Mental Health NHS Foundation Trust respect • we work together • we go the ext
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o ndly • we are caring and kind • we value and a mile • we are welcoming and friendly • we we work together • we go the extra mile • g and kind • we value and respect • we work lcoming and friendly • we are caring and kind we go the extra mile • we are welcoming lue and respect • we work together • we go ndly • we are caring and kind • we value and a mile • we are welcoming and friendly • we we work together • we go the extra mile • The NHS Act 2006 that the chiefwork executive is the accounting officer of the NHS g and kind • we value andstates respect • we foundation trust. The relevant responsibilities of the accounting officer, including their lcoming and friendly • we are caringand and kind of public finances for which they are responsibility for the propriety regularity answerable, and•forwe the are keeping of proper account, are set out in the NHS Foundation we go the extra mile welcoming Trust Accounting Officer Memorandum issued by Monitor. lue and respect • we work together • we go the NHS Act 2006, Monitor has directed Greater Manchester West NHS Foundation ndly • we are Under caring and kind • we value and Trust to prepare for each financial year a statement of accounts in the form and on the a mile • we are and friendly • we basiswelcoming set out in the Account Direction. The accounts are prepared on an accruals basis and must give a true and fair view of the state of affairs of Greater Manchester West NHS we work together • we go the extra mile • Foundation Trust and of its income and expenditure, total recognised gains and losses and cash flows forand the financial year. g and kind • we value respect • we work lcoming and friendly • the weaccounts, are caring and kind In preparing the Accounting Officer is required to comply with the requirements of the NHS Foundation Trust Annual Reporting Manual and in particular to: we go the extra mile • we are welcoming • Observe Accounts Direction•issued lue and respect • we the work together we by goMonitor, including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent ndly • we are caring and kind • we value and basis; a mile • we are welcoming friendly we • Make judgements and and estimates on • a reasonable basis; we work together we go the extra mile • • State•whether applicable accounting standards as set out in the NHS Foundation Trust Annual Reporting Manual have been followed, and disclose and explain any material g and kind • we value and respect • we work departures in the financial statements; lcoming and friendly • we are caring and kind • Ensure that the use of public funds complies with the relevant legislation, delegated authorities and•guidance; we go the extra mile we areand welcoming • Prepare financial statement•on a going lue and respect • wethe work together we go concern basis. ndly • we are caring and kind • we value and Page 71 Annual Report 2014/15 tra mile • we are welcoming and friendly •
Statement of the chief executive’s responsibilities as the accounting officer of Greater Manchester West Mental Health NHS Foundation Trust
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 and to enable her to ensure the accounts comply with requirements outlined in the above mentioned Act. The Accounting Officer is also responsible for safeguarding the assets of the NHS
are caring and kind • we and foundation trustvalue and hence forrespect taking reasonable steps for the prevention and detection of fraud and other irregularities. we are welcoming and friendly • we are
the the best of my knowledge together • weTogo extra mile •and webelief, are I have properly discharged the responsibilities set out in Monitor’s NHS Foundation Trust Accounting Officer Memorandum.
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we work together • we go the extra mile Bev Humphrey, Chief Executive
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Date: 22nd May 2015
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Greater Manchester West Mental Health NHS Foundation Trust
Annual Governance kind • we value andStatement respect • we work together • we go
and friendly • we are caring and kind • we value and r the extra mile • we are welcoming and friendly • we Scope of Responsibility respect • we work together • we go the extra mile • As Accounting Officer, I have responsibility for maintaining a sound system of internal are caring and kind • trust’s we value respect • we work control that supports the achievement of the NHS foundation policies,and aims and objectives, whilst safeguarding the and departmental assets for which wepublic are funds welcoming and friendly • weI are caring and kin am personally responsible, in accordance with the responsibilities assigned to me. I am together • we go the extra mile • we are welcoming also responsible for ensuring that the NHS foundation trust is administered prudently and economically and that resources are applied efficiently and effectively. I also • we value and respect • we work together • we go t acknowledge my responsibilities as set out in the NHS Foundation Trust Accounting and friendly • we are caring and kind • we value and r Officer Memorandum. the extra mile • we are welcoming and friendly • we respect • we work together • we go the extra mile • The Purpose of the System Internal Control are caring and of kind • we value and respect • we work we are welcoming and friendly • we are caring and kin The system of internal control is designed to manage risk to a reasonable level rather than • we extra mile • weonly are welcoming to eliminate all risk of failure to together achieve policies, aimsgo andthe objectives; it can therefore provide reasonable and not absolute effectiveness. system of internal • weassurance value of and respectThe • we work together • we go t control is based on an on-going process designed to identify and prioritise the risks to friendly • we are caring and kind • we value and r the achievement of the policies,and aims and objectives of Greater Manchester West Mental Health NHS Foundation Trust, to evaluate the likelihood of those risks being realised the extra mile • we are welcoming and friendly • we and the impact should they be realised, and to manage them efficiently, effectively and economically. The system of internal control in place in Greater respect • has webeen work together • Manchester we go the extra mile • West Mental Health NHS Foundation Trust for the year ended 31 March 2015 and up to arereport caring and kind • we value and respect • we work the date of approval of the annual and accounts. we are welcoming and friendly • we are caring and kin together • we go the extra mile • we are welcoming • weRisk value and respect • we work together • we go t Capacity to Handle and friendly • we are caring and kind • we value and r I have overall accountability for ensuring an effective risk management system is in place the extra mile • we are welcoming and friendly • we within the Trust and I have delegated responsibility for the overall co-ordination of risk management to the Director of respect Human Resources and Governance. • we work together • we go the extra mile • are andensures kindan • effective we value and respect • we work The Director of Human Resources andcaring Governance overall approach to risk management including the of the Riskand Management Strategy wedevelopment are welcoming friendly • weand are caring and kin specifically the identification, assessment and management of risks. This also includes the together • weand go thelegislation, extra mile responsibility for ensuring compliance with health safety security• we are welcoming • we value and respect • we work together • we go t Page 73 Annual Report 2014/15 and friendly • we are caring and kind • we value and r
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The Medical Director leads on clinical risk management, medicines management and safe standards of medical practice. we go the extra mile • we are welcoming and friendly
and respect • we work together • leads we on go the extra mile The Director of Finance and Information Management & Technology (IM&T) financial and information risk we management. are caring and kind • we value and respect • we work
The Director of Nursing and Operations ensures the effective application of risk • we are welcoming and friendly • we are caring and kin management across clinical and operational services and leads specifically on safeguarding and infection prevention. together • we go the extra mile • we are welcoming a The Director of Estates and Facilities in relation to the development, • wemanages value risk and respect • we work together management and maintenance of the Trust estate and matters relating to fire safety.
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A supporting system for managing risk has been devolved to the Deputy Director of are support caringfrom and and respect Integrated Governance (Risk) with thekind Head • of we Risk, value Safety and Resilience. There are also clearly defined risk and clinical governance structures within directorates.
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The Risk Management Strategy was reviewed in March 2014 and is currently being updated. together • we go the extra mile • we are welcoming a It provides a framework for managing risks across the organisation which is consistent with best practice and Department of Health guidance. The Strategy•provides a clear, structured • we go the e • we value and respect we work together and systematic approach to the management of risks to ensure that risk assessment is an integral part of clinical, managerial and financial across the organisation. friendly • weprocesses are caring and kind • we value and respec
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Risk management training is provided induction for new we arethrough caringtheand kindprogramme • we value andstaff. respect • we work In addition tailored training for individual roles are identified by managers and agreed • we are plans. welcoming and friendly • we are caring and kin with staff through personal development
together • we go the milewith • we are welcoming a The corporate induction programme ensures that all new staffextra are provided details of the Trust’s risk management systems and processes and is augmented by local induction • we value and respect • we work together • we go the e organised by line managers. Mandatory training covers a variety of risk management process including health and safety, security etc.
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we go the extra mile • we are welcoming and friendly Greater Manchester West Mental Health NHS Foundation Trust
and respect • we work together • we go the extra mi
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briefings and governance meetings. lue and respect • we work together • The Trust has mechanisms to act upon alerts and recommendations made by all relevant • we are caring and kind • we value central bodies such as the National Patient Safety Agency (NPSA), National Health Service
Litigation Authority (NHSLA) and e • we are welcoming and friendly • the Health and Safety Executive (HSE).
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The Risk and Control Framework
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The Risk Management Strategy establishes the formal structured approach to the
he extra mile • we areassessment, welcoming identification, treatment and management of risks. The process starts with a systematic identification of risks throughout the organisation which are documented
espect • we work together • we go within risk registers. These risks are then analysed in order to determine their relative importance risk scoring are caring and kind •using we avalue andmatrix.
Low scoring risks are managed by the area in which they are found while higher scoring risks are managed at progressively higher levels within the organisation. we are welcoming and friendly Achieving • we control of the higher scoring risks is given priority over lower scoring risks. Risk control measures are identified and taken to reduce the potential harm. together • weforgo the extra mile •
d • we value The andsystem respect • wecontrol work of internal of quality governance risks is managed through the Risk
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bedded throughout the organisation and all staff are encouraged to report incidents ct • we work istogether • we go the
and raise concerns. The NHS Staff Survey for 2014 ranked the organisation better than national average mental health trusts in relation to the percentage of staff ring and kindthe • we value andof respect reporting errors, near misses or incidents. Risk management is further embedded through annual business•planning process with key risks to the delivery of Directorate plans e welcomingthe and friendly we are identified as a core requirement.
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The key in year risks facing the organisation which have been managed and mitigated at
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lue and respect arrangements • we workacross together Greater•Manchester. • we are caring and kind • we value Annual Report 2014/15
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With specific reference to Condition FT4 – NHS foundation trust governance arrangements – the Trust Board has continued to ensure that there are: • effective board and committee structures; • clear responsibilities for its Board, for committees reporting to the Board and for staff reporting to the Board and those committees; and • clear reporting lines and accountabilities throughout the organisation. The Board confirms that it has complied with Condition FT4 in-year, as at the date of this statement and that it expects to continue to comply with this condition throughout2015/16. Information governance and data security risks are managed as part of this process and assessed using the Information Governance Tool Kit. The risk register is updated with the currently identified information governance and data security risks. The Trust has a Data Quality Policy which is the responsibility of the Director of Finance and IM&T. Assurance with regard to Data Quality is provided through the Information Governance Steering Group. Potential and identified risks which may impact on external stakeholders and key partner agencies such as Local Authorities, other NHS Trusts, the judicial system, voluntary organisations and service users are handled through structured mechanisms and forums such as Overview and Scrutiny Committees, contract negotiation meetings, Council of Governor Meetings and service user forums. The Foundation Trust is fully compliant with the requirements of registration with the Care Quality Commission. As an employer with staff entitled to membership of the NHS Pension Scheme, control measures are in place to ensure all employer obligations contained within the Scheme Regulations are complied with. This includes ensuring that deductions from salary, employer’s contributions and payments into the Scheme are in accordance with the Scheme rules, and that member Pension Scheme records are accurately updated in accordance with the timescales detailed in the Regulations. Control measures are in place to ensure that all the organisation’s obligations under equality, diversity and human rights legislation are complied with. The Foundation Trust has undertaken risk assessments and Carbon Reduction Delivery Plans are in place in accordance with emergency preparedness and civil contingency requirements, as based on UKCIP 2009 weather projects, to ensure that the organisation’s obligations under the Climate Change Act and Adaptation Reporting requirements are complied with.
Review of the Trust’s Economy, Efficiency and Effectiveness of the Use of Resources The Strategic and Operational Plans are approved by the Board of Directors and submitted to Monitor. The Operational Plan is monitored in detail by the Board of Directors on a monthly basis with key performance indicators and Monitor Metrics reviewed quarterly by the Board. A full copy of the monthly Integrated Finance and Performance Report is issued to all Board Directors and the Trust’s External Auditors. The Trust’s resources are managed within the framework set by the Governance Manual, which includes Standing Financial Instructions. Financial governance arrangements are Page 76
Greater Manchester West Mental Health NHS Foundation Trust
supported by internal and external audit to ensure economic, efficient and effective use of resources. Directorate and Corporate Departments are responsible for the delivery of financial and other performance targets via a performance management framework. This is led through a monthly Directorate Management Board meeting which includes Executive Director scrutiny of performance.
Information governance Any Information Governance (IG) breaches are recorded in the Trust Datix system (incident reporting system) any breaches at a high level would be automatically sent to the Information Commissioner’s Office (ICO). GMW has not been referred to the ICO in 2014-15. However, GMW takes any IG incident seriously and has reported five IG related incidents in 2014-15. These incidents were in relation to unauthorised access to a patient’s record and patient letter’s being sent incorrectly by staff. Two incidents were reported whereby unauthorised access was undertaken by staff, accessing a patient’s record. Both incidents were investigated and the Trusts personal responsibility framework was used in dealing with the staff concerned. The action taken by the Trust was deemed appropriate and satisfactory. Three incidents where letters were incorrectly sent to the wrong location resulted in additional training provided to the staff members concerned. The ICO was assured that appropriate measures and action had been taken to reduce the risk of a reoccurrence.
