NHS East and North Hertfordshire Annual Report and Accounts 2008/09

Annual Report and Accounts 2008/09

During the production of this annual report, Pam Handley, Chair of NHS East and North Hertfordshire sadly died following a short illness.

The staff and Board of NHS East and North Hertfordshire would like to dedicate this report to Pam Handley in memory of her outstanding contribution to health services in Hertfordshire.

Contents Welcome About us

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Our history and background How we are managed Location and type of facilities provided

Keeping Herts healthy

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Planned care Patient experience Mental health and learning disabilities Maternity and newborn Our people Vision and values Children’s health End of life Staying healthy Changing services

Quality report Operating and financial review Our performance

Financial review

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Financial duties and targets Analysis of 2008/09 Net Expenditure Financial outlook Implementation of International Financial Reporting Standards (IFRS) in 2009/10

Looking to the future Governance controls and audit The accounts Notes to the accounts Alternative formats and additional copies

67 71 85 96 128

Contact us Another language

43 47 51

Strategic objectives and progress Key performance indicators Annual health check

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We 4 | Annual Report and Accounts 2008/09

We are very pleased to welcome you to our third annual report. We have come a long way since we were established in October 2006. Back then we were struggling to get to grips with a massive inherited debt; working with our residents and stakeholders to agree on the future of health services in Hertfordshire and to improve staff morale following yet another reorganisation.

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How things have changed since those days! Our financial position is now back on track; we are beginning to see real progress with the implementation phase of Delivering quality health care for Hertfordshire and we have developed a vision and set of values for our organisation that we are all working hard to achieve.

As ever things have not stood still in the NHS. Since the two Hertfordshire PCTs were established we have been moving steadily towards separating our “provider arm” from the commissioning part of the organisations. By provider arm we mean those health services delivered directly to patients in their own homes, in community hospitals and health clinics by clinical staff such as community nurses, health visitors and therapists.

Similar changes are taking place across the country and reflect the fact that community services are now seen as central to the modernisation of the NHS with the transfer of services traditionally provided in hospital settings out into the community close to where patients live and work.

As from 1 April 2009 the provider arm of NHS West Hertfordshire and NHS East and North Hertfordshire formally became an “arms length” organisation that is now known as Hertfordshire Community Health Services.

This separation will enable NHS East and North Hertfordshire to concentrate on becoming a world class commissioning organisation, purchasing health care from a range of providers including the private and third (voluntary) sector.

Throughout this report we refer to ourselves as NHS East and North Hertfordshire. This name was adopted in 2009 to better reflect our position as local leaders of the NHS. The change of name is in line with national recommendations and follows

Anne Walker Richard Henry Chief Executive Chair Chair

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what is happening elsewhere around the country. It does not change our legal status as primary care trusts.

During the year our staff and local people participated in the national consultation which led up to the first ever NHS Constitution. The Constitution establishes the principles and values of the NHS in England. It sets out rights to which patients, public and staff are entitled, and pledges which the NHS is committed to achieve, together with responsibilities which the public, patients and staff owe to one another to ensure that the NHS operates fairly and effectively.

2008 also saw the NHS reach its 60th birthday. As part of the celebrations we held well attended events that took a look at the way key NHS services had changed over the six decades; held a poster competition for local school children and some of our staff attended a service at Westminster Abbey.

Other achievements this year include the expansion of our minor injuries unit at Herts and Essex Hospital, working with local patient and community representatives to choose the preferred site for the new local general hospital in Welwyn Hatfield, increased investment to improve the availability of NHS dental appointments and extended opening hours at a large number of GP practices to make it easier for you to see a GP or nurse at a time that suits you. More detail about these and a range of other developments and new health services can be found within this report.

Finally we would like to pay tribute to the outstanding contribution and dedication of our staff. Whether on the front line delivering services directly to patients or working behind the scenes to ensure that quality services are in place when our residents need them, everyone has a played their part in helping people in Hertfordshire to remain healthy and stay active.

Dr Tony Kostick Professional Executive

Achievements this year include the expansion of our minor injuries unit at Herts and Essex Hospital, extended opening hours at many GP surgeries, working with local patient and community representatives to choose the preferred site for the new local general hospital in Welwyn Hatfield

Everyone has a played their part in helping people in Hertfordshire to remain healthy and stay active.

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About us NHS East and North Hertfordshire was established on 1 October 2006. We are made up of the former South East Hertfordshire; Welwyn Hatfield; North Hertfordshire and Stevenage; and Royston, Buntingford and Bishop’s Stortford primary care trusts.

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Our history and background Although primary care trusts have been in existence since 2000, our organisation came into being on 1 October 2006 with the merger of four predecessor organisations. There are now 152 PCTs in England, the majority of which are linked to county/unitary council boundaries to ensure better joint working with social care.

Structure of business, its main services and users With NHS West Hertfordshire, we hold the vast majority of the NHS budget locally and are the lead health commissioning organisation in the county. Commissioning means that we assess the health needs of our population then use our resources to buy services from hospitals and other providers such as mental health trusts, GPs and dentists to meet those needs. By doing this we can have a positive impact on the health and well-being of the local population. We also fund the cost of medicines and drugs prescribed by GPs and nurse prescribers.

We commission services in a number of different ways: • •

•

•

Directly with providers such as hospitals Practice based commissioning (PBC) – where GPs, nurses and therapists can design services that meet the needs of their patients in a particular area.

Primary care commissioning – this involves services provided by GPs, community pharmacists, dentists and optometrists Sharing the commissioning of services - this means that we join together with Hertfordshire County Council and we both contribute some of our budgets to a partnership who then arrange mental health and learning disability services in the county. We use the majority of this money to commission services from Hertfordshire Partnership NHS Foundation Trust and from Adult Care Services.

Providing care As we explained in our introduction, on 1 April 2009 our clinical staff together with their support teams became an arms length organisation from NHS East and North Hertfordshire. This organisation is now known as

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Hertfordshire Community Health Services (HCHS). From October 2009 all HCHS staff will be formally employed by NHS East and North Hertfordshire until their separation into a new organisation is complete.

Effective commissioning means that we can help people to stay healthy whilst ensuring that we have the right services in place to help people if they fall ill and to assist them with their recovery.

These moves are in response to national guidance which requires that all PCT direct provider organisations move into a contractual relationship with their PCT commissioning function by April 2009. In addition we will be applying for HCHS to become a Community Foundation Trust (CFT). A CFT is a ‘Public Benefit Organisation’ authorised to provide goods and services to the NHS. It is an independent legal entity, accountable to local people who can become members and governors.

We are managed by a board of non executive and executive directors and share a single management team with NHS West Hertfordshire.

Initially NHS East and North Hertfordshire has to ensure that HCHS can operate effectively as an arms length organisation, and this is the first priority. A detailed action plan is in place to ensure robust internal organisational arrangements are put in place to deliver this organisational change.

The board is responsible for ensuring we meet our performance targets and also oversees the work of the Professional Executive Committee (PEC) that covers the whole of Hertfordshire. In 2008/09 the PEC was made up of GPs and other clinical staff who advised us on clinical matters.

Before becoming a CFT, directly provided services would have to operate successfully as an arms length organisation for at least one year.

This separation will mean that the PCT can concentrate on becoming world class commissioners.

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The executive directors on the board are employed by the PCTs. The non executive directors are independent people who work on a part time basis, to make sure that we act in the best interests of the public. (The names of the board directors can be found on the following page).

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How we are managed We are run by a Board of non-executive and executive directors and share a single management team with NHS West Hertfordshire.

Elaine Fox

Richard Henry

Chair

Non-executive Director

Non-executive Director

Non-executive Director

Dr Tony Kostick

Chris Learmonth

Phil Picton

Julia Witting

Joint Chair, Professional Executive Committee

Non-executive Director

Non-executive Director

Non-executive Director

Non-executive Directors

Linda Farrant

Chairs

Pam Handley

The executive directors of the Board are employed by the PCT. The non-executive directors are independent people appointed to make sure that the PCT acts in the best interest of local people. The Board is responsible for the performance of the PCT and also oversees the work of the Professional Executive Committee (PEC).

The joint PEC, which covers the whole of Hertfordshire, is made up of local clinicians who advise on clinical matters.

Gloria Barber

Beverley Flowers

Jane Halpin

Clare Hawkins

Chief Executive

Director of Human Resources (HR)

Director of Commissioning

Director of Public Health

Interim Director of Nursing

Gareth Jones

Pauline Pearce

Andrew Parker

Heather Moulder

Alan Pond

Director of Strategic Planning

Director of Public Involvement and Corporate Services

Director of Primary Care and Service Redesign

Director of Nursing/Interim Chief Operating Officer, HCHS

Director of FinanceÂ

Executive Directors

Anne Walker

Location and type of facilities provided The main facilities and community hospitals from which we provide services and at which our clinical staff are based are: • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

Bedford Road Health Centre, Hitchin Bull Plain Clinic, Hertford Bishop’s Stortford Health Centre Bowling Road Clinic, Ware Buntingford Health Centre Cheshunt Community Hospital Cuffley Health Centre Danesbury Hospital, Welwyn Danestrete Clinic, Stevenage Hertford County Hospital Herts and Essex Hospital, Bishop’s Stortford Hitchin Hospital Hoddesdon Health Centre Lister Hospital, Stevenage Nevells Road Health Centre, Letchworth Garden City Park Drive Clinic, Baldock Parkway Health Centre, Welwyn Garden City QEII Hospital, Welwyn Garden City Queensway Health Centre, Hatfield Queen Victoria Memorial Hospital, Welwyn Royston Health Centre Royston Hospital Sawbridgeworth Clinic South Street Clinic/Church Street Clinic, Bishop’s Stortford Southgate Health Clinic, Stevenage St. Nicholas Health Centre, Stevenage Standon Health Centre Stanmore Road Health Centre, Stevenage Waltham Cross Clinic.

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In addition, services are also provided in other locations such as GP practices and in people’s own homes.

This year saw the adoption of the PCT’s Estate Strategy.

The strategy included a summary of the results of the most comprehensive survey of the PCT buildings ever undertaken and clearly set out the short and medium-term objectives for the development of the estate.

In addition, we have spent an additional £500,000 of revenue monies on small works improvements, such as redecoration, concentrating on improving the patient environment which we expect to be reflected in improved Patient Environmental Action Team assessment scores.

Improving the health and safety of staff and patients has been another priority for the PCT during the financial year.

The results of the surveys highlighted that the PCT had many elderly buildings that were poorly maintained and no longer suitable for delivering health services in the 21st century.

To this end, we have completed:

Well-designed and well-maintained buildings can improve a patient’s experience of healthcare, promote wellbeing and assist recovery. They can also help in recruiting and retaining high quality staff. This is recognised in the East of England Commissioning Framework that requires PCTs to secure year-on-year improvements in the patient experience.

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Therefore, this year it has been a priority to improve the quality of the therapeutic environment for both staff and patients and to bring some older buildings in line with the requirements of the Disability Discrimination Act (2005). In the past year, NHS East and North Hertfordshire spent over £1m of capital monies to improve buildings and facilities.

•

• •

In addition, we have: •

• These projects have included: • •

• •

r efurbishment at Bull Plain, Queensway, Bowling Road, Danestrete and Southgate Clinics internal and external improvements to Danesbury, Queen Victoria Memorial and Royston Community Hospital upgrade at Tewin Road Wheelchair centre redevelopment of the Minor Injuries Unit at Herts and Essex Hospital

a £200,000 programme of health and safety upgrades across the PCT a comprehensive gas boiler servicing and safety testing programme new Type 2 asbestos surveys for all building new water safety risk assessments for all buildings and a programme of works to remove piping dead legs and redundant sanitary ware to reduce the risk of legionella.

• •

ut in place a new comprehensive solution for the p management of medical devices, including an audit of all current medical equipment. implemented a comprehensive programme of planned preventative maintenance of all critical plant and machinery. implemented a programme of fixed wire testing for all buildings created a new web-based database of all relevant risk assessments with access for staff and external building contractors working onsite

.

The estate contributes significantly to the local NHS’ carbon footprint and this year we began the process of reducing carbon emissions.

This has included: • •

•

roducing energy certificates for all buildings over p 1000 m2 ensuring that 25% of our energy is procured from suppliers who use Combined Heat and Power (a fuel-efficient energy technology) or renewables a commitment to achieving a BREEAM (Building Research Establishment Environmental Assessment Method) Healthcare score rating of ‘excellent’ and energy efficiency levels of at least 35-55 GJ/ m3 for new builds and ‘very good’ for major refurbishments.

External environment The external environment within which the PCT operates is characterised by partnership working. Key to developing appropriate health and social care services are partnerships with the public, carers, other health service organisations, county council, district councils, housing providers, colleges and employment services. This year we have strengthened these partnerships, especially those with users and carers and have developed ways to enable more people to have their say and so influence our work.

We work with a large number of partners including: • • • • • • •

Hertfordshire County Council All Hertfordshire District/Borough Councils Hertfordshire Constabulary and Police Authority University of Hertfordshire A number of Hertfordshire voluntary organisations Hertfordshire Fire Service Utility organisations relating to Hertfordshire

The ways in which we work with these partners are described overleaf.

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Hertfordshire Forward – The countywide LSP Hertfordshire Forward is the countywide Local Strategic Partnership (LSP) which brings together key agencies which have an interest in improving the quality of life and wellbeing of local people.

As a full partner the PCT has played a large part in assisting in the development of the sustainable Community Strategy.

‘Hertfordshire 2021: a brighter future’ is the county’s Community Strategy. It identifies an ageing population, and health and wellbeing as key areas of concern for improvement and describes both long-term objectives (2008–2021) and short-term actions (2008–2011).

The ‘ageing population’ long-term objectives are: • • •

A focus on prevention of illnesses Helping older people to maintain their independence Ensuring older people have the opportunities to be active members of their communities.

The short-term actions include: • • •

Strengthening intermediate care provision Supporting independent living Increasing physical activity.

The Local Area Agreement (LAA) Hertfordshire Forward is responsible for coordinating the Local Area Agreement (LAA). The LAA is a contract between central and local government designed to improve services to the public by bringing organisations together locally to focus on the issues that matter most to local people.

services from the voluntary sector such as Carers in Herts, Age Concern Herts, Herts Health Action for the Homeless, The Crescent and Herts Hearing Advisory Service. Funding is also available through the Joint Commissioning team for initiatives such as Viewpoint and other mental health and learning disability groups.

Hertfordshire’s LAAs are a major part of the PCT’s partnership working. LAA1 finished on 31 March 2009.

Delivery of ‘stretch’ targets will generate a significant financial reward to be shared by LAA partners. The Performance Reward Grant is expected to be in the region of £18m and available at the end of 2010.

Community safety partnerships Community safety partnerships are linked to the LAA ‘Safer and Stronger’ strand and set additional local targets based upon the findings of their strategic assessments. In addition to targeting crime and anti-social behaviour, community safety partnerships seek to address the underlying societal problems caused by alcohol and drugs, and the various elements that cause fear of crime in communities. Reducing both crime and fear of crime has an impact on physical and mental health, which helps to promote independent living for vulnerable groups of people and helps to build social cohesion.

In LAA1, three of the four ‘Healthier Communities and Older People’s’ (HCOP) sub-group stretch targets are on track to generate the expected Performance Reward Grant.

Hertfordshire’s LAA2 was signed off by the Government Office East of England (GO-East) in June 2008. Five of the National Indicators chosen by Hertfordshire are being delivered under the HCOP theme, which is aligned with the ‘Health and Wellbeing’ and ‘An Ageing Population’ themes of Hertfordshire’s Sustainable Community Strategy, Hertfordshire 2021: ‘A Brighter Future’ and with the PCTs’ Health Inequalities Plans.

The five HCOP indicators are:

The ‘health and wellbeing’ long-term objectives include: •

I mproving health and wellbeing, life chances, and access to health care.

The short-term actions include: • • •

Increasing levels of physical activity across all age groups Reducing smoking and obesity in areas of deprivation Providing greater support to carers.

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• • • • •

NI 8 Physical activity NI123 Stopping smoking NI125 Achieving independent living for older people NI135 Carers receiving needs assessment NI141 Percentage of vulnerable people achieving independent living

Working with the voluntary sector The voluntary sector plays an important role in promoting healthy lifestyles, disease prevention, supporting the elderly and disabled to live healthy lives in their own homes and in a variety of ways. The PCT commissions a number of

Children and young people’s partnership Hertfordshire Children’s Trust Partnership, supported by District Children’s Trust Partnerships (DCTPs) supports delivery of the five Every Child Matters outcomes. They are set to become key vehicles to support the delivery of children’s services countywide and in local districts.

Working with vulnerable groups The PCT recognises the importance of providing appropriate services for vulnerable people, minority ethnic communities, travellers, homeless people, migrants (including asylum seekers), and people with learning disabilities or mental health problems. The PCT works closely with partnership groups on their specific issues and links closely with relevant communities. NHS East and North Hertfordshire was a partner in events organised for the Polish community, aimed at informing them about services available and listening to their needs. These events were held in Royston and Hatfield.

NHS East and North Hertfordshire is a key member of the Hertfordshire Asylum Seekers Multi Agency Forum which is

a partnership that seeks to improve services for groups of migrant workers and asylum seekers.

Partnership working on planning for emergencies The PCT is an active member of Hertfordshire Resilience, the county’s local resilience forum, and many of its subcommittees, including the Health Services group which it chairs. The PCT takes part in local risk assessment work and emergency planning exercises, covering emergencies such as flooding, train crashes, London evacuation and radiation.

The PCT also plays a lead role in county-wide pandemic flu planning and preparedness, supporting partners in the development of multi-agency arrangements and ensuring that rigorous plans are in place including not only the health sector, but also local authorities, police, fire, utilities and voluntary organisations .

Partnership working with utility companies The PCT works closely with suppliers of gas, electricity and water as well as the Highways agencies in its emergency planning roles. In recognition of the particular effect water supply has on public health, we have developed a strong relationship with Three Valleys Water.

Sustaining a healthy future Herts NHS Environment Group, which includes all major NHS organisations in Hertfordshire and representatives from the county council and district councils has helped individual NHS organisations undertake environmental improvements in their own workplaces including recycling, waste control and green transport.

The group is a member of Hertfordshire Environment Forum (HEF) and we have developed good links with county and district council officers on various environmental projects.

The group also produces the annual Hertfordshire ‘Quality of Life’ report, which has won plaudits worldwide.

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Keeping Herts Healthy www.enherts-pct.nhs.uk | 21

Planned care NHS East and North Hertfordshire, together with NHS West Hertfordshire, are the lead health commissioning organisation in the county. This means that, alongside NHS West Hertfordshire, we are responsible for planning and improving local NHS services for the residents of Hertfordshire and ensuring that we help people to keep fit and healthy. To do this we work closely with GPs, dentists, optometrists, community pharmacists, the county and district councils, hospitals and the mental health trust to secure the best possible healthcare and health services for over one million residents in the county. Here are some of our key achievements over the past year.

Longer GP surgery opening hours and more choice in your healthcare Patients tell us they want more convenience and choice from the service they receive from GPs - for instance, being able to see a doctor in the evening, at weekends or when you’re away from home.

Extended hours We understand that ill-health doesn’t just strike during office hours. That is why we have been working with local GP surgeries to ensure that many stay open for longer, giving you the opportunity to see a doctor early in the morning, during the evening, or at the weekend.

This means that now 39 GP practices (around 62%) in East and North Hertfordshire now offer appointments outside normal working hours, including more than 20 which open on a Saturday morning.

New health centre provides extra GP services A new kind of GP surgery – Spring House Medical Centre is now open in Welwyn Garden City, close to the QEII Hospital.

Shortest waits ever get thumbs-up from patients Virtually all patients in Hertfordshire are now seen, diagnosed and start their hospital treatment within 18 weeks – the shortest waits since NHS records began. *

Open from 8am to 8pm, 7 days a week, every day of the year, Spring House is open to anyone who wants to use it – and you don’t need to be registered with the centre to use its services.

Anne Walker, Chief Executive of NHS East and North Hertfordshire, said: “This is excellent news for Hertfordshire patients, who are now having their treatment faster than ever before. This challenging target has been met and exceeded thanks to the close partnership between the PCTs and the hospital trust.”

Open to everyone living, working or visiting east and north Hertfordshire (not just Welwyn Garden City), Spring House Medical Centre offers: • • •

Fast, easy access to your doctor When you need to see a doctor quickly, you should be offered an appointment within two working days. All GP surgeries should also allow you to book an appointment more than two days in advance, if you prefer.

P re-booked appointments to people registered with the centre Pre-booked appointments to people not registered with the centre, and A walk-in service (no appointment needed)

Results from a recent Department of Health survey also show that the majority of Hertfordshire patients reported having good experiences when being referred for hospital treatment: • •

You can contact the centre on 01707 294354 or find out more online go to: www.springhouse.nhs.uk

•

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8% of patients were happy with how long they had 6 to wait for treatment Two-thirds of patients found it easy to make their first hospital appointment (either by phone, online or within their GP practice) and 91% who were offered a choice of where to be treated, were able to go to their preferred hospital 96% of patients felt that they were treated with respect and dignity during their treatment.

Anne Walker said: “The feedback from this survey shows that in general, local people are having a positive patient experience in hospital. Our focus for the coming year will be on those areas we know can be improved, including reducing the number of cancelled outpatient appointments, reducing waits in clinics and helping more patients to choose the hospital they want to be treated at”.

As a patient you may want to consider a number of factors when deciding which hospital to choose, including: • •

Your own personal experience of a particular hospital The location – whether it is easy for you to get to, close to work, or near family and friends Reputation of the hospital The hygiene standards and MRSA infection rates Waiting times for your care Good facilities at the hospital e.g. parking and disabled facilities.

* The 18 Week target levels are 90% for admitted patients and 95% for non-admitted patients to allow for patients who do not want to start their treatment within 18 weeks and patients for who need further tests before treatment begins.

• • • •

Choose your hospital!

Patient choice was introduced in April 2008, which means that if your GP refers you to a hospital you can choose which hospital you go to. You can choose to go anywhere in England where your treatment is being offered, funded by the NHS. This includes all NHS hospitals as well as some private hospitals. Patient choice allows you to make decisions about your care based on your personal circumstances and what is most convenient for you.

More information is available at www.nhs.uk/choices

Making your choice is simple. Your GP has access to information on all the different hospitals which offer the care you need. You can discuss your options with your GP and make a decision together. Once you have made a decision, your appointment can be booked then and there on a day and time that’s convenient for you.

Alternatively, if you would like some time to think your options through, your GP can give you a unique password and booking reference which you can use to make your own appointment online or via an appointment line.

Hotline to NHS dental appointments Getting an NHS dental appointment has been made easier this year with the launch of a new dental appointments helpline.

Hertfordshire residents can telephone 01707 369645 or email dentalappointments@herts-pcts.nhs.uk to find out the practice nearest to where they live or work that is offering NHS dental appointments.

Since its launch in January 2009, the dental appointments helpline has received more than 600 calls from people in East and North Hertfordshire (to April 2009).

“It’s a popular misconception that NHS dental appointments are rare - but that is simply not the case”, says Jane Robinson, Dental Lead at NHS East and North Hertfordshire.

“We really want to make sure that good quality and accessible NHS dental treatment is available locally for all who need it. Across the county, there are 204 dental practices offering approximately 47,000 appointments every month.

So there really are plenty of appointments out there.”

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Patient experience We believe in putting people at the centre of everything we do and believe that understanding and improving the health care experiences of patients, families and carers is fundamental to providing safe and effective care.

Over the past 12 months, a number of initiatives have been put in place locally and nationally to improve patient experience.

NHS Constitution launched Local patient groups in Hertfordshire got a preview of the first ever NHS constitution last summer, when we sought their views on the contents of this historic document.

We passed on people’s comments to the Department of Health and were pleased to be given the opportunity to witness first hand the official launch of the constitution at a Downing Street reception in January 2009.

Heather Aylward from the PCTs’ public engagement team attended the launch. She said: “This landmark document will put in one place what patients, staff and the public can expect of the health service. It is designed to safeguard the future of the NHS, making sure it continues to be relevant to the needs of patients, the public and staff for many years to come. We were delighted that the NHS in Hertfordshire was able to be present at this historic event.”

The constitution sets out patients’ rights as well as their responsibilities to look after their own health, and also contains a range of pledges to patients, public and staff, which the NHS is committed to achieving.

The NHS Constitution can be found at: www.dh.gov.uk/nhsconstitution

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Birthday celebrations for the NHS Youngsters from a Hitchin primary school had a rare encounter with a 1950s Daimler ambulance when it parked up on their playground during a special day to mark the 60th anniversary of the NHS.

The independent Hertfordshire Local Involvement Network (LINk) was also launched in 2008 as a way for everyone in the community – from individuals to voluntary groups to: •

Pam Handley, Chair of NHS East and North Hertfordshire, visited Wilshere-Dacre Junior School in July 2008 to explain to Year 3 and 4 pupils about how the health service has changed since 1948.

During the event, children met a modern day paramedic, designed posters which will be displayed in health centres and clinics across the county, and released 60 balloons, one for every year of the NHS. Talking to the public Throughout the past year patients and other members of the public have been giving us their views on existing services and helping us develop new ones.

A Stakeholder Forum – independently chaired, with senior representation from councils, voluntary sector and patient groups is supporting the local NHS through its major service changes. Since its inception the forum has given its views on several key projects including hospital transport, how intermediate care services will develop and the PCTs’ commissioning priorities for the next five years. You can find our more about service changes on page 40.

