NHS West Hertfordshire Annual Report and Accounts 2008/09

Annual Report and Accounts 2008/09

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 83 94 126

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 getting 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 West Hertfordshire to concentrate on becoming a world class commissioning organisation, which means purchasing the best possible health care from a range of providers including the private and third (voluntary) sector.

Throughout this report we refer to ourselves as NHS West Hertfordshire. This name was adopted in 2009 to better reflect our position as local leaders of the NHS. The change

Anne Walker Stuart Bloom Chief Executive Chair

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of name is in line with national recommendations and follows 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 opening of the new urgent care centre in Hemel Hempstead, 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.

Mike Edwards Chair of the Professional Executive Committee

Achievements this year include the opening of the new urgent care centre in Hemel Hempstead, increased investment to improve the availability of NHS dental appointments and extended opening hours at a large number of GP practices

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

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About us NHS West Hertfordshire was established on 1 October 2006. We are made up of the former Dacorum, Hertsmere, St Albans and Harpenden and Watford and Three Rivers 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

We commission services in a number of different ways:

With NHS East and North 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 or nurse prescribers.

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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 West Hertfordshire.

This organisation is now known as Hertfordshire

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Community Health Services (HCHS). From October 2009 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 are 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 East and North Hertfordshire.

Initially NHS West 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 East and North Hertfordshire.

Dr Diane Bailey

Chair

Non-executive Director

Non-executive Director

Non-executive Directors

Femi Adewole

Chairs

Stuart Bloom

Mark Gainsborough Non-executive Director

Dr Mike Edwards

Eliza Hermann

Anne McPherson

Paul Smith

Joint Chair, Professional Executive Committee

Non-executive Director

Non-executive Director

Non-executive Director

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 the PCT 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 include: • • • • • • • • • • • • • • • • • • • • • • • • • •

Bushey Health Centre Elstree Way Clinic, Elstree Garston Clinic, Watford Gossoms End Rehabilitation Unit, Berkhamsted Grove Clinic, Harpenden Grovehill Clinic, Hemel Hempstead Harpenden Memorial Hospital Hemel Hempstead Hospital Jacketts Field Rehabilitation Unit, Abbots Langley Langley House Rehabilitation Unit, Watford London Colney Clinic Mandeville Clinic, St Albans Marlowes Clinic, Hemel Hempstead Oxhey Drive Primary Health Care Centre, South Oxhey Potters Bar Community Hospital Principal Health Centre, St Albans Skidmore Way Clinic, Rickmansworth St Albans City Hospital The Avenue Clinic, Watford The Isbister Centre, Hemel Hempstead The Peace Children’s Centre, Watford Tring Clinic Victory Road Clinic, Berkhamsted Watford General Hospital West Hertfordshire Wheelchair Service, Shenley Windmill House Rehabilitation Unit, Bushey.

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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.

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.

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.

Improving the health and safety of staff and patients has been another priority for the PCT during the financial year. To this end, we have completed: • • •

In addition, we have:

We work with a large number of partners including:

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• Therefore, this year it has been a priority for the PCT 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 West Hertfordshire spent almost £0.7m of capital monies to improve buildings and facilities.

These projects have included: • • •

refurbishment of South Oxhey Clinic internal and external improvements to Potters Bar Community Hospital upgrades at Nascot Lawn Children’s Centre

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.

a comprehensive gas boiler servicing and safety testing programme new Type 2 asbestos surveys for all buildings 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.

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.

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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.

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 on the next page.

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

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roducing energy certificates for all buildings p over 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.

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

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

The short-term actions include: • • •

I ncreasing 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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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.

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.

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.

in a variety of ways. The PCT commissions a number of 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.

Community safety partnerships Community safety partnerships are linked to the LAA ‘Safer & 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.

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.

The five HCOP indicators are: • • • • •

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

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), prisoners 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 West Hertfordshire was a partner in an event organised for the Polish community, aimed at informing them about services available and listening to their needs. NHS West 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. Our prison healthcare team worked with partners including prison officers, Hertfordshire LINk and prisoner representatives to establish an innovative project that aims to address health inequalities at HMP the Mount in Bovingdon. This groundbreaking project gives prisoners the opportunity to become more involved in developments in healthcare within the criminal justice system. The project appoints prison representatives to report on matters relating to the provision of health services and has enabled problems to be resolved and found solutions to improve matters such as a new appointment system to reduce waiting times and improving privacy when attending the prison medical service. These positive measures and partnerships have created excellent community links which are advantageous when prisoners are released.

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.

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.

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

Planned care NHS West Hertfordshire, together with NHS East and North Hertfordshire, are the lead health commissioning organisation in the county. This means that, alongside NHS East and North 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.

New health centre to provide extra GP services A new kind of GP surgery – West Herts Medical Centre is now open in Hemel Hempstead, on the hospital site.

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

Open to everyone living, working or visiting west Hertfordshire (not just Hemel Hempstead), the centre offers: •

This means that now 51 GP practices (around 72%) in West Hertfordshire now offer appointments outside normal working hours, including more than 30 which open on a Saturday morning.

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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)

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. * Stuart Bloom, Chair of NHS West 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.”

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: • •

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.

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Find out more online at: www.westhertsmedicalcentre.nhs.uk or on 03000 33 22 33.

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1% of patients were happy with how long they had 7 to wait for treatment nearly three quarters of patients found it easy to make their first hospital appointment (either by phone, online or within their GP practice) 84% of patients who were offered a choice of where to be treated, were able to go to their preferred hospital 95% of patients felt that they were treated with respect and dignity during their treatment.

Stuart Bloom 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”. * 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.

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.

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.