Annual Quality Report The directors are required under the Health Act 2009 and the National Health Service (Quality Accounts) Regulations 2010 (as amended) to prepare Quality Accounts for each financial year. Monitor has issued guidance to NHS foundation trust boards on the form and content of annual Quality Reports which incorporate the above legal requirements in the NHS Foundation Trust Annual Reporting Manual. We are an organisation that is passionate about delivering high quality care. Quality and continuous improvement is at the heart of everything we do. Through the hard work of our workforce, we have taken significant steps to improve the experience of service users and the safety and effectiveness of care in 2014/15. We have committed to making further improvements in 2015/16. The Quality Governance Committee, which is a formal sub-committee of the Trust Board, is responsible for developing and defining the Trust’s quality strategy and monitoring progress against the quality improvement priorities set out in our Quality Account. The Quality Governance Committee is chaired by a nonexecutive director and includes representation from all professional groups and services through the Quality Governance Committee, the Board is assured that clear and effective systems and processes are in place to govern quality. As described in our Quality Account, directors have taken steps to satisfy themselves that the content of our Quality Account presents a fair and balanced view and is consistent with internal and external sources of information including: • Feedback from Commissioners, governors, local Healthwatch organisations and our joint Scrutiny Committee Annual Report 2014/15
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• Feedback from service user forums including from our Recovery Academy courses • Complaints and compliments • Our most recent national Community Mental Health Survey and Staff Survey • Local inpatient surveys • Board to Ward ‘walk-arounds’ • Video diary room events • Care Quality Commission quality and risk profiles and inspection reports • Head of Internal Audit’s opinion on the Trust’s control environment All Trust policies and procedures are available on the Trust’s intranet and representatives of all professional groups and services are encouraged to participate in consultation on new policies and/or policy updates. Newly approved policies are shared via a network of policy leads, published on the Trust’s intranet and highlighted in internal staff communications. Our staff are critical to the achievement of our quality improvement priorities. Learning and development opportunities are available for all members of staff, at every stage of their personal development. Through this, staff are equipped with the knowledge and skills needed to deliver high quality services that are positively experienced by our service users. The Trust keeps staff informed about our plans, achievements, examples of best practice and any issues facing the organisation through a range of briefings including ‘GMW Messenger’. Exceptional staff achievements are recognised and celebrated in our annual staff awards. The Trust also participates in the annual National NHS Staff Survey and acts on the feedback received from this survey to improve the working lives of our staff and help provide better care to our service users. Feedback from our service users, and other key stakeholders including carers, is central to our quality strategy. Delivering improvements in how we listen to and learn from service user feedback remains one of our quality improvement priorities for 2015/16. With regard to complaints handling, all information on complaints is included in monthly ‘Customer Care Reports’, which are reviewed in local governance meetings.. The Trust produces an annual complaints report in accordance with Regulation 18 of the ‘Local Authority Social Services and NHS Complaints (England) Regulations 2009’. Our annual complaints report is reviewed and agreed by the Quality Governance Committee. The Trust Board receives a monthly summary of complaints activity. The Trust has achieved a ‘green’ rating for performance against the Information Governance Toolkit standards. The Information Governance Toolkit provides an overall measure of the quality of data systems, standards and processes. The Trust has robust systems in place to review and report data quality and performance against our Quality Account improvement priorities and other key quality indicators. The remit of our ‘Performance Measures and Data Quality Group’ includes raising awareness of the importance of data quality, ensuring all staff are aware of their data quality responsibilities, and supporting the development of policies and procedures to improve data quality. The Trust Board receives assurance on data quality and performance via a monthly ‘Board Performance Report’. The ‘Board Performance Report’ is informed by individual directorate performance reports, which are subject to local scrutiny and monitoring. For more information on our approach to quality, please see our ‘Quality Account 2014/15’.
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Greater Manchester West Mental Health NHS Foundation Trust
Review of effectiveness As Accounting Officer, I have responsibility for reviewing the effectiveness of the system of internal control. My review of the effectiveness of the system of internal control is informed by the work of the internal auditors, clinical audit and the executive managers and clinical leads within the NHS Foundation Trust who have responsibility for the development and maintenance of the internal control framework. I have drawn on the content of the Quality Report attached to this Annual Report and other performance information available to me. My review is also informed by comments made by the external auditors in their management letter and other reports. I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the Board, the Audit Committee and Quality Governance Committee and plan to address weaknesses and ensure continuous improvement of the system is in place. The assurance framework itself provides me with evidence that the effectiveness of controls that manage the risks to the organisation achieving its principle objectives have been reviewed. The Director of Internal Audit provides me with an opinion on the overall arrangements for gaining assurance through the assurance framework and on controls reviewed as part of the internal audit work through reviews by the Quality Governance and Audit Committees. The Board Assurance Framework is reviewed by the Board of Directors quarterly and it provides me and the Board with evidence of the effectiveness of controls in place to manage risks to achieving the organisation’s principle objectives. My review is also informed by External Audit, the National Health Service Litigation Authority and periodic audits of compliance with the Standards by the Care Quality Commission, Mental Health Commission and other external inspections, accreditations and reviews. Processes are well established and ensure regular review of systems and action plans on the effectiveness of the systems of internal control through: • Board review of Board Assurance Framework and action plans; • Audit Committee scrutiny of controls in place; • Review of serious incidents and learning by the Quality Governance Committee, including those for Risk Management and Clinical Effectiveness; • Review of progress in meeting the requirements as set by the Care Quality Commission; • Internal audits of effectiveness of systems of internal control
Conclusion No significant control issues were identified.
Signed: Bev Humphrey, Chief Executive
Annual Report 2014/15
Dated: 22nd May 2015
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Independent Auditor’s Report
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Refer to page 51 (Audit Committee Report), page 111 (accounting policy) and page and respect • we work together • we go the 130 (financial disclosures).
extra mile •
we are caring and kind • we value and respect • we work to
• we are welcoming and friendly • we are caring and kind • together • we go the extra mile • we are welcoming and • we value and respect • we work together • we go the
and friendly • we are caring and kind • we value and respe
the extra mile • we are welcoming and friendly • we are respect • we work together • we go the extra mile • we
are caring and kind • we value and respect • we work toge we are welcoming and friendly • we are caring and kind • together • we go the extra mile • we are welcoming and
• we value and respect • we work together • we go the ext
friendly • we are caring and kind • we value and respect •
extra mile • we are welcoming and friendly • we are caring
• we work together • we go the extra mile • we are w
caring and kind • we value and respect • we work together • welcoming and friendly • we are caring and kind • we value
we go the extra mile • we are welcoming and friendly • w and respect • we work together • we go the extra mile •
we are caring and kind • we value and respect • we work to
• we are welcoming and friendly • we are caring and kind • Annual Report 2014/15
together • we go the extra mile • we are welcoming and Page 81
• we value and respect • we work together • we go the ext
Page 82
Greater Manchester West Mental Health NHS Foundation Trust
71
Annual Report 2014/15
Page 83
Appendix 1
endly • we are caring and kind • we value and tra mile • we are welcoming and friendly • we NHS Foundation Trust Code of Governance • we work together • we go the extra mile • ing and kind •Part we value and respect • we Summary work of requirement of Relating to Code of Page Schedule A Governance Reference welcoming and friendly • we are caring and kind Reference Disclose Board and A.1.1 welcoming The schedule of matters reserved for the board of Page 39 • we go the2:extra mile • we are Council of directors should include a clear statement detailing the roles value and respect • weGovernors work together • we goand responsibilities of the council of governors. This statement should also describe any disagreements between the council of endly • we are caring and kind • we valuehow and governors and the board will be resolved. The report should include this schedule of tra mile • we are welcoming and friendlyannual • we matters or a summary statement of how the board of directors and the council of governors operate, • we work together • we go the extra mile • including a summary of the types of decisions to taken by each of the boards and which are ing and kind • we value and respect • we be work delegated to the executive management of the of directors. welcoming and friendly • we are caring andboard kind 2: Disclose Board, A.1.2 The annual report should identify the chairperson, Pages 47 to Nomination the deputy chairperson (where there is one), the 53 • we go the extra mile • we are welcoming Committee(s), chief executive, the senior independent director Committee, (see A.4.1) value and respect • weAudit work together • we goand the chairperson and members Remuneration of the nominations, audit and remuneration* Committee endly • we are caring and kind • we valuecommittees. and It should also set out the number of meetings of the board and those committees and tra mile • we are welcoming and friendlyindividual • weattendance by directors. 2: Disclose Council of A.5.3 The annual report should identify the members Page 40 Governors of the council • we work together • we go the extra mile • of governors, including a description of the constituency or organisation they represent, whether they were ing and kind • we value and respect • we that work elected or appointed, and the duration of their annual report should also welcoming and friendly • we are caring andappointments. The kind identify the nominated lead governor. • we go theAdditional extra mile • we are Council of n/a welcoming The annual report should include a statement Page 40 requirement Governors about the number of meetings of the council of value and respect • we work together • we goand individual attendance by governors of FT Arm governors and directors. endly • we are2: Disclose caring and kind •B.1.1 we valueTheand Board board of directors should identify in the Pages 43 to annual report each non-executive director it tra mile • we are welcoming and friendlyconsiders • weto be independent, with reasons where 45 necessary. • we work together • we go theB.1.4 extra mile • 2: Disclose Board The board of directors should include in its annual Pages 42 to report a description of each director’s skills, ing and kind • we value and respect • we expertise workand experience. Alongside this, in the 46 report, the board should make a clear welcoming and friendly • we are caring andannual kind statement about its own balance, completeness and appropriateness of the NHS foundation trust. • we go the extra mile • we are welcoming value and respect • we work together • we go endly • we are caring and kind • we value and Greater Manchester West Mental Health NHS Foundation Trust extra mile • Page we84are welcoming and friendly •
Additional requirement of FT ARM
Board
n/a
The annual report should include a brief description of the length of appointments of the non-executive directors, and how they may be terminated.
Page 38
2: Disclose
Nominations Committee(s)
B.2.10
A separate selection of the annual report should describe the work of the nominations committee(s), including the process it has used in relation to board appointments.
Pages 48
Additional requirement of FT ARM
Nominations Committee
n/a
The disclosure in the annual report on the work
Page 48
2: Disclose
Chair / Council of Governors
extra mile • we are committee welcoming and friendly • we are caring of the nominations should include an explanation if neither an external search
nor open• advertising has been used extra mile • we are w • we workconsultancy together we go the in the appointment of a chair or non-executive director.
caring andA kind • we value and respectPage • we work together • B.3.1 chairperson’s other significant commitments 42 should be disclosed to the council of governors
welcomingbefore and friendly • weinare caring and kind • we value appointment and included the annual report. Changes to such commitments should be
reported to themile council of • governors as theywelcoming arise, we go the extra we are and friendly • w and included in the next annual report. 2: Disclose
Council of Governors
B.5.6 respect Governors canvasstogether the opinion of the Page 39 and • weshould work • we go the extra mile • trust’s members and the public, and for appointed governors the body they represent, on the NHS
we are caring and kind we value foundation trust’s forward•plan, including its and respect • we work to objectives, priorities and strategy, and their views
should be communicated board of directors. • we are welcoming andto the friendly • we are caring and kind • The annual report should contain a statement as to how this requirement has been undertaken and
together •satisfied. we go the extra mile • we are welcoming and Additional requirement of FT ARM
Council of Governors
n/a
If, during the financial year, the Governors have
N/A
• we valueexercised andtheir respect • paragraph we work power* under 10C** oftogether • we go the schedule 7 of the NHS Act 2006, then information
on this in the annual report. This and friendly •must webe included are caring and kind • we value and respe is required by paragraph 26(2) (aa) of schedule 7 to the NHS Act 2006, as amended by section 151 (8) of
the extrathemile • Social weCare are welcoming and friendly • we are Health and Act 2012. *Power to require one or more of the directors respect • we work together • we go the extra mile • we to attend a governors’ meeting for the purpose of obtaining information about the foundation trust’s performance of its function or the directors’ performance of their duties (and deciding whether to propose a vote on the foundation trust’s or directors’ performance).
are caring and kind • we value and respect • we work toge we are welcoming and friendly • we are caring and kind • together •**As we go the extra mile • we are welcoming and inserted by section 151 (6) of the Health and Social Care Act 2012)
2: Disclose
Board
• B.6.1 we valueThe and respect • we work together • we go the ext board of directors should state in the annual Page 37 report how performance evaluation of the board,
committees, and its directors, including the • we value and respect • friendly • itswe are caring and kind chairperson, has been conducted.
2: Disclose
Board
B.6.2 Where there has been external evaluation and of the friendly N/A extra mile • we are welcoming • we are caring board, and/or governance of the Trust, the external
should be identified in the annual report • we workfacilitator together • we go the extra mile • we are w and a statement made as to whether they have any other connection to the trust.
2: Disclose
Board
caring andThekind •should we explain value and respect • we work together • C.1.1 directors in the annual report Page 28 and their responsibility for preparing the annual report
73
accounts, and state that welcomingandand friendly •they weconsider are the caring and kind • we value annual report and accounts, taken as a whole, are
fair, balanced and understandable and provide the we go the extra mile • we are welcoming and friendly • w information necessary for patients, regulators and other stakeholders to assess the NHS foundation
trust’s business model and strategy. and respect • performance, we work together • we go the extra mile • Directors should also explain their approach to
quality governance in the Annual Governance we are caring and kind • we value and respect • we work to Statement (within the annual report). 2: Disclose
Board
The annual report should contain a statement Page 80 • C.2.1 we are welcoming and friendly that the board has conducted a review of the• we are caring and kind • effectiveness of its systems of internal controls.
together • we go the extra mile • we are welcoming and
• we value and respect • we work together • we go the ext Annual Report 2014/15
Page 85
friendly • we are caring and kind • we value and respect •
2: Disclose
Audit Committee / control environment
C.2.2
A trust should disclose in the annual report:
Page 50
(a) If it has an internal audit function, how the function is structured and what role it performs; or (b) If it does not have an internal audit function, that fact and the processes it employs for evaluating and continually improving the effectiveness of its risk management and internal control processes
2: Disclose
Audit Committee / Council of Governors
C.3.5
If the council of governors does not accept the audit committee’s recommendation on the appointment, reappointment or removal of an external auditor, the board of directors should include in the annual report a statement from the audit committee explaining the recommendation and should set out reasons why the council of governors has taken a different position.
N/A
2: Disclosure
Audit Committee
C.3.9
A separate section of the annual report should describe the work of the audit committee in discharging its responsibilities. The report should include:
Pages 48 to 52
• The significant issues that the committee considered in relation to financial settlements, operation and compliance, and how these issues were addressed; • An explanation of how it has assessed the effectiveness of the external audit process and the approach taken to the appointment or reappointment of the external auditor, the value of external audit services and information on the length of tenure of the current audit firm and when a tender was last conducted; and • If the external auditor provides non-audit services, the value of the non-audit services provided and an explanation of how auditor objectivity and independence are safeguarded. 2: Disclose
Board / Remuneration Committee
D.1.3
Where an NHS foundation trust releases an executive director, for example to serve as a nonexecutive director elsewhere, the remuneration disclosures of the annual report should include a statement of whether or not the director will retain such earnings.*
N/A
2: Disclose
Board
E.1.5
The board of directors should state in the annual report the steps they have taken to ensure that the members of the board, and in particular the non-executive directors, develop an understanding of the views of governors and members about the NHS foundation trust, for example through attendance at meetings of the council of governors, direct face-to-face contact, surveys of members’ opinions and consultations
Page 39
2: Disclose
Board / Membership
E.1.6
The board of directors should monitor how representative the NHS foundation trust’s membership is and the level and effectiveness of member engagement and report on this in the annual report.
Pages 54 to 55
2: Disclose
Membership
E.1.4
Contact procedures for members who wish to communicate with governors and/or directors should be made clearly available to members on the NHS foundation trust’s website and in the annual report.
Page 55
Page 86
Greater Manchester West Mental Health NHS Foundation Trust
Additional requirement of FT ARM
Membership
n/a
The annual report should include:
Pages 54 to 55
• A brief description of the eligibility requirements for joining different membership constituencies, including the boundaries for public membership; • Information on the number of members and the number of members in each constituency; and • A summary of the membership strategy, an assessment of the membership and a description of any steps taken during the year to ensure a representative membership (see also E.1.6 above), including progress towards any recruitment targets for members.