• •

S ay what they think about local health and social care services – what is working and what is not Influence how services are planned and run See how their feedback helps services to improve

The LINK has focused its work on issues such as access to dentists, the location of family planning clinics and cancer screening. More information on the LINk can be found at: www.communityvoicesonline.org/ Local patient groups A number of local patients are also now supporting the practice based commissioning group in Welwyn Hatfield.

This group of eight GP surgeries in the area are responsible for buying and designing health services that best meet the needs of local residents. During the past year the group has begun working with GPs and consultants to introduce some gynaecology services in local surgeries. This means that many women won’t have to go to hospital for their outpatient appointments.

Over the next year we aim to establish a patient group to support each practice based commissioning area – 13 in total across the county.

Mental health and learning disabilities We work alongside Hertfordshire County Council to make sure mental health and learning disability services are in place for all who need them. Here are some of our achievements from the past 12 months.

BrainBox – unlocking the secrets of mental health We are proud of our innovative and committed approach to caring for people with mental health and learning disabilities. Last year, adults and children with anxiety, anger and addiction issues all benefited from using the BrainBox – the unique creation of our Emotional and Mental Health Advisor Deborah Bone. Deborah explains more: What inspired you to develop the BrainBox? I wanted a tool that I could use with young people to help deal with anger and anxiety and help remove the stigma surrounding accessing mental health services.

How does it work?

The BrainBox uses recycled computer parts to show how our bodies react in stressful situations. It demonstrates to children, young people and adults how the response is triggered, how neuro connections are re-routed and why children are not always to blame for their actions but can do something about them.

How effective is it?

It has proved to be very popular, especially with boys, and has been found to make a real difference to their emotional and mental health and wellbeing.

Who uses it?

The BrainBox can be used for anger management and to treat anxiety and addiction issues in both children and adults. Best of all, it can be used in the classroom by educational professionals who do not have advanced mental health training.

It comes complete with a manual and DVD, which includes a demonstration of the BrainBox in action. Around 25 organisations across East and North Hertfordshire are now using the BrainBox as part of a new wellbeing project in schools.

PCT is award winning!

Deborah Bone and her colleague Julie Nash picked up a prize in the 2009 Innovation Competition organised by Health Enterprise East. Their Sticking Plasters for Children’s Souls story book won in the ‘Publications and Training Aids’ category. Aimed at five to 11 year olds, this contains poems and stories written to help with healing, learning and

personal transformation. The stories deal with a number of mental health issues and can be used by parents, teachers or children themselves.

Talking therapies expanded across county People with mental health problems in Hertfordshire are getting faster access to more treatment choices, thanks to an expansion in our ‘Improving Access to Psychological Therapies’ (IAPT) programme.

‘Talking therapies’ have already been offered to more than 1,000 people with mild to moderate mental health issues in Letchworth and Stevenage. Each patient is given a fast-track service which involves an assessment within 10 days of the initial referral, and a choice of therapy sessions in their GP surgery, over the phone or even online. This allows patients to fit therapy around their busy lives and helps some patients to remain in work while undergoing treatment.

Initial project findings show that more than 90% of patients are satisfied with their psychological treatment; many preferring ‘talking therapy’ to being dependent on anti-depressant medication. In addition, waiting times for psychological treatment of anxiety and depression have fallen to just 25 days where the IAPT service is available.

Thanks to the success of the initial pilot, talking therapies will now be available across the county.

One patient, a retired senior manager suffering from agoraphobia, received psychological therapy on the IAPT programme following unsuccessful drug treatment. After 10 sessions with a psychologist, and attending an anxiety management group, the patient was discharged. In a letter, he wrote: “Our sessions have encouraged me to build on the lessons from the anxiety management course and the ‘targets’ you have set me have given me something to aim for. All of this has helped me to improve and gradually increase my quality of life. I aim to make the most out of it – thank you.”

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Maternity and newborn Our main goal is to ensure that our maternity and newborn services are of high quality, give women choice in how they give birth and put parents and babies at the centre of planning decisions.

On track to give mothers and babies improved care We are determined to provide the highest levels of care for our patients, which is why we commissioned an independent review of our maternity and women’s services.

The review involved talking to mothers, maternity staff, GPs, local councillors and patient representatives about their experiences. It will shape the way we care for mums-tobe when women and children’s inpatient services transfer from the QEII Hospital in Welwyn Garden City to the Lister Hospital in Stevenage in the next few years.

The review’s key recommendations include: •

•

•

S upport for introducing midwife-led birthing units alongside consultant-led services to give pregnant women choice over how they give birth Improving local antenatal and postnatal services run by midwives at the QEII site in Welwyn Garden City and also on the other side of the county in St Albans and in Hemel Hempstead Support for the decision to close the birthing unit at Hemel Hempstead Hospital

26 | Annual Report and Accounts 2008/09

Anne Walker, Chief Executive of NHS East and North Hertfordshire, said: “Our aim is to provide women with access to safe, high quality maternity care for themselves and their babies. It is now our responsibility to make sure that services are developed that meet these needs and which provide the right balance of quality, choice, safety and accessibility for mums-to-be.”

Listening to local mothers Maternity services are some of the most widely used and important services delivered by the local NHS. Ensuring that the views and experiences of mothers help shape these services is the idea behind our Maternity Service Liaison Committee (MSLC). In Hertfordshire there are two local MSLCs – one in East and North Hertfordshire and one in West Hertfordshire.

Members of the group include people who are currently or have recently used maternity services, as well as NHS staff such as doctors, midwives, GPs and paediatricians.

The committee performs an important role, ensuring that families from all parts of the community have an opportunity to comment on services, suggesting which areas could benefit from improvement, and providing advice to the community on childbirth.

that ‘lay’ members make a valuable contribution to the development of local maternity services. Women talk about their birth experiences to their friends so why not share them with the people who can make a real difference?”

If you are interested in joining the MSLC please contact NHS East and North Hertfordshire on enquiries@hertspcts.nhs.uk

Melanie Peeke is a parent and a member of the East and North Hertfordshire MSLC. She says: “I have been involved with the local MSLC for about four years. I must admit that at first, the thought of attending meetings with consultants, midwives and NHS managers was a little daunting but they couldn’t have been more welcoming. My thoughts and opinions are taken as seriously as anybody else’s and I believe

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Our people Our staff are our greatest asset and we are proud of the first class services they deliver for patients.

We have in place an organisational development programme to make sure that our organisation is somewhere people want to come and work and where they feel their contribution is recognised.

During the past year we have held our first long service awards ceremony for staff where we celebrated those staff who have committed their careers to the NHS. We also hosted our first staff awards to say thank you to those staff who have gone the extra mile.

Applauding our people From nurses and therapists to office administrators, our staff are working hard to provide excellent health services. Last year we launched the ‘Applauding Our People’ awards as a way of recognising the individuals and teams who go the extra mile to help patients.

Nominations for awards came from patients, staff and managers. Here are the deserving winners:

Patient Excellence Winner: Jane Scanlon, Community Matron Nominated by a colleague, Jane was recognised for being a true patient advocate. She said: “I feel really overwhelmed to win as there were so many outstanding applicants and I hope this award will bring greater recognition for the matron service.

Achievement in Learning Winner: Karen Kelly, Senior Occupational Health Nurse Karen was rewarded for studying for a degree in Occupational Health Nursing - a qualification which was above and beyond what her role required. She is now regularly putting forward innovative ideas to improve the quality of services. Karen said: “It was lovely to have my achievements recognised in such a positive way. All too often no news is good news, with regards to performance and development, so it was great that the opposite was the case this time.”

Innovation Winner: Patient Advice and Liaison (PALS) Team and Heather Aylward, Patient Engagement Manager The team was recognised for its work with prisoners at the Mount Prison in Bovingdon. A team member said: “The PALS team were happy and surprised to be nominated – it was morale boosting and was great to feel appreciated.”

Unsung Hero Winner: Dot Lutkin, Communications Officer Dot was recognised for being enthusiastic, dedicated to her role and for her personal commitment to improving communication within the organisation. She said: “I have always enjoyed my job and working with staff. The fact that I’ve received an award has inspired me to encourage people in everything they do.”

Team of the Year Winner: Intermediate Care Team East (based in Welwyn) This team was nominated for its tireless efforts to provide outstanding care to patients. Staff were praised for their ability to alleviate both the clinical and social problems that can prevent older people living in their own homes.

Individual of the Year Winner: Pam Gledstone, Professional Lead – Health Visiting Pam received support from many different colleagues for this award.

She has been described by her staff as “vigilant, reliable, sensible, approachable and knowledgeable”, and described by her managers as someone who always gives her best and puts patient care at the forefront of all her endeavours.

Pam said: “I started as a student nurse in 1964 and have worked continuously within the NHS, mainly as a community health visitor. I have seen many changes and reorganisations but I can honestly say I still look forward to coming to work and have enjoyed all my 44 years in the NHS, and especially within Hertfordshire.“

Vision and values In 2006 the merger of eight PCTs in Hertfordshire into two, severely disrupted traditional lines of communication and ways of operating. This led to low staff morale and uncertainty about the future. In order to help establish a new identity for our organisation and to make it somewhere people wanted to come and work, we introduced and developed our first vision and values.

Our Vision Our ambition is to be a high performing PCT, recognised by our people, patients and partners as commissioning outstanding care and improving the wellbeing of all.

Our Values •

•

•

•

•

•

aring C I care about everything I do for colleagues, patients and partners.

Confident I am trusted to make informed and timely decisions and have the confidence to see them through.

Creative I have the freedom to bring forward new ideas and solutions Learning I take responsibility for my personal development as part of our learning culture Fun I play my part in making this an enjoyable and rewarding place to work Proud I am proud to work for NHS East and North Hertfordshire

More than 2,000 of our staff have taken part in events we have hosted to introduce our vision and values during 2008/09. These events have given staff the opportunity to meet the executive team and get to know colleagues from across the organisation.

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Children’s health We are committed to improving the health and wellbeing of children in Hertfordshire and responding to their particular needs. We want to make sure that services are childfriendly and we want to take their own views into account when planning services

Where children take centre-stage

bodies. This can cause life-threatening diseases like cancer, diabetes and heart disease - so it’s really important that we do something about it.

In 2008, Hertfordshire reached its ambitious aim of having 50 Children’s Centres across the county with the opening of a centre in Sawbridgeworth.

It can be hard these days to live a happy, healthy life but Change4Life can help. After all, none of us are perfect. The way we live in modern society means a lot of us, especially our kids, have fallen into unhealthy habits. But we can make small changes that make a big difference.

Children’s Centres are facilities for local communities, where under-fives and their families can receive a range of services under one roof.

Offering day care for babies and children, a variety of parenting programmes and clinics, centres give help to parents and children alike. All of our centres reflect the needs and concerns of local people. Reflecting the large number of parents who work, centres in our towns have well established day care programmes, whereas centres in more rural parts of Hertfordshire may have more of an emphasis on signposting parents to local services.

Children’s Centres are managed by a variety of statutory and voluntary agencies. Ensuring that families receive care that is seamless and joined-up, staff work alongside many other agencies including Children’s Schools and Families, schools and community groups.

By 2010 there will be a Sure Start Children’s Centre in every community in Hertfordshire – a total of 82 centres serving children and families from birth, right through to when children start school.

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If you join Change4Life you will receive lots of helpful information, games, tools, tips and a free welcome pack designed to help you to give your family a happier, healthier future.

Healthy eating starts young If national trends continue, 90% of today’s children could be overweight or obese by 2050. That shocking statistic is the motivation behind the Department of Health-led campaign Change4Life These days, ‘modern life’ can mean that we’re a lot less active. With so many opportunities to watch TV or play computer games, and with so much convenience and fast food available, we don’t move about as much, or eat as well as we used to. Which means that 9 out of 10 kids today could grow up with dangerous amounts of fat in their

You can join Change4Life by visiting www.nhs.uk/ changeforlife or by phoning 0300 123 4567* for a chat.

Offices are open 9am – 6.30pm, Monday to Friday.

End of life Being diagnosed with cancer or a life-limiting illness is challenging for the patient but also for the people who love and care for them. Our team give people living with cancer and their families and carers, the support and help they need to improve their quality of life.

Dignity until the end Our palliative care team comprises Macmillan nurses, consultants and nurse specialists who work with patients and their families mainly in their own home but also in care homes and community hospitals. They work alongside our local hospices.

They provide complex specialist care and advice regarding symptom control, act as advocates and help patients discuss the choices they have and the extremely sensitive subject of where they want to die. They help families prepare for the death of their loved one and encourage patients and their families to talk about their feelings as well as more practical issues such as the type of funeral the patient would prefer.

They can offer a calm and practical presence at what is a very emotional time.

which people access them. These goals include giving patients greater choice about where they receive care, ensuring that patients can be admitted to a hospice seven days a week, and delivering a 24-hour community nursing service across the county. We will also implement a scheme that will improve the care given to patients in their final few days.

We are also working closely with other agencies including cancer and other clinical networks, patients and carers associations, social care services and the private sector to help ensure that the care of terminally-ill patients is as seamless and coordinated as possible.

Making sure that patients who need palliative care receive an effective and supportive service is a key priority for NHS East and North Hertfordshire.

That is why we have carried out a review of our end-of-life care and identified specific goals which will help us improve the provision of these important services and the way in

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Staying healthy NHS East and North Hertfordshire offers a wide range of primary care services that can help you lead a healthier life, including help to quit smoking

Be a quitter!

Did you know that stopping smoking is the one single thing you can do to dramatically increase your chances of living longer?

If you want to quit the habit and you live or work in Hertfordshire, you’re in the right place! We have a broad range of local support services in locations and at times to suit you. From one-to-one clinics to drop ins at your nearest pharmacy, we’ve got the help that’s right for you.

In 2008/2009 the Hertfordshire Stop Smoking Service (SSS) helped 1,768 people in East and North Hertfordshire to give up smoking.

Once you stop smoking, your body’s self-healing mechanism kicks in very quickly – and marks the beginning of a remarkable journey: After 8 hours…

Your blood oxygen levels return to normal and your chance of having a heart attack falls After 24 hours…

Carbon monoxide leaves your body. Your lungs start to clear out mucus and debris After 48 hours…

Your body is now nicotine free and your sense of taste and smell should have improved

After 2-12 weeks…

Circulation is improved throughout your body. It’s easier for you to walk and exercise now After 3-9 months…

Your lung capacity has increased by 5-10%. Coughing, shortness of breath and wheezing are all steadily diminishing After 5 years…

You now have only half the chance of getting a heart attack compared to a smoker After 10 years…

The chance of you getting lung cancer is now half that of a smoker. Your chances of having a heart attack are now the same as someone who’s never smoked John Greaves successfully quit using the Hertfordshire Stop Smoking Service “Until I met Liz from the Hertfordshire Stop Smoking Service I had no intention of giving up. I met her by chance at an event where I was working and arranged to meet her again for a chat about quitting. I remember thinking on my way to our first meeting that there was no way I would be giving up but actually during that journey I smoked my last cigarette. Liz and the service supported me to kick a 32 year smoking habit and I have now been a non smoker for 20 weeks. If I can do it then anyone can.”

To find out more visit: www.hpherts.nhs.uk or call 0800 389 3998.

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Immunisation Immunisation is a way of protecting yourself against serious disease. Once you have been immunised, your body is equipped to fight that disease if you come into contact with it. NHS East and North Hertfordshire is responsible for making sure that local vaccination programmes are in place.

MMR The MMR vaccination provides protection against measles, mumps and rubella (German measles). MMR is given to children aged 12 to 15 months and again before starting school at three to five years of age.

Measles, mumps and rubella are viruses that are easily passed on by close contact, coughing and sneezing. All three are often mild illnesses but can be potentially more serious. If contracted during pregnancy they can both cause miscarriage, and rubella can cause babies to be born with heart problems, deafness, blindness or other major problems.

The uptake of the MMR vaccination in Hertfordshire is slightly lower than the national average. There were 37 confirmed cases of measles in Hertfordshire during 2008.

It is important that parents immunise their children against measles, mumps and rubella to help prevent measles becoming more widespread.

Dr Jane Halpin, Director of Public Health at NHS East and North Hertfordshire, says: “Some parents are worried that MMR is linked to autism or bowel problems. Researchers in many countries have not found evidence of any link between MMR and these conditions. I understand the anxieties that

this issue generates but parents need to be aware of how important it is for their children to receive this vaccination.

For further information on the MMR jab, speak to your health visitor or GP, or call NHS Direct on 0845 4647 or go to: www.immunisation.nhs.uk/vaccines/mmr Flu Flu, or influenza, can be a serious illness, contributing to the deaths of between 3,000 and 4,000 people each year in the UK. People aged 65 and over are particularly at risk, even if they are otherwise healthy. Flu jabs are also strongly recommended for anyone with a chronic illness, such as diabetes and asthma, and for people living close together in residential care homes.

Immunisation is a way of protecting yourself against serious disease.

Once you have been immunised, your body is equipped to fight that disease if you come into contact with it

You are eligible for a free flu jab on the NHS if you: • • • •

•

are aged 65 or older live in a long-stay residential home care for people who are elderly or infirm have a history of chronic illness including heart conditions, kidney disease, chronic asthma or diabetes that requires medication have lowered immunity to infection due to HIV, steroid medication or cancer treatment.

Last winter, almost 77% of people aged 65 and over had a free flu jab in East and North Hertfordshire, as did a further 46% of people identified as ‘at risk’ of contracting flu.

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For more information visit www.immunisation.nhs.uk/ vaccines/flu or www.nhchoices.nhs.uk Swine flu Since the emergence of a new kind of flu virus (swine flu) in Mexico this year, NHS East and North Hertfordshire has been implementing its plans to make sure we are well placed to manage pandemic flu in Hertfordshire.

We have worked closely with colleagues at the Health Protection Agency, the Strategic Health Authority, neighbouring NHS organisations, local councils and the emergency services so that our approach is co-ordinated, robust and involves all relevant bodies.

Pandemic flu is different from ordinary flu because it is a new flu virus that appears in humans and spreads very quickly from person to person worldwide.

Because it’s a new virus, no one will have immunity to it and everyone could be at risk of catching it. This includes healthy adults as well as older people, young children and those with existing medical conditions.

The best way to protect yourself and stop the spread of flu viruses is to: • • •

c over your nose and mouth when coughing or sneezing, using a tissue when possible dispose of dirty tissues promptly and carefully wash your hands with soap and water to reduce the spread of the virus from your hands to face, or to other people.

An easy way to remember this is: Catch it, Bin it, Kill it.

HPV Nearly three-quarters of cervical cancers could soon be eliminated thanks to a new vaccination programme.

36 | Annual Report and Accounts 2008/09

The HPV, or ‘human papilloma virus’ vaccine is now being offered to all 12 and 13-year-old girls in school year 8 across Hertfordshire.

The vaccine protects against the two types of HPV which cause more than 70% of cervical cancers.

“New cases of cervical cancer have been falling for years thanks to the national cervical cancer screening programme,” said Dr Hilary Angwin, Public Health Consultant for Women and Children’s Services at NHS East and North Hertfordshire.

“The HPV vaccination should ensure the number of women who get cervical cancer in Hertfordshire will fall significantly in the years to come.”

While the vaccine protects against the most dangerous types of HPV, it will still be necessary for girls, like their mothers, to take part in the NHS cervical cancer screening programme once they are old enough.

Girls who are currently aged 17 or 18 will also be offered a vaccination. From August 2009 there will be a catch-up vaccination programme for girls aged 15 to 18 (school years 10 and 11), so that by summer 2011, all girls in Hertfordshire up to the age of 18 will be protected.

Latest figures show that uptake of the HPV vaccine by 1213 year olds living in East and North Hertfordshire is broadly in line with the national average at around 80%. Uptake by 17-18 year olds is slightly higher than the national average at around 55% although this is still lower compared to the younger age group. This difference is because the vaccination programme for the school aged children is carried out in schools. The older age group receive their vaccination in health clinics. We plan to increase uptake by the older age group next year by offering the vaccination in school and in clinics.

Further information is available at www.immunisation. nhs.uk/Vaccines/HPV or by calling the national HPV helpline on 0845 602 3303.

cleanyourhands campaign Determined to reduce the number of healthcare-related infections, NHS East and North Hertfordshire has joined the National Patient Safety Agency’s ‘Cleanyourhands’ campaign.

‘Cleanyourhands’ staff champions have been identified at each of our sites, and are responsible for encouraging all staff, patients and visitors, to clean their hands regularly.

So far, informal feedback has been very positive and we believe the campaign will play an important role in reducing infection amongst patients.

Healthy weight, healthy lives Few parents like to admit that their child is overweight, many simply don’t realise what a healthy weight should be.

We want to raise awareness amongst parents about what a healthy weight is and how they can help their family to achieve it.

We have distributed 55,000 leaflets to parents of primary school children, explaining the link between a healthy weight and its importance for the future health of children.

We have also made sure that more than 10,000 children in reception class (aged 4 to 5 years) and year 6 (aged 10 to 11years) have been weighed and measured in 2007/08, as part of the National Child Measurement Programme. We have told parents the results and given them information to make the first small changes in lifestyle.

Hertfordshire area will use to talk to parents about healthy eating and fitness for their family.

By working closely with all our partners, and coordinating the support available to children and their families, we are determined to meet our target of halting the year-on-year rise in obesity among local children, helping families make healthier choices along the way.

Bowel Cancer Screening People across east and north Hertfordshire are benefiting from bowel cancer screening. The bowel cancer screening home kits have so far helped to save the lives of 30 people in its first year.

Under the NHS-funded scheme, nearly 37,000 screening packs were sent to people, aged between 60 and 69, across east and north Hertfordshire.

Faye Beard, one of East and North Hertfordshire NHS Trust’s specialist bowel cancer screening sisters, said: “We’ve been really busy over the last year and there’s been a lot of support for the screening programme.

“We’ve been working really hard to get the message out there about the programme but unfortunately there are still a lot of people who don’t know what it is and how beneficial it could potentially be for them.

“We also hear lots of people saying they haven’t got any symptoms, are fit and well and don’t see why they have to do anything. But the fact is that there are often no symptoms of bowel cancer when it’s at such an early stage, which is why the screening test kits are designed to detect early traces of bleeding from a cancer that are invisible to the naked eye.

We also understand that information must be clear. That’s why we have developed an easy-to-use toolkit, which every GP, health visitor and school nurse in the east and north

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“Basically, the earlier bowel cancer is caught, before it has chance to spread to other parts of the body, the easier it is to cure.”

Could you spot a stroke?

You could save a life

Susan Marsden, screening manager at NHS East and North Hertfordshire, says: “The NHS offers a range of cancer screening programmes including bowel, cervical and breast cancer screening. Routine screening aims to detect disease whilst it is in its early stages. The earlier we can start treating patients, the more likely they are to make a good recovery.

We strongly recommend that people take advantage of invitations to attend for screening.”

Every five minutes someone in the UK suffers a potentially deadly stroke. That’s more than 100,000 people every year, 1,000 of whom are under 30 years old.

Bowel cancer is the third most common cancer in the UK and claims the lives of more than 16,000 people every year.

But research has shown that regular screening reduces the risk of dying from bowel cancer by 16%.

It’s an undeniably gloomy picture but it doesn’t have to be this way. The quicker a stroke is spotted and treated by specialists, the better the chance of survival and recovery.

Learning the FAST test could save your life, or the life of a loved one.

FAST stands for: •

The programme is part of a nationwide initiative led by the Department of Health. From March 2008, the local NHS has offered every resident aged between 60-69 free screening once every two years to catch the disease before it has a chance to take hold. Although not part of the national programme, anyone over the age of 70 can request a home screening kit by contacting 0800 707 60 60.

• • •

F acial weakness - can the person smile?

Has their mouth or eye drooped?

Arm weakness - can the person raise both arms?

Speech problems - can the person speak clearly and understand what you say?

Time to call 999

Stroke is definitely an emergency and if you suspect one, you should dial 999 immediately.

Dr Declan O’Kane from the QEII Hospital in Welwyn Garden City agrees. He says: “If someone fails the FAST test, you must call 999. Swift action can prevent further damage to the brain and help someone make a full recovery. On the other hand, delay can result in death or major longterm disabilities, such as paralysis, severe memory loss and communication problems. Everyone should remember to think FAST!” You can find out more about how to spot the symptoms of a stroke and read about how other people have coped with a stroke by visiting www.nhs.uk/stroke

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Helping patients to help themselves We have also put in place a number of projects for patients to help them gain the confidence and the skills to manage their long term conditions themselves.

Over the past year we have run self management courses for patients with Diabetes and Multiple Sclerosis.

People with sight difficulties have also been taking part in the ‘Eye Can Help’ programme run by local charity Hertfordshire Society for the Blind in partnership with NHS East and North Hertfordshire.

The courses, held in Hertford and Letchworth give patients the knowledge, skills and confidence to live with their long term eye conditions. Further courses are planned across the county including some for patients with dual sight and hearing difficulties.

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Changing services Decision on site of new local general hospital

NHS East and North Hertfordshire and NHS West Hertfordshire have an ambitious strategy to improve and modernise acute care services across the county. Over the past year, significant progress has been made towards our goal of providing better levels of primary and community care closer to where people live and also investing in services such as mental health. Some of the milestones include:

In July 2008, NHS East and North Hertfordshire approved the QEII Hospital site in Welwyn Garden City as the location for a new local general hospital.