More information is available at www.nhs.uk/choices Hotline to NHS dental appointments NHS West Hertfordshire is committed to ensuring that good quality and accessible NHS dental treatment is available locally for all who need it.

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 500 calls from people in West 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 West Hertfordshire.

“In Hertfordshire, 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.

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.

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:

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.

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.

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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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• •

Say 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 groups in Hertsmere and St Albans. These groups of GP surgeries are responsible for buying and designing health services that best meet the needs of their local residents.

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 Mental illness affects just over one in every hundred people in Hertfordshire, which is slightly below the national average.

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.

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 St Albans and Watford. 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 and will shape the way we care for pregnant women.

The review’s key recommendations include: • • •

S upport for the decision to close the birthing unit at Hemel Hempstead Hospital Support for introducing midwife-led birthing units alongside consultant-led services Improving local antenatal and postnatal services run by midwives at Hemel Hempstead, St Albans and on the QEII site in Welwyn Garden City.

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Anne Walker, Chief Executive of NHS West 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 commissioned by NHS West Hertfordshire.

Ensuring that the views and experiences of service users help shape these services is the idea behind the West Hertfordshire Maternity Service Liaison Committee (MSLC).

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.

Maternity and children’s commissioning manager Julie Juliff, is a member of the West Herts MSLC on behalf of NHS West Hertfordshire. She has provided management and administrative help to the group for the last two years. Julie says: “The group is made up of both health professionals and lay members, who either represent local groups associated with pregnancy and childbirth like the National Childbirth Trust or are ordinary parents who have recently had a baby.

I know that people can find the thought of attending meetings with consultants, midwives and NHS managers a little daunting but everyone is very friendly and welcoming.

training specifically devised for members of MSLCs, we have also developed subgroups so that people who have a specific interest in say antenatal care or breastfeeding can concentrate on specific issues that are real for women. New members are always welcome and their input can make a real difference”.

If you are interested in joining the MSLC please contact NHS West Hertfordshire on enquiries@herts-pcts.nhs.uk

“Everyone’s thoughts and opinions are taken as seriously as anybody else’s and ‘lay’ members have a valuable contribution to make to the development of local maternity services. This year we have provided all members with

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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 was happy and surprised to be nominated – it was morale boosting and was great to feel appreciated.”

As well as being recognised by the PCT, this project is also a regional winner of a Health and Social Care Award. For more about this project, see page 38

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 West 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

Healthy eating starts young

In 2008, Hertfordshire reached its ambitious aim of having 50 Children’s Centres across the county.

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.

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. For example, our centre in St Albans has a well established day care programme, whereas centres in more rural parts of West Hertfordshire may have more of an emphasis on signposting parents to local services.

We are providing full spectrum family support in the community, by offering flexible and affordable childcare facilities in combination with assistance for parents.

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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NHS West Hertfordshire is supporting this national initiative with a series of cooking classes for children and parents.

The first sessions took place at Frances Bacon School in St Albans, and saw parents and children aged between nine and 13, learn how to cook healthy meals that are also affordable. The six-week course aims to promote healthy eating, contribute towards reducing childhood obesity, and teach cooking skills to families, while also having fun.

TV child psychologist Dr Tanya Byron celebrates the sixth birthday of Hertfordshire’s first ever children’s centre - the St Albans Children’s Centre in Church Crescent. Opened in 2002, the centre offers a range of services for parents and children including a nursery and pre-school, health services for children with special needs and the Sure Start centre for the local area.

Dr Tanya Byron said: “It is really encouraging to see so many agencies at the St Albans Children’s Centre, working in partnership to provide integrated support for local families. The enthusiasm amongst everyone at the centre is infectious.”

Sudip Das, who attended the cooking classes with his son Manesh, said: “I found that the classes have given me a new learning skill plus the added bonus of spending quality time with my son.”

Another parent, Karen Allison, said: “This is fantastic, and we need more classes like this. My son Jake loves cooking and has had a great time. He told me that he would like to be a chef when he is older.”

The courses will continue in different locations over the next two years.

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.

Making sure that patients who need palliative care, and their families, receive an effective and supportive service is a key priority for NHS West Hertfordshire.

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 seeks to 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.

A member of the team said: “Patients tell us that they value our service because we all work together to address their very specific needs. One patient recently described my colleague as an ‘asset to the NHS’ and it made me feel proud to work for a service that supports patients and their families at the end of their life.”

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 West 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 West 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 1,454 people in West 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

34 | Annual Report and Accounts 2008/09

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.

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 West 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 West 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 to 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 together in close proximity 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, more than 77% of people aged 65 and over had a free flu jab in West Hertfordshire, as did a further 50% of people identified as ‘at risk’ of contracting flu.

For more information visit www.immunisation.nhs.uk/ vaccines/flu

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Swine flu Since the emergence of a new kind of flu virus (swine flu) in Mexico this year, NHS West 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 be eliminated thanks to a new vaccination programme.

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.

36 | Annual Report and Accounts 2008/09

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 West 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 among 12-13 year olds living in West Hertfordshire is around 80% - broadly in line with the national average. Uptake by 17-18 year olds is slightly lower than the national average at around 35%. This variation in take-up rates can be put down to the fact that the vaccination programme for 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 West 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 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 thousands of 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.

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 West 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 west Hertfordshire are benefiting from bowel cancer screening. The bowel cancer screening home kits introduced last March have so far helped to save the lives of 32 people.

The bowel cancer screening unit, based at Hemel Hempstead Hospital, will see and treat any patients who are referred to them from the national screening programme.

Under the NHS-funded scheme, around 36,000 screening packs were sent to people, aged between 60 and 69, across West Hertfordshire.