Additional requirement of FT ARM (based on FReM requirement)
Board / Council of Governors
n/a
The annual report should disclose details of company directorships or other material interests in companies held by governors and/or directors where those companies or related parties are likely to do business, or are possibly seeking to do business, with the NHS foundation trust. As each NHS foundation trust must have registers of governors’ and directors’ interests which are available to the public, an alternative disclosure is for the annual report to simply state how members of the public can gain access to the registers instead of listing all the interests in the annual report.
Pages 31 and 40
See also ARM paragraph 7.33 as directors’ report requirement. 6: Comply or explain
Board
A.1.4
The board should ensure that adequate systems and processes are maintained to measure and monitor the NHS foundation trust’s effectiveness, efficiency and economy as well as the quality of its health care delivery
Comply
6: Comply or explain
Board
A.1.5
The board should ensure that relevant metrics, measures, milestones and accountabilities are developed and agreed so as to understand and assess progress and delivery of performance
Comply
6: Comply or explain
Board
A.1.6
The board should report on its approach to clinical governance.
Comply
6: Comply or explain
Board
A.1.7
The chief executive as the accounting officer should follow the procedure set out by Monitor for advising the board and the council and for recording and submitting objections to decisions.
Comply
6: Comply or explain
Board
A.1.8
The board should establish the constitution and standards of conduct for the NHS foundation trust and its staff in accordance with NHS values and accepted standards of behaviour in public life
Comply
6: Comply or explain
Board
A.1.9
The board should operate a code of conduct that builds on the values of the NHS foundation trust and reflect high standards of probity and responsibility.
Comply
6: Comply or explain
Board
A.1.10
The NHS foundation trust should arrange appropriate insurance to cover the risk of legal action against its directors.
Comply
6: Comply or explain
Chair
A.3.1
The chairperson should, on appointment by the council, meet the independence criteria set out in B.1.1. A chief executive should not go on to be the chairperson of the same NHS foundation trust.
Comply
6: Comply or explain
Board
A.4.1
In consultation with the council, the board should appoint one of the independent non-executive directors to be the senior independent director.
Comply
6: Comply or explain
Board
A.4.2
The chairperson should hold meetings with the non-executive directors without the executives present.
Comply
6: Comply or explain
Board
A.4.3
Where directors have concerns that cannot be resolved about the running of the NHS foundation trust or a proposed action, they should ensure that their concerns are recorded in the board minutes.
Comply
Annual Report 2014/15
Page 87
6: Comply or explain
Council of Governors
A.5.1
The council of governors should meet sufficiently regularly to discharge its duties.
Comply
6: Comply or explain
Council of Governors
A.5.2
The council of governors should not be so large as to be unwieldy.
Comply
6: Comply or explain
Council of Governors
A.5.4
The roles and responsibilities of the council of Comply governors should be set out in a written document.
6: Comply or explain
Council of Governors
A.5.5
The chairperson is responsible for leadership of both the board and the council but the governors also have a responsibility to make the arrangements work and should take the lead in inviting the chief executive to their meetings and inviting attendance by other executives and nonexecutives, as appropriate.
Comply
6: Comply or explain
Council of Governors
A.5.6
The council should establish a policy for engagement with the board of directors for those circumstances when they have concerns.
Comply
6: Comply or explain
Council of Governors
A.5.7
The council should ensure its interaction and relationship with the board of directors is appropriate and effective.
Comply
6: Comply or explain
Council of Governors
A.5.8
The council should only exercise its power to remove the chairperson or any non-executive directors after exhausting all means of engagement with the board.
Comply
6: Comply or explain
Council of Governors
A.5.9
The council should receive and consider other appropriate information required to enable it to discharge its duties.
Comply
6: Comply or explain
Board
B.1.2
At least half the board, excluding the chairperson, should comprise non-executive directors determined by the board to be independent.
Comply
6: Comply or explain
Board / Council of Governors
B.1.3
No individual should hold, at the same time, positions of director and governor of any NHS foundation trust.
Comply
6: Comply or explain
Nomination Committee(s)
B.2.1
The nominations committee or committees, with external advice as appropriate, are responsible for the identification and nomination of executive and non-executive directors.
Comply
6: Comply or explain
Board / Council of Governors
B.2.2
Directors on the board of directors and governors on the council should meet the “fit and proper� persons test described in the provider licence.
Comply
6: Comply or explain
Nomination Committee(s)
B.2.3
The nominations committee(s) should regularly review the structure, size and composition of the board and make recommendations for changes where appropriate.
Comply
6: Comply or explain
Nomination Committee(s)
B.2.4
The chairperson or an independent nonexecutive director should chair the nominations committee(s).
Comply
6: Comply or explain
Nomination Committee(s) / Council of Governors
B.2.5
The governors should agree with the nominations committee a clear process for the nomination of a new chairperson and non-executive directors.
Comply
6: Comply or explain
Nomination Committee(s)
B.2.6
Where an NHS foundation trust has two nominations committees, the nominations committee responsible for the appointment of nonexecutive directors should consist of a majority of governors.
Not applicable
6: Comply or explain
Council of Governors
B.2.7
When considering the appointment of nonexecutive directors, the council should take into account the views of the board and the nominations committee on the qualifications, skills and experience required for each position.
Comply
6: Comply or explain
Council of Governors
B.2.8
The annual report should describe the process followed by the council in relation to appointments of the chairperson and nonexecutive directors.
Comply
6: Comply or explain
Nomination Committee(s)
B.2.9
An independent external adviser should not be a member of or have a vote on the nominations committee(s).
Comply
Page 88
Greater Manchester West Mental Health NHS Foundation Trust
6: Comply or explain
Board
B.3.3
The board should not agree to a full-time executive director taking on more than one non-executive directorship of an NHS foundation trust or another organisation of comparable size and complexity.
Comply
6: Comply or explain
Board / Council of Governors
B.5.1
The board and the council governors should be provided with high quality information appropriate to their respective functions and relevant to the decisions they have to make.
Comply
6: Comply or explain
Board
B.5.2
The board and in particular non-executive directors, may reasonably wish to challenge assurances received from the executive management. They need not seek to appoint a relevant adviser for each and every subject area that comes before the board, although they should, wherever possible, ensure that they have sufficient information and understanding to enable challenge and to take decisions on an informed basis.
Comply
6: Comply or explain
Board
B.5.3
The board should ensure that directors, especially non-executive directors, have access to the independent professional advice, at the NHS foundation trust’s expense, where they judge it necessary to discharge their responsibilities as directors.
Comply
6: Comply or explain
Board / Committees
B.5.4
Committees should be provided with sufficient resources to undertake their duties.
Comply
6: Comply or explain
Chair
B.6.3
The senior independent director should lead the performance evaluation of the chairperson.
Comply
6: Comply or explain
Chair
B.6.4
The chairperson, with assistance of the board secretary, if applicable, should use the performance evaluations as the basis for determining individual and collective professional development programmes for non-executive directors relevant to their duties as board members.
Comply
6: Comply or explain
Chair / Council of Governors
B.6.5
Led by the chairperson, the council should periodically assess their collective performance and they should regularly communicate to members and the public details on how they have discharged their responsibilities.
Comply
6: Comply or explain
Council of Governors
B.6.6
There should be a clear policy and a fair process, agreed and adopted by the council, for the removal from the council of any governor who consistently and unjustifiably fails to attend the meetings of the council or has an actual or potential conflict of interest which prevents the proper exercise of their duties.
Comply
6: Comply or explain
Board / Remuneration Committee
B.8.1
The remuneration committee should not agree Comply to an executive member of the board leaving the employment of an NHS foundation trust, except in accordance with the terms of their contract of employment, including but not limited to service of their full notice period and/or material reductions in their time commitment to the role, without the board first having completed and approved a full risk assessment.
6: Comply or explain
Board
C.1.2
The directors should report that the NHS foundation trust is a going concern with supporting assumptions or qualifications as necessary.
Comply
See also ARM paragraph 7.17. 6: Comply or explain
Board
Annual Report 2014/15
C.1.3
At least annually and in a timely manner, the board should set out clearly its financial, quality and operating objectives for the NHS foundation trust and disclose sufficient information, both quantitative and qualitative, of the NHS foundation trust’s business and operation, including clinical outcome data, to allow members and governors to evaluate its performance.
Comply
Page 89
6: Comply or explain
Board
C.1.4
a) The board of directors must notify Monitor and the council of governors without delay and should consider whether it is in the public’s interest to bring to the public attention, any major new developments in the NHS foundation trust’s sphere of activity which are not public knowledge, which it is able to disclose and which may lead by virtue of their effect on its assets and liabilities, or financial position or on the general course of its business, to a substantial change to the financial wellbeing, health care delivery performance or reputation and standing of the NHS foundation trust.
Comply
b) The board of directors must notify Monitor and the council of governors without delay and should consider whether it is in the public interest to bring to public attention all relevant information which is not public knowledge concerning a material change in: • the NHS foundation trust’s financial condition; • the performance of its business; and/or • the NHS foundation trust’s expectations as to its performance which, if made public, would be likely to lead to a substantial change to the financial wellbeing, health care delivery performance or reputation and standing of the NHS foundation trust. 6: Comply or explain
Board / Audit Committee
C.3.1
The board should establish an audit committee composed of at least three members who are all independent non-executive directors.
Comply
6: Comply or explain
Council of Governors / Audit Committee
C.3.3
The council should take the lead in agreeing with the audit committee the criteria for appointing, reappointing and removing external auditors.
Comply
6: Comply or explain
Council of Governors / Audit Committee
C.3.6
The NHS foundation trust should appoint an external auditor for a period of time which allows the auditor to develop a strong understanding of the finances, operations and forward plans of the NHS foundation trust.
Comply
6: Comply or explain
Council of Governors
C.3.7
When the council ends an external auditor’s appointment in disputed circumstances, the chairperson should write to Monitor informing it of the reasons behind the decision.
Comply
6: Comply or explain
Audit Committee
C.3.8
The audit committee should review arrangements that allow staff of the NHS foundation trust and other individuals where relevant, to raise, in confidence, concerns about possible improprieties in matters of financial reporting and control, clinical quality, patient safety or other matters.
Comply
6: Comply or explain
Remuneration Committee
D.1.1
Any performance-related elements of the remuneration of executive directors should be designed to align their interests with those of patients, service users and taxpayers and to give these directors keen incentives to perform at the highest levels.
Not applicable
6: Comply or explain
Remuneration Committee
D.1.2
Levels of remuneration for the chairperson and other non-executive directors should reflect the time commitment and responsibilities of their roles.
Comply
6: Comply or explain
Remuneration Committee
D.1.4
The remuneration committee should carefully consider what compensation commitments (including pension contributions and all other elements) their directors’ terms of appointments would give rise to in the event of early termination.
Comply
6: Comply or explain
Remuneration Committee
D.2.2
The remuneration committee should have delegated responsibility for setting remuneration for all executive directors, including pension rights and any compensation payments.
Comply
Page 90
Greater Manchester West Mental Health NHS Foundation Trust
6: Comply or explain
Council of Governors / Remuneration Committee
D.2.3
The council should consult external professional advisers to market test the remuneration levels of the chairperson and other nonexecutives at least once every three years and when they intend to make a material change to the remuneration of a non-executive.
Comply
6: Comply or explain
Board
E.1.2
The board should clarify in writing how the public interests of patients and the local community will be represented, including its approach for addressing the overlap and interface between governors and any local consultative forums.
Comply
6: Comply or explain
Board
E.1.3
The chairperson should ensure that the views of governors and members are communicated to the board as a whole.
Comply
6: Comply or explain
Board
E.2.1
The board should be clear as to the specific third party bodies in relation to which the NHS foundation trust has a duty to co-operate.
Comply
6: Comply or explain
Board
E.2.2
The board should ensure that effective mechanisms are in place to co-operate with relevant third party bodies and that collaborative and productive relationships are maintained with relevant stakeholders at appropriate levels of seniority in each.
Comply
Annual Report 2014/15
Page 91
Appendix 2
lcoming and friendly • we are caring and kind we go the extra mile • we are welcoming lue and respect • we work to together • we go Foreword the Accounts ndly • we are caring and kind • we value and Greater Manchester West Mental Health NHS Foundation Trust a mile • we are welcoming and friendly • we These accounts, for the year ended 31 March•2015, have been prepared by Greater we work together • we go the extra mile Manchester West Mental Health NHS Foundation Trust in accordance with paragraphs 24 g and kind • we and7 within respect • we work & 25 value of Schedule the National Health Service Act 2006. lcoming and friendly • we are caring and kind we go the extra mile • we are welcoming lue and respect • we work together • we go Signed: ndly • we are caring and kind • we value and B e v welcoming H u m p h r e y , C hand i e f E xfriendly e c u t i v e • we Dated: 22nd May 2015 a mile • we are we work together • we go the extra mile • g and kind • we value and respect • we work lcoming and friendly • we are caring and kind we go the extra mile • we are welcoming lue and respect • we work together • we go ndly • we are caring and kind • we value and a mile • we are welcoming and friendly • we we work together • we go the extra mile • g and kind • we value and respect • we work lcoming and friendly • we are caring and kind e go the extra mile • we are welcoming and and respect • we work together • we go the we are caring and kind • we value and respect e • we are welcoming and friendly • we are ork together • we go the extra mile • we are d • we value and respect • we work together • d friendly • we are caring and kind • we value Page 92 Greater Manchester West Mental Health NHS Foundation Trust extra mile • we are welcoming and friendly
Statement of Comprehensive Income extra mile • we are welcoming2014/15 and friendly • we are caring a 2013/14
£000 £000 • we work together •Note we go the extra mile • we are we
Operating income from patient care activities Other operating income caring
3
153,131
146,043
and kind • we value and respect • we11,544 work together • w 4 13,407
Total operating income from continuing 166,538 157,587 welcoming and friendly • we are caring and kind • we value an operations Operating expenses
(156,452) (149,178) we go the extra mile5,•7 we are welcoming and friendly • we
Operating surplus/(deficit) from continuing operations and respect • we
8,409 work together10,086 • we go the extra mile • w
Finance income
we are caring and kind10• we value192 and respect • we work tog 164
Finance expenses
11 friendly (180) (145) and kind • w • we are welcoming and • we are caring
PDC dividends payable Net finance costs
(2,059)
(1,838)
together • we go the extra mile • we are(1,819) welcoming and fr (2,047)
• we value and respect • we work together • we go the ex
Share of profit of associates/joint arrangements
-
-
and friendly • we are caring and kind and respec Gains/ (losses) arising from transfers by absorption 34 - • we value Corporation tax expense the
- and friendly extra mile • we are welcoming • we are c
Surplus/(deficit) for the year from continuing operations respect • we work
6,590 together • we8,039 go the extra mile • we ar
Surplus/(deficit) on discontinued operations and the are caring and kind gain/(loss) on disposal of discontinued operations Surplus/(deficit) for the year we are
- work toget • we value and -respect • we
6,590 and kind • w welcoming and friendly •8,039 we are caring
together Other comprehensive income
• we go the extra mile • we are welcoming and fr
Will not be reclassified to income and • we value and expenditure:
respect • we work together • we go the extra
Gains/(loss) arising from transfer by absorption from caring friendly • we are demising bodies
and kind • -we value327 and respect • w
Impairments
extra mile • we are welcoming and- friendly • we are caring a 6 -
Revaluations
• we work together • 17 we go the extra mile- • we are we
Other reserve movements
caring and kind • we Total comprehensive income/(expense) for the period
(6)
(16)
value and respect • we6,901 work together • w 8,033
welcoming and friendly • we are caring and kind • we value an
we go the extra mile • we are welcoming and friendly • we
and respect • we work together • we go the extra mile • w
we are caring and kind • we value and respect • we work tog
• we are welcoming and friendly • we are caring and kind • w
together • we go the extra mile • we are welcoming and fr Annual Report 2014/15
• we value and respect • we work together •Page we 93 go the extra
Statement of Financial Position Note
31 March 2015
31 March 2014
£000
£000
Non-current assets Intangible assets
14
231
-
Property, plant and equipment
15
110,320
101,423
Trade and other receivables
23
10
706
110,561
102,129
Total non-current assets Current assets Inventories
20
-
-
Trade and other receivables
23
8,177
4,126
Cash and cash equivalents
25
Total current assets
49,844
56,436
58,021
60,562
Current liabilities Trade and other payables
26
(24,034)
(19,945)
Other liabilities
27
(19,855)
(11,924)
Provisions
28
(2,723)
(3,076)
Total current liabilities
(46,612)
(34,945)
Total assets less current liabilities
121,970
127,746
Non-current liabilities Trade and other payables
26
-
-
Other liabilities
27
(2,490)
(16,567)
Provisions
28
(3,100)
(3,090)
(5,590)
(19,657)
116,380
108,089
92,561
92,303
4,783
4,831
470
485
18,566
10,470
116,380
108,089
Total non-current liabilities Total assets employed Financed by Public dividend capital Revaluation reserve Other reserves Income and expenditure reserve Total taxpayers’ equity The notes 1 - 37 form part of these accounts.