This decision was supported by local patient and community representatives and follows a rigorous financial appraisal to select the most suitable and sustainable site for the new development.

Work on redeveloping the QEII site is expected to start at the end of 2011 with the new hospital ready to open by the end of 2013.

Full steam ahead for Lister Surgicentre In April 2009, plans were approved for the creation of a state-of-the-art, multi-million pound Surgicentre at the Lister hospital site in Stevenage.

The Surgicentre will serve patients from across east and north Hertfordshire and south Bedfordshire who require routine surgery, along with some short stay operations.

The three-storey, high-tech building will have six operating theatres including two with highly specialised ventilation systems needed for orthopaedic joint replacements, a dedicated eye theatre; and around 26 short-stay inpatient beds. The Surgicentre will also house day surgery, outpatient and ophthalmology services, including urgent eye clinic facilities.

It is estimated that the Surgicentre will treat around 15,000 NHS patients a year for common procedures such as hip and knee replacements, hernia repairs and cataracts.

40 | Annual Report and Accounts 2008/09

Nick Carver, Chief Executive of East and North Hertfordshire NHS Trust said: “Patients are always the driving force behind any decisions we make and the development of the new Surgicentre is excellent news for them. By helping us to separate planned and emergency surgery, this exciting new facility should mean that our patients experience much shorter waiting times and fewer cancelled operations.’

Urgent Care Centres

Clinicenta will finance the building of the Surgicentre, with NHS East and North Hertfordshire purchasing clinical services on behalf of local people.

Latest figures show that the average waiting time is just 20 minutes and the majority of people are seen, treated and discharged within two hours.

Construction work will begin shortly with the centre expected to open in March 2011.

Brand new Urgent Care Centres for Hertford and Cheshunt will open in autumn 2009, St Albans in March 2010 with more to follow across the county over the next 3 years.

Major boost to maternity services In 2008, further steps were taken towards a major £15.4m expansion of the maternity unit at the Lister hospital in Stevenage, which will create state-of-the-art midwife and consultant-led units.

The project will expand the Lister’s current maternity unit and will be designed with new delivery rooms – some of which will have water birth facilities – and neonatal cots.

The new facility, is expected to assist more than 5,500 births every year.

The county’s first 24-hour, 7 days a week Urgent Care Centre (UCC) opened at Hemel Hempstead Hospital in October 2008. It is designed to treat the majority of people who have an illness or minor injury that is not life threatening.

Elsewhere in Hertfordshire Changes are also afoot in neighbouring West Hertfordshire.

In 2008/09, progress has included the successful transfer of AandE services from Hemel Hempstead to Watford General Hospital and agreement has been reached on plans for a new local hospital for Hemel Hempstead.

The unit will enable the hospital trust to bring together all of its specialist maternity staff on to a single site, providing women with more choice in how they give birth. These choices may include home birth, a midwife-led birth, or specialist care in a consultant-led unit. Whichever option is chosen, women will continue to receive their ante and post natal care close to where they live, just as they do now.

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Quality 42 | Annual Report and Accounts 2008/09

This year is the first year the PCTs have had to write a quality report as part of the annual report. The introduction of a quality report was proposed as a first step towards the introduction of quality accounts which are to be a statutory requirement from 2009/10. The PCTs quality report focuses on the clinical services provided by our provider services.

Report www.enherts-pct.nhs.uk | 43

The drive for improvements in quality are firmly embedded in the strategic plans of the PCT and the 3 components of quality: safety, clinical effectiveness and patient experience all come together to inform the board, clinicians, patients and the public about the services we provide.

In 2008/09 we continued to develop our competencies as World Class Commissioners and with that saw the separation of our provider services into Hertfordshire Community Health Services (HCHS). It is vital in taking forward the development of HCHS we do not lose focus on the need to ensure a high quality service is delivered to our population.

As commissioners of services we continue to implement the Delivering quality health care for Hertfordshire (DQHH) programme with increasing emphasis on the need to ensure where it is clinical effective and safe to do so we bring care closer to home.

Quality improvement priorities for 2009/10

Quality overview 2008/09 Patient experience The patient experience has remained at the core of the clinical governance activity undertaken in year. Work undertaken in the first six months of the year supported the transfer of the complaints process from the Hertfordshire PCTs central team to the HCHS team.

For the year April 2008 to March 2009 a total of 159 complaints were received over the whole year. In addition 142 compliments were received from October 2008 to March 2009. Follow up with services by a named patient experience lead and implementation of the complaints training programme has assisted improved engagement by service leads in the management of complaints and this programme will be continued as part of the annual training programme.

Some changes in practice following investigation of complaints include: • •

In determining our priorities we are building on the work already in place to improve quality and considered areas which fit with our agreed strategic plans. The quality priorities relate to the services provided by HCHS.

• •

We consider our quality priorities to be: • • • •

Delivery of same sex accommodation healthcare associated infections safeguarding children developing a systematic approach to patient experience.

I ntroduction of revised patient group directions for Genito Urinary Medicine, reaffirming safe clinical practice.

Introduction of specialist speech and language therapists in children’s services, improving access for children with specific needs.

A review of access to the complaints process to improve access for patients wishing to respond via email.

Implementation of specific training and managerial support for identified bed based intermediate care services to raise awareness of privacy and dignity and communication needs of patients in this care pathway.

To read the full quality report please visit our website: www.enherts-pct.nhs.uk

44 | Annual Report and Accounts 2008/09

GP access In response to the commitment to offer patients choice in their healthcare and longer GP surgery opening hours the PCTs have worked closely with GP practices to commission extended hours services across the county. As a result 39 GP practices (around 62%) in East and North Hertfordshire now offer appointments outside normal working hours, including more than 20 which open on a Saturday morning.

Dental services The PCTs are committed to ensuring that good quality and accessible NHS dental treatment is available locally for all who need it. Opinion Research Services (ORS) was commissioned by the two PCTs to undertake a telephone survey of residents’ attitudes and opinions about dental care in Hertfordshire. In particular, the PCTs were interested to know whether the perception that patients were unable to obtain an NHS dental appointment was true.

Overview of performance against the key national priorities from the operating framework and the DH core standards National targets and regulatory requirements

2008-2009

The Trust has fully met the CQC core standards and national targets

23/24

18-week maximum wait from point of referral to treatment (non-admitted patients)

West Herts PCT 98.1% East and North Herts PCT 98.8%

The survey results reveal that for most people visits to the dentist are part of their regular routine with most making dental visits at least yearly. However, there is some evidence to suggest that younger people and those in full time work are less inclined to make regular check-up visits with a tendency to visit only when seeking treatment. On the other hand, part time workers and retired people find the time to make regular visits to the dentist.

Views about how easy or difficult it is to access NHS appointments were split between respondents with about two fifths saying it is easy to get appointments and the same proportion saying it is difficult. This is in spite of the fact that awareness of NHS dentists within 12 miles of home is relatively high at 68%.

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46 | Annual Report and Accounts 2008/09

The year ending 31 March 2009 has seen NHS East and North Hertfordshire build on its financial recovery of the preceding year, and marks an important shift in our direction of travel.

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Overview NHS East and North Hertfordshire is in financial balance and stable. While we are never complacent, we are no longer restricted by debt or deficit, and can look forward to a year of continued financial security which is good news for our patients, staff and the wider health and wellbeing agenda.

Agreement has been reached to consolidate emergency and acute care on the Lister Hospital site in Stevenage, and on the same site, moves are afoot to create an elective care centre, known as a Surgicentre. This new centre will mean less disruption for patients because planned operations will be separate from emergency treatment, reducing the likelihood of operations being cancelled due to unexpected emergencies.

From April 2009 our clinical services became an ‘arms-length’ organisation –Hertfordshire Community Health Services. We are now aiming for excellence in local services by developing our role as strong and ambitious commissioners.

Our out-of-hours GP service has been launched, offering access to GP services between 6.30pm-8am, and all day at weekends. The service is fulfilling a vital role in bringing healthcare provision closer to the community.

We are making good progress on the world-class commissioning programme – a government-backed scheme aimed at transforming the way health and care services are commissioned. In undertaking this challenging reform of the way we work, NHS East and North Hertfordshire is seeking to deliver a more strategic and long-term approach to commissioning services, with a clear focus on improving the health of our population and delivering improved health outcomes. This is guided by our ambitious commissioning strategy which will frame our vision for more patient-centred care, delivered in a variety of community settings.

A fresh approach to the treatment of people with mental health problems has been agreed which seeks to consolidate inpatient provision while strengthening our community-based services. Specialist care will be provided at sites in Hemel Hempstead, Welwyn/Hatfield and Stevenage; all designed to complement a more proactive and community-based approach to treating people with mental health needs.

Responsibility for the healthcare budget lies with us, and we are determined to carry out our commissioning role with precision, creativity and the needs of patients at the fore.

48 | Annual Report and Accounts 2008/09

As ever, our staff have proved instrumental in our achievements. Over the past 12 months, their dedication to the health and wellbeing of the people of East and North Hertfordshire has helped the PCT consolidate its financial recovery and embed new ways of working.

To help support them during these changing times, we developed a staff organisational development programme

called ‘Making the Difference’. Many of our staff from across departments have taken part in workshops, appraisals and other learning opportunities to equip them with the skills and knowledge needed to deliver our ambitious vision.

The past year has also seen the implementation of our ‘Reward and Recognition’ scheme which aims to acknowledge formally the hard work and commitment of our staff. During four awards ceremonies in November and December, the achievements of staff members were recognised with many also receiving awards for long service.

While we have much to be proud of and certainly more challenges ahead, ensuring that local people play a greater role in shaping health services is one of our key strategic objectives.

Going forward into 2009/2010, as we develop better and more innovative ways of delivering healthcare, we will seek to further strengthen our patient and public involvement processes enabling the people of East and North Hertfordshire to have their say in the way services are provided.

50 | Annual Report and Accounts 2008/09

Our Performance Operating and financial review

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Strategic objectives and progress The PCT’s objectives for 2008/09 are shown below.

Objective

Progress

The PCT, together with Practice Based Commissioning Groups (PBC) lead the local NHS

- Clinical leadership roles agreed - PBC commissioning plans agreed

Implement ‘Delivering quality health care for Hertfordshire’

- - - -

Building and sustaining the reputation of the PCT and local NHS

- Communications strategy agreed

Develop an effective and engaged workforce

- - - -

Continue to develop the Boards and Committees, to ensure that robust arrangements are in place for all aspects of integrated governance

- Performance Management Framework agreed - Integrated Governance Strategy updated and agreed - Board 360o Review undertaken

Deliver on local and national targets and standards

- See section on Key Performance Indicators on page 54

Become increasingly effective commissioners

- Commissioning Strategy agreed - Joint Strategic Needs Assessment completed alongside social care colleagues - Primary Care Balanced Scorecard developed and published to help patients understand how their practice is performing - Quality metrics built into contracts and monitored - Key indicators agreed for GPs, dentists and pharmacists - First assessment under new World Class Commissioning programme completed - Organisation Development Programme to support World Class Commissioning developed.

Ensure patients and the public can contribute effectively to improving health and shaping health services

- Patient and Public Involvement Strategy agreed - Action plan developed and on track

Ensure further development of Practice Based Commissioning

- - - - -

52 | Annual Report and Accounts 2008/09

38 practices open for extended hours New ‘out of hours’ GP and dental contract in place covering all of Hertfordshire Contract awarded for new Spring House Medical Centre in Welwyn Garden City.

County workforce group in place ‘Making the Difference’ programme rolled out to all staff Reward and Recognition scheme in place Long service awards and staff awards scheme now in place Significant increase in staff appraisals and personal development plans

PBC group-based needs assessments complete Better information given to PBC groups Increased financial support and advice to PBC groups Template for review of business cases agreed Fast track process for business cases in place

Objective

Progress

Sustain financial recovery

- Financial targets met - Priorities for investment agreed in Commissioning Strategy See Financial Review section for further details

Ensure our Provider arm delivers services to patients that are personalised, effective and of high quality

- - - - -

Build capacity and capability within PCT Provider Services to enable their progression towards arms- length status

- Organisation Development Programme in place - Contract agreed between Provider Services and PCT

Patient Experience Group established Revised privacy and dignity toolkit being rolled out to staff Complaints and incident reporting processes in place Plan in place to reduce waiting times Staff vacancy rates reduced

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Key performance indicators In addition to finance, performance in the NHS is judged by measuring a large number of non-financial targets. In the 2008/09 operating framework, the Department of Health described five key priority areas which had been developed through listening to what patients and the public believe are the most important issues.

Performance or progress on measures which contribute to delivery of the key priority areas is shown below.

The national key priority areas for 2008/09 were:

3 Improving cleanliness and reducing healthcareassociated infections, eg:

•

1 Improving access, eg: • • • •

maximum 18 weeks waiting time for referral to treatment improving access (including at evenings and weekends) to GP services better access to genito-urinary medicine (GUM) clinics maintaining 98% operational standard for accident and emergency departments

2 Keeping adults and children well, improving their health and reducing health inequalities, eg: • • • •

helping people to stop smoking tackling childhood obesity increased screening for chlamydia reducing waiting times for cancer treatment

54 | Annual Report and Accounts 2008/09

From December 2008, the targets are:

• •

Methicillin Resistant Staphylococcus Aureus (MRSA) Clostridium Difficile (CDiff)

4 Improving patient experience, staff satisfaction, and engagement

•

f or patients needing admission, 90% to wait no more than 18 weeks from referral by their GP to treatment for patients treated without admission, 95% to wait no more than 18 weeks from referral by their GP to treatment.

Performance in these priority areas

In December 2008, NHS East and North Hertfordshire achieved these targets, with 91% of patients requiring admission being seen and treated within 18 weeks; and 96% of non-admitted patients being seen and treated within 18 weeks. Performance against these targets was maintained during the remaining months of 2008/09.

1 Improving access Maximum 18 weeks waiting time for referral to treatment Throughout 2008/09 the PCT has been working with service providers to reduce the length of time patients wait for treatment in consultant-led services.

Improving access (including at evenings and weekends) to GP services 38 GP practices (62.3%) now operate extended hours, exceeding the target of 50% of practices which was set for 31 March 2009.

5 Preparing to respond in a state of emergency, such as an outbreak of pandemic flu

Better access to genito-urinary medicine (GUM) clinics The national target is to ensure 100% of patients are offered an appointment to be seen within 48 hours by GUM services. By the end of March 2009 performance was 99.37% - this is close to target and improving further. This figure incorporates performance across a high number of GUM clinics, some of which are local, others further afield.

The changes implemented within local services, where we obviously have the greatest influence, are now regularly delivering 100%.

Maintaining 98% operational standard for accident and emergency departments The standard for A&E performance is that 98% of people should not have to wait for more than four hours before being admitted or discharged. East and North Hertfordshire NHS Trust achieved this operational standard across the year. There were times from late December to early February where performance was less than 98%. However, the PCT supported its partners to find solutions to ease the pressures and improve performance during this period. Performance has subsequently improved.

2 Keeping adults and children well, improving their health and reducing health inequalities Helping people to stop smoking Achievement of the smoking cessation target remains a significant challenge. Our target for 2008/09 was to achieve 3,489 4-week quitters. By the end of March 2009 we had reached 1,768. A number of measures have been undertaken over the year to increase the numbers of patients making use of these services. These include recruiting more staff, advertising the service more actively, training up a large number of smoking cessation advisers in local pharmacies and general practices, offering an incentive scheme for service providers seeing more patients, and working directly with large pharmacy groups.

Whilst our performance against the quitting target is not where we would like it to be, this is only one element of more widespread work to reduce smoking across the whole

population, e.g. discouraging teenagers from becoming smokers in the first place. A recent ‘health and lifestyle’ survey has shown the success of the overall approach, and smoking levels are continuing to fall across NHS East and North Hertfordshire.

Tackling childhood obesity The national objective for the NHS and its partners is to halt the year-on-year rise in obesity among children under 11 by 2010. At a local level, the PCT is expected to deliver the National Child Height and Weight programme to 85% of children in reception and year 6. Under this programme, every child is measured, with the data used to help the PCT forward plan health provision and provide more tailored health services for local children.

This year NHS East and North Hertfordshire weighed and measured more children than its original plan, however the overall participation rate for the year just missed the target (84.986%) because there were more children than expected in each year.

Increased screening for chlamydia The target is to screen 17% of 15-24 year olds. During 2008/09 we screened 11.3%. Performance in the final quarter of 2008/09 shows improvement with 3,421 screens undertaken in the final quarter. Had this rate been undertaken across the whole year 12.8% of the target population would have been screened. The target for 2009/10 has increased from 17% of the “at risk” population to 25% of the “at risk” population. The PCT will need to assure it begins its screening programme early enough in the year to achieve this even more challenging target. Further mailshots continue, and together with other initiatives, are leading to an ongoing increase in screening levels.

Reducing cancer waiting times Performance for quarter 3 showed that each of the four cancer waiting times targets were met. This means that 100% of patients waited less than 2 weeks from urgent GP referral to first outpatient appointment. The overall

wait from referral to treatment was 62 days or less for all patients and there was a wait of 31 days or less from diagnosis to treatment for all patients.

Quarter 4 performance was measured against a new set of definitions to bring them in line with the 18 week measurement definitions. This meant fewer opportunities to ‘stop the clock’, for example if a patient wanted to consider their treatment options then the clock could not be paused whilst they were deciding what they wanted to do.

Performance against two of the four indicators was affected by this change. Our performance is shown below: Q1 – Q3

% receiving first definitive treatment in one month

99.734%

Q4

% receiving first definitive treatment in one month

97.590%

Q4

% subsequent treatment in one month

98.305%

Q1 – Q3

Percent treated in 2 months GP

98.380%

Q4

Percent treated in 2 months GP

84.375%

Q4

Percent treated in 2 months screening

100%

Q4

Percent treated in 2 months – consultant upgrade

100%

3 Improving cleanliness and reducing healthcare-associated infections The further reduction of methicillin resistant staphylococcus aureus (MRSA) and clostridium difficile (CDiff) rates remained key targets for 2008/09.

East and North Hertfordshire NHS Trust met both these targets with just 18 MRSA infections reported to the end of the year against a limit of 21, and 114 CDiff cases against a

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limit of 183. Primary care organisations also worked towards targets on cleanliness and reducing healthcare-associated infections during 2008/09. This was constructed on the basis of incidence rates for the population. The target for 2008/09 was to have fewer than 386 incidents of clostridium difficile.

NHS East and North Hertfordshire has made excellent progress with 239 reported cases by the end of March 2009.

4 Improving patient experience, staff satisfaction, and engagement NHS East and North Hertfordshire is committed to developing a strategic approach to patient and public engagement, to ensure that involvement is linked to both national and local NHS priorities; and to provide an opportunity for patients to have a say in their health services.

The PCT is a partner in a public engagement partnership with the county and district councils, and Hertfordshire Police.

A countywide stakeholder forum of local authority and voluntary sector partners has been established to advise on the implementation of health service changes from a stakeholder perspective.

The PCT regularly engages with carers, black and minority ethnic (BME) communities, people who are homeless, Travellers, Gypsy and Roma communities; and young people, through the Health Care Ambassador programme.

Members of the Hertfordshire Local Involvement Network (LINK) serve on many of the PCT’s committees, and play an active part in PCT activities. The PCT has an observer on the LINK Board.

56 | Annual Report and Accounts 2008/09

Staff engagement is considered to be a high priority within the PCT and communication with staff continues to improve.

planning exercises that included scenarios involving train and aircraft accidents and pandemic flu.

The NHS National Staff Survey which takes place every October revealed that staff are generally more satisfied that the PCT has improved in many areas.

During this year we spent much of our time developing arrangements to prepare for and respond to an influenza pandemic. This included examining workforce issues, preparing for massive increases in demand for care, as well as developing recovery management arrangements.

We also worked with GP surgeries to implement business continuity software that would enable them to plan for a pandemic flu outbreak.

Twice as many staff as last year responded positively when asked if management has set out a clear vision for the organisation and if they had a clear understanding of the values of the organisation.

Further indicators include the number of staff who have considered leaving the organisation. This has dropped by 10%, with 90% of staff saying they felt trusted to do their job, 84% believing their role makes a difference, and 80% saying they found their jobs interesting.

Further actions from the results of the staff survey are being identified and followed up to reinforce our position as an employer of choice.

5 Preparing to respond in a state of emergency, such as an outbreak of pandemic flu NHS East and North Hertfordshire is the lead PCT for emergency planning in Hertfordshire. Our emergency planning team works across both of the Hertfordshire PCTs. The role of our team is to prepare the two Hertfordshire PCTs to respond to a range of incidents as defined in NHS and central government guidance and to support our local hospitals and mental health trust to do the same.

In 2008/09 we created a dedicated control and command centre from which we can manage incidents. We participated in a number of local and regional emergency

We worked on supporting all Hertfordshire trusts in developing business continuity arrangements and the continuing development of hospital evacuation plans, aiming to ensure that the local health economy has flexible arrangements in place to maintain services during challenging circumstances.

During the year we also dealt with live incidents including the delivery of a suspicious package to the PCT offices and the effects of severe weather and snow.

Reporting to the PCTs’ Emergency Planning and Resilience Sub-Committee ensures that the work of our emergency planning team reflects local needs, while our active engagement with partners across Hertfordshire and the East of England region is building robust working arrangements essential in responding to major incidents and emergencies.

Annual health check The Annual Health Check, published by the Healthcare Commission (now the Care Quality Commission) in October each year, is the system for assessing and rating the performance of NHS organisations in England.

The results published in October 2008 (covering the period April 2007 to March 2008) gave the PCT a ‘fair’ rating in both ‘Use of Resources’ and ‘Quality of Services’. These ratings were a marked improvement from the previous year when the PCT was assessed as ‘weak’ for both.

For 2008/09, the PCT will for the first time do separate self assessments on core standards for better health for the provider and commissioning functions. This will form part of the assessment of the quality of services that we provide to our residents and commission on behalf of the population that we serve.

The PCT continues to make good progress on meeting the core standards and the national targets. The following tables show our performance for this year’s (2008/09) existing commitments and national priorities.

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Existing Commitments Indicators

Target 2008/09;

Performance

Access to GUM clinics within 48 hours

100%

3

Category A calls meeting 19 minute standard (Ambulance Trust Performance)

95%

3

75%

–

95%

–

829

7

Category A calls meeting 8 minute standard (Ambulance Trust Performance)

We are measured on the performance of the ambulance trust as a whole across the East of England region.

The performance of the ambulance trust for Hertfordshire residents met the targets.

Category A calls meeting 8 minute standard (Ambulance Trust Performance)

We are measured on the performance of the ambulance trust as a whole across the East of England region.

The performance of the ambulance trust for Hertfordshire residents met the targets.

Commissioning of crisis resolution/home treatment services

Hertfordshire Partnership Foundation Trust (HPfT) has identified a data quality issue in the counting of people receiving Crisis Home Treatment. The data issue which has now been corrected resulted in the performance against target which was thought to be good, being below target. An action plan is being prepared by HPfT and the Joint Commissioning Team to rectify the situation in 2009/10.

Commissioning of early intervention in psychosis services

3

Data quality on ethnic group

Despite significant improvement over recent years NHS East and North Hertfordshire did not meet this target. This target predominately relates to data collected at the East and North Herts NHS Trust. Plans are in place to improve, with performance being monitored at the commissioning and information group

85%

–

Delayed transfers of care (6 per 100,000 pop)

We have identified that these delays were the result of poor communication between the various agencies involved and a lack of awareness of the correct process in some cases. We have developed a project to integrate all those involved in the discharge planning process with the objective of reducing the number of delays.

Diabetic retinopathy screening

– 100%

3

Inpatients waiting longer than the 26 week standard

0%

3

Outpatients waiting longer than the 13 week standard

0%

3

Patients waiting longer than three months (13 weeks) for revascularisation

0%

–

Time to reperfusion for patients who have had a heart attack

68%

–

Total time in AandE (maximum 4 hour wait)

98%

3

Target 2008/09;

Performance

This target was missed under achieved by 0.059% (the equivalent of one patient).