Dr Alistair King, consultant gastroenterologist and screening programme director, said: “A year after starting this programme we are beginning to see real benefits for people. The initial test is simple and can be done in the privacy of your own home. Anyone with an abnormal test will be seen within days by a specialist nurse at Hemel Hempstead Hospital, and usually advised to have an internal examination of the bowel called a colonoscopy. In this way we are detecting cancers early, when there is a very good chance of complete cure.”

He added: “Unfortunately only half the people being sent kits are currently returning them. I really would like to see this number increase so we can extend the benefits of this programme to as many people as possible. That way we can save even more lives.”

Susan Marsden, screening manager at NHS West 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.

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

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%.

FAST stands for:

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.

• • •

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.

Could you spot a stroke?

You could save a life 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.

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.

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 R. Farag, Consultant physician in stroke medicine for West Hertfordshire Hospitals NHS Trust said: “The outlook for patients who suffer a stroke has changed dramatically in the last few years. Now they are given the highest priority from the moment someone dials 999. Ambulance crews are quick to spot a possible stroke.

“However, what we need people to understand is that early treatment can make a very significant improvement in reducing and minimising the disability from stroke and some can make a near full recovery, but only if the signs are spotted early and the patient receives emergency care as quickly as possible.

“Friends and family who react quickly and dial 999 also make all the difference. They may need to over-rule the patient who sometimes fails to recognise what is happening to them.”

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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Over the past year we have run self management courses for patients with Diabetes and Multiple Sclerosis. Further courses for patients with sight difficulties are being planned in partnership with local charity Hertfordshire Society for the Blind.

Prisoners in HMP The Mount in Bovingdon have also been offered the chance to take control of their health conditions. An Expert Patient Programme was piloted within the prison during 2008 which contributed to the prison healthcare staff and NHS West Hertfordshire winning a prestigious regional Health and Social Care Award for partnership working.

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Changing services NHS West Hertfordshire and NHS East and North 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:

Launch of an Urgent Care Centre in Hemel Hempstead A new 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. It is located in the former A&E department in Jubilee Wing.

The Urgent Care Centre is a ‘walk-in’ service. Those attending with minor injuries and less serious illnesses will be seen promptly by either a nurse or doctor. The centre is also treating children with minor illnesses and minor injuries such as cuts, bites, fractures, strains and sprains. People who require emergency help however, are still advised to call 999 or attend their nearest A&E department.

During its first year, the UCC has seen thousands of local people needing care. 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. Those who require more specialised care are assessed at the Urgent Care Centre and transferred to an A&E department.

Dr Tony Davies, lead GP at the Hemel Hempstead Urgent Care Centre, says: “The centre is staffed by GPs and nurses with specialist training and skills. This means that we are able to deal with a wider range of conditions than a traditional minor injuries unit as all of the GPs have additional experience in treating the more serious injuries and illnesses that people may come in with.

“The centre is working well and is proving to be very popular with both the staff who work here and the patients who are being seen. Whilst the UCC is subject to the same four-hour maximum wait target as any A&E department, most patients who use us wait significantly less time than that.”

40 | Annual Report and Accounts 2008/09

Dr Davies adds: “We will see all patients who walk into the centre at any time during the day or night. Some patients may also come to us by ambulance. These patients are brought here under strict guidelines drawn up in partnership between the Urgent Care Centre, the hospital and the ambulance service.”

Following the results of a public consultation during 2007, there are plans to develop a network of eight Urgent Care Centres across Hertfordshire. The centre at Hemel Hempstead is the first of these to open. New Urgent Care Centres will open at Hertford and Cheshunt in autumn 2009, and St Albans in March 2010.

A&E transfer In March 2009, A&E services transferred from Hemel Hempstead to Watford General Hospital. Patients arriving as an emergency to the hospital are admitted to the new 120-bed Acute Admissions Unit, where they are seen and assessed rapidly by a consultant, who can call upon the advice of specialists in respiratory medicine, cardiology, neurology, gastroenterology and rheumatology, among others. This ensures that patients are cared for by the most appropriate speciality team in the shortest possible time.

New local general hospital

In the meantime, many outpatient services remain at the hospital site in Hillfield Road, including: • • • • • • • •

Outpatient clinics Pathology services The Urgent Care Centre Fracture clinic Pharmacy Therapy services Pre-operative assessment Intermediate care – 20 new intermediate care beds opened in Lancaster Ward at Hemel Hempstead Hospital in July 2008 and are taking patients from the area who are recovering after an acute hospital stay but are not well enough to manage on their own at home. The beds are in addition to the 24 intermediate care beds at Gossoms End Unit in Berkhamsted.

Elsewhere in Hertfordshire Changes are also afoot in neighbouring East and North Hertfordshire. In 2008/09, progress has included agreement on the site of a new local general hospital in Welwyn Garden City (QEII Hospital site), agreement on plans for a state-of-the-art surgicentre at the Lister Hospital in Stevenage; and moves towards a multi-million pound expansion of the maternity unit also at the Lister Hospital.

With the transfer of acute services to Watford General Hospital, NHS West Hertfordshire is leading the planning and development of a new local hospital for Hemel Hempstead.

During 2009, local patient and community representatives helped the NHS consider the pros and cons of potential sites for the new hospital. An independent review of the costs for each site was also undertaken, with both the existing hospital site on Hillfield Road and a new site at Breakspear Way being taken forward. The new hospital should be ready to open at the end of 2013.

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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.

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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 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 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.