Signed: Bev Humphrey, Chief Executive
Page 94
Dated: 22nd May 2015
Greater Manchester West Mental Health NHS Foundation Trust
Statement of Changes in Equity for the year ended 31 March 2015 Public dividend capital
Revaluation reserve
Available for sale investment reserve
Other reserves
Merger reserve
Income and expenditure reserve
Total
£000
£000
£000
£000
£000
£000
£000
92,303
4,831
-
485
-
10,470
108,089
At start of period for new FTs
-
-
-
-
-
-
-
Surplus/(deficit) for the year
-
-
-
-
-
8,039
8,039
251
-
-
-
-
-
251
7
(48)
-
(15)
-
57
1
92,561
4,783
-
470
-
18,566
116,380
Taxpayers’ and others’ equity at 1 April 2014 - brought forward
Public dividend capital received Other reserve movements Taxpayers’ and others’ equity at 31 March 2015
Statement of Changes in Equity for the year ended 31 March 2014 Public dividend capital
Revaluation reserve
Available for sale investment reserve
Other reserves
Merger reserve
Income and expenditure reserve
Total
£000
£000
£000
£000
£000
£000
£000
92,303
4,978
-
500
-
3,407
101,188
-
-
-
-
-
-
-
92,303
4,978
-
500
-
3,407
101,188
At start of period for new FTs
-
-
-
-
-
-
-
Surplus/(deficit) for the year
-
-
-
-
-
6,590
6,590
Transfers by absorption: gains/ (losses) on 1 April transfers
-
-
-
-
-
327
327
Transfers by absorption: transfers between reserves
-
-
-
-
-
-
-
Transfer from revaluation reserve to income and expenditure reserve for impairments arising from consumption of economic benefits
-
(99)
-
-
-
99
-
Other movements in public dividend capital in year
-
-
-
-
-
-
-
Other reserve movements
-
(48)
-
(15)
-
47
(16)
92,303
4,831
-
485
-
10,470
108,089
Taxpayers’ and others’ equity at 1 April 2013 - brought forward Prior period adjustment Taxpayers’ and others’ equity at 1 April 2013 - restated
Taxpayers’ and others’ equity at 31 March 2014
Annual Report 2014/15
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Information on reserves 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 predecessor NHS trust. Additional PDC may also be issued to NHS foundation trusts by the Department of Health. A charge, reflecting the cost of capital utilised by the NHS foundation trust, is payable to the Department of Health as the public dividend capital dividend.
Revaluation reserve Increases in asset values arising from revaluations are recognised in the revaluation reserve, except where, and to the extent that, they reverse impairments previously recognised in operating expenses, in which case they are recognised in operating income. Subsequent downward movements in asset valuations are charged to the revaluation reserve to the extent that a previous gain was recognised unless the downward movement represents a clear consumption of economic benefit or a reduction in service potential.
Other reserve The balance of this reserve is from the transfer of property to the Trust in 2000-2001.
Income and expenditure reserve The balance of this reserve is the accumulated surpluses and deficits of the NHS foundation trust.
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Greater Manchester West Mental Health NHS Foundation Trust
Statement of Cash Flows Note
2014/15
2013/14
ÂŁ000
ÂŁ000
10,086
8,409
Cash flows from operating activities Operating surplus/(deficit) Non-cash income and expense: Depreciation and amortisation
5
3,226
2,713
Impairments and reversals of impairments
6
885
1,826
(Gain)/loss on disposal of non-current assets
4
(1)
-
(3,431)
(496)
(Increase)/decrease in receivables and other assets (Increase)/decrease in inventories
-
-
(3,916)
4,149
(523)
(1,178)
Tax (paid)/received
-
-
Operating cash flows movement of discontinued operations
-
-
Other movements in operating cash flows
1
(23)
6,327
15,400
189
164
Increase/(decrease) in payables and other liabilities Increase/(decrease) in provisions
Net cash generated from/(used in) operating activities Cash flows from investing activities Interest received Purchase and sale of financial assets
-
-
(148)
-
-
-
(11,278)
(9,172)
14
-
PFI lifecycle prepayments
-
-
Investing cash flows of discontinued operations
-
-
(11,223)
(9,008)
251
7
Purchase of intangible assets Sales of intangible assets Purchase of property, plant, equipment and investment property Sales of property, plant, equipment and investment property
Net cash generated from/(used in) investing activities Cash flows from financing activities Public dividend capital received Other interest paid
-
-
PDC dividend paid
(1,947)
(1,824)
Financing cash flows of discontinued operations
-
-
Cash flows from (used in) other financing activities
-
-
Net cash generated from/(used in) financing activities
(1,696)
(1,817)
Increase/(decrease) in cash and cash equivalents
(6,592)
4,575
Cash and cash equivalents at 1 April
56,436
51,861
-
-
Cash and cash equivalents at start of period for new FTs Cash and cash equivalents transferred under absorption accounting
34
-
-
Cash and cash equivalents at 31 March
25
49,844
56,436
Annual Report 2014/15
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Notes to the Accounts Note 1: Accounting policies and other information 1.1 Basis of preparation Monitor has directed the financial statements of NHS foundation trusts shall meet the accounting requirements of the FT ARM which shall be agreed with HM Treasury. Consequently, the following financial statements have been prepared in accordance with the FT ARM 2014/15 issued by Monitor. The accounting policies contained in that manual follow IFRS and HM Treasury’s FReM to the extent 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.
1.1.1 Accounting convention These accounts have been prepared under the historical cost convention modified to account for the revaluation of property, plant and equipment, intangible assets, inventories and certain financial assets and financial liabilities.
1.1.2 Going concern These accounts have been prepared on a going concern basis. International Accounting Standard (IAS) 1, requires management to assess, as part of the accounts preparation process, the NHS Foundation Trust’s ability to continue as a going concern. At the Board meeting held on 30th March 2015, the Board ratified the Trust’s ability to continue on a going concern basis. As a consequence the financial statements have been prepared on a going concern basis.
1.1.3 Consolidation 1.1.3.1 Subsidiaries, Associates and Joint Ventures In considering IAS 27 (revised) the Trust is not required to produce consolidated accounts as it has no Subsidiaries (IFRS 10) , Associates (IAS 28), and Joint Venture Arrangements (IFRS 11). 1.1.3.2 Charitable Funds From 2013-14, under the provisions of IAS 27 Consolidated and Separate Financial Statements, those Charitable Funds that fall under common control with NHS bodies should be considered for consolidation within the entities’ Returns. The Trust Board reviewed the charitable funds in March 2014 and again in 2015 and determined them not to be material and therefore not to be accounted for as a subsidiary. (reference IAS 8 ‘Accounting requirements need not be applied to immaterial items).
Note 1.2 Income Income in respect of services provided is recognised when, and to the extent that, performance occurs and is measured at the fair value of the consideration receivable. The main source of income for the trust is contracts with commissioners in respect of health care services. Page 98
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Where income is received for a specific activity which is to be delivered in a subsequent financial year, that income is deferred. Income from the sale of non-current assets is recognised only when all material conditions of sale have been met, and is measured as the sums due under the sale contract.
Note 1.3 Expenditure on employee benefits 1.3.1 Short-term employee benefits Salaries, wages and employment-related payments are recognised in the period in which the service is received from employees. The cost of annual leave entitlement earned but not taken by employees at the end of the period is recognised in the financial statements to the extent that employees are permitted to carry-forward leave into the following period.
1.3.2 Pension costs 1.3.2.1 NHS Pension Scheme Past and present employees are covered by the provisions of the NHS Pension Scheme. The scheme is an unfunded, defined benefit scheme that covers NHS employers, general practices and other bodies, allowed under the direction of Secretary of State, in England and Wales. It is not possible for the NHS foundation trust to identify its share of the underlying scheme liabilities. Therefore, the scheme is accounted for as a defined contribution scheme. Employers pension cost contributions are charged to operating expenses as and when they become due. Additional pension liabilities arising from early retirements are not funded by the scheme except where the retirement is due to ill-health. The full amount of the liability for the additional costs is charged to the operating expenses at the time the trust commits itself to the retirement, regardless of the method of payment.. 1.3.2.2 National Employment Savings Pension Scheme (NEST) Under the Pensions Act 2008 employers must offer a pension scheme to all its employees. As from the 1st July 2013, when the scheme came into operation in the Trust (its staging date), staff who are not eligible to join the NHS Pensions Scheme are automatically enrolled into NEST. This scheme is a defined contribution pension scheme created as part of the government’s workplace pensions reforms. Accounting for defined contribution plans requires the Trust to report on the amounts contributed for that period. Consequently, no actuarial assumptions are required to measure the obligation for the expense and there is no possibility of any actuarial gain or loss. The Trust settles its obligations within the annual reporting period in which the employees render the related service. Please refer to Note 7.3.7 for further details of the pension scheme.
Note 1.4 Expenditure on other goods and services Expenditure on goods and services is recognised when, and to the extent that they have been received, and is measured at the fair value of those goods and services. Expenditure is recognised in operating expenses except where it results in the creation of a noncurrent asset such as property, plant and equipment.
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Note 1.5 Property, plant and equipment 1.5.1 Recognition
Property, Plant and Equipment is capitalised where: • it is held for use in delivering services or for administrative purposes; • it is probable that future economic benefits will flow to, or service potential be provided to, the Trust; • it is expected to be used for more than one financial year; and • the cost of the item can be measured reliably • items form part of the initial equipping and setting-up cost of a new building, ward or unit, irrespective of their individual or collective cost Where a large asset, for example a building, includes a number of components with significantly different asset lives e.g. plant and equipment, then these components are treated as separate assets and depreciated over their own useful economic lives. (see Note 15.1).
1.5.2 Measurement 1.5.2.1 Valuation All property, plant and equipment assets are measured initially at cost, representing the costs directly attributable to acquiring or constructing the asset and bringing it to the location and condition necessary for it to be capable of operating in the manner intended by management. All assets are measured subsequently at fair value. Land and buildings are stated in the statement of financial position at their revalued amounts as at 31st March 2013. Revaluations are performed with sufficient regularity to ensure that carrying amounts are not materially different from those that would be determined at the end of the reporting period. Fair values are determined as follows: (i) Land and non-specialised buildings – market value for existing use (ii) Specialised buildings – depreciated replacement cost using a Modern Equivalent Asset Valuation IAS16 (34) requires that the accounts reflect changes in asset values. Where insignificant, revaluation may be necessary only every 3 or 5 years. In Monitor’s view property assets are likely to require a full revaluation at least every 5 years, with which the Trust complies. Monitor’s Financial Reporting Manual states (5.5 2014/15 FReM) : ‘There is no predetermined frequency with which assets must be re-valued. Instead, the standard requires that asset values should be kept up to date and that the frequency of revaluation will need to reflect the volatility of asset values. Where assets are subject to significant volatility, then annual revaluations may be required. Conversely, where changes in asset values are insignificant then a revaluation may be necessary only every 3 or 5 years. In Monitor’s view, property assets are likely to require revaluation at least every 5 years.’ The Trust has complied with these recommendation and its latest desk top review was carried out in 2013/14. The Trust’s most recent full revaluation took place on 31st March 2013. Properties in the course of construction are carried at cost. Cost includes professional fees but not borrowing costs, which are recognised as expenses immediately, as allowed by IAS 23 for assets held at fair value. Page 100
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For newly acquired or newly constructed assets, a formal revaluation will only be carried out if there is an indication that the initial cost is significantly different to its fair value. Depreciation commences when assets are brought into use, starting from the first complete accounting quarter. The carrying amount for fixtures and equipment is depreciated at historic cost as this is not considered to be materially different from fair value. An increase arising on revaluation is taken to the revaluation reserve except when it reverses an impairment for the same asset previously recognised in expenditure in which case it is credited to the SOCI. A revaluation decrease that does not result from a loss of economic value or services potential is recognised as an impairment charge to the revaluation reserve to the extent there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a clear consumption of economic benefit have been taken to the SOCI. Gains and losses recognised in the revaluation reserve are reported as other comprehensive income in the SOCI. 1.5.2.2 Subsequent expenditure Subsequent expenditure relating to an item of property, plant and equipment is recognised as an increase in the carrying amount of the asset when it is probable that additional future economic benefits or service potential deriving from the cost incurred to replace a component of such item will flow to the enterprise and the cost of the item can be determined reliably. Where a component of an asset is replaced, the cost of the replacement is capitalised if it meets the criteria for recognition above. The carrying amount of the part replaced is de-recognised. Other expenditure that does not generate additional future economic benefits or service potential, such as repairs and maintenance, is charged to the Statement of Comprehensive Income in the period in which it is incurred. 1.5.2.3 Depreciation Items of property, plant and equipment are depreciated over their remaining useful economic lives in a manner consistent with the consumption of economic or service delivery benefits. Freehold land is considered to have an infinite life and is not depreciated. Property, plant and equipment which has been reclassified as ‘held for sale’ ceases to be depreciated upon the reclassification. Assets in the course of construction and residual interests in off-Statement of Financial Position PFI contract assets are not depreciated until the asset is brought into use or reverts to the trust, respectively.