National Priorities Indicators 18 week referral to treatment times 18-week Referral to Treatment (RTT) target for Admitted pathways 18-week Referral to Treatment (RTT) Data Completeness for Admitted pathways 18-week Referral to Treatment (RTT) target for Non-Admitted pathways 18-week Referral to Treatment (RTT) Data Completeness for Non-Admitted pathways Access to primary care

This indicator is now wholly based on the GP survey results across 5 areas. We underachieved on this in 07/08 and thresholds for 08/09 have not yet been published so the estimate is that we will underachieve

Access to primary care dental services – the proportion of population visiting an NHS dentist in past 24 months

3 90%

3

90-110%

3

95%

3

90-110%

3

85%

–

338,269

3

National Priorities Indicators

Target 2008/09;

Performance

640 males - 463 females

3

65.441

3

Reduction in cancer mortality rate in people age under 75 (20% by 2010)

105

3

All cancers: one month diagnosis to treatment (including new cancer strategy commitment)

96%

3

All cancers: two month GP urgent referral to treatment (including new cancer strategy commitment)

85%

3 Subject to benchmarking

All cancers: two week wait

93%

3

>70% (aged 53-64) >65% (aged 65-70)

3

85% participation rate Maintain / reduce rate 9% for YR 15% for yr 6

7

17% of population

7

Achieve level 3

3

60

3

3,528

7

Incidence of Clostridium difficile

386

3

NHS staff satisfaction

3%

3

1,652

3 Subject to benchmarking

Recorded coverage 85% Prevalence 46%

7

(Dtap/IPV/Hib: aged 1) = 95% (PCV: aged 2) 86% (Hib/ MenC: aged 2) 85% (MMR: aged 2) 86% (DTaP/IV:aged 5) 95% (MMR:aged 5) 85%

3

25%

7

24.6

– Subject to benchmarking

Level 2

–

All age all cause mortality Reduction in CVD mortality rate in people age under 75 (40% by 2010)

Breast cancer screening for women aged 53 to 70 years Childhood obesity rate

Participation rate fell below target of 85% due to increase in number of pupils in each year above expected levels

Chlamydia screening (as a proxy for chlamydia prevalence)

This is a challenging target for Hertfordshire and further promotional work will continue to bring about an ongoing increase in screening levels

Commissioning a comprehensive child and adolescent mental health service (CAMHS) Experience of patients Four week smoking quitters See information on page 34

Number of drug users recorded as being in effective treatment Prevalence of breastfeeding at 6-8 weeks from birth (data completeness)

Our data was rejected as the CQC did not record that the PCT had submitted Q3 data. The PCT have queried this.

Proportion of individuals who complete immunisation by recommended ages Stroke care

This target refers to the percentage of patients spending time on a dedicated stoke ward after being admitted with a stoke. The Stroke Network manage this on behalf of the PCT and a plan is in place to improve this.

Teenage conception rates per 1,000 females aged 15-17

This target was missed by 7% more than planned figure (Herts-wide figure)

Women who have seen a midwife or maternity healthcare professional by 12 completed weeks of pregnancy

This target relates to women who have seen a midwife or maternity healthcare professional by 12 completed weeks of pregnancy. The indicator this year relates to the data quality of the information submission. We reported that data was collected from some trusts but not comprehensive across all locations.

Key: 3 = achieved – = close to achieving 7 = not achieved

60 | Annual Report and Accounts 2008/09

Financial Review The year ended 31 March 2009 was successful on many fronts. The PCT returned to a strong financial position, recording an underspend of ÂŁ1.7m, whilst at the same time improving performance on key service targets.

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Whilst the PCT can look forward with some confidence, the economic situation and the fact that the PCT receives more than its target share of funding, is likely to result in lower growth in resources beyond 2010/11. Therefore the PCT must continue to strive to achieve value for money across all of its spending.

The key features in setting budgets for 2008/09 were: • • •

• • • •

• • • • •

eadline growth in revenue resources of £36m (5.46%) h additional funding of £25m available because the historic accumulated debt has now been paid off a deposit of £7.5m into a strategic reserve held at the Strategic Health Authority (SHA) to ensure that growth is smoothed over the next three years to ensure a more sustainable approach to new investment contingency reserves set aside at the beginning of the year of 1% of funding planned increase in expenditure compared to 2007/08 recurrent expenditure of 7.8% inflation of generally 2.3%, except for primary care where the uplift was 1.5% additional net investment above inflation, on acute services of 2.8%, to meet the targets for reducing waiting times growth in prescribing budgets of 7% over 2007/08 expenditure growth in other primary care budgets, including dentistry, of 6% above inflation reinvestment of all the underspends on provider services in 2007/08 investment in continuing care of 3.7% above inflation investment in mental health and learning disabilities of 4% above inflation.

62 | Annual Report and Accounts 2008/09

Whilst achieving financial balance in 2008/09, there were some significant variances on individual budget lines.

Expenditure on acute services exceeded the budget set, with the main contributory factors being the higher than expected levels of activity required to achieve the 18-week waiting time target, increased referrals and higher than planned costs for some specific treatments including renal activity, critical care, cancer services and high cost drugs.

The overspend on acute services was offset by underspends on corporate services, mental health, primary care services and drugs prescribed. The underspend on mental health arose because not all of the 4% additional funding included in the budget was spent by year end.

Financial duties and targets There are four main financial targets. Performance on these in 2008/09 is detailed below.

1) Costs not to exceed revenue resource limit The PCT’s revenue resource limit was £693m and expenditure was £691m. The PCT had always planned to underspend by £1m and this target was exceeded with expenditure being within the agreed resource limit by £1,683,000. This underspend will be returned to the PCT by the Department of Health, who will increase the PCT’s resource limit by £1,683,000 in 2009/10.(Accounts – Note 2.1) 2) To remain within cash limit All PCTs are set a cash limit. This is the amount of cash that can be drawn from the Department of Health. PCTs are not allowed to be overdrawn and are expected to end the year with minimal cash balances.

Management costs Although no formal national targets are set for PCTs, a concerted effort was made to keep costs to the minimum while still ensuring the smooth running of the PCT and achievement of its objectives. Management costs recorded in the accounts are only a small part of ‘headquarters’ costs and are defined nationally. In 2008/09 management costs made up less than 1.6% of total spending. The total for the year was £10.8m or £22.08 per head of weighted population, a reduction on 2007/08.

The PCT drew down its full cash limit and retained no cash at 31 March 2009.

The pay rise for staff and managers in 2008/09 was 2.75% and was the first year of a three-year agreement on pay.

This was in line with the guidance from the Department of Health. Lower paid staff received slightly higher awards, with the removal of the lowest pay point which increased the NHS minimum wage by 5.8%.

The target was therefore achieved.

(Accounts – Balance Sheet)

The pay rise for Very Senior Managers in 2008/09 was 2.2%.

(Accounts – Note 5.5)

3) Capital costs not to exceed capital resource limit The PCT’s capital resource limit was set at £2.7m and capital expenditure incurred was £2.6m. The PCT achieved this duty, underspending by £66,000. (Accounts – Note 2.2)

Public Sector Payment Policy The PCT has an obligation to pay non-NHS creditors within 30 days of receipt of goods or a valid invoice (whichever is later), unless other payment terms have been agreed. This is monitored during the year. The PCT paid 88% of invoices from non-NHS organisations within this target. This is an improvement on performance in 2007/08 (71%), but is still short of good practice. By value, 90% of invoices were paid within target, an improvement on 2007/08, but also short of good practice.

4) To recover the full cost of provider services NHS East and North Hertfordshire both commissions services and also provides them directly. The PCT has to demonstrate that it has received income to cover the full costs of the services it directly provides. In 2008/09, the net cost of services provided was £48m and the funding provided from the PCT’s own allocation was £48m. The PCT therefore achieved an underspend on provider services of £31,000, consequently meeting the target.

(Accounts – Note 2.3)

On invoices from other NHS organisations, the PCT paid 72% of invoices (97% by value) within 30 days. In both cases this is an improvement on 2007/08. Performance on all measures steadily improved during the year and the PCT expects performance in 2009/10 to be better still.

(Accounts – Note 6.1)

Related party transactions In the year to 31 March 2009, a number of local GPs sat on the Board and Executive Committee of the PCT. Payments amounting to £5.5m were made to these GPs’ practices, in their capacity as providers of primary care services.

Payments for similar services were made to other GP practices within the PCT. The GPs on the Board and Executive Committee had no direct control over how these funds were allocated.

All Board members and senior managers are required to complete a declaration setting out any outside interests. In the year to 31 March 2009, there were no payments made by the PCT to organisations included in the register of interests.

The Department of Health is regarded as a related party.

During the year, the PCT had a significant number of material transactions with the Department, and with other entities for which the Department is regarded as the parent Department. Further details of the amounts and the parties involved are included in the accounts. (Accounts – Note 20) Where the money was spent As mentioned above, the PCT is both a commissioner of services and a provider. The majority of the PCT’s funding was spent on commissioning services from other NHS and non-NHS organisations. The largest single element was spent on general and acute services (43.6%). Next came prescribing (10.9%), and primary care general medical services (10.4%). Around 7% of total spending went on services provided directly by the PCT. A more detailed analysis of where the money was spent is shown in the pie chart on the following page.

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Analysis of 2008/09 Net Expenditure Mental Healthcare 6.8%

Other Healthcare 4%

PCT Provided Services 7.0%

Prescribing 10.9% Learning Disabilities 6.6%

AandE 2.1%

General Medical Services 10.4%

Other Family Health Services 6.5%

Maternity 2.0%

General and Acute 43.6%

64 | Annual Report and Accounts 2008/09

Financial outlook Achieving financial balance in the last two years has been a major success Growth funding for next year and the year after is 5.5% and 5.8% respectively. However, it is clear that growth funding in the following years will be considerably less.

The PCT has therefore developed a five-year financial plan, alongside the Commissioning Strategy. The plan will see increased investment in services, but with £2.6m additional funds held back in reserve for investment after 2009/10 when growth in funding is expected to be smaller. The plan also sees a reduction in the proportion of the PCT’s funding spent on acute services. There will be increased funding in particular for mental health services, prescribing, community and primary care. The strategy also includes the development of a new local general hospital in the Welwyn Hatfield area, with a likely capital cost of around £30m.

Implementation of International Financial Reporting Standards (IFRS) in 2009/10 In the 2008 budget it was announced that public sector bodies would produce financial statements based on IFRS from 2009/10.

The reasons for introducing IFRS were set in the context of the government’s need for “high value performance data in combination with appropriate financial data”. IFRS, as adapted for use in the public sector, will be used to provide benefits in consistency and comparability between financial reports in the global economy and to follow private sector best practice.

In April 2008, the PCT created a project team to oversee implementation. Members of the team attended specialised

external training courses to ensure appropriate accounting treatment. An internal course was developed and delivered for the development of the wider finance community and other relevant PCT staff.

The PCT successfully restated its 2007/8 closing balances on 19 December 2008. The PCT has reviewed and amended its internal procedures to ensure that IFRS was fully operational from 1 April 2009.

In 2009/10, with the additional deposit with the SHA of £2.6m (making £10.1m in total), and the return of the underspend in 2008/09, the PCT is planning for an underspend of £1m. This will act as a safety net in-year and be carried forward to future years if not utilised.

www.enherts-pct.nhs.uk | 65

66 | Annual Report and Accounts 2008/09

The business plan for 2009/10 is important as it is the first plan produced by the PCT to reflect its aspiration to become a World Class Commissioner.

Looking to the Future www.enherts-pct.nhs.uk | 67

Our strategic objectives 1) Delivering our strategy and national targets The vision of the PCT is as follows: “Our ambition is to be a high performing PCT recognised by our people, patients and partners as commissioning outstanding care and improving the wellbeing of all.”

The strategy has three strategic priorities. These are: • • •

Keeping Hertfordshire healthy Enhancing the patient experience Commissioning high quality healthcare for the population of Hertfordshire

The World Class Commissioning assurance framework requires us to select a number of outcomes to measure our success. These clearly need to relate to the delivery of our strategic priorities. With this in mind, we have chosen the following 15 outcomes:

1. Increase life expectancy 2. Reduce the difference in life expectancy between the most and least deprived communities 3. Increase the number of people who give up smoking 4. Reduce the prevalence of obesity in year 6 school children 5. Increase uptake of the MMR vaccination 6. Reduce the mortality rate from cardiovascular disease 7. Improve patient satisfaction with access to GP services 8. Increase the proportion of people visiting an NHS dentist.

9. Reduce the number of babies born by caesarean section 10. Increase the number of people who can control their diabetes 11. Reduce the prevalence of chronic obstructive pulmonary disease 12. Increase the number of people with long-term conditions who have personal health plans 13. Increase the number of people who are able to die in their own homes 14. Improve patient experience scores 15. Reduce then eliminate Clostridium Difficile within healthcare settings.

In order to deliver our strategy we have identified the following nine strategic workstreams: • • • • • • • • •

Staying Healthy Acute Care, Planned Care Mental Health Learning Disabilities Maternity and New Born Children’s Health Long Term Conditions End of Life Patient Experience

2) Developing capacity and capability The World Class Commissioning Assurance Framework recognises 10 competencies. In order to become World Class Commissioners, PCTs need to demonstrate that they are at level 4 for each of these competencies. At the end of 2008, NHS East and North Hertfordshire was assessed against these competencies. This identified that we were operating at either level 2 or 1 for all of the competencies. In order to improve and become World Class Commissioners, we have developed a World Class Commissioning Organisational Development Plan. This aims to transform the PCT so that it will operate at level 3 or 4 for all of the competencies within a two-year period and at level 4 for all of the competencies in a three-year period.

The development plan includes the following 10 strategic priorities: 1.Develop a commissioning mindset 2. Improve contracting and commercial capabilities 3. Develop and utilise a prioritisation framework for all investment and service redesign 4. Development of a data repository and analytical skills 5. Assessment of provider market 6. Drive clinically led evidence based change 7. Proactively engage public and patients 8. Focus on working with all our partners to improve care and reduce health inequalities 9. Develop real and structured processes and an appropriate workforce to deliver World Class Commissioning 10. To be more responsive to patient experience within commissioning.

In order to deliver the strategic priorities we have identified eight projects. Detailed plans have been drafted for these projects.

Key to our success will be the further development of Practice Based Commissioning.

68 | Annual Report and Accounts 2008/09

3) Making best use of resources In order to achieve our strategic priorities, the PCT needs to ensure that it makes the most efficient and effective use of its resources including: • • • • •

Finance Human Resources Estates Information Communication and Technology Governance

The business plan outlines objectives for these areas, clearly relating them to the delivery of our strategic priorities.

The PCT has two strategies in place setting out the configuration of community and hospital services – ‘Delivering Quality Healthcare for Hertfordshire’ (DQHH) and ‘Investing in Your Mental Health’ (IiYMH).

These have both been widely consulted on and DQHH is the subject of a full business case. Implementation has commenced, with IiYMH currently being the subject of a stock take. This aim is for both strategies to align with the recommendations of Professor Lord Ara Darzi’s Next Stage Review and the East of England SHA’s ‘Towards the Best, Together’, as well as the requirements of the World Class Commissioning assurance programme.

www.enherts-pct.nhs.uk | 69

70 | Annual Report and Accounts 2008/09

Governance Controls and Audit www.enherts-pct.nhs.uk | 71

Policy on managing principal risks The Assurance Framework provides a comprehensive method for the effective management of the principal risks that arise in meeting the key strategic objectives agreed by the PCT Board.

It identifies objectives which are at risk, gaps in control and insufficient assurances. It also provides a structure for evidence to support the ‘Statement on Internal Control’ and facilitates reporting key information regularly to the PCT Board.

Directors are responsible for the continual updating of the Assurance Framework including evaluation of the risk score, updates on progress and identification of actions against gaps in control and assurance. The Assurance Framework is monitored by the Joint Integrated Governance Committee and PCT Board.

Role of the Joint Integrated Governance Committee The committee is responsible for the management of risk including organisational and that related to the delivery of healthcare. It also provides assurance to the Board on the systems and processes by which the PCT achieves organisational objectives, and the safety and quality of clinical services.

The core membership of the committee includes representatives from the Audit Committee. This provides a mechanism for the Audit Committees together with management reporting to oversee the detailed monitoring of progress against the Assurance Framework.

Information Governance In line with the Information Governance Strategy the PCT has assigned responsibility for information governance. Risks are managed, monitored and reviewed by the Information Governance Sub-Committee, which reports through the Joint Integrated Governance Committee, to the Board.

72 | Annual Report and Accounts 2008/09

Any personal data-related incidents and breaches are published within the PCT’s annual report in line with Department of Health directives.

Our staff induction has been revised to incorporate a stronger emphasis on information governance.

Freedom of Information requests There has been one Freedom of Information request.

The enquirer request the PCT provide the number of patient records that have potentially been reported as ‘compromised’.

In total there were 36 personal data-related incidents reported to the PCT in 2008/09. This includes seven incidents classified as serious untoward incidents and reported to the SHA. The table below shows serious untoward incidents that were reported to NHS East and North Hertfordshire from commissioned and Provider Services.

Role of the Audit Committee The committee’s principle function is to advise the Board on the adequacy and effectiveness of the PCT’s systems of internal control and its arrangements for risk management, control and governance processes.

Category

Nature of Incident

Total

I

Loss of inadequately protected electronic equipment, devices or paper documents from secured NHS premises

5

II

Loss of inadequately protected electronic equipment, devices or paper documents from outside secured NHS premises

14

Insecure disposal of inadequately protected electronic equipment, devices or paper documents

0

The opinion of the Audit Committee was that adequate assurance can be given to the Board on the effectiveness of the risk management and control processes in place during 2008/09.

IV

Unauthorised disclosure

4

Environmental matters, including policies NHS East and North Hertfordshire is committed to playing an active role in reducing carbon emissions.

V

Other

13

III

In view of the high level of national interest in potential data loss, all hardware and portal devices have now been encrypted. Policies and procedures incorporating information governance have been reviewed, ratified and approved by the board. Stringent reporting procedures have been implemented with associated risk assurance measures being assigned.

In order to fulfil this function, the Audit Committee prepares an annual report for the Board and Accountable Officer. This report includes information provided by Internal Audit, External Audit and other assurance providers.

We have signed up and been accepted on a programme run by the Carbon Trust. This will assist us in our work to implement the NHS Carbon Management Initiative - which provides healthcare organisations with support and guidance to identify realistic carbon reduction opportunities that deliver significant cost savings. All of the PCT’s operations will be assessed in terms of their energy consumption and related carbon emissions. Technical and change management support is provided to enable organisations to work through a step-by-step process to identify and quantify carbon reduction opportunities. The final element of the

programme; a Carbon Management Plan (CMP) will provide a business case to support each of the most appropriate measures of reducing carbon emissions.

In addition, the PCT is represented on the multi agency Climate Change LAA Group; and the Herts NHS Environment Group which feeds into the Hertfordshire Environmental Forum (HEF) has been active for almost five years.

without the need for patients to ask their GP, helping to ensure that patients receive care closer to home.

• Where training cannot be provided locally, we have funded individuals to train at specialist centres. For example, our paediatric speech and language therapists have been continually updating their skills, helping to enhance their work with children who have speech and language difficulties.

•

With the support of this group the PCT has undertaken a range of environmental improvements in the workplace which include recycling schemes for waste paper and cardboard, installation of compactors for waste control and green transport initiatives.

Furthermore, Hertfordshire County Council and Herts NHS Environment Group recently commissioned a review of the effects of climate change on the delivery of health and adult care services in Hertfordshire.

PCT employees, including policies The PCT is fully committed to supporting all staff to develop and enhance their skills ensuring they can provide the best patient care and support services possible.

Our staff undertake training to ensure they can deliver safe care, for example infection control and hand hygiene, health and safety, and fire training. This year we have provided our biggest health and safety training programme ever, with more than 1,400 course places taken up.

During 2008/09 the PCT developed and implemented a number of HR policies including a bullying and harassment policy, recruitment and selection policy and Working time regulations policy and guidance. All approved policies can be viewed on our website at www.enherts-pct.nhs.uk and clicking on ‘Publications’.

Absence due to staff sickness The overall sickness absence rate for the PCT from April 1st 2008 to March 31st 2009 was 3.91%. 1

The PCT offers staff the opportunity to join the NHS pension scheme, details of which are set out in note 1(o) of the Accounts on page 77.

The average regional PCT rate for 2008 was 5.58% (placing the organisation 2nd out of 14 PCTs regionally). 2

Provision of information to and consultation with employees

The average national PCT rate for 2008 was 4.48% (placing the organisation 37th out of 147 PCTs nationally). 2

We have a range of mechanisms that encourage twoway dialogue within the PCT. These include: 1

•

We have also sought to ensure that clinical skills are up-to-date by providing a range of in-house training sessions covering issues such as continence and intravenous therapy. Other courses have been provided by the University of Hertfordshire.

Several of our community matrons and other nursing staff have attended a ‘Non Medical Prescribing’ course at the University of Hertfordshire. This means that an increasing number of our nurses can prescribe some medicines

•

such as policies, training courses and information on forthcoming events. It also contains a social area Regular chief executive meetings with staff that take place in a range of locations around the county.

These meetings give community and other staff the opportunity to meet the chief executive, learn about progress with our priorities and to raise issues or ask questions A programme of visits to staff at their bases or to their team meetings by the chair and the executive team All staff have been invited to an event to understand and engage in our new vision and values.

•

monthly team briefing, comprising key messages A from the executive team, an update on our organisational development programme, a list of newly approved policies and guidance documents; and opportunities for managers to add items of interest for their individual service. The team briefing is cascaded throughout the organisation and its purpose is to encourage managers to discuss PCT matters with their staff face to face and includes a mechanism to convey staff views, thoughts and comments back up to the executive team A very successful intranet that receives many hits per day containing a wide range of corporate information

2

Source: ESR Absence Timeline Analysis Source NHS Information Centre iView database

www.enherts-pct.nhs.uk | 73

We have confirmed our commitment to improving access of services to all through publication of a ‘Single Equality Scheme’ and the ongoing implementation of the action plan.

NHS East and North Hertfordshire works with many partners on the advancement of equal opportunities.

Over the past year we have: Policy in relation to disabled employees The PCT retains the positive (or two ticks) symbol from Jobcentre Plus and actively supports the employment of staff with disabilities.

A Disability Staff Network Group was launched in March 2009 and a participant of this group is also a member of the Equality and Diversity Steering Group. Our latest records show that 10 members of staff from NHS East and North Hertfordshire declare themselves to have a disability.

Policy on equal opportunities The PCT has an equal opportunities policy which aims to ensure that all employees, irrespective of their background, are supported to develop their full potential. An equal opportunity statement is also included in all contracts of employment to ensure that all staff are aware of their responsibilities.

NHS East and North Hertfordshire is determined to ensure that we practise a culture of equality, diversity and human rights in the heart of the organisation and improve relations with the diverse population and identify health inequalities among our patients.

The PCT recruited an Equality and Diversity Manager in December 2008.

The PCT also has the following staff network groups: • • •

Black and minority ethnic staff (BME) Lesbian, Gay, Bisexual and Transgender staff (LGBT) Staff with a disability

•

• •

eld discussions with Hertfordshire County Council H to support the development of Hertfordshire Race Equality Council. This will assist the development of direct partnership work with local BME communities and help to improve relations within the county Produced information in 16 different languages as well as large print, Braille and audio Continued to develop close links with local disability organisations and BME communities through a series of ‘Fresh Start’ workshops which have helped us identify key issues such as funding for specialist services, production of accessible communications, interpretation services and promoted links with the traveller communities.

A three-year action plan has been developed to address health inequalities among certain groups in Hertfordshire, including people with learning difficulties, people in contact with the criminal justice system, and travellers.

The public health team has also been working with localised communities on specific health issues such smoking and adult obesity.

The PCTs jointly commissioned chartered surveyors to carry out Disability Discrimination Act (DDA) compliance surveys of the majority of our leasehold and freehold premises. As a result we have prioritised the issues identified by the audit and allocated £60,000 for adaptations to premises.

Remuneration report Members of the Remuneration Committee are non-executive directors only, and membership during the year was: • • • • • •

P hil Picton, Non executive Director, East and North, (Chair and member of the Committee for part year) Pam Handley, Chair, East and North PCT Linda Farrant, Non Executive Director, East and North Stuart Bloom, Chair, West Diane Bailey, Non executive director, West Herts, (Chair of the Committee for part year) Elaine Fox, Non executive director, East and North, (part year to replace Phil Picton).

The remuneration of senior managers is determined by national terms and conditions – Very Senior Manager Pay Framework. The framework includes the ability to pay performance related pay and in 2008/09 this has been applied.

The senior managers are employed under the nationally agreed contractual arrangements, all having been employed on permanent contracts which include a six month notice period. There is no provision in the contracts for termination payments save any contractual entitlements to redundancy compensation which would be calculated using the agreed NHS formula.

The majority of senior manager contracts commenced on 1st October 2007, are not fixed term so do not have any unexpired term, and include a six month notice period.