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: • •

• 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.wherts-pct.nhs.uk

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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 51 GP practices (around 72%) in West Hertfordshire now offer appointments outside normal working hours, including more than 30 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 West Hertfordshire build on its financial recovery of the preceding year, and marks an important shift in our direction of travel.

Operating & financial review www.wherts-pct.nhs.uk | 47

Overview NHS West 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 wider health and wellbeing agenda.

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.

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 West 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.

Responsibility for the health care 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 part of our ‘Delivering Quality Healthcare for Hertfordshire’ programme, we opened an Urgent Care Centre (UCC) in Hemel Hempstead in October 2008. From October 2008 to March 2009 the UCC has seen in excess of 12,600 patients, more than 85% of whom were treated and discharged within two hours. The average wait for a consultation is less than 20 minutes and only a very small minority of patients were referred on to an A&E department. In time, we hope to see the UCC handling around two thirds of the work of an accident & emergency department.

Elsewhere, we have reached agreement on locating an elective care centre at St Albans City Hospital. This centre means less disruption for patients because planned operations are separate from emergency treatment, reducing the likelihood of operations being cancelled due to unexpected emergencies.

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.

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.

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 West 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 West Hertfordshire to have their say in the way services are provided.

50 | Annual Report and Accounts 2008/09

Our Performance Operating & financial review

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Strategic objectives and progress The PCT’s objectives for 2008/09 are shown below, highlighting our progress as of 31 March 2009.

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

- ‘Making the Difference’ programme rolled out to all staff - Reward and Recognition scheme in place - Significant increase in staff appraisals and personal development plans

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 o - Board 360 Review undertaken

Deliver on local and national targets and standards

- See section on Key Performance Indicators

Become increasingly effective commissioners

- - - - - - -

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

Acute services centralised at Watford Urgent Care Centre open at Hemel Hempstead Hospital County-wide ‘out of hours’ GP and dental contract in place 51 GP practices in West Hertfordshire are now operating extended hours Contract awarded for new GP-led Health Centre County workforce group in place

Commissioning Strategy agreed Joint Strategic Needs Assessment completed Primary Care Balanced Scorecard developed and published Quality metrics built into contracts and monitored Key indicators agreed for GPs, dentists and pharmacists First round of World Class Commissioning assurance process completed Organisation Development Programme to support World Class Commissioning developed.

PBC group-based needs assessments complete Information provision to PBC groups improved 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 tool rolled out Complaints and incident reporting processes in place Plan in place to reduce waiting times Staff vacancy rates reduced Intermediate care ward opened at Hemel Hempstead Hospital

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

Performance in these priority areas 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.

•

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.

In December 2008, NHS West Hertfordshire achieved these targets, with 90.2% of patients requiring admission being seen and treated within 18 weeks; and 98.4% of nonadmitted patients being seen and treated within 18 weeks.

Performance against these targets was maintained during the remaining months of 2008/09.

Improving access (including at evenings and weekends) to GP services 51 GP practices (73.9%) now operate extended hours, exceeding the target of 50% of practices which was set for 31 March 2009.

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 97.95% - 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. West Hertfordshire Hospitals 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 1,454. 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 & lifestyle’ survey has shown the success of the overall approach, and smoking levels are continuing to fall across NHS West 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. NHS West Hertfordshire exceeded this target set for 2008/09, achieving 87%. This programme will continue alongside other incentives aimed at reducing childhood obesity.

Increased screening for chlamydia The target is to screen 17% of 15-24 year olds. During 2008/09 we screened 7.4%. Performance in the final quarter of 2008/09 shows improvement with 3,033 screens undertaken in the final quarter. Had this rate been undertaken across the whole year 11.4% 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 ensure 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

100%

Q4

% receiving first definitive treatment in one month

98.982%

Q4

% subsequent treatment in one month

99.482%

Q1 – Q3

Percent treated in 2 months - GP

99.642%

Q4

Percent treated in 2 months - GP

93.296%

Q4

Percent treated in 2 months screening

58.333%

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.

West Hertfordshire Hospitals NHS Trust met both these targets with just 15 MRSA infections reported to the end of the year against a limit of 21, and 63 CDiff cases against a 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

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incidence rates for the population. The target for 2008/09 was to have fewer than 388 incidents of clostridium difficile. NHS West Hertfordshire has made excellent progress with 221 reported cases by year end.

4 Improving patient experience, staff satisfaction, and engagement NHS West 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 prisoners at HMP The Mount, 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. 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.

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 13%, with 91% of staff saying they felt trusted to do their job, 84% believing their role makes a difference, and 83% 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 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

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

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.

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 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.

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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 Data quality on ethnic group

3 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

3

100%

3

Inpatients waiting longer than the 26 week standard

0%

–

Outpatients waiting longer than the 13 week standard

0%

–

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

0%

3

Time to reperfusion for patients who have had a heart attack

68%

3

Total time in A&E

98%

3

Target 2008/09;

Performance

0.004% over the threshold to achieve 0.001% over the threshold to achieve

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%

–

307,211

–

National Priorities Indicators

Target 2008/09;

Performance

650 males - 470 females

3

70.33

3

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

107

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

93%

3

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

3

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

All cancers: two week wait Breast cancer screening for women aged 53 to 70 years Childhood obesity rate

Reception year achieved our local plan. Year 6 was 1.2% over plan. This may achieve when the CQC draw the thresholds

Chlamydia screening (as a proxy for chlamydia prevalence)

85% participation rate – Maintain / reduce rate 9% for YR 14% for yr 6 17%

7

Achieve level 3

3

60

3

3,564

7

Incidence of Clostridium difficile

386

3

NHS staff satisfaction

3%

3

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 (proxy for smoking prevalence)

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

1,652

3

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

–

Level 2

–

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 ÂŁ0.6m, 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 £37m (5.46%) h additional funding of £27m available because the historic accumulated debt has now been paid off a deposit of £6.8m 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 8.9% inflation of generally 2.3%, except for primary care where the uplift was 1.5% additional net investment above inflation, on acute services of 3.9%, 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 3.9% 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.