1.5.3. Revaluation gains and losses Revaluation gains are recognised in the revaluation reserve, except where, and to the extent that, they reverse a revaluation decrease that has previously been recognised in operating expenses, in which case they are recognised in operating income. For newly acquired or newly constructed assets, a desk top revaluation is undertaken to determine the fair value of the asset. A formal revaluation will only be carried out if there is an indication that the initial cost is significantly different to its fair value. Revaluation losses are charged to the revaluation reserve to the extent that there is an available balance for the asset concerned, and thereafter are charged to operating expenses. Gains and losses recognised in the revaluation reserve are reported in the Statement of Comprehensive Income as an item of ‘other comprehensive income’.
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1.5.4 Impairments In accordance with the FT ARM, impairments that are due to loss of economic benefits or service potential in the asset are charged to operating expenses. A compensating transfer is made from the revaluation reserve to the income and expenditure reserve of an amount equal to the lower of (i) the impairment charged to operating expenses; and (ii) the balance in the revaluation reserve attributable to that asset before the impairment. An impairment arising from the loss of economic benefit or service potential is reversed when, and to the extent that, the circumstances that gave rise to the loss is reversed. Reversals are recognised in operating income to the extent that the asset is restored to the carrying amount it would have had if the impairment had never been recognised. Any remaining reversal is recognised in the revaluation reserve. Where, at the time of the original impairment, a transfer was made from the revaluation reserve to the income and expenditure reserve, an amount is transferred back to the revaluation reserve when the impairment reversal is recognised. Other impairments are treated as revaluation losses. Reversals of ‘other impairments’ are treated as revaluation gains. Impairments identified by the District Valuer, as a result of the March 2015 review, have been recognised in the accounts.
1.5.5 De-recognition Assets intended for disposal are reclassified as ‘held for sale’ once all of the following criteria are met: • the asset is available for immediate sale in its present condition subject only to terms which are usual and customary for such sales; • the sale must be highly probable i.e.: o management are committed to a plan to sell the asset; o an active programme has begun to find a buyer and complete the sale; o the asset is being actively marketed at a reasonable price; o the sale is expected to be completed within 12 months of the date of classification as ‘held for sale’; and o the actions needed to complete the plan indicate it is unlikely that the plan will be dropped or significant changes made to it. Following reclassification, the assets are measured at the lower of their existing carrying amount and their ‘fair value less costs to sell’. Depreciation ceases to be charged. Assets are de-recognised when all material sale contract conditions have been met. Property, plant and equipment which is to be scrapped or demolished does not qualify for recognition as ‘held for sale’ and instead is retained as an operational asset and the asset’s economic life is adjusted. The asset is de-recognised when scrapping or demolition occurs.
1.5.6 Donated, government grant and other grant funded assets Donated and grant funded property, plant and equipment assets are capitalised at their fair value on receipt. The donation/grant is credited to income at the same time, unless the donor has imposed a condition that the future economic benefits embodied in the grant are to be consumed in a manner specified by the donor, in which case, the donation/grant is deferred within liabilities and is carried forward to future financial years to the extent that the condition has not yet been met.
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The donated and grant funded assets are subsequently accounted for in the same manner as other items of property, plant and equipment.
Note 1.6 Intangible assets Recognition Intangible assets are non-monetary assets without physical substance which are capable of being sold separately from the rest of the trust’s business or which arise from contractual or other legal rights. They are recognised only where it is probable that future economic benefits will flow to, or service potential be provided to, the trust and where the cost of the asset can be measured reliably. Internally generated intangible assets Internally generated goodwill, brands, mastheads, publishing titles, customer lists and similar items are not capitalised as intangible assets. Expenditure on research is not capitalised. Expenditure on development is capitalised only where all of the following can be demonstrated: • the project is technically feasible to the point of completion and will result in an intangible asset for sale or use; • the trust intends to complete the asset and sell or use it; • the trust has the ability to sell or use the asset; • how the intangible asset will generate probable future economic or service delivery benefits, eg, the presence of a market for it or its output, or where it is to be used for internal use, the usefulness of the asset; • adequate financial, technical and other resources are available to the trust to complete the development and sell or use the asset; and • the trust can measure reliably the expenses attributable to the asset during development. Software Software which is integral to the operation of hardware, eg an operating system, is capitalised as part of the relevant item of property, plant and equipment. Software which is not integral to the operation of hardware, eg application software, is capitalised as an intangible asset. Measurement Intangible assets are recognised initially at cost, comprising all directly attributable costs needed to create, produce and prepare the asset to the point that it is capable of operating in the manner intended by management. Subsequently intangible assets are measured at fair value. Revaluations gains and losses and impairments are treated in the same manner as for property, plant and equipment Intangible assets held for sale are measured at the lower of their carrying amount or “fair value less costs to sell”. Amortisation Intangible assets are amortised over their expected useful economic lives in a manner consistent with the consumption of economic or service delivery benefits.
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Useful economic life of intangible assets Useful economic lives reflect the total life of an asset and not the remaining life of an asset. The range of useful economic lives are shown in the table below: Min life Years 2
Intangible assets – purchased Software
Max life Years 5
Note 1.7 Revenue government and other grants Government grants are grants from Government bodies other than income from commissioners or NHS trusts for the provision of services. Where a grant is used to fund revenue expenditure it is taken to the Statement of Comprehensive Income to match that expenditure. The Trust has not received any such grants in 2014/15.
Note 1.8 Inventories The value of stocks and works in progress are deemed to be immaterial to the accounts when consideration is given to the costs of collation and verification, this is in line with Financial Reporting Standard 18 (Page 3 {c}) and IAS 1 Presentation of Financial Statements which states that specific disclosure requirements set out in individual standards or interpretations need not be satisfied if the information is not material. The Standard also states (at paragraph 44) ‘the benefits derived from information should exceed the cost of providing it’.
Note 1.9 Financial instruments and financial liabilities 1.9.1 Recognition Financial assets and financial liabilities which arise from contracts for the purchase or sale of non-financial items (such as goods or services), which are entered into in accordance with the trust’s normal purchase, sale or usage requirements, are recognised when, and to the extent which, performance occurs, i.e., when receipt or delivery of the goods or services is made. All other financial assets and financial liabilities are recognised when the trust becomes a party to the contractual provisions of the instrument.
1.9.2 De-recognition All financial assets are de-recognised when the rights to receive cash flows from the assets have expired or the trust has transferred substantially all of the risks and rewards of ownership. Financial liabilities are de-recognised when the obligation is discharged, cancelled or expires.
1.9.3 Classification and measurement Financial assets are categorised as loans and receivables Financial liabilities are classified as” ‘other financial liabilities”.
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1.9.4 Loans and receivables Loans and receivables are non-derivative financial assets with fixed or determinable payments which are not quoted in an active market. They are included in current assets. The trust’s loans and receivables comprise: cash and cash equivalents, NHS receivables, accrued income and “other receivables”. 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 Statement of Comprehensive Income.
1.9.5 Available-for-sale financial assets The Trust does not hold any 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 Statement of Financial Position date.
1.9.6 Other financial liabilities All other financial liabilities are recognised initially at fair value, net of transaction costs incurred, and measured subsequently at amortised cost using the effective interest method. The effective interest rate is the rate that discounts exactly estimated future cash payments through the expected life of the financial liability or, when appropriate, a shorter period, to the net carrying amount of the financial liability. They are included in current liabilities except for amounts payable more than 12 months after the Statement of Financial Position date, which are classified as long-term liabilities. Interest on financial liabilities carried at amortised cost is calculated using the effective interest method and charged to finance costs. Interest on financial liabilities taken out to finance property, plant and equipment or intangible assets is not capitalised as part of the cost of those assets.
1.9.7 Determination of fair value For financial assets and financial liabilities carried at fair value, the carrying amounts are determined from quoted market prices, independent appraisals and discounted cash flow analysis as appropriate to the financial asset or liability. The provision for Injury Benefit liability cash flows are discounted remain at the Treasury’s discount rate of 1.3% 2014/15 (2013/14 1.8%).
1.9.8 Impairment of financial assets At the Statement of Financial Position date, the Trust assesses whether any financial assets are impaired. Financial assets are impaired and impairment losses are recognised if, and only if, there is objective evidence of impairment as a result of one or more events which occurred after the initial recognition of the asset and which has an impact on the estimated future cash flows 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 SOCI and in the case of trade receivables, the carrying amount of Annual Report 2014/15
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the asset is reduced through the use of an allowance for irrecoverable amounts, and for other financial assets the carrying amount is reduced directly.
Note 1.10 Leases 1.10.1 Finance leases The Trust has no Finance leases as at the 31 March 2015..
1.10.2 Operating leases Other leases are regarded as operating leases and the rentals are charged to operating expenses on a straight-line basis over the term of the lease. Operating lease incentives received are added to the lease rentals and charged to operating expenses over the life of the lease.
1.10.3 Leases of land and buildings Where a lease is for land and buildings, the land component is separated from the building component and the classification for each is assessed separately.
Note 1.11 Provisions The Trust recognises a provision where it has a present legal or constructive obligation of uncertain timing or amount; for which it is probable that there will be a future outflow of cash or other resources; and a reliable estimate can be made of the amount. The amount recognised in the Statement of Financial Position is the best estimate of the resources required to settle the obligation. Where the effect of the time value of money is significant, the estimated risk-adjusted cash flows are discounted using the discount rates published and mandated by HM Treasury. For employee early departure obligations the Trust has used the HM Treasury’s pension discount rate of 1.3% 2014/15 (2013/14 1.8%) in real terms. A restructuring provision is recognised when the Trust has developed a detailed formal plan for the restructuring and has raised a valid expectation in those affected that it will carry out the restructuring by starting to implement the plan or announcing its main features to those affected by it. The measurement of a restructuring provision includes only the direct expenditures arising from the restructuring, which are those amounts that are both necessarily entailed by the restructuring and not associated with ongoing activities of the entity.
1.11.1 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 29 but is not recognised in the Trust’s accounts.
1.11.2 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. Page 106
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Note 1.12 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 29 where an inflow of economic benefits is probable. Contingent liabilities are not recognised, but are disclosed in note 29, 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.
Note 1.13 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 predecessor NHS trust. HM Treasury has determined that PDC is not a financial instrument within the meaning of IAS 32. A charge, reflecting the cost of capital utilised by the NHS foundation trust, is payable as public dividend capital dividend. The charge is calculated at the rate set by HM Treasury (currently 3.5%) on the average relevant net assets of the NHS foundation trust during the financial year. Relevant net assets are calculated as the value of all assets less the value of all liabilities, except for (i) donated assets (including lottery funded assets), (ii) average daily cash balances held with the Government Banking Services (GBS) and National Loans Fund (NLF) deposits, excluding cash balances held in GBS accounts that relate to a shortterm working capital facility, and (iii) any PDC dividend balance receivable or payable. In accordance with the requirements laid down by the Department of Health (as the issuer of PDC), the dividend for the year is calculated on the actual average relevant net assets as set out in the “pre-audit” version of the annual accounts. The dividend thus calculated is not revised should any adjustment to net assets occur as a result the audit of the annual accounts.
Note 1.14 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.
Note 1.15 Corporation tax For 2014/15 there is to be no application of Corporation Tax liability. 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 withdraw the exemption in relation to the specified activities Annual Report 2014/15
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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 pa, of which the Trust has none.
Note 1.16 Foreign exchange The Trust has only minimal foreign exchange transactions. Transactions that are denominated in a foreign currency are translated into sterling at the exchange rate ruling on the date of the transaction. Resulting exchange gains and losses are taken to the Income and Expenditure account. All sales of healthcare services are denominated in sterling
Note 1.17 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 disclosed in a separate note to the accounts in accordance with the requirements of HM Treasury’s FReM.
Note 1.18 Losses and special payments Losses and special payments are items that Parliament would not have contemplated when it agreed funds for the health service or passed legislation. By their nature they are items that ideally should not arise. They are therefore subject to special control procedures compared with the generality of payments. They are divided into different categories, which govern the way that individual cases are handled. Losses and special payments are charged to the relevant functional headings in expenditure on an accruals basis, including losses which would have been made good through insurance cover had NHS foundation trusts not been bearing their own risks (with insurance premiums then being included as normal revenue expenditure). However the losses and special payments note is compiled directly from the losses and compensations register which reports on an accrual basis with the exception of provisions for future losses. Losses and special payments are disclosed in Note 33.
Note 1.19 Transfers of functions to / from other NHS bodies / local government bodies The Trust had no transfers of function from other NHS Bodies in 2014/15. Property was transferred to the Trust on 1 April 2013. The Cost and Accumulated Depreciation/ Amortisation balances from the transferring entity’s accounts were preserved on recognition in the Trust’s accounts.
Note 1.20 Early adoption of standards, amendments and interpretations No new accounting standards or revisions to existing standards have been early adopted in 2014/15. Page 108
Greater Manchester West Mental Health NHS Foundation Trust
Note 1.21 Standards, amendments and interpretations in issue but not yet effective or adopted The Treasury FReM does not require the following Standards and Interpretations to be applied in 2014-15. The application of the Standards as revised would not have a material impact on the accounts for 2014-15, were they applied in that year: IFRS 9 - Financial Instruments IFRS 9 - Financial Instruments - Subject to IFRS 13 - Fair Value - Effective from 1 April 2015 consultation. IFRS 15 - Revenue for Contract with Customers - Effective from 1 January 2017 IAS 19 (amendment) - Employer contributions to defined benefit pension schemes Effective from 2015-16 but not yet EU adopted IAS 36 (amendment) - Recoverable Amount Disclosures - To be adopted from 2015-16 (aligned to IFRS 13 adoption)
IFRIC 21 - Levies - EU adopted in June 2014 but not yet adopted by HM Treasury Note 1.22 Critical accounting estimates and judgements In the application of the Trust’s accounting policies, management is required to make judgements, estimates and assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources. The Trust confirms that it has not used any key assumptions concerning the future or had any key sources of estimation uncertainty at the end of the reporting period, that have a significant risk of causing a material adjustment to the carrying amounts of assets and liabilities within the next financial year that need to be disclosed under IAS 1. The provisions have been calculated having recognised an obligating event during the year and include estimates and assumptions relating to the carrying amounts and timing of anticipated payments. Other less significant areas of judgement and estimation techniques (e.g. depreciation and deferred income) have been disclosed in the Trust’s accounting policies and in the notes to the financial statements, as required by the relevant IFRS.