The PCTs have commissioned services from DisabledGo to provide information on all our estate facilities and make information on disabled access available to the public.

www.enherts-pct.nhs.uk | 75

Remuneration Report Salaries and Allowances Relating to the period 1st April 2008 to 31st March 2009

Name

2008 - 09

2007 - 08

Salary/Fees (bands of £5,000)

Other Remuneration (bands of £5,000)

£000

£000

35-40

0

Title

Benefits in kind (rounded to the nearest £000)

Benefits in kind (rounded to the nearest £000)

Salary (bands of £5,000)

Other Remuneration (bands of £5,000)

£000

£000

0

35-40

0

0

Pam Handley

Chair

Richard Henry

Non Executive Member

5-10

0

0

5-10

0

0

Phil Picton

Non Executive Member and Chair of the Joint Remuneration Committee

5-10

0

0

5-10

0

0

Linda Farrant

Non Executive Member and Chair of E and N Herts Audit Committee

10-15

0

0

10-15

0

0

Julia Witting

Non Executive Member and Chair of Joint Integrated Governance Committee

5-10

0

0

5-10

0

0

Chris Learmonth

Non Executive Member

5-10

0

0

5-10

0

0

Elaine Fox

Non Executive Member [from 01/09/2008]

0-5

0

0

Anne Walker

Chief Executive (50%)

70-75

0

0

65-70

0

0

Alan Pond

Director of Finance and Commercial Development (50%)

55-60

0

0

45-50

0

0

Jane Halpin

Director of Public Health (50%)

60-65

0

0

55-60

0

0

Gareth Jones

Director of Strategic Planning (50%)

50-55

0

0

45-50

0

0

Beverley Flowers

Director of Commissioning [from 21/11/2007] (50%)

45-50

0

0

15-20

0

0

Pauline Pearce

Director of Public Involvement and Corporate Services (50%)

35-40

0

0

30-35

0

0

Heather Moulder

Interim Chief Operating Officer Provider Services [from 01/12/2008] and Director of Nursing [up to 30/11/2008] (50%)

55-60

0

0

40-45

0

0

Clare Hawkins

Interim Director of Nursing from [01/12/2008] (50%)

5-10

0

0

Andrew Parker

Director of Primary Care and Service Redesign (50%)

45-50

0

0

40-45

0

0

Gloria Barber

Director of Human Resources (50%)

40-45

0

0

35-40

0

0

Dr Tony Kostick

Chair of the Professional Executive Committee

65-70

0

0

30-35

0

0

76 | Annual Report and Accounts 2008/09

Pension Benefits: Relating to the period 1 April 2008 to 31st March 2009

Real increase In pension at age 60 (bands of £2,500)

Lump sum at aged 60 related to real increase in pension (bands of £2,500)

Lump sum at age 60 related Real increase to accrued Cash Cash in Cash pension at 31 Equivalent Equivalent Equivalent March 2008 Transfer Value Transfer Value Transfer Value (bands of at 31 March at 31 March funded by £5,000) 2009 2008 PCT

Total accrued pension at age 60 at 31 March 2008 (bands of £5,000)

Name and title

£000

£000

£000

£000

£000

£000

£000

£000

Anne Walker - Chief Executive

0-2.5

5-7.5

25-30

75-80

474

333

93

0

Alan Pond - Director of Finance and Commercial Development

0-2.5

2.5-5

15-20

45-50

247

173

49

0

Jane Halpin - Director of Public Health

2.5-5

7.5-10

15-20

45-50

245

162

56

0

Gareth Jones - Director of Strategic Planning

0-2.5

0-2.5

15-20

55-60

367

266

66

0

Beverley Flowers - Director of Commissioning (from 21/11/2007)

0-2.5

2.5-5

5-10

20-25

113

78

23

0

Pauline Pearce - Director of Public Involvement and Corporate Services

0-2.5

2.5-5

10-15

30-35

204

143

40

0

Heather Moulder - Interim Chief Operating Officer Provider Services

2.5-5

12.5-15

20-25

60-65

342

214

86

0

Clare Hawkins - Director of Nursing from [01/12/2008]

0-2.5

0-2.5

10-15

30-35

167

123

10

0

Gloria Barber - Director of Human Resources

0-2.5

2.5-5

15-20

5.-55

392

273

79

0

Andrew Parker - Director of Primary Care and Service Redesign

0-2.5

2.5-5

10-15

40-45

249

173

50

0

Employer’s contribution to stakeholder pension

www.enherts-pct.nhs.uk | 77

•

Notes: 1. As Non Executive Members do not receive pensionable remuneration, there will be no entries in respect of pensions for Non Executive Members.

• 2. Cash Equivalent Transfer Values •

•

Cash Equivalent Transfer Value (CETV) is the A actuarially assessed capital value of the pension scheme benefits accrued by a member at a particularly point in time.

The benefits valued are the member’s accrued benefits and any contingent spouse’s pension payable from the scheme.

•

•

A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme.

The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies.

The CETV figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme.

They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost.

•

ETVs are calculated within the guidelines and C framework prescribed by the Institute and Faculty of Actuaries.

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

4. Pension Benefits Represents 50% of the total amount claimed, the balance being paid by NHS West Hertfordshire.

Expenses The table below details the expenses claimed by Board members during 2008/09. This information is also available on the NHS East and North Hertfordshire website: www.enherts-pct.nhs.uk along with more details of the specific policies governing expense arrangements.

NHS East and North Hertfordshire Board Expenses 2008/2009 Position

Period From

To

Parking at Office £

Official Mileage £

Lump Sum £

Excess Travel £

0

3,561

0

3

Public Course Telephone Subsistence Parking Transport Expenses Costs £ £ £ £ £

Total Expenses £

Chair Pam Handley

01/04/08 31/03/09

0

0

1,095

0

0

4,656

Non-Executive Directors Richard Henry

01/04/08 31/03/09

Philip Picton

01/04/08 31/03/09

0

760

0

0

0

65

0

0

0

825

Linda Farrant

01/04/08 31/03/09

0

1,053

0

0

0

131

0

0

0

1,183

Julia Witting

01/04/08 31/03/09

0

675

0

0

0

250

0

0

0

925

Christopher Learmonth

01/04/08 31/03/09

0

225

0

0

0

33

0

0

0

258

78 | Annual Report and Accounts 2008/09

No Claim

NHS East and North Hertfordshire Board Expenses 2008/2009 Parking at Office £

Official Mileage £

Lump Sum £

Excess Travel £

01/09/08 31/03/09

0

608

0

0

0

139

0

0

0

747

Anne Walker* Chief Executive

01/04/08 31/03/09

(509)

1,315

700

544

0

145

363

0

(10)

2,548

Alan Pond* Director of Finance

01/04/08 31/03/09

(509)

1,690

917

0

0

114

88

0

0

2,299

Dr Jane Halpin* Director of Public Health

01/04/08 31/03/09

(509)

371

833

0

0

56

39

0

0

789

Gloria Barber* Director of Human Resources

01/04/08 31/03/09

(509)

0

0

0

0

0

0

0

0

(509)

Gareth Jones* Director of Strategic Planning

01/04/08 31/03/09

(509)

1,643

844

0

0

455

0

0

0

2,433

Pauline Pearce* 01/04/08 31/03/09 Director of Public Involvement and Corporate Services

(509)

43

0

0

0

3

7

0

0

(456)

Position Elaine Fox

Period From

To

Public Course Telephone Subsistence Parking Transport Expenses Costs £ £ £ £ £

Total Expenses £

Voting Directors

Non-Voting Directors

Heather Moulder* Director of Nursing / Interim Chief Operating Officer

01/04/08 31/03/09

0

0

253

0

0

0

0

0

0

253

Clare Hawkins* Interim Director of Nursing

01/12/08 31/03/09

0

0

253

0

0

0

0

0

0

253

Beverley Flowers* Director of Commissioning

01/04/08 31/03/09

Andrew Parker* Director of Primary Care and Service Redesign

01/04/08 30/11/08

No Claim (509)

683

844

0

0

23

0

0

0

1,041

*Represents 50% of the total amount claimed, the balance being paid by NHS East and North Hertfordshire Figures in brackets represent payments made to the organisation by the director for on-site parking.”

www.enherts-pct.nhs.uk | 79

Adherence to principles for remedy The PCT follows the six principles set down by the Parliamentary and Health Service Ombudsman in ‘Principles for Remedy’ (October 2007). The aim of these principles is to ensure that instances of injustice or hardship as a result of poor service or maladministration are redressed.

The principles are: • • • • • •

Getting it right Being customer focused Being open and accountable Acting fairly and proportionately Putting things right Seeking continuous improvement.

Directors’ statement on audit information All Executive and Non-Executive Directors have stated that as far as they are aware, there is no relevant audit information of which the NHS body’s auditors are unaware and that they have taken all the steps that they ought to have taken as a Director in order to make themselves aware of any relevant audit information and to establish that the NHS body’s auditors are aware of that information.

External auditors and costs of audit work Audit Commission 2nd Floor Sheffield House Lytton Way (Off Gates Way) Stevenage SG1 3HG

How have we met these principles?

The external audit fees for 2008/09 were £240,300 plus VAT. • • •

• •

•

e have incorporated the NHS complaints procedures W into our own policy The Chief Executive takes a personal interest in all complaints and the quality of investigation and response We have a responsive Patient Advice and Liaison Service (PALS) which can resolve many problems or concerns without the need for a formal complaint We have in place a ‘losses and compensations’ procedure Regular reporting to the Board of complaints received and PALS issues as part of the PCT’s performance monitoring Applying Department of Health published best practice guidance on NHS Continuing Healthcare Redress, in response to the Parliamentary and Health Service Ombudsman’s report ‘Retrospective Continuing Care Funding and Redress’.

80 | Annual Report and Accounts 2008/09

The external auditors have been commissioned to undertake statutory audit work only and have not provided any services of an audit or non-audit nature that would compromise their independence as auditors.

Audit Committee members East and North: Linda Farrant (Chair) Julia Witting Chris Learmonth

Directors’ disclosure of interests Board Member

Declarations of Pecuniary and other Interests for NHS East and North Herts Board

Date Declared

Pam Handley, Chair

Chair Watford CVS (unpaid)

18/10/2006

Trustee/Director (unpaid), Nine Lives Furniture (a charity receiving occasional grants from JCPB)

20/6/2007

Director, Choice Shapers (service brokerage for disabled people, with work possibly commissioned by HCC)

24/6/2008

Daughter works for HPFT

24/6/2008

Chair and Director Watford Charity Centre Ltd (unpaid) - a social enterprise

10/2/2009

Hypnotherapist in West Hertfordshire in private practice Consultancy work for Housing and Support Partnership Phil Picton, NED

PhD research in investment reform and transition in the NHS (Carrying out research throughout the NHS within the University Business School which develops contracts with a range of NHS organisations and their partners) in receipt of a research bursary

3/11/2006

Independent management consultant – Phil Picton Consulting (sole trader) carrying out assignments in police and local government organisations Richard Henry, NED

Councillor for Stevenage Borough Council (Executive member)

18/10/2006

Lecturer North Herts College Works 1 day/week for HPT specialist mental health team for older people Chair and Trustee member Group 117 (organises holidays for people with disabilities)

9/1/2008

Wife works for HPT as a manager Prospective Parliamentary Candidate, NE Hertfordshire Constituency Linda Farrant, NED

Chris Learmonth, NED

Husband is Chief Executive of Leisure Connection, a company which manages leisure facilities and works in partnership with PCTs to deliver health improvement programmes (outside of Hertfordshire) Board member of Metropolitan Housing Partnership

18/10/2006

Parent Governor of Mandeville Primary School in Sawbridgeworth

31/10/2006

Non-executive Director of Adroit-e (a Market Research Company). The company does not have any interaction with the PCT but it does pitch for contracts in the public sector (including health care)

14/7/2008

1/10/2007

Finance Director, The Bridal Path (est. 2006) Limited Director, Learmonth and Company (accountancy and financial advice – no health links) Julia Witting, NED

Parish Councillor and Chair, Stanstead Abbotts

16/10/2006

Eastern Region Development Officer (part time), National Association of Local Councils

24/6/2008

Independent Member of the Circle Anglia Group Audit Committee (Term of three years beginning 1 Sept 2008)

21/8/2008

One-off payment of £100 received for participation in a telephone interview for market research on behalf of pharmaceutical companies (March 2009)

17/3/2009

Husband is a training consultant, providing training in interpersonal communication, management skills, appraisal training and presentation skills. This occasionally includes provision of training to NHS trusts in other regions.

Directors’ disclosure of interests Board Member

Declarations of Pecuniary and other Interests for NHS East and North Herts Board

Elaine Fox

Committee member, Fairfield Park Residents association (looks after the interests of the new community being built in the grounds 3/9/2008 of (what was) Fairfield Park Hospital.

Anne Walker, Chief Executive

None

Alan Pond, Director of Finance

None

Heather Moulder, Interim Chief Operating Officer, Provider Services

Member of Vitiligo Society (a voluntary organisation that supports people, including a member of her family, with this condition)

Date Declared

16/10/2006 4/10/2006 25/6/2008

Andrew Parker Director of Primary Care and Wife is Bone Marrow Transplant Quality Manager at Royal Free Hospital NHS Trust, (PCT has an Service Level Agreement with RFH) Service Redesign

7/2/2007

Beverley Flowers Director of Commissioning

None

6/7/2007

Gareth Jones, Director of Strategic Planning

None

Clare Hawkins Interim Director of Nursing

None

Pauline Pearce, Director of Public Involvement and Corporate Services

Son undertakes occasional temporary clerical work in other directorates

Dr Jane Halpin Deputy Chief Executive and Director of Public Health

None

Gloria Barber Director of Human Resources

None

Tony Kostick Chair, Professional Executive Committee

4/10/2006 18/4/2007 20/7/2007

16/10/2006

25/1/2007

Principal, Dr Baxani and Partners, Stevenage, Clinical Lead, Stevenage PBC Group

13/12/2006

Club Doctor, Stevenage Borough Football Club, Navigant Consulting Clinical consultancy

10/1/2007

Expert 24 Ltd Health assessment software (clinical consultancy)

26/6/2008

82 | Annual Report and Accounts 2008/09

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The Alan Pond, Director of Finance

84 | Annual Report and Accounts 2008/09

Accounts These accounts for the year ended 31 March 2009 have been prepared by the East and North Hertfordshire Primary Care Trust (PCT) under section 232 Sch 15(3) of the National Health Service Act 2006 in the form which the Secretary of State has, with the approval of Treasury, directed.

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Statement of Chief Executive’s responsibilities as the Accountable Officer of the PCT The Secretary of State has directed that the Chief Executive should be the Accountable Officer to the Primary Care Trust.

The relevant responsibilities of Accountable Officers are set out in the Accountable Officers Memorandum issued by the Department of Health.

These include ensuring that: •

• •

• •

t here are effective management systems in place to safeguard public funds and assets and assist in the implementation of corporate governance; value for money is achieved from the resources available to the primary care trust; the expenditure and income of the primary care trust has been applied to the purposes intended by Parliament and conform to the authorities which govern them; effective and sound financial management systems are in place; and annual statutory accounts are prepared in a format directed by the Secretary of State with the approval of the Treasury to give a true and fair view of the state of affairs as at the end of the financial year and the net operating cost, recognised gains and losses and cash flows for the year.

To the best of my knowledge and belief, I have properly discharged the responsibilities set out in my letter of appointment as an Accountable Officer.

Statement of the Directors’ responsibilities in respect of the accounts The directors are required under the National Health Service Act 2006 to prepare accounts for each financial year. The Secretary of State, with the approval of the Treasury, directs that these accounts give a true and fair view of the state of affairs of the organisation and the net operating cost, recognised gains and losses and cash flows for the year. In preparing these accounts, Directors are required to: I. apply on a consistent basis accounting policies laid down by the Secretary of State with the approval of the Treasury; II. make judgements and estimates which are reasonable and prudent; III. state whether applicable accounting standards have been followed, subject to any material departures disclosed and explained in the accounts.

The directors are responsible for keeping proper accounting records which disclose with reasonable accuracy at any time the financial position of the organisation and to enable them to ensure that the accounts comply with requirements outlined in the above mentioned direction of the Secretary of State. They are also responsible for safeguarding the assets of the health authority and hence for taking reasonable steps for the prevention of fraud and other irregularities.

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

Anne Walker Chief Executive

86 | Annual Report and Accounts 2008/09

1. Scope of responsibility The Board is accountable for internal control. As Accountable Officer, and Chief Executive of this Board, I have responsibility for maintaining a sound system of internal control that supports the achievement of the organisation’s policies, aims and objectives. I also have responsibility for safeguarding the public funds and the organisation’s assets for which I am personally responsible as set out in the Accountable Officer Memorandum.

I am also the Chief Executive of West Hertfordshire PCT. Although the two PCTs are separate statutory bodies, they have a single management and executive team and share some common strategic and operational goals and control system objectives.

My responsibilities as Accountable Officer in respect of internal controls are supported by the (Joint) Integrated Governance Committee and the Audit Committee. Both of these committees report to the Board.

The (Joint) Integrated Governance Committee is chaired by a Non-Executive Director. The chair is rotated between the two PCTs on an annual basis. In addition the chairs of the two Hertfordshire PCTs’ Audit Committees are also members of the (Joint) Integrated Governance Committee.

The membership of the Audit Committee is entirely made up of Non-Executive Directors.

When appropriate, internal control issues also feature at weekly meetings of the Executive Director Team. Controls are also reviewed by the PCT’s internal and external auditors.

By order of the board.

Anne Walker Chief Executive

Statement on internal control 2008/09

Alan Pond Financial Director

The PCT is held to account for its performance by the East of England Strategic Health Authority. It also works closely with local authorities (Hertfordshire County Council, North Herts District Council, Stevenage Borough Council,

Welwyn Hatfield Borough Council, Broxbourne Borough Council, East Herts Council) and is subject to scrutiny by the Hertfordshire County Council Health Scrutiny Committee consisting of County and District Councillors.

The PCT in turn, its primary role as being a commissioning organisation, has responsibilities for monitoring levels of standards, compliance and quality achieved by healthcare organisations and independent health practitioners from which it commissions services. This is evidenced through the Annual Health Check and monitoring of the contracts entered into for services.

2. The purpose of the system of internal control The system of internal control is designed to manage risk to a reasonable level rather than to eliminate all risk of failure to achieve policies, aims and objectives; it can therefore only provide reasonable and not absolute assurance of effectiveness.

The system of internal control is based on an ongoing process designed to: • •

i dentify and prioritise the risks to the achievement of the organisation’s policies, aims and objectives, evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically.

The system of internal control has been in place in East and North Hertfordshire Primary Care Trust for the year ended 31 March 2009 and up to the date of approval of the annual report and accounts.

3. Capacity to handle risk The Chief Executive is the Accountable Officer for risk management within the PCT. Day to day executive responsibility for governance and control is delegated to the Director of Public Involvement and Corporate Services, who is supported by an Assistant Director of Integrated

Governance and a Compliance Team that provides organisational capacity to effectively monitor and facilitate risk control within the PCT.

The PCT’s Integrated Governance Strategy along with the Risk Management Policy provide details of the Risk Management systems and process in place.

A core programme of risk management training based on Training Needs Analysis for all staff groups is in place. Staff are made aware of the key risk-related policies, procedures and protocols at corporate induction and through team briefings, newsletters and the PCT’s intranet. Learning from the reporting and investigation of adverse incidents, serious untoward incidents, complaints, claims, PALS enquiries and internal and external audit reviews is a key part of the internal controls on mitigating risks.

The Integrated Governance Strategy and the Risk Management Policy are supported by the policy on Reporting and Investigating Adverse Incidents, Serious Untoward Incidents, Information Security, Information Governance and the Risk Assessment Procedure.

The Board Assurance Framework that identifies principal risks to achieving strategic objectives, assurances and controls to mitigate these risks along with the high level risk register are a standing agenda item on the (Joint) Integrated Governance Committee and reported to the board as per the board business cycle. The Audit Committee receives regular reports from the (Joint) Integrated Governance Committee for the purpose of assuring the board that risks are identified and managed appropriately.

The Secretary of State’s Directions 2004 on work to counter fraud and corruption require NHS bodies to appoint a Local Counter Fraud Specialist (LCFS). The overarching body is the NHS Counter Fraud and Security Management Service (CFSMS). The PCT employs a LCFS who reports directly to the Director of Finance and Commercial Development.

East and North Hertfordshire PCT participated in the Audit Commission’s National Fraud Initiative. The work plan for 2008/2009 has been completed. A local proactive exercise was conducted looking at time sheets and expenses for all PCT staff, as a result new policy and claim forms have been drafted.

4. The risk and control framework

An overview of the PCT’s strategic objectives, associated risks and controls is provided by the “Board Assurance Framework”. The Board Assurance Framework was approved by the Board in July 2008 following consideration by the (Joint) Integrated Governance Committee and the Audit Committee. The Framework is a working document and is regularly reviewed by the (Joint) Integrated Governance Committee, the Audit Committee and the Board and updated as objectives, risks, controls or required actions change.

The version of the Board Assurance Framework in place as at 31 March 2009 has identified 14 principal risks relating to the PCT’s 12 strategic objectives. The Board Assurance Framework along with regular performance reports provide a mechanism for the board to monitor the controls in place and manage the gaps or weaknesses in controls where the PCT is failing to achieve its strategic objectives. This includes regular reporting and discussions regarding management actions for mitigating the risks associated with under achieving choose and book, Chlamydia screening, smoking cessation, 18 weeks and AandE targets.

The full Assurance Framework can be seen on the PCT’s website by following the link below: http://www.enherts-pct.nhs.uk/Documents/ publications/AssuranceframeworkFeb09.pdf In addition as part of the risk and control framework the PCT maintains both “High Level” and operational risks

www.enherts-pct.nhs.uk | 87

registers, with risks rated as “high” being reported to the (Joint) Integrated Governance Committee and being subject to review by the Board.

The PCT’s Information Governance (IG) Strategy is based on the Department of Health’s guidance and the requirements of the Information Governance toolkit. Data security risks are managed in line with the Information Governance Strategy and the PCT’s risk management policy. The Director of Public Involvement and Corporate Services is the Senior Information Risk Owner (SIRO) at board level. The SIRO is also a member of the PCT’s Information Governance SubCommittee (IGSC) which is chaired by the PCT’s Caldicott Guardian and is responsible for the monitoring and management of the Information Governance arrangements.

The committee monitors trends in data security incidents with a view to improving security measures to protect personal identifiable data. This is achieved via a regular review of the identified gaps or risks in meeting the Information Governance agenda. Work on meeting the requirements of the IG toolkit has been ongoing through out the year with the PCT achieving good levels of compliance by March 2009.

The PCT has completed encryption of all PCT owned portable devices that connect to the network and is currently implementing encryption control for external memory devices.

Information Governance training is part of the corporate induction. In addition a training needs analysis for all staff groups for IG training has been completed with tailored training available to meet the needs of the different staff groups.

In 2008 the PCT verified the Information Governance Statement of Compliance (SoC) for all GPs in East and North Hertfordshire with action plans where required. Work is in progress to help support pharmacies to comply with the IG toolkit ahead of the requirement for these services to submit statement of compliance to the Department of Health.

88 | Annual Report and Accounts 2008/09

The PCT works in collaboration with public stakeholders including the Overview and Scrutiny Committee, Local Involvement Networks (LINks), Partnership Boards, Carers Forums and the local community networks. The collaborative work ensures that the public are involved with decision making and management of risks that impact on service provision.

Complementary to, and consistent with, the Assurance Framework, is the PCT’s Declaration on Compliance with the “Standards for Better Health”, which forms part of the Government’s “Annual Health Check” overseen by the Care Quality Commission.

Declaration on compliance covering 2008/09 was submitted in April 2009. A copy of the PCTs full Declaration can be seen on the PCT’s website by the following link. http://www.enherts-pct.nhs.uk/Content. asp?id=SXC74F-A77F7D62 The Commissioning Arm of the PCT is ‘fully met’ with the Standards for Better Health with one standard which was declared as ‘met at year end’ rather than for the full year.

The Provider arm of the PCT is ‘almost met’ with the Standards for Better Health with 4 standards declared as ‘met at year end’ and one standard where significant lapse in compliance has led to the standard being declared as ‘not met’ for the year.

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 in to 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.

5. Review of effectiveness As Accountable Officer, I have responsibility for reviewing the effectiveness of the system of internal control. My review is informed in a number of ways. The head of internal audit provides me with an opinion on the overall arrangements for gaining assurance through the Assurance Framework and on the controls reviewed as part of the internal audit work. Executive managers within the organisation who have responsibility for the development and maintenance of the system of internal control provide me with assurance. The Assurance Framework itself provides me with evidence that the effectiveness of controls that manage the risks to the organisation achieving its principal objectives have been reviewed.

My review is also informed by • • •

•

Audit Commission Use of Resources review A risk-based programme of internal audits The PCT’s self-declaration of compliance with the Healthcare Commission’s “Standards for Better Health” and a review of evidence to support the declaration Healthcare Commission monitoring visits

I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the following:•

•

T he PCT Board - The Board places reliance upon the Audit Committee and (Joint) Integrated Governance Committee for assurances on the extent to which the system of internal control is sound.

The Audit committee – The Audit Committee’s primary role is to independently oversee the governance and assurance process on behalf of the PCT and to report to the Board on the soundness and effectiveness of the systems in place for risk management and internal

•

•

•

•

control. In order to provide this assurance to the Board, both Internal and External Audit undertake systems based reviews providing an opinion to the committee on the processes and controls in place.

The (Joint) Integrated Governance Committee – the (Joint) Integrated Governance Committee is responsible for overseeing the identification and management of risks facing the PCT, including the development and monitoring of the PCT’s Assurance Framework and the self declaration on compliance with core standards as part of the Healthcare Commission’s “Annual Health Check”.

Executive Directors – the Executive Directors meet weekly. Risk-related items feature as agenda items for these meetings. All directors have signed and returned Stewardship Statements to me confirming that as far as they are aware, there is no relevant audit information of which the PCT’s auditors are unaware.

They have taken all steps that they ought to have taken as directors in order to make themselves aware of any relevant audit information and to establish that the PCT’s auditors are aware of that information.

Internal Audit – Internal Audit reviews the system of internal control and report their findings to the Audit Committee. This includes specific reports on areas relevant to controls, risk and governance and also a Head of Internal Audit Opinion, which informs this Statement on Internal Control.

External Audit – Use of Resources review

A plan to address weaknesses and ensure continuous improvement of the system is in place.

Significant Control Issues The Head of Internal Audit Opinion for the period 1 April 2008 – 31 March 2009, states that significant assurance can be given that there is a generally sound system of internal control, designed to meet the organisation’s objectives, and that controls are generally being applied consistently.

The Head of Internal Audit Opinion for 1 April 2008 – 31 March 2009 has not identified any significant issues which require disclosure within the Statement on Internal Control.