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 £11.1m or £23.20 per head of weighted population.

This is an increase of 3.2% compared to 2007/08.

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 £6.4m were made to these GPs’ practices, in their capacity as providers of primary care services.

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 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 £2.1m and capital expenditure incurred was £2.1m. The PCT achieved this duty, underspending by £6,000. (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 87% of invoices from non-NHS organisations within this target. This is an improvement on performance in 2007/08 (64%), but is still short of good practice. By value, 88% of invoices were paid within target, an improvement on 2007/08, but also short of good practice.

1) Costs not to exceed revenue resource limit The PCT’s revenue resource limit was £712m and expenditure was £711m. The PCT had always planned to underspend up to £1m and this target was achieved with expenditure being within the agreed resource limit by £576,000. This underspend will be returned to the PCT by the Department of Health, who will increase the PCT’s resource limit by £576,000 in 2008/09. (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.

4) To recover the full cost of provider services NHS West 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 £56.6m and the funding provided from the PCT’s own allocation was £57.8m. The PCT therefore achieved an underspend on provider services of £1,189,000, consequently meeting the target. (Accounts – Note 2.3)

On invoices from other NHS organisations, the PCT paid 74% of invoices (98% 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)

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.

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 (42.9%). Next came primary care general medical services (10.3%) and prescribing (9.8%). Around 8.2% 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 7.0%

Other Healthcare 4.0%

PCT Provided Services 8.2%

Prescribing 9.8% Learning Disabilities 7.5%

A&E 2.0%

General Medical Services 10.3%

Other Family Health 10.3%

Maternity 2.2%

General & Acute 42.9%

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 5.2% and 5.1% 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 £1.9m 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 Hemel Hempstead, 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 £1.9m (making £8.7m in total), and the return of the underspend in 2008/09, the PCT is planning for an underspend of £0.6m. This will act as a safety net in-year and be carried forward to future years if not utilised.

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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.wherts-pct.nhs.uk | 67

Our strategic objectives for next year 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 Newborn 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 West 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 re-design 4. Development of a data repository and analytical skills 5. Assessment of provider market 6. Drive clinically led evidence based change 7. Pro-actively 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 & 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 Health care 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.wherts-pct.nhs.uk | 69

70 | Annual Report and Accounts 2008/09

Governance Controls and Audit www.wherts-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.

In total there were 21 personal data-related incidents reported to the PCT in 2008/09. The table below shows serious untoward incidents that were reported to NHS West Hertfordshire from commissioned and Provider Services in 2008/09.

Category

Nature of Incident

Total

I

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

4

II

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

3

III

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

0

IV

Unauthorised disclosure

7

V

Other

7

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.

Freedom of Information requests There has been one Freedom of Information request relating to data incidents. The enquirer request the PCT provide the number of patient records that have potentially been reported as ‘compromised’.

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.

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.

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.

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

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) which 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 1,600 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.wherts-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 3.86%. 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 1st 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 35th out of 147 PCTs nationally). 2

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

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

1 2

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

www.wherts-pct.nhs.uk | 73

74 | Annual Report and Accounts 2008/09

NHS West 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 7 members of staff from NHS West 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 West 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

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.

•

• •

orked with the Patient Advice & Liaison Service W (PALS) to ensure prisoners can express their views on healthcare provision Held discussions with Hertfordshire County Council 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.

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

• •

• • •

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.

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

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

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.

www.wherts-pct.nhs.uk | 75

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

Name

2008 - 09

2007 - 08 Benefits in kind (rounded to the nearest £000)

Salary (bands of £5,000)

Other Remuneration (bands of £5,000)

£000

£000

Benefits in kind (rounded to the nearest £000)

Salary/Fees (bands of £5,000)

Other Remuneration (bands of £5,000)

£000

£000

35-40

0

0

35-40

0

0

Title

Stuart Bloom

Chair

Anne McPherson

Non Executive Member

5-10

0

0

5-10

0

0

Femi Adewole

Non Executive Member

5-10

0

0

5-10

0

0

Dr Diane Bailey

Non Executive Member

5-10

0

0

5-10

0

0

Mark Gainsborough

Non Executive Member

5-10

0

0

5-10

0

0

Paul Smith

Non Executive Member & Chair of West Herts Audit Committee

10-15

0

0

10-15

0

0

Eliza Hermann

Non Executive Member [from 01/09/2008]

5-10

0

0

Dr Mike Edwards

Chair of the Professional Executive Committee

65-70

0

0

30-35

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 & 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

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)

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

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

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

Employer’s contribution to stakeholder pension

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 & Corporate Services

0-2.5

2.5-5

10-15

30-35

204

143

40

0

Heather Moulder - Director of Nursing

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

50-55

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

www.wherts-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.

•

•

CETV is a payment made by a pension scheme or A 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 The above amount represents 50/50 split with NHS East and North Hertfordshire.