Note 1.23 Current Asset Investments Current Asset investments are short-term deposits which are readily convertible into known amounts of cash at or close to their carrying amounts. They are treated as liquid resources in the cashflow statement.
Note 1.24 Cash and Cash Equivalents Cash is cash in hand, and deposit with any financial institution repayable without penalty on notice of not more than 24 hours. Cash equivalents are investments that mature in 3 months or less from the date of acquisition and are readily convertible to known amounts of cash with insignificant of change in value. Cash, bank and overdrafts are recorded at the current values of these balances in the Trust’s cash book. Annual Report 2014/15
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These balances exclude monies held in the Trust bank account belonging to third parties (see third party assets 25.1). Account balances are only set-off where a formal agreement has been made with the bank to do so. Interest earned on bank accounts is recorded as “interest receivable” in the period to which it relates. Bank charges are recorded as operating expenditure in the period to which they relate.
Note 1.25 Research and development Expenditure on research and development is not capitalised.
Note 1.26 Acquisitions and discontinued operations The Trust has no acquisitions or discontinued operations to report on. Activities are considered to be ‘acquired’ only if they are taken from outside the public sector. Activities are considered to be ‘discontinued’ only if they cease entirely. They are not considered to be ‘discontinued’ if they transfer from one public sector body to another.
Note 2: Operating Segments All of GMW’s activities are in the provision of healthcare, which is an aggregate of all the individual specialty components included therein. Similarly, the large majority of the Foundation Trust’s income originates with the UK Whole of Government Accounting (WGA) bodies. The majority of expenses incurred are payroll expenditure on staff involved in the production or support of healthcare activities generally across the Trust together with the related supplies and overheads needed to establish this production. The business activities which earn revenue and incur expenses are therefore of one broad combined nature and therefore on this basis one segment of Healthcare is deemed appropriate. The operating results of the Foundation Trust are reviewed monthly or more frequently by the Trust’s chief operating decision maker which is the overall Foundation Trust Board and which includes senior professional non-executive directors. The Trust Board review the financial position of the Foundation Trust as a whole in their decision making process, rather than individual components included in the totals, in terms of allocating resources. This process again implies a single operating segment under IFRS 8. The finance report considered monthly by the Trust Board contains summary figures for the whole Trust together with graphical line and bar charts relating to different total income activity levels, and directorate expense budgets with their cost improvement positions. Similarly only total balance sheet positions and cash flow forecasts are considered for the whole Foundation Trust. The Board as chief operating decision maker therefore only considers one segment of healthcare in its decision making process. The single segment of ‘Healthcare’ has therefore been identified consistent with the core principle of IFRS8 which is to enable users of the financial statements to evaluate the nature and financial effects of business activities and economic environments.”
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Greater Manchester West Mental Health NHS Foundation Trust
Note 3: Operating Income Note 3.1 Income from patient care activities (by nature) 2014/15
2013/14
£000
£000
4,268
3,192
111,502
103,275
2,282
3,984
33,221
32,195
1,858
3,397
153,131
146,043
Mental health services Cost and volume contract income Block contract income Clinical income for the secondary commissioning of mandatory services Other clinical income from mandatory services Other clinical income* Total income from activities
* Other clinical income for 2014/15 relates to funding received from our Lead Commissioners for service developments outside the contract. 2013/14 has been restated from £3,038k to £3,397K as income previously classed as non clinical has been reclassified as clinical income.
Note 3.2 Income from patient care activities (by source) Income from patient care activities received from:
2014/15
2013/14
£000
£000
128,619
123,556
21,575
20,020
NHS other
1,430
978
Non NHS: other
1,507
1,489
153,131
146,043
153,131
146,043
-
-
CCGs and NHS England Local authorities
Total income from activities Of which: Related to continuing operations Related to discontinued operations
Total income from activities includes income of £153,131 2014/15 (2013/14 £146,043 ) from Commissioner Requested Services
Note 3.3 Overseas visitors (relating to patients charged directly by the NHS foundation trust) The only overseas activities are in respect of reciprocal EU treatments generating no income.
Annual Report 2014/15
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Note 4: Other operating income 2014/15
2013/14
£000
£000
Research and development
2,922
2,447
Education and training
4,240
5,490
1
-
Profit on disposal of non-current assets Reversal of impairments Rental revenue from operating leases Income in respect of staff costs where accounted on gross basis Other income* Total other operating income
-
19
323
311
-
211
5,921
3,066
13,407
11,544
13,407
11,544
-
-
Of which: Related to continuing operations Related to discontinued operations
*Other Operating Income for 2013/14 has been restated from £3,425k to £3,066k as income from the provision of clinical services at Recovery First were incorrectly classified as non clinical income in 2013/14.
Other Operating Income
2014/15
2013/14
£000
£000
202
165
60
62
Catering
153
153
Property Rentals
618
317
Council grant
0
239
VAT reclaims
155
438
Release of deferred income *
3,518
988
Other **
1,215
704
5,921
3,066
Car parking Clinical excellence awards
* Relates to the release of deferred income to match expenditure spent on Low and Medium Secure wards and the Recovery Academy. ** Relates to increase in ECT income, Interpreter fees and Court report income.
Note 4.1 Income from activities arising from commissioner requested services Under the terms of its Provider License, the trust is required to analyse the level of income from activities that has arisen from commissioner requested and non-commissioner requested services. Commissioner requested services are defined in the provider license and are services that commissioners believe would need to be protected in the event of provider failure. This information is provided in the table below: 2014/15 Income from services designated (or grandfathered) as commissioner requested services Income from services not designated as commissioner requested services Total
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2013/14
£000
£000
153,131
146,043
13,407
11,544
166,538
157,587
Greater Manchester West Mental Health NHS Foundation Trust
Note 4.2 Profits and losses on disposal of property, plant and equipment There were no disposals of land and buildings during the year.
Note 5: Operating expenses Note 5.1 Operating expenses
Services from NHS foundation trusts Services from NHS trusts Purchase of healthcare from non NHS bodies Purchase of social care Employee expenses - executive directors Employee expenses - non-executive directors
2014/15
2013/14
ÂŁ000
ÂŁ000
1,043
460
-
83
4,684
4,883
528
578
1,037
1,023
133
136
114,542
109,119
Supplies and services - clinical
3,098
2,975
Supplies and services - general
2,871
3,043
Establishment
2,125
1,708
Research and development
2,855
1,451
Transport
1,521
1,670
Premises
9,400
9,454
486
(189)
81
358
2,453
2,481
-
-
Rentals under operating leases
1,172
967
Depreciation on property, plant and equipment
3,226
2,713
885
1,845
audit services- statutory audit
51
47
audit services- regulatory reporting (external auditor only)
14
16
9
9
Clinical negligence
357
492
Legal fees
496
559
Consultancy costs
200
168
Training, courses and conferences
957
1,382
3
3
Car parking & security
84
234
Redundancy ***
78
215
Early retirements
-
136
Hospitality
29
9
Publishing
75
88
Insurance
25
18
194
194
Employee expenses - staff
Increase/(decrease) in provision for impairment of receivables* Change in provisions discount rate(s) Drug costs Inventories consumed
Impairments Audit fees payable to the external auditor
other auditor remuneration (external auditor only)
Patient travel
Other services, e.g. external payroll
Annual Report 2014/15
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Grossing up consortium arrangements Losses, ex gratia & special payments Other ** Total
-
-
123
78
1,617
772
156,452
149,178
156,452
149,178
-
-
Of which: Related to continuing operations Related to discontinued operations * Refer to note 23.1 for analysis in the movement of the provision for doubtful debts ** Other expenses has increased in year as a result of the costs incurred for the implementation of the new Patient administration system ***The termination benefits for 2013/14 included a provision for redundancy for the implementation of the Acute Care Pathways (ACP) and other restructuring costs. The ACP redundancies have been charged against provisions in year, thus reducing the termination benefits charged against employee expenses.
Note 5.2 Other auditor remuneration 2014/15
2013/14
£000
£000
Audit-related assurance services
8
9
All taxation advisory services not falling within item 3 above
1
-
Total
9
9
Other auditor remuneration paid to the external auditor:
Note 5.3 Limitation on auditor’s liability The limitation on auditors’ liability for external audit work is £1m (2013/14: £1m).
Note 6: Impairment of assets 2014/15
2013/14
£000
£000
Abandonment of assets in course of construction
159
-
Changes in market price
726
1,826
Total net impairments charged to operating surplus / deficit
885
1,826
-
-
885
1,826
Net impairments charged to operating surplus / deficit resulting from:
Impairments charged to the revaluation reserve Total net impairments
A valuation of capital builds completed during the year was undertaken by the District Valuer in February 2015, this resulted in impairments of £726k.
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Greater Manchester West Mental Health NHS Foundation Trust
Note 7: Employee benefits 2014/15
2013/14
Permanent
Other
Total
Total
£000
£000
£000
£000
Salaries and wages
91,508
8,632
100,140
97,877
Social security costs
7,234
602
7,836
7,190
11,969
996
12,965
11,899
Pension cost - other
-
-
-
2
Other post employment benefits
-
-
-
-
Other employment benefits
-
-
-
-
78
-
78
351
-
6,904
6,904
5,543
110,789
17,134
127,923
122,862
(2,152)
(8,853)
(11,005)
(11,108)
108,637
8,281
116,918
111,754
245
-
245
224
Employer’s contributions to NHS pensions
Termination benefits* Agency/contract staff Total gross staff costs Recoveries in respect of seconded staff Total staff costs Included within: Costs capitalised as part of assets
* The termination benefits for 2013/14 included a provision for redundancy for the implementation of the Acute Care Pathways (ACP) and other restructuring costs. The ACP redundancies have been charged against provisions in year, thus reducing the termination benefits charged against employee expenses.
Note 7.1 Average number of employees (WTE basis) 2014/15
2013/14
Permanent
Other
Total
Total
Number
Number
Number
Number
138
8
146
147
-
-
-
-
Administration and estates
523
-
523
498
Healthcare assistants and other support staff
121
-
121
125
Nursing, midwifery and health visiting staff
1,274
2
1,276
1,289
Scientific, therapeutic and technical staff
352
-
352
350
Social care staff
173
6
179
166
Agency and contract staff
-
104
104
77
Bank staff
-
163
163
173
124
10
134
132
2,705
293
2,998
2,957
4
-
4
4
Medical and dental Ambulance staff
Other Total average numbers Of which: Number of employees (WTE) engaged on capital projects
Annual Report 2014/15
Page 115
Note 7.2 Retirements due to ill-health During 2014/15 there were 4 early retirements from the trust agreed on the grounds of ill-health (7 in the year ended 31 March 2014). The estimated additional pension liabilities of these ill-health retirements is £415k (£573k in 2013/14). The cost of these ill-health retirements will be borne by the NHS Business Services Authority - Pensions Division.
Note 7.3 Staff sickness absence
Total days lost Total staff years Average working days lost (per WTE)
2014/15
2013/14
Number
Number
38,633
39,111
2,646
2,631
15
15
Note 7.4 Reporting of compensation schemes - exit packages 2014/15 Number of compulsory redundancies
Number of other departures agreed
Total number of exit packages
Number
Number
Number
<£10,000
-
1
1
£10,001 - £25,000
1
4
5
£25,001 - 50,000
-
9
9
£50,001 - £100,000
1
2
3
£100,001 - £150,000
-
-
-
£150,001 - £200,000
-
1
1
>£200,000
-
-
-
Total number of exit packages by type
2
17
19
Total resource cost (£)
£71,000
£678,000
£749,000
Exit package cost band (including any special payment element)
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Greater Manchester West Mental Health NHS Foundation Trust
Note 7.5 Reporting of compensation schemes - exit packages 2013/14 Number of compulsory redundancies
Number of other departures agreed
Total number of exit packages
Number
Number
Number
<£10,000
1
1
2
£10,001 - £25,000
1
2
3
£25,001 - 50,000
1
3
4
£50,001 - £100,000
1
-
1
Total number of exit packages by type
4
6
10
£99,000
£137,000
£236,000
Exit package cost band (including any special payment element)
Total resource cost (£)
The exit packages within the scope of this disclosure have arisen as a result of Organisational restructures. The exit packages within the scope of this disclosure include, but are not limited to, those made under nationally agreed arrangements or local arrangements for which Treasury approval was required. Exit packages in respect of senior managers have been disclosed in the Director’s Remuneration Report Exit costs in this note are accounted for in full as agreed in the year, irrespective of the actual date of accrual or payment. Where the trust has agreed early retirements, the additional costs are met by the trust and not by the NHS Pensions scheme. Ill health retirement costs are met by the NHS pensions scheme and are not included in the above table (refer to note 8).
Note 7.6 Voluntary Redundancies
Voluntary redundancies including early retirement contractual costs Contractual payments in lieu of notice Total
Payments agreed
Total value of agreements
Payments agreed
Total value of agreements
Number
£000
Number
£000
17
677
6
136
2
1
2
1
19
678
8
137
Note 7.7 Directors’ remuneration The aggregate amounts payable to directors were: Salary Taxable benefits Employer’s pension contributions Total
2014/15
2013/14
£000
£000
966,254
954,163
16,835
15,212
116,235
115,133
1,099,324
1,084,508
Further details of directors’ remuneration can be found in the remuneration report. Annual Report 2014/15
Page 117
Note 7.8 Off Payroll Engagements Note 7.8.1 For all off-payroll engagements as of 31 March 2015, for more than £220 per day and lasting for longer than six months 2014/15 Number of existing engagements
4
Of which; Number that have existed for less than one year at the time of reporting
1
Number that have existed for between one and two years at the time of reporting
3
All existing off-payroll engagements, outlined above, have been subject to a risk based assessment as to whether assurance is required that the individual is paying the right amount of tax, and, where necessary, that assurance has been sought.
Note 7.8.2 For all new off-payroll engagements, or those that reached six months in duration, between 01 April 2014 and 31 March 2015, for more than £220 per day and lasting for longer than six months. 2014/15 Number of new engagements, or those that reach six months in duration between 01 April 2014 and 31 March 2015
1
Number of the above which include contractual clauses giving the Trust the right to request assurance in relation to income tax and national insurance obligations.
1
Number for whom assurance has been requested
1
Of which; Number for whom assurance has been received
1
Note7.8.3 For any off-payroll engagements, of board members, and/or senior officials with significant financial responsibility, between 01April 2014 and 31 March 2015. 2014/15 Number of individuals that have been deemed ‘board members, and/or senior officials with significant financial responsibility’. Includes off-payroll and on-payroll engagements.