There have been no personal data related serious untoward incidents (as classified by the Department of Health) reported by East and North Hertfordshire PCT. For Standards for Better Health the Commissioning Arm is ‘fully’ compliant with all standards with the exception of C1b (safety alerts) which was ‘met at year end’ rather than for the full year: Standard C1b (Safety alerts) Met at year end – this position is based on a lapse identified during the year whereby safety alerts from the predecessor PCTs and also those received and circulated during 2007/08 and early part of 2008/09 were not actioned within the required timescales.

Action taken: Robust actions were put in place with regular reporting to the Clinical Governance Committee.

All outstanding alerts were dealt with and appropriately managed with no recorded lapses since December 2008.

The provider arm declared ‘met at year end’ rather than met for the full year on the following 4 standards: Standard C1b (Safety alerts) Met at year end – this position is based on a lapse identified during the year whereby safety alerts from the predecessor PCTs and also those received and circulated during 2007/08 and early part of 2008/09 were not actioned within the required timescales.

Action taken: Robust actions were put in place with regular reporting to the Clinical Governance Committee.

All outstanding alerts were dealt with and appropriately managed with no recorded lapses since December 2008.

Standard C4b (Medical devices) Met at year end – this position is based on a lapse identified during the year regarding lack of inventory for medical devices across all services from predecessor PCTs. Action taken: Action plan has been progressed in year to meet this lapse with a Medical Devices Policy, detailed inventory in place and an annual report to the Board in March 2009.

Standard C5b (Clinical supervision) Met at year end –A formal supervision framework that was consistently used across the PCT could not be established.

Action taken: A clinical supervision policy and framework has been developed and was implemented by 31 March 2009.

Standard C13c (Confidential Information) Met at year end – this is based on a lapse identified through incidents of mislaid records during transfer Action taken: Actions implemented to ensure all records are transferred using secure courier bags and using a tracking system.

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The provider arm declared ‘not met’ for standard C9 details for which are as follows: Standard C9 – Records Management Not met - The position is based on lapse identified through the reporting and investigation of serious untoward incidents regarding misplacement of confidential information and lack of universal archiving and retrieval process for medical notes.

Action planned or taken: An action plan has been commenced in year to address this gap with projected completion by June 2009. Actions implemented by March 2009 include all records are transferred using secure courier bags and using a tracking system.

Signed Anne Walker, Chief Executive Officer East and North Hertfordshire Primary Care Trust Date: 10th June 2009 (on behalf of the Board)

Independent Auditors Report of the Board of Directors of East and North Hertfordshire Primary Care Trust Opinion on the financial statements I have audited the financial statements of East and North Hertfordshire Primary Care Trust for the year ended 31 March 2009 under the Audit Commission Act 1998.

The financial statements comprise the Operating Cost Statement, the Balance Sheet, the Cashflow Statement, the Statement of Total Recognised Gains and Losses and the related notes. These financial statements have been prepared in accordance with the accounting policies directed by the Secretary of State with the consent of the Treasury as relevant to the National Health Service set out within them. I have also audited the information in the Remuneration Report that is described as having been audited.

This report is made solely to the Board of Directors of East and North Hertfordshire Primary Care Trust in accordance with Part II of the Audit Commission Act 1998 and for no other purpose, as set out in paragraph 49 of the Statement of Responsibilities of Auditors and of Audited Bodies prepared by the Audit Commission.

Respective responsibilities of Directors and auditor The Directors’ responsibilities for preparing the financial statements in accordance with directions made by the Secretary of State are set out in the Statement of Directors’ Responsibilities. The Chief Executive’s responsibility, as Accountable Officer, for ensuring the regularity of financial transactions is set out in the Statement of the Chief Executive’s Responsibilities.

My responsibility is to audit the financial statements in accordance with relevant legal and regulatory requirements and International Standards on Auditing (UK and Ireland).

I report to you my opinion as to whether the financial statements give a true and fair view in accordance with the accounting policies directed by the Secretary of State as

90 | Annual Report and Accounts 2008/09

being relevant to the National Health Service in England.

I report whether the financial statements and the part of the Remuneration Report to be audited have been properly prepared in accordance with the accounting policies directed by the Secretary of State as being relevant to the National Health Service in England. I report to you whether, in my opinion, the information which comprises the commentary on the financial performance included within the Financial Review, included in the Annual Report, is consistent with the financial statements. I also report whether in all material respects the expenditure and income have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them.

I review whether the Directors’ Statement on Internal Control reflects compliance with the Department of Health’s requirements, set out in ‘Guidance on Completing the Statement on Internal Control 2008/09’, issued on 25 February 2009. I report if it does not meet the requirements specified by the Department of Health or if the statement is misleading or inconsistent with other information I am aware of from my audit of the financial statements. I am not required to consider, nor have I considered, whether the Directors’ Statement on Internal Control covers all risks and controls. Neither am I required to form an opinion on the effectiveness of the PCT’s corporate governance procedures or its risk and control procedures.

I read the other information contained in the Annual Report and consider whether it is consistent with the audited financial statements. This other information comprises the welcome, about us, facts and figures, the remaining elements of our performance and the unaudited part of the Remuneration Report. I consider the implications for my report if I become aware of any apparent misstatements or material inconsistencies with the financial statements. My responsibilities do not extend to any other information.

Basis of audit opinion I conducted my audit in accordance with the Audit Commission Act 1998, the Code of Audit Practice issued by the Audit Commission and International Standards on Auditing (UK and Ireland) issued by the Auditing Practices Board. An audit includes examination, on a test basis, of evidence relevant to the amounts and disclosures in the financial statements and the part of the Remuneration Report to be audited. It also includes an assessment of the significant estimates and judgments made by the Directors in the preparation of the financial statements, and of whether the accounting policies are appropriate to the PCT’s circumstances, consistently applied and adequately disclosed.

Opinion In my opinion: •

•

• I planned and performed my audit so as to obtain all the information and explanations which I considered necessary in order to provide me with sufficient evidence to give reasonable assurance that: •

•

•

t he financial statements are free from material misstatement, whether caused by fraud or other irregularity or error; the financial statements and the part of the Remuneration Report to be audited have been properly prepared; and in all material respects the expenditure and income have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them.

In forming my opinion I also evaluated the overall adequacy of the presentation of information in the financial statements and the part of the Remuneration Report to be audited.

•

t he financial statements give a true and fair view, in accordance with the accounting policies directed by the Secretary of State as being relevant to the National Health Service in England, of the state of the PCT’s affairs as at 31 March 2009 and of its net operating costs for the year then ended; the part of the Remuneration Report to be audited has been properly prepared in accordance with the accounting policies directed by the Secretary of State as being relevant to the National Health Service in England; in all material respects the expenditure and income have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them; and information which comprises the commentary on the financial performance included within the Financial Review, included within the Annual Report, is consistent with the financial statements.

Conclusion on arrangements for securing economy, efficiency and effectiveness in the use of resources Directors’ Responsibilities The Directors are responsible for putting in place proper arrangements to secure economy, efficiency and effectiveness in the PCT’s use of resources, to ensure proper stewardship and governance and regularly to review the adequacy and effectiveness of these arrangements.

in its use of resources. The Code of Audit Practice issued by the Audit Commission requires me to report to you my conclusion in relation to proper arrangements, having regard to the Use of Resources Guidance issued by the Audit Commission. I report if significant matters have come to my attention which prevent me from concluding that the PCT has made such proper arrangements. I am not required to consider, nor have I considered, whether all aspects of the PCT’s arrangements for securing economy, efficiency and effectiveness in its use of resources are operating effectively.

Conclusion I have undertaken my audit in accordance with the Code of Audit Practice and having regard to the Use of Resources Guidance published by the Audit Commission in May 2008 and updated in February 2009, I am satisfied that, in all significant respects, East and North Hertfordshire Primary Care Trust made proper arrangements to secure economy, efficiency and effectiveness in its use of resources for the year ending 31 March 2009.

Certificate I certify that I have completed the audit of the accounts in accordance with the requirements of the Audit Commission Act 1998 and the Code of Audit Practice issued by the Audit Commission.

Mark Hodgson Date: 12 June 2009 Officer of the Audit Commission Regus House, 1010 Cambourne Business Park, Cambourne, Cambridge, CB23 6DP

Auditor’s Responsibilities I am required by the Audit Commission Act 1998 to be satisfied that proper arrangements have been made by the PCT for securing economy, efficiency and effectiveness

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92 | Annual Report and Accounts 2008/09 - For the year ended 31 March 2009 3

Less: Miscellaneous income

The notes on pages 96 to 127 form part of this account.

695,563

647,045

22

18

Interest payable Net operating cost for the financial year

0

0

Interest receivable

41,961

48,012

647,023

(9,141)

(8,377)

605,062

647,533

51,102

(10,517)

(14,430)

56,389

615,579

ÂŁ000

ÂŁ000

661,963

2007/08

2008/09

695,545

Net operating costs before interest

8

3

Less: Miscellaneous income Provider Net operating costs

4

Gross operating costs

Provider

Commissioning net operating costs

4

Gross operating costs

Commissioning

Note

Operating cost statement for the year ended 31 March 2009

www.enherts-pct.nhs.uk | 93

0 2,601

0 0

(13,377) 2,149 0

0 0

Unrealised surplus / (deficit) on fixed asset revaluations/indexation Increase in the donated asset reserve and government grant reserve due to receipt of donated and government granted assets Additions / (reductions) in the General Fund due to the transfer of assets from/ (to) NHS bodies and the Department of Health Additions / (reductions) in “other reserves”

The notes on pages 96 to 127 form part of this account.

Gains and losses recognised in the financial year

Prior period adjustment - other

Recognised gains and losses for the financial year

2,601

0

0 (11,228)

2,601

(11,228)

0

£000

£000 Fixed asset impairment losses

2007/08

2008/09

Statement of recognised gains and losses for the year ended 31 March 2009

94 | Annual Report and Accounts 2008/09 - For the year ended 31 March 2009 29 0

10.1 10.4 10.5

Tangible assets Investments Financial assets

13,823 0 0

12 10.5 16.3

Debtors Other financial assets Cash at bank and in hand

1,619 0 0

15 15 15

Donated asset reserve Government grant reserve Other reserves

Chief Executive:

Date: 10th June 2009

13,769

0

0

1,779

20,043

(8,053)

13,769

(2,802)

(97)

16,668

(28,430)

(40,122)

11,692

0

11,573

119

45,098

0

45,098

0

£000

31 March 2008

The financial statements on pages 1 to 4 were approved by the Board on 10th June 2009 and signed on its behalf by

The notes on pages 96 to 127 form part of this account.

(1,924)

8,917

15 Revaluation reserve

Total Taxpayers Equity

(12,460)

15

(1,924)

(3,484)

General fund

Taxpayers equity

Financed by:

Total assets employed

14

0

13.1/1

Other financial liabilities falling due after more than one year Provisions for liabilities and charges

(32)

13.1

1,592

Creditors: Amounts falling due after more than one year

Total assets less current liabilities

(33,309)

0

13.1/1

Other financial liabilities falling due within one year Net current assets / (liabilities)

(47,251)

13.1

13,942

34,901

£000

31 March 2009

CREDITORS : Amounts falling due within one year

Total current assets

119

11

Stocks and work in progress

Current assets

34,872

9 0

£000

Intangible assets

Fixed assets

NOTE

Balance sheet as at 31 March 2009

www.enherts-pct.nhs.uk | 95

The notes on pages 96 to 127 form part of this account.

Increase/(decrease) in cash

Net cash inflow/(outflow) from financing

Cash transfers (to)/from other NHS bodies

0

(16)

0

Capital grants received Capital element of finance lease rental payments

0

Other capital receipts surrendered

Net Parliamentary Funding

0

690,993

(690,993)

Net cash inflow/(outflow) before financing

691,009

0

Net cash inflow/(outflow) from management of liquid resources

Financing

0

0 Sale of other current asset investments

0

650,142

0

(16)

0

0

650,158

(650,142)

0

0

(650,142)

(1,047)

0

0

0

0

0

(1,047)

0

0

(22)

0

(690,993)

(2,672)

(18)

(17)

0

(5)

(649,073)

£000

£000

(688,303)

2007/08

2008/09

(Purchase) of other current asset investments

Management of liquid resources

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

Net cash inflow/(outflow) from capital expenditure

0

0

Receipts from sale of fixed asset investments

Receipts from sale of financial instruments

0

Payments to acquire fixed asset investments

(29)

0

Receipts from sale of tangible fixed assets

Payments to acquire financial instruments

(2,643)

0

Receipts from sale of intangible assets Payments to acquire tangible fixed assets

0

Payments to acquire intangible assets

Capital expenditure

Net cash inflow/(outflow) from servicing of finance and returns on investment

(18)

0

Interest received Interest element of finance leases

0

16.3

16.1

£000

Interest paid

Servicing of finance and returns on investment:

Net cash outflow from operating activities

Operating activities

NOTE

Cash flow statement for the year ended 31 March 2009

96 | Annual Report and Accounts 2008/09 - For the year ended 31 March 2009 Purchased computer software licences are capitalised

Intangible fixed assets held for operational use are valued at historical cost and are depreciated over the estimated life of the asset on a straight line basis. The carrying value of intangible assets is reviewed for impairment at the end of the first full year following acquisition and in other periods if events or changes in circumstances indicate the carrying value may not be recoverable.

Intangible assets which can be valued, are capable of being used in the PCT’s activities for more than one year and have a cost equal to or greater than £5,000;

c) Fixed Assets i. Capitalisation All assets falling into the following categories are capitalised:

b) Taxation The PCT is not liable to pay corporation tax. Most of the activities of the PCT 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 stated are net of VAT.

Income is accounted for applying the accruals convention.

Income is recognised in the period in which services are provided. Where income has been received for a specific activity to be delivered in the following financial year, that income will be deferred.

Miscellaneous income is income which relates directly to the operating activities of the PCT. It principally comprises fees and charges for services provided on a full cost basis to external customers, as well as public repayment work. It includes both income appropriated-in-aid of the Vote and income to the Consolidated Fund which HM Treasury has agreed should be treated as operating income.

a) Income and Funding The main source of funding for the PCT is allocations (Parliamentary funding) from the Department of Health within an approved cash limit, which is credited to the General Fund of the PCT. Parliamentary funding is recognised in the financial period in which the cash is received.

These accounts have been prepared under the historical cost convention, modified to account for the revaluation of fixed assets, and stock where material, at their value to the business by reference to current costs. This is in accordance with directions issued by the Secretary of State and approved

by HM Treasury.

The financial statements have been prepared in accordance with the 2008/09 Financial Reporting Manual (FReM) issued

by HM Treasury. The particular accounting policies adopted by the Primary Care Trust (PCT) are described below. They have been applied in dealing with items considered material in relation to the accounts.

Notes to the accounts

The valuations were carried out in accordance with the Royal Institute of Chartered Surveyors (RICS) Appraisal and Valuation Manual insofar as these terms are consistent with the agreed requirements of the Department of Health and

In view of the significant falls in the UK property market, East and North Hertfordshire PCT instructed Boshier and Company an independent firm of chartered surveyors (RICS), to provide advice in accordance with FRS 11 in respect of various freehold properties forming part of the PCT’s estate as at 31 March 2009. The revaluation resulted in a net reduction of £10,995,000 on Land and £266,000 on Buildings totalling £11,261,000.

Land and Buildings and Dwellings Land and buildings are restated at current cost using professional valuations at five-yearly intervals in accordance with FRS 15. Between valuations price indices appropriate to the category of asset are applied to arrive at the current value. The buildings indexation is based on the All in Tender Price Index published by the Building Cost Information Service (BCIS). The land index is based on the residential building and land values reported in the Property Market Report published by the Valuation Office. Professional valuations are carried out by Valuers on a five-yearly basis.

The previous valuation was carried out as at 1 April 2006.

Tangible fixed assets are stated at the lower of replacement cost and recoverable amount. On initial recognition they are measured at cost (for leased assets, fair value) including any costs such as installation directly attributable to bringing them into working condition. The carrying values of tangible fixed assets are reviewed for impairment in periods if events or changes in circumstances indicate the carrying value may not be recoverable.

Tangible assets which are capable of being used for a period which exceeds one year and which: - individually have a cost equal to or greater than £5,000; or - collectively have a cost equal to or greater than £5,000 and individually cost more than £250, where the assets are functionally interdependent, they had broadly simultaneous purchase dates and are anticipated to have simultaneous disposal dates; and are under single managerial control; or - form part of the initial equipping and setting-up cost of a new building, ward or unit irrespective of their individual or collective costs; or - form part of an I.T. network which collectively has a cost of more than £5,000 and individually have a cost of more than £250. ii. Valuation Intangible fixed assets held for operational use are valued at historical cost, except Research and Development which is valued using appropriate index figures. Surplus intangible assets are valued at the net recoverable amount.

as intangible fixed assets where expenditure of at least £5,000 is incurred.They are amortised over the shorter of the term of the licence and their useful economic lives

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Buildings, installations and fittings are depreciated on their current value over the estimated remaining life of the asset as advised by the District Valuer.

Land and buildings held under finance leases are capitalised at inception at the fair value of the asset but may be subsequently revalued by the District Valuer. The valuations do not include notional directly attributable acquisition costs nor have selling costs been deducted, since they are regarded as not material.

Equipment Operational equipment is carried at current value. Where assets are at low value, and/or have short useful economic lives, these are carried at depreciated historic cost as a proxy for current value. Equipment surplus to requirements is

This type of arrangement is formally know as LIFT (Local Improvement Finance Trust) and the value is shown at the historical cost to acquire the loan notes and shares as at 1st July 2008. Fixed asset investments are recorded at Market Value and will be valued annually. Any increase in value is taken in full to the revaluation reserve. Any impairment in value is charged to operating expenditure.

Fixed asset investments On 1st July 2008 East and North Hertfordshire PCT acquired both loan notes and 400 shares to the value of £27,570 and £400 respectively in “Assemble Community Partnership” the name of the newly formed partnership company. This 25 year partnering agreement arrangement is with Bedfordshire PCT, Milton Keynes PCT, Guildhouse (a private development company) and local public sector authorities covered by the three participant PCT areas.

Freehold land and land and buildings surplus to requirements are not depreciated. Assets in the course of construction and residual interests in off-balance sheet Private Finance Initiative contract assets are not depreciated until the asset is brought into use or reverts to the PCT, respectively.

As a result of this revaluation, a total of £33,000 was charged to the OCS in 2008/9 financial year. Falls in value when newly constructed assets are brought into use are charged in full to the OCS. These falls in value result from the adoption of ideal conditions as the basis for depreciated replacement cost valuations.

iv. D onated Assets Donated tangible fixed assets are capitalised at their valuation on receipt and this value is credited to the donated asset reserve. Donated assets are revalued and depreciated as described above for purchased assets. Gains and losses on revaluations are taken

Purchased computer software licences are amortised over the shorter of the term of the license and their useful economic lives. They are amortised over the shorter of the term of the licence and their useful economic lives.

Information Technology equipment is depreciated over 4 years in line with its replacement policy.

Where the useful economic life of an asset is reduced from that initially estimated due to the revaluation of an asset for sale, depreciation is charged to bring the value of the asset to its value at the point of sale.

Intangible assets are amortised over the estimated lives of the assets.

Equipment is depreciated on current cost evenly over the estimated life of the asset.

Leaseholds are depreciated over the primary lease term.

iii. D epreciation, amortisation and impairments Tangible fixed assets are depreciated at rates calculated to write them down to estimated residual value on a straight line basis over their estimated useful lives.

Residual interests in off-balance sheet Private Finance Initiative properties Residual interests in off-balance sheet Private Finance Initiative properties are included in tangible fixed assets under ‘’assets under construction and payments on account’ where the PFI contract specifies the amount at which the assets will be transferred to the PCT at the end of the contract.

The residual interest is built up during the life of the contract by capitalising the unitary charge so that at the end of the contract the balance sheet value of the residual value plus the specified amount equal the expected value of the residual asset at the end of the contract. The estimated fair value of the asset on reversion is determined by the District Valuer based on Department of Health guidance.

Assets in the course of construction Assets in the course of construction are valued at current cost using the index as for land and buildings (see above). These assets include any existing land or buildings under the control of a contractor.

valued at net recoverable amount and assets held under finance leases are capitalised at the fair value of the assets.

Gains made from indexation and revaluations are taken to the revaluation reserve. Losses arising from revaluations are recognised as impairments and are charged to the revaluation reserve to the extent that a balance exists in relation to the revalued asset. Losses in excess of that amount are charged to the current year’s Operating Cost Statement (OCS), unless it can be demonstrated that the recoverable amount is greater than the revalued amount in which case the impairment is taken to the revaluation reserve. Impairments resulting from price changes are charged to the Statement of Recognised Gains and Losses.

Additional alternative Open Market Value figures have only been supplied for operational assets scheduled for imminent closure and subsequent disposal.

The valuations have been carried out primarily on the basis of Depreciated Replacement Cost for specialised operational property and Existing Use Value for non-specialised operational property.

In respect of non-operational properties, including surplus land, the valuations have been carried out at Open Market Value. The value of land for existing use purposes is assessed to Existing Use Value.

HM Treasury. There are departures from the RICS Appraisal and Valuations Standards agreed between H M Treasury and the NHS Executive which are noted in the valuation report.

98 | Annual Report and Accounts 2008/09 - For the year ended 31 March 2009 g) Private Finance Initiative The NHS follows HM Treasury’s ‘Technical Note 1 (revised) How to Account for PFI transactions ‘ which provides practical guidance for the application of the Application

Other leases are regarded as operating leases and the rentals are charged to the Operating Cost Statement on a straight line basis over the term of the lease.

f) Leases Where substantially all risks and rewards of ownership of a leased asset are borne by the PCT, the asset is recorded as a tangible fixed asset and a debt is recorded to the lessor of the minimum lease payment discounted by the interest rate implicit in the lease. The interest element of finance lease payments is charged to the Operating Cost Statement over the period of the lease at a constant rate in relation to the balance outstanding.

In accordance with FRS9, the PCT’s share of the assets and liabilities of the pool will be accounted for in the books of accounts as determined in the pooled budget agreement.

The pool is hosted by Hertfordshire County Council. The PCT makes contributions to the pool for services to be provided as part of its commissioning role.

e) Pooled budgets The PCT has entered into a pooled budget with Hertfordshire County Council. Under the arrangement funds are pooled under S75 of the NHS Act 2006 for Mental Health, Learning Disabilities and certain other services.

d) Cash, Bank and Overdraft: Cash, bank and overdraft balances are recorded at current values. Interest earned on bank accounts and interest charged on overdrafts are recorded as, respectively, ‘Interest receivable’ and ‘ Interest payable’ in the periods to which they relate. Bank charges are recorded as operating expenditure in the periods to which they relate.

v. Government Grants Government grants are grants from Government bodies other than funds from NHS bodies or funds awarded by Parliamentary Vote. Government grants in respect of capital expenditure are credited to a government grant reserve and are released to the OCS over the expected useful lives of the relevant assets by equal annual instalments. Grants of a revenue nature are credited to miscellaneous income in the Operating Cost Statement so as to match them with the expenditure to which they relate.

to the Donated Asset Reserve and, each year, an amount equal to the depreciation charge on the asset is released from the Donated Asset Reserve to the Operating Cost Statement. Similarly, any impairment on donated assets charged to the Operating Cost Statement is matched by a transfer from the donated asset reserve. On sale of donated assets, the value of the sale proceeds is transferred from the donated asset reserve to the general fund.

Notes to the accounts

j) Provisions The PCT provides for legal or constructive obligations that are of uncertain timing or amount at the balance sheet date on the basis of the best estimate of the expenditure required to settle the obligation. Where the effect of the time value of money is significant, the estimated risk-adjusted cash

Fixed assets acquired for use in research and development are amortised over the life of the associated project.

PCTs are unable to disclose the total amount of research and development expenditure charged to the Operating Cost Statement because some research and development activity cannot be separated from patient care activity.

Expenditure so deferred is limited to the value of future benefits expected and is amortised through the Operating Cost Statement on a systematic basis over the period expected to benefit from the project. It is revalued on the basis of current cost. The amortisation charge is calculated on the same basis as for depreciation i.e. on a quarterly basis. Expenditure which does not meet the criteria for capitalisation is treated as an operating cost in the year in which it is incurred.

i) Research and development Expenditure on research is not capitalised. Expenditure on development is capitalised if it meets the following criteria; - there is a clearly defined project - the related expenditure is separately identifiable - the outcome of the project has been assessed with reasonable certainty as to; - its technical feasibility - its resulting in a product or service which will eventually be brought into use - adequate resources exist, or are reasonably expected to be available, to enable the project to be completed and to provide any consequential increase in working capital.

h) Stocks and work-in-progress Stocks comprise raw materials and consumables and are valued at the lower of cost and net realisable value.

Where the balance of the risks and rewards of ownership of the PFI property are borne by the PFI operator, the PFI payments are recorded as an operating expense. Where the PCT has contributed assets, a prepayment for their fair value is recognised and amortised over the life of the PFI contract by a charge to the OCS. Where, at the end of a PFI contract, a property reverts to the PCT, the difference between the expected fair value of the residual asset on reversion and any agreed payment on reversion is built up over the life of the contract by capitalising part of the unitary charge each year, as a tangible fixed asset.Under UK GAAP, the current Herts and Essex hospital is an off balance sheet scheme. The PCT is capitalising part of the annual unitary payment to reach the residual interest of approx £7m in the year 2033. This residual interest is shown as an asset under construction within fixed assets and the value as at 31st March 2009 is £956,000.