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

NHS West Hertfordshire Board Expenses 2008/2009 Position

Period From £

To £

Mileage £

Parking at Office Subsistence £ £

Public Parking Transport £ £

Total Expenses £

Chair Stuart Bloom

01/04/08 31/03/09

3355

0

0

0

1,887

5242

Anne McPherson

01/04/08 31/03/09

1107

0

0

0

378

1485

Femi Adewole

01/04/08 31/03/09

Dr Diane Bailey

01/04/08 31/03/09

Mark Gainsborough

01/04/08 31/03/09

Paul Smith

01/04/08 31/03/09

Non-Executive Directors

78 | Annual Report and Accounts 2008/09

No Claim 440

0

0

0

73

513 No Claim

165

0

0

0

18

183

NHS West Hertfordshire Board Expenses 2008/2009 Position Eliza Hermann

Period From £

To £

Mileage £

Parking at Office Subsistence £ £

Public Parking Transport £ £

Total Expenses £

01/09/08 31/03/09

336

0

0

0

188

542

Anne Walker* Chief Executive

01/04/08 31/03/09

1280

(255)

0

73

182

1280

Alan Pond* Director of Finance

01/04/08 31/03/09

1304

(255)

0

57

44

1150

Dr Jane Halpin* Director of Public Health

01/04/08 31/03/09

602

(255)

0

56

39

395

Dr Mike Edwards Chair of Professional Executive Committee

01/04/08 31/03/09

Voting Directors

No Claim

Non-Voting Directors Gloria Barber* Director of Human Resources

01/04/08 31/03/09

Gareth Jones* Director of Strategic Planning

01/04/08 31/03/09

Pauline Pearce* Director of Public Involvement & Corporate Services

(255)

0

0

0

(255)

1244

(255)

0

228

0

1217

01/04/08 31/03/09

22

(255)

0

2

4

(227)

Heather Moulder* Director of Nursing / Interim Chief Operating Officer

01/04/08 31/03/09

127

0

0

0

0

127

Clare Hawkins* Interim Director of Nursing

01/12/08 31/03/09

127

0

0

0

0

127

Beverley Flowers* Director of Commissioning

01/04/08 31/03/09

Andrew Parker* Director of Primary Care & Service Redesign

01/04/08 30/11/08

No Claim 764

(255)

0

12

0

521

*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.wherts-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?

• • •

• •

•

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’.

Directors’ disclosure of interests Board Member Stuart Bloom, Chair

Mrs Anne McPherson Mr Femi Adewole Dr Diane Bailey Mr Mark Gainsborough Mr Paul Smith

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

Ms Eliza Hermann

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.

Anne Walker, Chief Executive

Audit Committee members West: Paul Smith (Chair) Diane Bailey Femi Adewole Mark Gainsborough

Alan Pond, Director of Finance & Commercial Development Heather Moulder, Interim Chief Operating Officer Provider Services Gareth Jones, Director of Strategic Commissioning Pauline Pearce, Director of Public Involvement and Corporate Services Dr Jane Halpin, Deputy Chief Executive & Director of Public Health Gloria Barber Director of Human Resources Clare Hawkins, Interim Director of Nursing Andrew Parker, Director of Primary care and service redesign Beverley Flowers, Director of Commissioning Mike Edwards, Chair of the Professional Executive Committee

80 | Annual Report and Accounts 2008/09

NHS West Hertfordshire Board members Declarations of Pecuniary and other Interests

Date Declared

Voluntary Co-ordinator, Bushey Community Cares Welfare Group

26/6/2008

Consultancy to support United Synagogues welfare groups

24/2/2009

Mental health Panel Manager, Cygnet Clinics

24/2/2009

Executive officer, Nurse Directors Association

13/10/2006

Governor Hertfordshire Partnership NHS Foundation Trust on behalf of the PCT

20/6/2007

Non Executive Director, Expert Patients Programme Commissioning Interests Co.(set up by DoH to write a programme for PCTs for rolling out across England) Investments Director, Guinness Trust (operates social housing)

17/10/2006

None

18/10/2006

None

18/10/2006

Non Executive Director, William Sutton Housing Association (operates social housing)

26/6/2007

None

4/9/2008

None

16/10/2006

None

4/10/2006

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

25/62008

None

4/10/2006

Son undertakes occasional temporary clerical work in other directorates

20/7/2007

None

9/10/2006

None

25/1/2007

None

4/7/2007

Wife is Bone Marrow Transplant Quality Manager at Royal Free Hospital NHS Trust, (PCT has an Service Level Agreement with RFH)

7/2/2007

None

6/7/2007)

Principal at Fairbrook Medical Centre, Borehamwood Director, Herts Health Limited since September 2006 (the company has bid for a tender to provide CATS services)

19/12/2006

Wife is a Trustee of Cherry Lodge Cancer Care Charity, Barnet (since October 2006)

www.wherts-pct.nhs.uk | 81

The Alan Pond, Director of Finance

82 | Annual Report and Accounts 2008/09

Accounts These accounts for the year ended 31 March 2009 have been prepared by the West 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.

www.wherts-pct.nhs.uk | 83

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

84 | 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 East and North 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, Hertsmere Borough Council, St Albans City and District

Council, Three Rivers District Council, Watford Borough Council and Dacorum Borough 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 West 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. 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 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.

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

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

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 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.

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 A&E targets.

West Hertfordshire PCT participated in the Audit Commission’s National Fraud Initiative. The work plan for 2008/2009 has been completed. A local pro-active exercise was conducted

The full Assurance Framework can be seen here: http://www.wherts-pct.nhs.uk/Documents/ publications/AssuranceframeworkFeb09.pdf

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In addition as part of the risk and control framework the PCT maintains both “High Level” and operational risks 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.

86 | Annual Report and Accounts 2008/09

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 West Hertfordshire with action plans where required. Work is in progress to help support the prison service and pharmacies to comply with the IG toolkit ahead of the requirement for these services to submit statement of compliance to the Department of Health.

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 Healthcare 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 under the publications section.

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:•

•

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 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 – 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; and that 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 – which 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.