0
Note 8: Pension costs Note 8.1 NHS Pension Scheme 8.1.1 Unfunded, defined benefit scheme Past and present employees are covered by the provisions of the NHS Pensions Scheme. Details of the benefits payable under these provisions can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/pensions. The scheme is an unfunded, defined benefit scheme that covers NHS employers, GP 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 defined Page 118
Greater Manchester West Mental Health NHS Foundation Trust
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. In order that the defined benefit obligations recognised in the financial statements do not differ materially from those that would be determined at the reporting date by a formal actuarial valuation, the FReM requires that “the period between formal valuations shall be four years, with approximate assessments in intervening years”.
8.1.2 Accounting valuation A valuation of the scheme liability is carried out annually by the scheme actuary as at the end of the reporting period. This utilises an actuarial assessment for the previous accounting period in conjunction with updated membership and financial data for the current reporting period, and are accepted as providing suitably robust figures for financial reporting purposes. The valuation of the scheme liability as at 31 March 2015, is based on valuation data as 31 March 2014, updated to 31 March 2015 with summary global member and accounting data. In undertaking this actuarial assessment, the methodology prescribed in IAS 19, relevant FReM interpretations, and the discount rate prescribed by HM Treasury have also been used. The latest assessment of the liabilities of the scheme is contained in the scheme actuary report, which forms part of the annual NHS Pension Scheme (England and Wales) Pension Accounts, published annually. These accounts can be viewed on the NHS Pensions website. Copies can also be obtained from The Stationery Office.
8.1.3 Full actuarial (funding) valuation The purpose of this valuation 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. The last published actuarial valuation undertaken for the NHS Pension Scheme was completed for the year ending 31 March 2012. The Scheme Regulations allow contribution rates to be set by the Secretary of State for Health, with the consent of HM Treasury, and consideration of the advice of the Scheme Actuary and appropriate employee and employer representatives as deemed appropriate.
8.1.4 Scheme provisions The NHS Pension Scheme provided defined benefits, which are summarised below. This list is an illustrative guide only, and is not intended to detail all the benefits provided by the Scheme or the specific conditions that must be met before these benefits can be obtained: The Scheme is a “final salary” scheme. Annual pensions are normally based on 1/80th for the 1995 section and of the best of the last three years pensionable pay for each year of service, and 1/60th for the 2008 section of reckonable pay per year of membership. Members who are practitioners as defined by the Scheme Regulations have their annual pensions based upon total pensionable earnings over the relevant pensionable service. With effect from 1 April 2008 members can choose to give up some of their annual pension for an additional tax free lump sum, up to a maximum amount permitted under HMRC rules. This new provision is known as “pension commutation”. Annual increases are applied to pension payments at rates defined by the Pensions (Increase) Act 1971, and are based on changes in retail prices in the twelve months ending 30 September in the previous calendar year. From 2011-12 the Consumer Price Index (CPI) has been used and replaced the Retail Prices Index (RPI). Early payment of a pension, with enhancement, is available to members of the scheme who are permanently incapable of fulfilling their duties effectively through illness or infirmity. A death gratuity of twice final year’s pensionable pay for death in service, and Annual Report 2014/15
Page 119
five times their annual pension for death after retirement is payable. For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full amount of the liability for the additional costs is charged to the employer. Members can purchase additional service in the NHS scheme and contribute to money purchase AVCs run by the Scheme’s approved providers or by other Free Standing Additional Voluntary Contributions (FSAVC) providers.
8.2 National Employment Savings Pension Scheme (NEST). Under the Pensions Act 2008 employers must offer a pension scheme to all its employees. As from the 1st July 2013 when the scheme came into operation in the trust (its staging date), staff who are not eligible to join the NHS Pension Scheme are automatically enrolled into NEST. The scheme is a defined contribution pension scheme. Under a defined contribution plan, an entity pays fixed contributions to a separate entity (a fund) and has no obligation to pay further contributions if the fund does not hold sufficient assets to pay employee benefits. Contributions payable to a defined contribution plan are recognised as an expense as the employee provides services in exchange for the contribution. The trust contributes 1% of their pensionable pay. The total contribution by the trust for 2014/15 has been fully charged to expenses in the period. Details of the scheme can be found on the NEST Pensions website at: http://www. nestpensions.org.uk/schemeweb/NestWeb/includes/public/docs/understanding-NEST.PDF. pdf
Note 9: Operating leases 9.1 Operating leases as lessor 2014/15
2013/14
£000
£000
Minimum lease receipts
211
268
Other
112
43
Total
323
311
31 March 2015
31 March 2014
£000
£000
322
358
- later than one year and not later than five years;
1,191
1,365
- later than five years.
2,983
3,330
Total
4,496
5,053
Operating lease revenue
Future minimum lease receipts due: - not later than one year;
The Trust is a lessor in a small number of operating leases for various premises, the longest of which expires in 2033 Page 120
Greater Manchester West Mental Health NHS Foundation Trust
9.2 Operating Leases as lessee The Trust is a lessee in a number of operating leases for various premises and vehicles, the longest of which expires in 2025. The most significant of these in annual value is for the lease of Victoria Square, Bolton. The value of the payment for the period was £106,190, and the lease ends in 2018. Each lease has standard terms and conditions without the option to purchase upon the expiry of the lease. Under existing arrangements there are no operating restrictions imposed by the leases. Proposals to change the use would require consultation with the relevant landlord. 2014/15
2013/14
£000
£000
Minimum lease payments
1,172
967
Total
1,172
967
31 March 2015
31 March 2014
£000
£000
994
999
- later than one year and not later than five years;
1,940
889
- later than five years.
1,428
143
Total
4,362
2,031
-
-
Operating lease expense
Future minimum lease payments due: - not later than one year;
Future minimum sublease payments to be received
Note 10: Finance income/Expenditure Interest on bank accounts and short term deposits in 2014/15 was £192k (£164k 2013/14).
Note 11: Finance expenditure The Trust has no Finance expenditure to report.
Note 12: Corporation tax For 2014/15 there is to be no application of Corporation Tax liability. 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 Act.
Note 13: Discontinued operations The Trust has no discontinued operations Annual Report 2014/15
Page 121
Note 14: Intangible assets - 2014/15 Software licences (Purchased)
Intangible assets under construction
Total
£000
£000
£000
Valuation/gross cost at 1 April 2014 - brought forward
-
-
-
Valuation/gross cost at start of period for new FTs
-
-
-
Additions
148
83
231
Gross cost at 31 March 2015
148
83
231
0
0
0
148
83
231
-
-
-
Amortisation at 31 March 2015 Net book value at 31 March 2015 Net book value at 1 April 2014
Note 14.1 Intangible assets - 2013/14 The Trust had no intangible assets in 2013/14
14.2 ValuationSoftware licences required for the Trusts Patient Administration System have been capitalised as an intangible asset at cost. 14.3 Useful economic life of intangible assets Useful economic lives reflect the total life of an asset and not the remaining life of an asset. The range of useful economic lives are shown in the table below: Intangible assets – purchased Software
Page 122
Min life
Max life
Years
Years
2
5
Greater Manchester West Mental Health NHS Foundation Trust
Note 15: Property, plant and equipment Note 15.1 Property, plant and equipment - 2014/15 Land
Buildings excluding dwellings
Dwellings
Assets under construction
Plant & machinery
Transport equipment
Information technology
Furniture & fittings
Total
£000
£000
£000
£000
£000
£000
£000
£000
£000
Valuation/gross cost at 1 April 2014 - brought forward
15,123
120,705
-
4,333
569
651
556
1,326
143,263
Valuation/gross cost at start of period as FT
-
-
-
-
-
-
-
-
-
Additions
-
-
-
12,550
-
64
156
251
13,021
Impairments
-
-
-
(159)
-
-
-
-
(159)
Reclassifications
-
9,650
-
(9,650)
-
-
-
-
-
Disposals / derecognition
-
(614)
-
-
-
(28)
-
-
(642)
Valuation/gross cost at 31 March 2015
15,123
129,741
-
7,074
569
687
712
1,577
155,483
Accumulated depreciation at 1 April 2014 brought forward
-
39,427
-
-
418
385
556
1,054
41,840
Depreciation at start of period as FT
-
-
-
-
-
-
-
-
-
Provided during the year
-
2,932
-
-
40
75
39
140
3,226
Impairments
-
726
-
-
-
-
-
-
726
Disposals/ derecognition
-
(614)
-
-
-
(15)
-
-
(629)
Accumulated depreciation at 31 March 2015
-
42,471
-
-
458
445
595
1,194
45,163
Net book value at 31 March 2015 Owned
15,123
87,270
-
7,074
111
242
117
383
110,320
Net book value at 1 April 2014 Owned
15,123
81,278
-
4,333
151
266
-
272
101,423
Annual Report 2014/15
Page 123
Note 15.2 Property, plant and equipment - 2013/14 Land
Buildings excluding dwellings
Dwellings
Assets under construction
Plant & machinery
Transport equipment
Information technology
Furniture & fittings
Total
£000
£000
£000
£000
£000
£000
£000
£000
£000
15,123
107,352
-
9,125
616
661
565
1,017
134,459
-
-
-
-
-
-
-
-
-
15,123
107,352
-
9,125
616
661
565
1,017
134,459
Valuation/gross cost at start of period as FT
-
-
-
-
-
-
-
-
-
Transfers by absorption
-
582
-
-
-
-
-
-
582
Additions purchased/ leased/ grants/ donations
-
-
-
8,766
-
58
-
309
9,133
Reclassifications
-
13,558
-
(13,558)
-
-
-
-
-
Disposals / derecognition
-
(787)
-
-
(47)
(68)
(9)
-
(911)
15,123
120,705
-
4,333
569
651
556
1,326
143,263
Accumulated depreciation at 1 April 2013 - as previously stated
-
35,584
-
-
424
382
565
1,017
37,972
Prior period adjustments
-
-
-
-
-
-
-
-
-
Accumulated depreciation at 1 April 2013 restated
-
35,584
-
-
424
382
565
1,017
37,972
Depreciation at start of period as FT
-
-
-
-
-
-
-
-
-
Transfers by absorption
-
240
-
-
-
-
-
-
240
Provided during the year
-
2,564
-
-
41
71
-
37
2,713
Impairments
-
1,845
-
-
-
-
-
-
1,845
Reversals of impairments
-
(19)
-
-
-
-
-
-
(19)
Disposals / derecognition
-
(787)
-
-
(47)
(68)
(9)
-
(911)
Accumulated depreciation at 31 March 2014
-
39,427
-
-
418
385
556
1,054
41,840
Net book value at 31 March 2014 - Owned
15,123
81,278
-
4,333
151
266
-
272
101,423
Net book value at 1 April 2013 Owned
15,123
71,768
-
9,125
192
279
-
-
96,487
Valuation/ gross cost at 1 April 2013 as previously stated Prior period adjustments Valuation/gross cost at 1 April 2013 - restated
Valuation/ gross cost at 31 March 2014
Page 124
Greater Manchester West Mental Health NHS Foundation Trust
Note 16: Donations of property, plant and equipment The Trust has not received any donations of property, plant or equipment in 2014/15.
Note 17: Revaluations of property, plant and equipment Note 17.1 Land and Buildings - basis of valuation Land and buildings are stated in the statement of financial position at their revalued amounts as at 31st March 2013. Revaluations are performed with sufficient regularity to ensure that carrying amounts are not materially different from those that would be determined at the end of the reporting period. IAS16 (34) requires that the accounts reflect changes in asset values. Where insignificant, revaluation may be necessary only every 3 or 5 years. In Monitorâ&#x20AC;&#x2122;s view property assets are likely to require a full revaluation at least every 5 years, with which the Trust complies. Properties in the course of construction are carried at cost. Cost includes professional fees but not borrowing costs, which are recognised as expenses immediately, as allowed by IAS 23 for assets held at fair value. An asset valuation of the Trustâ&#x20AC;&#x2122;s land and buildings as at 31st March 2013 was carried out by independent professional valuers. Fair values for operational assets were determined as follows :Land and non-specialised buildings - market value for existing use (Existing Use Value). Specialised buildings â&#x20AC;&#x201C; depreciated replacement cost using a Modern Equivalent Asset Valuation. The following non-operational asset has been valued at Market Value: Clifton House - Land
Note 17.2 Plant and Equipment The carrying amount for fixtures and equipment is depreciated historic cost as this is not considered to be materially different from fair value.
Annual Report 2014/15
Page 125
Note 17.3 Asset Lives The estimated useful life for Information Technology equipment is 3 years (amended in 2010/11 from 5 years). Min Life
Max Life
Years
Years
Land
0
0
Buildings excluding dwellings
1
70
Dwellings
0
0
Assets under Construction & POA
0
0
Plant & Machinery
5
15
Transport Equipment
7
7
Information Technology
3
3
Furniture & Fittings
3
3
Economic life of property, plant and equipment
For newly acquired or newly constructed assets, a formal revaluation, including assessment of economic life, will only be carried out if there is an indication that the initial cost is significantly different to its fair value.
Note 17.4 Gross carrying amount of any fully depreciated assets still in use There are 169 equipment assets which are fully depreciated. The gross carrying cost of these totals £2,085,715
Note 18: Investment The Trust has no investments 2014/15 (2013/14 £nil)
Note 19: Disclosure of interests in other entities The Trust has no interest in other entities 2014/15 (2013/14 £nil)
Note 20: Inventories The value of stocks and work in progress are deemed to be immaterial to the accounts when consideration is given to the costs of collation and verification.
Note 21: Other Assets The Trust has no other assets 2014/15 (2013/14 £nil)
Page 126
Greater Manchester West Mental Health NHS Foundation Trust
Note 22: Other Financial Assets The Trust has no other assets 2014/15 (2013/14 £nil)
Note 23: Trade receivables and other receivables 31 March 2015
31 March 2014
£000
£000
Trade receivables due from NHS bodies
3,776
1,614
Other receivables due from related parties
3,654
1,442
Provision for impaired receivables
(834)
(348)
Prepayments (non-PFI)
1,037
716
541
161
Interest receivable
3
-
PDC dividend receivable
-
79
Current
Accrued income
VAT receivable
-
462
8,177
4,126
Prepayments (non-PFI)
10
706
Total non-current trade and other receivables
10
706
Total current trade and other receivables Non-current
The majority of trade is with Clinical Commissioning Groups and NHS England, as commissioners for NHS patient care services. As CCGs’ and NHS England are funded by Government to buy NHS patient care services, no credit scoring of them is considered necessary
Note 23.1 Provision for impairment of receivables
At 1 April as previously stated Prior period adjustments At 1 April - restated At start of period for new FTs Increase in provision Unused amounts reversed At 31 March
2014/15
2013/14
£000
£000
348
537
-
-
348
537
-
-
486
-
-
(189)
834
348
With the exclusion of NHS debtors, in general, receivables 90 days past their due date are fully impaired. Additionally, where specific circumstances are known individual invoices are impaired in full. Other debts are partially provided for.