Note F FRS5 amendment and the guidance ‘Land and Buildings in PFI schemes Version 2’.

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a. Full

actuarial (funding) valuation The purpose of this valuation is to assess the level of liability in respect of the benefits due under the

The scheme is subject to a full actuarial valuation every four years (until 2004, based on a five year valuation cycle), and a FRS17 accounting valuation every year. An outline of these follow:

n) Pension Costs 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.nhspa.nhs.uk/pensions. The Scheme is an unfunded, defined benefit scheme that covers NHS employers, General Practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying Scheme assets and liabilities. Therefore, the Scheme is accounted for as if it were a defined contribution scheme: the cost to the NHS body of participating in the Scheme is taken as equal to the contributions payable to the Scheme for the accounting period.

Losses and special payments are charged to the relevant functional headings, including losses which would have been made good through insurance cover had PCTs not been bearing their own risks (with insurance premiums then being included as normal revenue expenditure). However, the losses note is compiled directly from the losses and compensations register which is prepared on a cash basis.

m) 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 each individual case is handled.

l) Non-clinical risk pooling The PCT participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both are risk pooling schemes under which the PCT 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 as and when they become due.

k) Clinical Negligence Costs The NHS Litigation Authority (NHSLA) operates a risk pooling scheme under which the PCT 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 PCT. The total value of clinical negligence provisions carried by the NHSLA on behalf of the PCT is disclosed at Note 14.

flows are discounted using the Treasury’s discount rate of 2.2% in real terms.

Notes to the accounts

The Scheme provides the opportunity to members to increase their benefits through money purchase Additional Voluntary Contributions (AVCs) provided by an approved panel of life companies. Under the arrangement the employee/member can make contributions to enhance an employee’s pension benefits. The benefits payable relate directly to the value of the investments made. From 1

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 Operating Cost Statement at the time the PCT commits itself to the retirement, regardless of the method of payment.

Scheme Provisions as at 31 March 2009.

The scheme is a ‘final salary’ scheme.

The valuation of the Scheme liability as at 31 March 2009, is based on detailed membership data as at 31 March 2006 (the latest midpoint) updated to 31 March 2009 with summary global member and accounting data. 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) Resource Account, published annually. These accounts can be viewed on the NHS Pensions website. Copies can also be obtained from The Stationery Office.

Between the full actuarial valuations at a two-year midpoint, a full and detailed member data-set is provided to the Scheme Actuary. At this point the assumptions regarding the composition of the Scheme membership are updated to allow the Scheme liability to be valued.

b. FRS17

Accounting valuation In accordance with FRS17, a valuation of the Scheme liability is carried out annually by the Scheme Actuary as at the balance sheet date by updating the results of the full actuarial valuation.

The conclusion from the 2004 valuation was that the Scheme had accumulated a notional deficit of £3.3 billion against the notional assets as at 31 March 2004.

However, after taking into account the changes in the benefit and contribution structure effective from 1 April 2008, the Scheme actuary reported that employer contributions could continue at the existing rate of 14% of pensionable pay. On advice from the Scheme actuary, scheme contributions may be varied from time to time to reflect changes in the scheme’s liabilities. Up to 31 March 2008, the vast majority of employees paid contributions at the rate of 6% of pensionable pay.

From 1 April 2008, employees contributions are on a tiered scale from 5% up to 8.5% of their pensionable pay depending on total earnings.

scheme (taking into account its recent demographic experience), and to recommend the contribution rates to be paid by employers and scheme members. The last such valuation, which determined current contribution rates was undertaken as at 31 March 2004 and covered the period from 1 April 1999 to that date.

100 | Annual Report and Accounts 2008/09 - For the year ended 31 March 2009 q) Cost of Capital Charge The treatment of fixed assets in the accounts is in accordance with the principal capital charges objective to ensure that such charges are fully reflected in the cost of capital. The interest rate applied to the cost of capital charge in the financial year 2008/2009 was 3.5% (2007/2008 : 3.5%) on all assets less liabilities, except for cashbalances with the Office of the Paymaster General (OPG) and for Donated assets where the charge is nil.

p) Third Party Assets Assets belonging to third parties (such as money held on behalf of Patients) are not recognised in the accounts since the Primary Care Trust has no beneficial interest in them.

Details of third party assets are given in Note 23 to the accounts and Note 16.3 for Patients monies.

o) Foreign Currency Transactions in foreign currencies are translated into sterling at the rates of exchange current at the dates of the transactions.Resulting exchange gains and losses are taken into the Operating Cost Statement.

New entrants from 1 April 2008 Annual pensions for new entrants from 1 April 2008 were based on 1/60th of the best three-year average of pensionable earnings in the ten years before retirement.

Members wishing to obtain a retirement lu p sum may give up some of this pension to obtain a retirement lump of up to 25% of the total value of their retirement benefits. Survivor pensions will be available to married and unmarried partners and will be equal to 37.5% of the member’s pension.

Existing members at 1 April 2008 Annual pensions are normally based on 1/80th of the best of the last 3 years pensionable pay for each year of service. A lump sum normally equivalent to 3 years pension is payable on retirement. From 1 April 2008 there is the opportunity of giving up some of the pension to increase the retirement lump sum. 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. On death, a pension of 50% of the member’s pension is normally payable to the surviving spouse or eligible unmarried partner.

Early payment of a pension 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 five times their annual pension for death after retirement, less pension already paid, subject to a maximum amount equal to twice the member’s final year’s pensionable pay less their retirement lump sum for those who die after retirement, is payable.

April 2008 a voluntary additional pension facility becomes available, under which members may purchase up to £5,000 per annum of additional pension at a cost determined by the actuary from time-to-time.

Notes to the accounts

At the balance sheet date, the PCT assesses whether any financial assets, other than those held at ‘fair value through profit and loss’ are impaired. Financial assets are impaired and impairment losses recognised if there is objective evidence of impairment as a result of one or more events

Fair value is determined by reference to quoted market prices where possible, otherwise by valuation techniques.

The effective interest rate is the rate that exactly discounts estimated future cash receipts through the expected life of the financial asset, to the net carrying amount of the financial asset.

Loans and receivables Loans and receivables are non-derivative financial assets with fixed or determinable payments which are not quoted in an active market. After initial recognition, they are measured at amortised cost using the effective interest method, less any impairment. Interest is recognised using the effective interest method.

Available for sale financial assets Available for sale financial assets are non-derivative financial assets that are designated as available for sale or that do not fall within any of the other three financial asset classifications. They are measured at fair value with changes in value taken to the revaluation reserve, with the exception of impairment losses. Accumulated gains or losses are recycled to the income statement on de-recognition.

Held to maturity investments Held to maturity investments are non-derivative financial assets with fixed or determinable payments and fixed maturity, and there is a positive intention and ability to hold to maturity. After initial recognition, they are held at amortised cost using the effective interest method, less any impairment.

Interest is recognised using the effective interest method.

Financial assets at fair value through profit and loss Embedded derivatives that have different risks and characteristics to their host contracts, and contracts with embedded derivatives whose separate value cannot be ascertained, are treated as financial assets at fair value through profit and loss. They are held at fair value, with any resultant gain or loss recognised in the OCS. The net gain or loss incorporates any interest earned on the financial asset.

Financial assets are classified into the following categories: financial assets ‘at fair value through profit and loss’; ‘held to maturity investments’; ‘available for sale’ financial assets, and ‘loans and receivables’. The classification depends on the nature and purpose of the financial assets and is determined at the time of initial recognition.

Financial assets are initially recognised at fair value.

r) Financial Instruments Financial assets Financial assets are recognised on the balance sheet when the PCT becomes party to the financial instrument contract or, in the case of trade debtors, when the goods or services have been delivered. Financial assets are derecognised when the contractual rights have expired or the asset has been transferred.

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s) Going concern The PCT is funded by the Department of Health and therefore remains a going concern.

Other financial liabilities After initial recognition, all other financial liabilities are measured at amortised cost using the effective interest method.

The effective interest rate is the rate that exactly discounts estimated future cash payments through the life of the asset, to the net carrying amount of the financial liability. Interest is recognised using the effective interest method.

Financial liabilities at fair value through profit and loss Embedded derivatives that have different risks and characteristics to their host contracts, and contracts with embedded derivatives whose separate value cannot be ascertained, are treated as financial liabilities at fair value through profit and loss. They are held at fair value, with any resultant gain or loss recognised in the income statement.

The net gain or loss incorporates any interest earned on the financial asset.

Financial liabilities are initially recognised at fair value.

Financial liabilities are classified as either financial liabilities ‘at fair value through profit and loss’ or other financial liabilities.

Financial liabilities Financial liabilities are recognised on the balance sheet when the Trust becomes party to the contractual provisions of the financial instrument or, in the case of trade creditors, when the goods or services have been received. Financial liabilities are de-recognised when the liability has been discharged, that is, the liability has been paid or has expired.

If, in a subsequent period, the amount of the impairment loss decreases and the decrease can be related objectively to an event occurring after the impairment was recognised, the previously recognised impairment loss is reversed through the income statement to the extent that the carrying amount of the receivable at the date of the impairment is reversed does not exceed what the amortised cost would have been had the impairment not been recognised.

For financial assets carried at amortised cost, the amount of the impairment loss is measured as the difference between the asset’s carrying amount and the present value of the revised future cash flows discounted at the asset’s original effective interest rate. The loss is recognised in the income statement and the carrying amount of the asset is reduced directly, or through a provision for impairment of receivables.

which occurred after the initial recognition of the asset and which has an impact on the estimated future cash flows of the asset.

Notes to the accounts

102 | Annual Report and Accounts 2008/09 - For the year ended 31 March 2009

0 0

0 0

Plus: RRL in-year increases funded by the NHS bank Plus: RRL in-year increases funded by the NHS bank (other)

0 (5,750) 0 23,000 17,250

(17,250) 0 17,250 (7,520)

Net cash management position from prior periods Net cash management position at 31 March 2009

0 0 0 0

0 0 0 0

Add: Loss in respect of disposals of donated assets less: Net book value of assets disposed of less: Capital grants less: Donations

66

2,660

Capital Resource Limit (Over) / Under spend against Capital Resource Limit

2,594

Charge Against the Capital Resource Limit

326

2,077

1,751

1,751

2,594 Gross Capital Expenditure

2007/08 £000

2008/09 £000

Note 2.2. Capital Resource Limit The PCT is required to keep within its Capital Resource Limit

Cash limit - subsequently increased in-year

Cash limit - subsequently reduced in-year

Cash limit retained centrally in respect of local reserve

(7,520)

Cash Management

642,783

(28,282)

(3,667)

Plus: RRL in-year increases/(decreases)

693,012

0

(7,520)

(less): Transfers to the SHA Revenue reserve

Final Revenue Resource Limit for year

671,065

704,199

20

Initial Revenue Resource Limit

The revenue Resource Limit above has been arrived at as follows:

1,683

642,763

693,012

Final Revenue Resource Limit for year Under/(over) spend against Revenue Resource Limit

642,763

4,282

4,234 691,329

647,045

2007/08 £000

695,563

2008/09 £000

Operating Costs less non-discretionary expenditure

Less: Non-discretionary Expenditure

Total net operating cost for the financial year

The PCTs’ performance for 2008/09 is as follows:

Note 2.1 Revenue Resource Limit

Note 2: Financial Performance Targets

Notes to the accounts

www.enherts-pct.nhs.uk | 103

0

0

NHS Injury Costs Recovery

0 0 0

Transfer from the government grant reserve Rental income from finance leases Rental income from operating leases Total miscellaneous income

8,964

102

0

Transfer from the donated asset reserve

Other income

0

Charitable and other contributions to expenditure

218

0

Non-NHS: Overseas Patients (non-reciprocal) Other Non-NHS patient care services

0

232

0 Non NHS: Private Patients

Education, Training and Research

Patient Transport Services

1,232

13,843

939

0

0

0

58

0

0

0

0

Income for Trust Impairment Local Authorities

240

0

Department of Health - SMPTB Department of Health - other

0

98

0

1,956

0

Other English Special Health Authorities/CGA Bodies

English RAB Special Health Authorities

Primary Care Trusts - Lead Commissioning Income

Primary Care Trusts - other

Primary Care Trusts for Drug Action Teams

882

4,826

Foundation Trusts

4,844

NHS Trusts

256

0

6,833

91

Strategic Health Authorities

Prescription Charge Income

Dental Charge income from trust led GDS and PDS

Dental Charge income from contractor led GDS and PDS

Fees and Charges

Note 3. Miscellaneous Income

22,807

19,658

1,447

1,041

753

218

0

0

0

0

0

0

0

1

0

0

479

232

0

0

0

0

513

1,232

58

0

0

58

1

240

15

0

0

0

0

0

0

2,732

1,956

98

0

0

20

1,140

882

0

352 5,056

4,826

229

256 4,844

0

6,774 0

6,833

88

(1,261)

(31)

Under / (over) recovery of costs

91

(43,222)

(48,043)

2007/08 £000

41,961

48,012

Net Operating Cost

2008/09 £000

(9,141)

(8,377)

less: Miscellaneous income relating to provider functions

£000 £000 Appropriated in Aid Not Appropriated in Aid

51,102

56,389

Provider gross operating cost

less: Costs met from PCT’s own allocation

2007/08 £000

2008/09 £000

Note 2.3. Provider full cost recovery duty The PCT is required to recover full costs in relation to its provider functions. The performance for 2008/09 is as follows:

Notes to the accounts

104 | Annual Report and Accounts 2008/09 - For the year ended 31 March 2009 91,294 0 0 1,185 28,937 0 385 67 43,622 569 65,605 73,565 2,179 0 3,233 4,282 2,619 1,458 3,100 1 6,341 1 2,115 0 0 0 0

96,377 0 0 1,507 30,663 179 422 139 47,401 886 70,413 75,535 2,619 0 6,965 4,234 2,901 2,058 2,965 3 8,276 49 1,559 0 33 0 0

Purchase of healthcare from non-NHS providers Social Care from independent providers Expenditure on Drugs Action Teams Non-GMS services from GPs Contractor led GDS and PDS Trust led GDS and PDS PCT Board members’ costs PCT Executive Committee non-officer members’ costs

GMS/PMS/APMS/PCTMS Prescribing costs

New Pharmacy Contract General Ophthalmic Services Supplies and services - clinical Supplies and services - general Establishment Transport Premises

Depreciation Amortisation Tangible fixed asset impairments and reversals Intangible fixed asset impairments and reversals Impairments and reversals of finacial assets (by class)

Impairment of debtors

Local Pharmaceutical Service Pilots

Pharmaceutical Services

Consultancy services

Staff costs

36,267

32,186

Goods and Services from Foundation Trusts

234

715

259,032

258,798

262,558

35,860

428

590 62,432

35,432

2007/08 £000

61,842

2008/09 £000

263,273

Total

Non Healthcare

Healthcare

Goods and services from other NHS bodies excluding Foundation Trusts

Total

Non Healthcare

Healthcare

Goods and services from other Primary Care Trusts

Note 4.1. Analysis of gross operating costs:

Note 4. Operating Costs

Notes to the accounts

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0 0 0 317 227 0 0 85 216 708 3,411 666,681

0 0 0 148 278 0 0 52 273 683 3,843 718,352

Change in the fair value of financial instruments NHS Trust Impairments (Profit)/loss on disposal of fixed assets Cost of capital charge Audit fees Other auditor’s remuneration Clinical negligence costs

Redundancies Education and training Other Total

PCT Board members’ costs above include £0 for early retirements prior to 6/3/95 (2007/08 £0).

Staff costs above include £0 for early retirements prior to 6/3/95 (2007/08 £0).

Other finance costs - unwinding of discount

2007/08 £000

2008/09 £000

Note 4.1. Analysis of gross operating costs:

Note 4. Operating Costs

Notes to the accounts

106 | Annual Report and Accounts 2008/09 - For the year ended 31 March 2009 27,883 0 4,282 0 0 3,233 1,185 0

30,663 677 4,234 0 0 6,965 1,507 0

Department of Health Initiative Funding Local Pharmaceutical Services Pilots New Pharmacy Contract Non-GMS Services from GPs

45,867 11,926 281,303 13,449 36,373 29,473

47,098 13,602 301,134 14,321 41,767 33,203

Mental Illness Maternity

Accident And Emergency Community Health Services Other Contractual

0 0 136 1,272 0 0

0 0 0 403 0 0

Impairments in Trusts Grants (revenue) to fund Capital Projects - GMS Grants (revenue) to LAs to fund Capital Projects

Grants (revenue) to fund Capital Projects - Dental Grants (revenue) to fund Capital Projects - other

43,222 35,847

48,043 32,186

Amount of self-commissioned secondary healthcare included above* Healthcare purchased from Foundation Trusts included above

Expenditure on mental health and learning disabilities include the contributions made by the PCT to the county-wide pooled budget with Hertfordshire County Council.

* This is the total of secondary healthcare that the PCT commissioned from itself

Social Care from Independent Providers

640,453

689,915

Total healthcare purchased by PCT

Grants (revenue) to private sector to fund Capital Projects

461,113

496,899

Total Secondary Healthcare Purchased

General and Acute

42,722

45,774

Learning Difficulties

Purchase of Secondary Healthcare

Total Primary Healthcare purchased

Other

General Ophthalmic Services

Trust led GDS and PDS

Contractor led GDS and PDS

177,932

2,179

2,619

192,613

73,565

75,535

Prescribing costs Pharmaceutical services

65,605

2007/08 ÂŁ000

70,413

2008/09 ÂŁ000

GMS / PMS/ APMS / PCTMS

Purchase of Primary Health Care

Note 4.2. Analysis of operating expenditure by expenditure classification Note 4.2. Purchase of Health Care by PCT

Notes to the accounts

www.enherts-pct.nhs.uk | 107

0

262

After 5 years Total

95

67

794

Between 1 and 5 years

1,056

28

Within 1 year

0

Operating leases which expire:

976

950

26

0

2007/08 2007/08 Other leases Land and Buildings £000 £000

1,146

Total

2008/09 Land and Buildings £000

1,118

1,146

Other operating lease rentals

Note 4.3/2. Operating expenses include:

0

0

Hire of plant and machinery

86

0

32

54

2007/08 Other leases £000

1,118

2007/08 £000

2008/09 £000

Note 4.3. Operating Leases Note 4.3/1. Operating expenses include:

Notes to the accounts

108 | Annual Report and Accounts 2008/09 - For the year ended 31 March 2009 5,101 0

2,875 5,101 0

Social security costs Employer contributions to NHSBSA

0 444

16 0 488 226 425 8

Administration and estates Healthcare assistants and other support staff Nursing, midwifery and health visiting staff Nursing, midwifery and health visiting learners

0 20 1390

0 20 1448

Other Total

Social Care staff

261

8

419

265

Scientific, therapeutic and technical staff

Ambulance staff

223

15

Total Number Medical and dental

2008/09 Permanently Employed Number

Note 5.2. Staff Numbers

Total

45,596

2,875

39,847

Salaries and wages

47,823

37,620

Total £000

Other pension costs

2008/09 Permanently Employed £000

Note 5.1. Staff costs

Note 5. Staff numbers and related costs

Notes to the accounts

58

0

0

4

0

6

3

44

0

1

Other Number

2,227

0

0

0

2,227

Other £000

1344

13

0

269

9

415

209

418

0

11

Total Number

44,007

0

4,700

2,638

36,669

Total £000

1310

13

0

261

9

410

209

400

0

8

2007/08 Permanently Employed Number

42,988

0

4,700

2,638

35,650

2007/08 Permanently Employed £000

34

0

0

8

0

5

0

18

0

3

Other Number

1,019

0

0

0

1,019

Other £000

www.enherts-pct.nhs.uk | 109

490,489

490,489

114,013 90.34%

17,504 87.81%

Total bills paid within target Percentage of bills paid within target

324,514 97.18%

1,448 72.15%

Total bills paid within target

60.01%

1,136

1,893

70.68%

10,720

15,168

2007/08 Number

Note 6.2. The Late Payment of Commercial Debts (Interest) Act 1998 No payments were made in respect of claims under this legislation in 2008/9 or 2007/8.

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

Percentage of bills paid within target

333,943

2,007

Total bills paid in the year

NHS Creditors

126,210

19,935

2008/09 £000

Total bills paid in the year

Non-NHS Creditors

2008/09 Number

Note 6.1. Better Payment Practice Code - measure of compliance

Note 6. Better Payment Practice Code

95.45%

308,396

323,099

87.69%

108,334

123,537

2007/08 £000

22.41

10,990

10,829

22.08

2007/08

2008/09

The PCT measures its management costs according to the definitions provided by the Department of Health

Management cost per head of weighted population (£)

Weighted population (Number)

Management costs (£000s)

Note 5.5. Management costs

Note 5.4. Retirements due to ill-health During 2008/09 there were 6 early retirements from the Primary Care Trust agreed on the grounds of ill-health (2007/08: 2). The estimated additional pension liabilities of these ill-health retirements (calculated on an average basis and borne by the NHS Pension Scheme) will be £220,527 (2007/08: £87,111).

Note 5.3. Employee benefits There were no employee benefits in 2008/9 or 2007/8

Notes to the accounts

110 | Annual Report and Accounts 2008/09 - For the year ended 31 March 2009 0 0 0 0 0 33

0 0 0 0 0 0 0

Loss as a result of catastrophe Abandonment of assets in course of construction Unforseen obsolescence Over specification of assets Other (detail below) Changes in Market Price Total

0 5

0 0

Bank loans and overdrafts Other interest and finance costs

The PCT did not hold any intangible fixed assets in 2008/9 or 2007/8.

Note 9 Intangible Fixed Assets

Total

22

0

0

Loans

18

0

Finance leases

0

2007/08 £000

33

33

0

0

0

0

0

0

Total Impairments £000

Late payment of commercial debt penalties

2008/09 £000

0

0

0

0

0

0

0

0

Current Financial Instruments £000

17

0

0

0

0

0

0

0

0

Fixed Financial Instruments £000

18

Payable:

Note 8. Finance Costs

0

0

Loss or damage from normal operations

33

Tangible Assets £000

Intangible Assets £000

Note 7.2. Analysis of Impairments charged to operating costs

There was no profit or loss on the disposal of tangible, intangible and investment assets, in 2008/9 and 2007/8.

Note 7.1. Other Gains and Losses

Notes to the accounts

0 0

0 (8)

0

- Government Granted at 1 April 2008

0 16,374

- Government Granted at 31 March 2009 Total at 31 March 2009

www.enherts-pct.nhs.uk | 111

0

0

0

0

0

0

0

0

0

1,080

0

0

1,080

803

0

0

803

0

1,080

0

0

0

0

0

0

0

0

277

414

0

13

401

233

0

14

219

556

0

0

0

0

0

0

60

496

970

0

0

0

0

0

0

0

0

241

729

Of the totals at 31 March 2009, £500,000 related to land valued at open market value.