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 West 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:

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

T he PCT 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 – whose 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

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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

88 | Annual Report and Accounts 2008/09

Action taken: Actions implemented to ensure all records are transferred using secure courier bags and using a tracking system.

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 West Hertfordshire Primary Care Trust Date: 9th June 2009 (on behalf of the Board) Independent Auditors Report of the Board of Directors of West Hertfordshire Primary Care Trust Opinion on the financial statements I have audited the financial statements of West 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 West 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 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.

•

•

•

the 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.

Opinion In my opinion: •

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.

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.

•

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:

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.

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 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, West 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

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

Less: Miscellaneous income

The notes on pages 94 to 125 form part of this account.

714,868

656,774

32

29

Interest payable Net operating cost for the financial year

0

0

Interest receivable

52,814

56,599

656,742

(5,174)

(5,207)

603,928

658,240

57,988

(24,088)

(27,660)

61,806

628,016

ÂŁ000

ÂŁ000

685,900

2007/08

2008/09

714,839

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

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The notes on pages 94 to 125 form part of this account.

Gains and losses recognised in the financial year

Prior period adjustment - other

3,242

0

0 (2,680)

3,242

(2,680)

0

0

Additions / (reductions) in “other reserves” Recognised gains and losses for the financial year

0

0

Additions / (reductions) in the General Fund due to the transfer of assets from/ (to) NHS bodies and the Department of Health

3,242

1,963

0

0

(4,643)

0

£000

£000

Increase in the donated asset reserve and government grant reserve due to receipt of donated and government granted assets

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

Fixed asset impairment losses

2007/08

2008/09

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

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

10.1 10.4 10.5

Tangible assets Investments Financial assets

13,014 0 0

12 10.5 16.3

Debtors Other financial assets Cash at bank and in hand

2 0 0 11,737

15 15 15 15

Revaluation reserve Donated asset reserve Government grant reserve Other reserves

Chief Executive:

Date: 9th June 2009

17,178

0

0

6

13,507

3,665

17,178

(3,424)

(394)

20,996

(30,156)

(42,488)

12,332

0

10,797

1,535

51,152

0

51,122

30

£000

31 March 2008

The financial statements on pages 1 to 4 were approved by the Board on 9th June 2009 and signed on its behalf by

The notes on pages 94 to 125 form part of this account.

Total Taxpayers Equity

10,827

15

908

11,737

(4,002)

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

(380)

13.1

16,119

Creditors: Amounts falling due after more than one year

Total assets less current liabilities

(32,651)

0

13.1/1

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

(48,004)

13.1

15,353

48,770

£000

31 March 2009

CREDITORS : Amounts falling due within one year

Total current assets

2,339

11

Stocks and work in progress

Current assets

48,770

9 0

£000

Intangible assets

Fixed assets

NOTE

Balance sheet as at 31 March 2009

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0 0 0 0

Payments to acquire fixed asset investments Receipts from sale of fixed asset investments Payments to acquire financial instruments Receipts from sale of financial instruments

(711,580)

Net cash inflow/(outflow) before financing

The notes on pages 94 to 125 form part of this account.

Increase/(decrease) in cash

Net cash inflow/(outflow) from financing

Cash transfers (to)/from other NHS bodies

0

(25)

0

Capital grants received Capital element of finance lease rental payments

0

Other capital receipts surrendered

Net Parliamentary Funding

0

711,580

0

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

Financing

0

0

Sale of other current asset investments

0

655,098

0

(23)

0

0

655,121

(655,098)

0

0

(655,098)

(1,369)

0

0

0

0

0

(1,369)

0

0

(32)

0

(711,580)

(1,631)

(29)

(32)

0

0

(653,697)

£000

£000

(709,920)

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

711,605

0

Receipts from sale of tangible fixed assets

Net cash inflow/(outflow) from capital expenditure

(1,631)

0

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

0

(29)

Payments to acquire intangible assets

Capital expenditure

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

Interest element of finance leases

0

Interest received

£000

0

16.3

16.1

NOTE

Interest paid

Servicing of finance and returns on investment:

Net cash outflow from operating activities

Operating activities

Cash flow statement

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

Note 1. Accounting policies

Notes to the accounts

The valuations were carried out in accordance with the Royal Institute of Chartered Surveyors (RICS) Appraisal and

In view of the significant falls in the UK property market, West Hertfordshire PCT instructed Boshier & 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 £1,875,000 on Land and £821,000 on Buildings totalling £2,696,000.

Land & 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.

Purchased computer software licences are capitalised 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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e) Pooled budgets The PCT has entered into a pooled budget with Hertfordshire County Council. Under the arrangement funds are pooled

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.

Freehold land and land and buildings surplus to requirements are not depreciated. Assets in the course of construction and residual interests in off-balance

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.

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 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.

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.

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

sheet Private Finance Initiative contract assets are not depreciated until the asset is brought into use or reverts to the PCT, respectively.

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.

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.

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

As a result of this revaluation, a total of £16,000 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.

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.

Valuation Manual insofar as these terms are consistent with the agreed requirements of the Department of Health and 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.

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

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

h) 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.

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. 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.

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

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.

under S75 of the NHS Act 2006 for Mental Health, Learning Disabilities and certain other services.

Notes to the accounts

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:

m) 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.

l) 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.

k) 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.

j) 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.

to settle the obligation. Where the effect of the time value of money is significant, the estimated risk-adjusted cash flows are discounted using the Treasury’s discount rate of 2.2% in real terms.

www.wherts-pct.nhs.uk | 97

The Scheme provides the opportunity to members to increase their benefits through money purchase Additional

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.

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.