Annual Report 2014/15
Page 127
Note 23.2 Analysis of impaired receivables 31 March 2015
31 March 2014
Trade receivables
Other receivables
Trade receivables
Other receivables
£000
£000
£000
£000
0 - 30 days
173
-
-
-
30-60 Days
8
-
2
-
Ageing of impaired receivables
60-90 days
16
-
19
-
90- 180 days
421
-
229
-
Over 180 days
216
-
98
-
Total
834
-
348
-
Ageing of non-impaired receivables past their due date
0 - 30 days
-
30-60 Days
130
-
(40)
-
60-90 days
42
-
29
-
280
-
41
-
66
-
(9)
-
518
-
21
-
90- 180 days Over 180 days Total
Note 24: Non-current assets for sale and assets in disposal groups The Trust has no Non-current assets for sale and assets in disposal groups
Note 24.1 Liabilities in disposal groups The Trust has no Liabilities in disposal groups
Page 128
Greater Manchester West Mental Health NHS Foundation Trust
Note 25: Cash and cash equivalents movements Cash and cash equivalents comprise cash at bank, in hand and cash equivalents. Cash equivalents are readily convertible investments of known value which are subject to an insignificant risk of change in value. 2014/15
2013/14
£000
£000
56,436
51,861
-
-
56,436
51,861
At start of period for new FTs
-
-
Transfers by absorption
-
-
Net change in year
(6,592)
4,575
At 31 March
49,844
56,436
At 1 April Prior period adjustments At 1 April (restated)
Broken down into: Cash at commercial banks and in hand
-
538
Cash with the Government Banking Service
13,644
6,898
Deposits with the National Loan Fund
36,200
49,000
-
-
49,844
56,436
Bank overdrafts (GBS and commercial banks)
-
-
Drawdown in committed facility
-
-
49,844
56,436
Other current investments Total cash and cash equivalents as in SoFP
Total cash and cash equivalents as in SoCF
Note 25.1 Third party assets held by the NHS foundation trust Greater Manchester West Mental Health NHS Foundation Trust held cash and cash equivalents which relate to monies held by the the foundation trust on behalf of patients or other parties. This has been excluded from the cash and cash equivalents figure reported in the accounts. 31 March 2015
31 March 2014
£000
£000
76
104
Monies on deposit
562
542
Total third party assets
638
646
Bank balances
Annual Report 2014/15
Page 129
Note 26: Trade and other payables Note 26.1 Trade and other payables 31 March 2015
31 March 2014
£000
£000
Receipts in advance
-
-
NHS trade payables
1
86
1,717
1,821
-
-
Capital payables
3,618
1,792
Social security costs
2,301
2,310
374
-
Other taxes payable
-
-
Other payables
-
-
15,990
13,936
33
-
24,034
19,945
Non-current
-
-
Total non-current trade and other payables
-
-
Current
Amounts due to other related parties Other trade payables
VAT payable
Accruals PDC dividend payable Total current trade and other payables
Note 26.2 Early retirements in NHS payables above The Trust has no payments due in respect of arrangements under buy out liability, early retirement over 5 instalments or other outstanding pensions contributions.
Note 27: Other liabilities 31 March 2015
31 March 2014
£000
£000
19,855
11,924
2,490
16,567
Current Other deferred income Non-current Other deferred income
Page 130
Greater Manchester West Mental Health NHS Foundation Trust
Note 28: Provisions for liabilities and charges analysis Current
Non-current
2014/15
2013/14
2014/15
2013/14
£000
£000
£000
£000
Pensions relating to other staff
181
176
3,100
2,922
Other Legal Claims *
156
123
0
0
Restructurings
1,120
1,612
0
168
Other **
1,266
1,165
0
0
Total
2,723
3,076
3,100
3,090
Pensions - former directors
Pensions other staff
Other legal claims
Agenda for change
Restructurings
Continuing care
Equal pay
Redundancy
Other
Total
£000
£000
£000
£000
£000
£000
£000
£000
£000
£000
At 1 April 2014
-
3,098
123
-
1,780
-
-
-
1,165
6,166
At start of period for new FTs
-
-
-
-
-
-
-
-
-
-
Transfers by absorption
-
-
-
-
-
-
-
-
-
-
Change in the discount rate
-
81
-
-
-
-
-
-
-
81
Arising during the year
-
102
33
-
458
-
-
-
382
975
Utilised during the year
-
(180)
-
-
(639)
-
-
-
(139)
(958)
Reclassified to liabilities held in disposal groups
-
-
-
-
-
-
-
-
-
-
Reversed unused
-
-
-
-
(479)
-
-
-
(142)
(621)
Unwinding of discount
-
180
-
-
-
-
-
-
-
180
At 31 March 2015
-
3,281
156
-
1,120
-
-
-
1,266
5,823
- not later than one year;
-
181
156
-
1,120
-
-
-
1,266
2,723
- later than one year and not later than five years;
-
562
-
-
-
-
-
-
-
562
- later than five years.
-
2,538
-
-
-
-
-
-
-
2,538
Total
-
3,281
156
-
1,120
-
-
-
1,266
5,823
Expected timing of cash flows:
* The NHS Litigation Authority has informed the Trust of Employers’ and Public Liability claims totalling £156,000 2014/15 (£123,000 2013/14) (as shown above). The amount is disclosed as a provision. ** Other provisions include amounts of £425,000 in respect of estates costs, and £1,120,050 due to unforeseen costs as a result of loss of contracts/legal claims. No individual provision is greater than £1m.
Note 28.1Clinical Negligence Liabilities At 31 March 2015, £541k was included in provisions of the NHSLA in respect of clinical negligence liabilities of Greater Manchester West Mental Health NHS Foundation Trust (31 March 2014: £229k).
Annual Report 2014/15
Page 131
Note 29: Contingent assets and liabilities 31 March 2015
31 March 2014
£000
£000
NHS Litigation Authority legal claims
(134)
(104)
Gross value of contingent liabilities
(134)
(104)
-
-
(134)
(104)
-
-
Value of contingent liabilities
Amounts recoverable against liabilities Net value of contingent liabilities Net value of contingent assets
The NHS Litigation Authority has informed the Trust of a contingent liability of £134,000 2014/15 (£104,000 2013/14) for Employers’ and Public Liability claims. The figure has been calculated on an expected value basis after taking legal opinion. It is anticipated these claims will be settled within the financial year 2015/16 and a further amount of £156,000 2014/15 (£123,000 2013/14) has been included in Provisions due within 12 months (see note 28)
Note 30: Contractual capital commitments
Property, plant and equipment Total
31 March 2015
31 March 2014
£000
£000
12,055
4,838
12,055
4,838
The capital commitments are predominantly in respect of the costs of the provision of additional Medium and Low Secure Unit beds, the new build Recovery Academy, and the redevelopment of Older Adult beds at Woodlands.
Note 31: Financial instruments Note 31.1 Financial risk management Financial reporting standard IFRS 7 requires disclosure of the role financial instruments have had during the period in creating or changing the risks a body faces in undertaking its activities. Due to the service provider relationship the Trust has with Clinical Commissioning Groups (CCG): and the way those CCG are financed, the Trust is not exposed to the degree of financial risk faced by business entities. Also financial instruments play a much more limited role in undertaking its activities. creating or changing risk than would be typical of listed companies, to which the financial reporting standards mainly apply. The Trust has restricted powers to borrow or invest surplus funds, and 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. The Trust’s treasury management operations are carried out by the finance department, within parameters defined formally within the Trust’s standing financial instructions and policies agreed by the Board of directors. Trust treasury activity is subject to review by the Trust’s internal auditors. Page 132
Greater Manchester West Mental Health NHS Foundation Trust
Note 31.2 Currency Risk The Trust is principally a “domestic” organisation with the great majority of transactions, assets and liabilities being in the UK and sterling based. The Trust has no overseas operations. The Trust therefore has low exposure to currency rate fluctuations.
Note 31.3 Interest Rate Risk The Trust largely finances its capital expenditure from internally generated funds. In addition to this, additional capital expenditure can be financed within an agreed borrowing limit
Note 31.4 Credit risk As the majority of the Trust’s income comes from contracts with other public sector bodies, the Trust has low exposure to credit risk. The maximum exposures as at 31 March 2015 are in receivables from customers, as disclosed in the Trade and other receivables note.
Note 31.5 Liquidity Risk The Trust’s operating costs are incurred under contracts with a range of commissioners Clinical Commissioning Groups (CCGs), NHS England for Specialist Commissioned services, Local Authorities and Drug Action Teams, under legally binding arrangements. Local Authorities, CCGs and NHS England have their resources voted annually by Parliament. The Trust finances its capital expenditure from internally generated funds.
Annual Report 2014/15
Page 133
Note 31.6 Financial assets Loans and receivables
Assets at fair value through the I&E
Held to maturity
Availablefor-sale
Total
£000
£000
£000
£000
£000
Assets as per SoFP as at 31 March 2015 Trade and other receivables excluding non financial assets
7,141
-
7,141
Cash and cash equivalents at bank and in hand
49,844
-
49,844
Total at 31 March 2015
56,985
-
56,985-
Loans and receivables
Assets at fair value through the I&E
Held to maturity
Availablefor-sale
Total
£000
£000
£000
£000
£000
Assets as per SoFP as at 31 March 2014 Trade and other receivables excluding non financial assets
3,331
-
3,331
Cash and cash equivalents at bank and in hand
56,436
-
56,436
Total at 31 March 2014
59,767
-
59,767
Note 31.7 Financial liabilities Other financial liabilities
Liabilities at fair value through the I&E
Total
£000
£000
£000
24,034
-
24,034
Provisions under contract
5,823
-
5,823
Total at 31 March 2015
29,857
-
29,857
Other financial liabilities
Liabilities at fair value through the I&E
Total
£000
£000
£000
19,945
-
19,945
Provisions under contract
6,166
-
6,166
Total at 31 March 2014
26,111
-
26,111
Liabilities as per SoFP as at 31 March 2015 Trade and other payables excluding non financial liabilities
Liabilities as per SoFP as at 31 March 2014 Trade and other payables excluding non financial liabilities
Page 134
Greater Manchester West Mental Health NHS Foundation Trust
Note 31.8 Maturity of financial liabilities 31 March 2015
31 March 2014
£000
£000
26,757
19,945
In more than one year but not more than two years
274
3,076
In more than two years but not more than five years
288
707
2,538
2,383
29,857
26,111
In one year or less
In more than five years Total
Note 31.9 Fair values of financial assets at 31 March 2015 Book value
Fair value
£000
£000
10
10
Other
49,884
49,884
Total
49,894
49,894
Non-current trade and other receivables excluding non financial assets
Note 32 Fair values of financial liabilities at 31 March 2015 Book value
Fair value
£000
£000
-
-
3,100
3,100
Loans
-
-
Other
-
-
Total
3,100
3,100
Non-current trade and other payables excluding non financial liabilities Provisions under contract
Annual Report 2014/15
Page 135
Note 33 Losses and special payments 2014/15
2013/14
Total number of cases
Total value of cases
Total number of cases
Total value of cases
Number
£000
Number
£000
21
4
13
4
6
2
10
4
Stores losses and damage to property
2,259
114
1,500
66
Total losses
2,286
120
1,523
74
Losses Cash losses Bad debts and claims abandoned
Special payments Ex-gratia payments
15
3
22
4
Total special payments
15
3
22
4
2,301
123
1,545
78
Total losses and special payments
There were no cases of £300,000 or more
Note 34 Transfers by absorption The Trust had no transfers by absorption in 2014/15 (2013/14 £327,000)
Note 35 Event after the reporting period There are no material events after the reporting period to disclose.
Note 36 Prior period adjustments Under IAS 8 the Trust must disclose where comparative information has been restated due to either a change in accounting policy or material prior period error. The Trust has no disclosures under either category to disclose.
Page 136
Greater Manchester West Mental Health NHS Foundation Trust
Note 37 Related parties In 2014/15 one executive member and four non-members of the Trust Board have relationships with organisations with which the Trust has immaterial transactions. The details are: Alan Maden GMW Chair is a Trustee of the St Ann’s Hospice Pension Fund who had transaction with the Trust totalling £4,400 Karen Luker GMW Non Executive Director is a Professor/Head University nominated NonExecutive Director post Head of School of Nursing, Midwifery and Social Work, Queen’s Nursing Institute of Professor of Community Nursing, The University of Manchester who had transactions with the Trust totalling £nil. Jon Bashford GMW Non Executive Director resigned 1st July 2014, is a Director of Research and Development TiFCi and a Senior Partner, Community Innovations Enterprise LLP who had £nil transactions with the Trust. Anthony Bell GMW Non Executive Director appointed 1st July 2014, is a Non Executive Director of The Guinness Partnership and Carrioca Enterprises, and is Vice Principal of Grimsby Institute of Further Education. There were no transactions between the Trust and these organisations in 2014/15. Julie Jarman GMW Non Executive Director appointed 1st August 2014, is a Trustee of MIND in Salford who had £nil transactions with the Trust. The Department of Health is regarded as a related party. During the year the Trust has had a significant number of material transactions with the Department, and with other entities for which the Department is regarded as the parent Department. These entities are: • Age UK • British Telecom • Cambridge University • Cumberland Lodge • London School of Economics • Medical Research Council • National Society for Epilepsy • Whitehall and Industry Group • Medicines and Healthcare Products Regulatory Agency The aggregate remuneration and other benefits due to the key management in respect of the current year totalled £983,000 2014/15 (£970,000 2013/14); Remuneration £959,000 2014/15 (£948,000 2013/14), Employer contributions to the pensions scheme £116,000 2014/15 (£115,000 2013/14), Lease car benefits £17,000 2014/15 (£16,000 2013/14) and expenses £7,000 2014/15 (£7000 2013/14).
Annual Report 2014/15
Page 137
Receivables
Payables
31 March 2015
31 March 2014
31 March 2015
31 March 2014
£000
£000
£000
£000
147
125
397
892
Other NHS Bodies
4,077
1,628
5,054
7,855
Other
2,557
1,224
Value of balances with other Related parties at 31 March 2015 Department of Health
NHS Shared Business Services Total
5,576 432
-
5,883
14,323
6,781
2,977
Income
Expenditure
2014/15
2013/14
2014/15
2013/14
£000
£000
£000
£000
1,012
932
133,770
130,464
8,081
7,033
23,835
22,282
21,288
20,765
29
35
29,398
27,833
Value of balances with other Related parties at 31 March 2015 Department of Health Other NHS Bodies Other NHS Shared Business Services Total
Page 138
158,617
153,678
Greater Manchester West Mental Health NHS Foundation Trust