14,637

0

1,597

0 - Donated at 31 March 2009

- Purchased at 31 March 2009

13,040

14,777

16,374

Net book value

Total at 1 April 2008

27,328

1,755

0 - Donated at 1 April 2008

0

13,022 - Purchased at 1 April 2008

27,328

Net book value

877

0

0 Disposals Accumulated depreciation at 31 March 2009

0

0

In year transfers to/from NHS bodies

0

0

0

0

33

852

15,514

0

0

0

0

16,374

0

0

0

0

0

0

0

0

0

Other in year revaluation

Indexation

Reclassifications

Reversal of Impairments

Impairments

Provided during the year

Accumulated depreciation at 1 April 2008

At 31 March 2009

Disposals

Other in year revaluation

In year transfers to/from NHS bodies 0

(174)

41

Reclassifications

1,118

0

0

Indexation

1,031

(1,351)

(12,026)

0

0

0

Additions - government granted

0

0

0

Additions - donated

Impairments

1,144

Land £000 0

Buildings excluding dwellings £000

Additions - purchased

Dwellings £000 803

Assets under construction and payments on account £000

0

Plant and machinery £000

14,777

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

1,741

0

0

1,741

1,738

0

0

1,738

4,297

0

0

0

0

0

604

3,693

6,038

0

0

0

0

0

0

0

0

607

5,431

Information technology £000 Transport equipment £000

27,328

0

0

2,594

0

2,149

0

0

0

6,181

0

0

0

0

0

0

33

1,559

4,589

0

1,779

0

1,619

626 34,872

0

9

617 33,253

219 45,098

0

10

209 43,319

451

0

0

0

0

8

0

0

43

400

1,077 41,053

0

0

0

133

0

0 (13,377)

0

0

325

619 49,687

Furniture and fittings £000

Cost or valuation at 1 April 2008

Note 10.1. Tangible fixed assets at the balance sheet date comprise the following elements:

Note 10. Tangible Fixed Assets

Notes to the accounts

Total £000

112 | Annual Report and Accounts 2008/09 - For the year ended 31 March 2009 16,374

Total 31 March 2009

14,777

0

0

0

0

0

0

0

0

0

0

803

803

0

0

0

1,080

956

0

0

124

233

0

0

0

233

414

0

0

0

414

0

0

0

0

0

0

0

0

0

0

1,738

0

0

0

1,738

1,741

0

0

0

1,741

219

0

0

0

219

626

0

0

0

626

13

Depreciation 31 March 2008

0

0

0

0

0

0

0 0

466 0

Long Leasehold Short Leasehold Total

1,597

1,597

28,948

29,414

Donated £000

Purchased £000 Freehold

2008/09

2008/09

0

0

0

0

Government Granted £000

2008/09

31,011

0

466

30,545

Total £000

2008/09

42,105

0

330

41,775

Total £000

2007/08

0

0

0

0

Assets under construction Furniture and and payments Plant and Transport Information Dwellings on account machinery equipment technology fittings £000 £000 £000 £000 £000 £000

Note 10.3 The net book value of land, buildings and dwellings at 31 March 2009 comprises:

64

Depreciation 31 March 2009

Buildings excluding Land dwellings £000 £000

Note 10.2/2 The total amount of depreciation charged to the income and expenditure in respect of assets held under finance leases and hire purchase contracts:

27,328

0

0

PFI residual interests Total 1 April 2008

0

231

99 0

14,546

27,229

On balance sheet PFI contracts

Finance Leased

Owned

Net book value 1 April 2008

0

0

PFI residual interests 14,637

0

167

299 0

14,470

16,075

On balance sheet PFI contracts

Finance Leased

Owned

Net book value 31 March 2009

Assets under Buildings construction excluding and payments Plant and Transport Information Furniture Land dwellings Dwellings on account machinery equipment technologyand fittings £000 £000 £000 £000 £000 £000 £000 £000

Note 10.2/1 Asset Financing

Notes to the accounts

13

64

Total £000

45,098

803

0

330

43,965

34,872

956

0

466

33,450

Total £000

www.enherts-pct.nhs.uk | 113

0 0 0 0 40 0 15 0 4 28

0 0 0 0 5 0 5 0 3 5

Software Licences Licences and Trademarks Patents Development Expenditure Buildings excl. Dwellings Dwellings Plant and Machinery Transport Equipment Information Technology Furniture and Fittings

0

0 Finished goods

2,442 0 0 0 1,976 9,859

4,299 0 0 0 1,801 12,187

Prepayments and accrued income Capital debtors - NHS Capital debtors - Non NHS Current part of PFI prepayments Other debtors

0

(49) Provision for impairment of debtors

4,485

31 March 2008 £000

956

4,883

31 March 2009 £000

1,253 Non NHS trade debtors

NHS debtors

Amounts falling due within one year:

Note 12. Debtors

Total

119

0

0 Work-in-progress

119

119

119

Raw materials and consumables

31 March 2008 £000

31 March 2009 £000

Note 11. Stock and work in progress

Maximum Life (years)

Minimum Life (years)

Note 10.6. Economic Lives of Fixed Assets

Note 10.5 Other Financial Assets Apart from Note 10.4 above, the PCT did not hold any fixed or current financial asset which is not separately disclosed elsewhere on the financial statements in 2008/9 or 2007/8.

Note 10.4 Fixed assets investments On 1st July 2008, the PCT acquired loan notes and shares to the value of £27,570 and £400 respectively.

This is in respect of the Assemble Community Partnership, the name of the newly formed partnership company between Bedfordshire PCT, Milton Keynes PCT, Guildhouse (a private developing company) and local public sector authorities covered by the three participant PCT areas.

Notes to the accounts

114 | Annual Report and Accounts 2008/09 - For the year ended 31 March 2009

1,714 0 0 1,714

1,636 0 0 1,636

Capital debtors - Non NHS Other debtors

405 By more than 6 months

5,836

610 By 3 to 6 months

Total

4,821

31 March 2009 £000 By up to 3 months

Note 12.2 Debtors past due date but not impaired:

(49)

Balance at 31 March

0

Amount recovered during the year

(49)

0

Amount written off during the year

(Increase)/decrease in debtors impaired

0

31 March 2009 £000 Balance at 1 April

Note 12.1 Provision for impairment of debtors

NHS Debtors include; - £0 prepaid pension contributions at 31 March 2009 (31 March 2008 £0); and - £0 prepayments from the buyout of early retirements (31 March 2008 £0).

Total

11,573

0

0

Provision for impairment of debtors

13,823

0

0

Non NHS trade debtors

Prepayments and accrued income

0

31 March 2008 £000

0

31 March 2009 £000

NHS debtors

Amounts falling due after more than one year:

Note 12. Debtors

Notes to the accounts

www.enherts-pct.nhs.uk | 115

0 0 8,088 0 20,934 7,615 704 229 0 440 16 2,007 89 0

0 0 10,728 0 25,152 7,956 656 517 1 472 16 1,601 152 0

Interest payable Payments received on account

Family Health Services (FHS) creditors Non - NHS trade creditors - revenue Non - NHS trade creditors - capital Tax VAT

0 49 97

0 0 32

Imputed finance leases element of on balance sheet PFI contracts Other

Note 13.1/1 Other Financial Liabilities There are no financial liabilities carried at fair value through profit and loss for 2008/9.

Other creditors include; - £49,127 for payments due in future years under arrangements to buy out the liability for one early retirements over 5 years (2007/08 £98,254); and - £659,000 outstanding pensions contributions at 31 March 2009 (£582,900 at 31 March 2008)

Total

40,219

0

0

NHS creditors

47,283

48

Obligations under finance leases and hire purchase contracts

32

Amounts falling due after more than one year:

Current part of finance lease element of on balance sheet PFI contracts

Accruals and deferred income

Other creditors

Obligations under finance leases and hire purchase contracts

Social Security costs

NHS creditors - capital

NHS creditors - revenue

0

31 March 2008 £000

0

31 March 2009 £000

Bank overdrafts

Amounts falling due within one year:

Note 13.1. Creditors at the balance sheet date are made up of:

Note 13 Creditors

Notes to the accounts

116 | Annual Report and Accounts 2008/09 - For the year ended 31 March 2009

273 353 (289)

268 320 (272)

After five years Subtotal

54 (237) 0 35 0 1,767 512

0 0 0 0 0 0 0 0 0

Arising during the year* Utilised during the year Reversed unused Unwinding of discount Transfer in-year At 31 March 2009 Future Payments to NHS trusts Future Payments to NHS Foundation Trusts Future Payments to Primary Care Trusts

395 1,109

0 0

1 - 5 years Over 5 years

0

8

0

0

0

0

8

0

0

0

0

0

8

0

0

481

0

0

0

481

0

0

0

0

481

0

Legal claims Restructurings £000 £000

538

128

562

0

0

700

1,228

0

17

0

(40)

372

879

Other £000

1,647

531

1,306

0

1,173

1,212

3,484

0

52

0

(277)

907

2,802

Total £000

* Provisions relating to the PCT’s own provider functions are shown gross with the expected reimbursements from the NHSLA included in debtors.

Pensions relating to other staff is the estimated full amount of the PCT’s liability for the additional cost to the NHS Pensions scheme of employees retiring early. The liability has been calculated following actuarial advice, but is by its nature only an estimate.

Restructuring provisions relate to the Provider Services arm of the PCT and the management structure changes required, as it moves to become a separate organisation.

The Other Provisions relate to the PCT’s future liability for Continuing Care under the Coughlan agreement and injury benefit. £280,218 is included in the provisions of the NHSLA at 31.3.2009 in respect of clinical negligence provisions of the PCT (31.3.2008 £15,609)

263

0

0

Within 1 year

Expected timing of cash flows:

1,915

0

At 1 April 2008

1,173

Pensions relating to other staff £000

Pensions relating to former directors/ members £000

Note 14. Provisions for liabilities and charges

Note 13.3 Finance Lease Commitments The PCT has no finance lease commitments, other than those in note 13.2.

Total

Less finance charges allocated to future periods

64

14

14

In more than 2 years but no longer than 5 years

48

33

5

In not more than 1 year or in demand In more than 1 year but no longer than 2 years

31 March 2008 £000

33

31 March 2009 £000

33

Payable:

Note 13.2. Finance lease obligations

Notes to the accounts

www.enherts-pct.nhs.uk | 117

0

Transfer of realised profits (losses)

8,917

20,043

1,619

0

Other movements on reserves At 31 March

0

Transfers to/(from) other NHS Bodies

0

0

15

(117)

0

1,779

(58)

0

0

2,461

0

17,582

Depreciation and disposal of donated/Government granted assets

0

2,134

Surplus/(deficit) on other revaluations/indexation of fixed assets

Receipt of donated/ Government granted assets

(13,260)

0

20,043

Fixed asset impairments

Transfer from the OCS

Cost of Capital Charge

Net Parliamentary Funding

PPA: elimination of negative revaluation reserves in respect of change in policy on impairments

At 1 April

Donated asset reserve

Government grant reserve

Other reserves

General Fund

1,779

0

0

(58)

0

0

140

0

1,697

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

317

(1)

0

0

(8,053)

0

0

0

(695,563) (647,045)

148

691,009 650,158

0

(8,053) (11,483)

0 (12,460)

0

0

2008/09 2007/08 2008/09 2007/08 2008/09 2007/08 2008/09 2007/08 2008/09 2007/08 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000

Revaluation reserve

Movements on reserves in the year comprised the following:

Note 15 Movements on Reserves

Notes to the accounts

118 | Annual Report and Accounts 2008/09 - For the year ended 31 March 2009

317 0 0 151 (58) 0 57 15,058 (16,523) (3,167)

148 33 0 959 (58) 0 0 (2,250) 7,128 (277)

Cost of capital charge Fixed asset impairments

Non-cash movement in provisions Transfer from donated asset reserve Transfer from the Government grant reserve (Increase)/decrease in stocks (Increase)/decrease in debtors Increase/(decrease) in creditors Increase/(decrease) in provisions Net cash inflow/(outflow) from operating activities

(649,073)

2,115

1,559

Depreciation charge

(688,303)

(647,023)

(695,545)

Net operating Cost

(Profit)/loss on disposal of fixed assets

2007/08 ÂŁ000

2008/09 ÂŁ000

Note 16.1. Reconciliation of operating costs to net cash flow from operating activities:

Note 16 Notes to the cash flow statement

Notes to the accounts

www.enherts-pct.nhs.uk | 119

16

16

0 16

(16) (32)

Finance leases due within one year Finance leases due after one year

(64)

0

0

0

0

0

0

0

0

0

(64)

(48)

(16)

0

0

0

Non-cash changes in Transfers to/ year from NHS bodies At 1 April 2008 £000 £000 £000

Excluded above: £1,906 held in PCT accounts relating to Patients’ money (£1,902 at 31 March 2008) Patients’ monies are excluded from creditors.

Total

16

0

0

Bank overdrafts

(48)

0

0

Cash at bank and in hand

Current asset investments

0

0

OPG cash at bank

Note 16.3 Analysis of changes in net debt

(48)

Net debt at 31 March 2009

0

0

(80)

16

16

(64)

At 31 March Cash flows in 2009 year £000 £000

0

0

0

2007/08 £000

2008/09 £000

Net debt at 1 April 2008

Non - cash changes in debt

Change in net debt resulting from cash flows

Cash (inflow)/outflow from (decrease)/increase in liquid resources

Cash outflow from finance lease payments

Increase/(decrease) in cash in the period

Note 16.2. Reconciliation of net cash flow to movement in net debt

Notes to the accounts

120 | Annual Report and Accounts 2008/09 - For the year ended 31 March 2009

(244) 0 (244)

(479) 0 (479)

The majority of contingent liability relates to claims for the reimbursement of continuing care expenditure, following the decision of the Health Service Ombudsman. Where a reasonable estimate of the PCT’s liability can be made, based on experience to date, it has been included as a provision (Note 14). However, given the uncertainty regarding the final outcome of individual cases, a contingent liability has been included to reflect the potential cost of those claims to the PCT.

Net Contingent Liability

Amounts recoverable (if any)

Gross value

2007/08 £000

2008/09 £000

The Primary Care Trust has the following contingent (losses)/gains which have not been included in the accounts:

Note 19. Contingencies

There are no post balance sheet events having a material effect on the financial statements.

Note 18. Post Balance Sheet Events

Commitments under capital expenditure contracts at the balance sheet date were £277,000 (2007/08: £0).

Note 17. Capital Commitments

Notes to the accounts

www.enherts-pct.nhs.uk | 121

1,333 1,910 1,177

Dr T Kostick: Partner at Dr Baxani and Partners Dr M Hoffman:Partner at Dr Hoffman and Partners Dr P Shilliday: Partner at Garden City Practice

0 0 4,028 5,128 32 1,622 0 0 0 837 0 861

20,382 17,658 177,700 479 14,439 87,574 6,092 5,101 41,779 35,794 8,764 18,245

Barnet and Chase Farm Hospitals NHS Trust Cambridge University Hospitals NHS Foundation Trust

East of England Ambulance Services NHS Trust Hertfordshire County Council HM Revenue and Customs NHS Pension Scheme South East Essex PCT The Princess Alexandra Hospital NHS Trust

3,835

133

486

881

659

518

0

709

32

2,862

762

320

Amounts owed to Related Party £000

The PCT has also received revenue and capital payments from a number of charitable funds, certain of the Trustees for which are also members of the PCT Board.

0

0

837

0

0

378

0

0

997

1,157

0

0

Amounts due from Related Party £000

In addition, the PCT has had a significant number of material transactions with other Government Departments and other central and local Government bodies. Where appropriate, these transactions have been reflected in the above table.

West Hertfordshire PCT

University College London NHS Foundation Trust

East of England Strategic Health Authority

East and North Herts NHS Trust

Receipts from Related Party £000

Payments to Related Party £000

The Department of Health is regarded as a related party. During the year the PCT 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. The PCT has adopted a disclosure level of £5million in 2008/09. These entities are listed below;

1,102

Dr M Andrews: Partner at Dr Henderson and Partners

£000’s

Details of payments during the year to GP’s on the Boards and Professional Executive Committee were as follows.

During the year local GPs sat on the Board and Executive Committee of the PCT. Payments are made to all practices in the PCT under the new GP contract for the provision of GP services and reimbursement expenses for staffing and computing.

The GPs on the Board and Professional Executive Committee had no direct control over how these funds were allocated.

During the year none of the Board Members or members of the key management staff or parties related to them has undertaken any material transactions with the PCT.

East and North Hertfordshire PCT is a body corporate established by order of the Secretary of State for Health.

Note 20. Related Party Transactions

Notes to the accounts

122 | Annual Report and Accounts 2008/09 - For the year ended 31 March 2009 1,003 1,210 1,656 1,004

Dr M Andrews: Partner at Dr Henderson and Partners Dr T Kostick: Partner at Dr Baxani and Partners Dr M Hoffman: Partner at Dr Hoffman andPartners Dr P Shilliday: Partner at Garden City Practice

£000’s

Details of payments during the year to GPs on the Boards and Executive Committee or their practices.

During the year local GPs sat on the Board and Executive Committee of the PCTs. Payments are made to all practices in the PCT under the new GP contract for the provision of GP services and reimbursement expenses for staffing and computing.

The GPs on the Board and Professional Executive Committee had no direct control over how these funds were allocated.

During the year none of the Board Members or members of the key management staff or parties related to them has undertaken any material transactions with the PCT

Note 20A. Related Party Transactions 2007/08 East and North Herfordshire PCT is a body corporate established by order of the Secretary of State for Health.

Notes to the accounts

www.enherts-pct.nhs.uk | 123

79 1,152

184 101

974 51

994 513 1,362

16 12,833 1,083 243 80,227 6,106 2,272 2,238 701 628 352 2,581

East of England Ambulance Services NHS Trust Guy’s and St Thomas’ NHS Foundation Trust Hertfordshire Partnership NHS Foundation Trust Hertfordshire County Council HM Revenue and Customs Imperial College Healthcare NHS Trust Luton and Dunstable Hospital NHS Foundation Trust Mid Essex Hospital Services NHS Trust Moorfields Eye Hospital NHS Foundation Trust North Essex Partnership NHS Foundation Trust North Middlesex University Hospital NHS Trust

230

46 583 157

483 4,700 3,168 6,241 6,090

NHS Pension Scheme Papworth Hospital NHS Foundation Trust Royal Brompton and Harefield NHS Trust Royal Free Hampstead NHS Trust

814

32,537 The Princess Alexandra Hospital NHS Trust

West Hertfordshire NHS Trust

West Hertfordshire PCT

West Essex PCT

Welwyn Hatfield District Council

University College London NHS Foundation Trust

202

23

14,527 South East Essex PCT

38 50

1,820 651 168

636 3,841 16,443 575

172

1,065

7,590

115

459

2,176 Royal Nat. Orthopaedic Hospital NHS Trust

NHS Business Services Authority

154

65

353

611

3

184

423 National Insurance Fund

North West London Hospitals NHS Trust

2,638

52

200

536

270

1,043

9

29

206

95

229

119

751

330

628

5

25

166

Amounts due from Related Party £000

458

East of England Strategic Health Authority

351

3,351

4,184

168,733

East and North Herts NHS Trust

74

49

768

Cambridgeshire PCT

158

19,000

Cambridge University Hospitals NHS Foundation Trust

28

171

Bedfordshire PCT

550

369

439

Amounts owed to Related Party £000

631

3,239

19,949

Receipts from Related Party £000

Basildon and Thurrock University Hospitals NHS Foundation Trust

Barts and The London NHS Trust

Barnet and Chase Farm Hosp NHST

Payments to Related Party £000

The Department of Health is regarded as a related party. During the year the PCT 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 listed below;

Notes to the accounts

124 | Annual Report and Accounts 2008/09 - For the year ended 31 March 2009 (150)

(153) 2,262

Amortisation of PFI deferred asset Net charge to operating costs

0 0 0 0 2,321

0 0 0 0 2,415

2 to 5 years (inclusive) 6 to 10 years (inclusive) 11 to 15 years (inclusive) 16 to 20 years (inclusive) 21 to 25 years (inclusive)

28/04/2033

The PFI scheme is a redevelopment on the Herts and Essex Hospital site to provide modern updated Health Services to include Elderly Medicine and Mental Health.Outpatient facilities for a range of specialities are also being provided. The development also includes a Minor injuries unit and accommodation for community services. The scheme has been developed in conjunction with a nursing home development situated at Harlow.

28/04/2003 Contract end date

14,200 Contract start date

The estimated capital value of the PFI scheme

0

0

Within one year

£000

2007/08 £000

2008/09 £000

The PCT is committed to make the following payments during the next year, in which the PFI scheme expires

2,321

2,415

Amounts included within operating expenses in respect of PFI transactions deemed to be off-balance sheet -gross.

2,171

2007/08 £000

2008/09 £000

Note 21.1. PFI schemes deemed to be off-balance sheet

Note 21. Private Finance Transactions

The PCT has also received revenue and capital payments from a number of charitable funds, certain of the Trustees for which are also members of the PCT Board.

In addition, the PCT has had a significant number of material transactions with other Government Departments and other central and local Government bodies. Where appropriate, these transactions have been reflected in this table.

Notes to the accounts

www.enherts-pct.nhs.uk | 125

1,792

0

0

0 Other Gross financial assets

0

1,792

0

Sterling

At 31 March 2008

1,636

0

0

Other Gross financial assets

0

1,636

Total £000

Floating rate £000

Sterling

At 31 March 2009

Currency

Note 22.1 Financial Assets

0

0

0

0

0

0

Fixed rate £000

1,792

0

1,792

1,636

0

1,636

Non-interest bearing £000

0

0

0

0

Weighted ave interest rate %

0

0

0

0

Weighted ave period for which fixed Years

Fixed Rate

0

23

0

22

Weighted average term Years

Non-interest bearing

Interest-Rate Risk 100% of the PCT’s financial assets and 100% of its financial liabilities carry nil or fixed rates of interest. East and North Hertfordshire PCT is not, therefore, exposed to significant interest-rate risk. The following two tables show the interest rate profiles of the PCT’s financial assets and liabilities:

Liquidity risk Most of the PCT’s net operating costs are incurred under annual service agreements with local PCTs, NHS Trusts and NHS Foundation Trusts and are financed from resources voted annually by Parliament or directly financed from resources voted annually by Parliament. The PCT also largely finances its capital expenditure from funds made available from Government.

East and North Hertfordshire PCT is not, therefore, exposed to significant liquidity risks.

As allowed by FRS 29, debtors and creditors that are due to mature or become payable within 12 months from the balance sheet date have been omitted from all disclosures other than the currency profile.

FRS 29, Financial Instruments: Disclosures, requires disclosure of the role that financial instruments have had during the period in creating or changing the risks an entity faces in undertaking its activities. Because of the way PCTs are financed, they are not exposed to the degree of financial risk faced by business entities. Also financial instruments play a much more limited role in creating or changing risk than would be typical of the listed companies to which FRS 29 mainly applies. The PCT has limited 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 PCT in undertaking its activities.

Note 22. Financial Instruments

Notes to the accounts

126 | Annual Report and Accounts 2008/09 - For the year ended 31 March 2009 81

Gross financial assets

0

162

0

162

81

0

81

Fixed rate £000

0

0

0

0

0

0

Non-interest bearing £000

0

0

0

0

0 0 0 1,636

0 0 0 0 0

NHS debtors Non NHS debtors Cash at bank and in hand Other financial assets Total at 31 March 2009

0 0 0 0 32 49

0 0 0 0 0 0 0

Embedded derivatives NHS creditors Non NHS creditors Borrowings Private Finance Initiative and finance lease obligations Other financial liabilities Total at 31 March 2009

81

Available f or sale £000

0

0

0

0

0

0

Available for sale £000

0

67

0

62

At fair value through profit and loss £000

Note 22.5 Financial Liabilities

0

0

Embedded derivatives

1,636

Loans and receivables £000

At fair value through profit and loss £000

Note 22.4 Financial Assets

Non-interest bearing

81

49

32

0

0

0

0

Total £000

1,636

1,636

0

0

0

0

Total £000

0

0

0

0

Weighted Weighted ave average term period for which fixed until maturity Years Years

Fixed Rate Weighted ave interest rate %

Note 22.3 Fair Values The fair values of financial assets and liabilities in Notes 22.4 and 22.5 opposite do not defer materially from their carrying amounts.

Foreign Currency Risk The PCT has negligible foreign currency income or expenditure.

162

0

0

Other Gross financial assets

0

162

Sterling

0

0

0

Other At 31 March 2008

0

81

Total £000

Floating rate £000

Sterling

At 31 March 2009

Currency

Note 22.2 Financial Liabilities

Notes to the accounts

www.enherts-pct.nhs.uk | 127

0 0 1,636 1,636 0 0 0 0 1,714

851 3,024 0 6,075 12,187 1,574 288 3,447 0 4,550

Balances with local authorities Balances with NHS Trusts/FTs

Balances with bodies external to Government At 31 March 2009 Balances with other central government bodies Balances with local authorities Balances with NHS Trusts/FTs

At 31 March 2008

Balances with bodies external to Government

Balances with public corporations and trading funds

1,714

0

2,237

Balances with other central government bodies

9,859

0

Debtors Amounts falling due within one year £000

Balances with public corporations and trading funds

Debtors Amounts falling due after more than one year £000

Note 25. Intra-government balances

Note: The total costs included in this note are on an accruals basis.

40,122

27,918

0

10,027

446

1,731

47,251

34,691

0

5,373

183

7,004

Creditors Amounts falling due within one year £000

97

97

0

0

0

0

32

32

0

0

0

0

Creditors Amounts falling due after more than one year £000

There were no fruitless payment cases where the net payment exceeded £100,000 in 2008/9 or 2007/8.

There were no compensation under legal obligation cases where the net payment exceeded £100,000 in 2008/9 or 2007/8.

There were no personal injury cases where the net payment exceeded £100,000 in 2008/9 or 2007/8.

There were no fraud cases where the net payment exceeded £100,000 in 2008/9 or 2007/8.

There were no clinical negligence cases where the net payment exceeded £100,000 in 2008/9 or 2007/8.

Note 24. Losses and Special Payments There were 26 cases of losses and special payments (2007/08: 25 cases) totalling £70,695 (2007/08: £34,830) approved during 2008/09.

Note 23. Third party assets The PCT held £1,906 cash at bank and in hand at 31/3/2009 which relates to monies held on behalf of patients (£1,902 at 31/3/08). This has been excluded from cash at bank and in hand figure reported in the accounts.

Notes to the accounts

Alternative formats and additional copies

Contact us

For people who may have difficulty reading the print in this report, a large print version can be made available by contacting our communications team:

You can write to us at:

Communications Team Hertfordshire Primary Care Trusts Charter House Parkway Welwyn Garden City Hertfordshire AL8 6JL Telephone: 01707 390855 Email: enquiries@herts-pcts.nhs.uk The communications team can also arrange to provide the following on request: • • •

dditional copies of this document A (hard copy or electronic version) An audio-cassette or CD version (arranged on request only) Help in understanding the document in languages other than English

Please note that this Report is also available to download from the NHS East and North Hertfordshire website as follows: www.enherts-pct.nhs.uk

128 | Annual Report and Accounts 2008/09

NHS East and North Hertfordshire Charter House Parkway Welwyn Garden City Hertfordshire AL8 6JL You can telephone us on: 01707 390855 (Switchboard open 8am – 6pm) You can email us at: enquiries@herts-pcts.nhs.uk Or visit our website: www.enherts-pct.nhs.uk

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We would like to pay tribute to the outstanding contribution and dedication of our staff. Everyone has a played their part in helping people in Hertfordshire to remain healthy and stay active.

Published September 2009