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.

p) 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 :

n) 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. o) 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.

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.

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 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.

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 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.

Notes to the accounts

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

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.

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

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.

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.

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.

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

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.

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.

q) Financial Instruments

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.

Notes to the accounts

www.wherts-pct.nhs.uk | 99

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 (5,522) 0 27,610 22,088

(22,088) 0 22,088 (6,780)

Net cash management position from prior periods Net cash management position at 31 March 2009

Cash limit - subsequently increased in-year

Cash limit - subsequently reduced in-year

Cash limit retained centrally in respect of local reserve

(6,780)

Cash Management

Final Revenue Resource Limit for year

652,773

(30,806)

1,616

711,614

0

(6,780)

(less): Transfers to the SHA Revenue reserve Plus: RRL in-year increases/(decreases)

683,579

716,778

37

Initial Revenue Resource Limit

The revenue Resource Limit above has been arrived at as follows:

576

652,773

711,614

Final Revenue Resource Limit for year Under/(over) spend against Revenue Resource Limit

652,736

4,038

3,830 711,038

656,774

2007/08 £000

714,868

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

100 | Annual Report and Accounts 2008/09 - For the year ended 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

57,988 (5,174) 52,814 (56,246) (3,432)

61,806 (5,207) 56,599 (57,788) (1,189)

Provider gross operating cost less: Miscellaneous income relating to provider functions Net Operating Cost

Under / (over) recovery of costs

less: Costs met from PCT’s own allocation

2007/08 £000

464

1,984

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:

6

2,131

Capital Resource Limit (Over) / Under spend against Capital Resource Limit

2,125

Charge Against the Capital Resource Limit

1,520

1,520

2,125

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

Notes to the accounts

www.wherts-pct.nhs.uk | 101

61 0

Department of Health - other Income for Trust Impairment

8,307

0

Rental income from operating leases

Total miscellaneous income

0

Rental income from finance leases

1,547

0

Transfer from the government grant reserve

Other income

0

Transfer from the donated asset reserve

0

NHS Injury Costs Recovery

31

0

Non-NHS: Overseas Patients (non-reciprocal)

Charitable and other contributions to expenditure

0

Non NHS: Private Patients

268

12

Education, Training and Research

Other Non-NHS patient care services

0

Patient Transport Services

24,560

0

0

0

0

4

0

241

0

0

Department of Health - SMPTB

1,004

2

Other English Special Health Authorities/CGA Bodies

Local Authorities

44

18,245

639

English RAB Special Health Authorities

Primary Care Trusts - Lead Commissioning Income

Primary Care Trusts - other

0

1,149

Foundation Trusts

0

2,436

NHS Trusts

Primary Care Trusts for Drug Action Teams

1,739

92

Prescription Charge Income Strategic Health Authorities

0

5,352

1

£000 £000 Appropriated in Aid Not Appropriated in Aid

Dental Charge income from trust led GDS & PDS

Dental Charge income from contractor led GDS & PDS

Fees and Charges

Note 3. Miscellaneous Income

Notes to the accounts

1,162

1,547

29,262

0

0

32,867

0

0

381

268

0

0

0

0

0

0

5

7

0

4

279

253

79

0

0

31

984

1,004

46

44

0

16,598

18,245

0

110

639

462

0

0

61

716

1,149

0

2,243

2,436

0

362

1,739

0

72

92

2

0

0

5,755

1

1 5,352

2007/08 £000

2008/09 £000

102 | Annual Report and Accounts 2008/09 - For the year ended 31 March 2009 24,375 123,480 0 0 1,898 26,307 0 379 66 48,005 592 68,734 68,043 1,193 0 2,633 4,038 3,471 1,253 3,166 9 5,447 0 2,008 16 0 0 0

131,221 0 0 1,523 30,057 756 422 145 54,309 793 70,458 69,466 1,570 0 5,858 3,830 4,328 2,563 2,885 64 6,212 39 1,781 30 16 0 0

Social Care from independent providers Expenditure on Drugs Action Teams Non-GMS services from GPs Contractor led GDS & PDS Trust led GDS & 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 financial assets (by class)

Impairment of debtors

Local Pharmaceutical Service Pilots

Pharmaceutical Services

Consultancy services

Staff costs

Purchase of healthcare from non-NHS providers

Goods and Services from Foundation Trusts

27,385

1,725

832

278,377

276,652

282,925

17,015

238

374 41,100

16,777

2007/08 £000

40,726

2008/09 £000

283,757

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

www.wherts-pct.nhs.uk | 103

0 0 0 563 222 0 0 99 375 249 3,975 686,004

0 0 0 506 274 1 0 67 266 635 5,389 747,706

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

104 | Annual Report and Accounts 2008/09 - For the year ended 31 March 2009 25,351 0 4,038 0 0 2,633 1,898 0

30,057 756 3,830 0 0 5,858 1,523 175

Contractor led GDS & PDS

Department of Health Initiative Funding Local Pharmaceutical Services Pilots New Pharmacy Contract Non-GMS Services from GPs

47,868 15,638 274,792 12,807 46,323 26,421

49,248 15,858 302,623 14,302 53,055 32,236

Mental Illness Maternity

Accident And Emergency Community Health Services Other Contractual

0 0 277 956 0 0

0 0 1,047 304 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

56,246 23,718 0

57,788 27,385 0

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

645,066

705,300

Total healthcare purchased by PCT

Grants (revenue) to private sector to fund Capital Projects

471,943

520,256

Total Secondary Healthcare Purchased

General and Acute

48,094

52,934

Learning Difficulties

Purchase of Secondary Healthcare

Total Primary Healthcare purchased

Other

General Ophthalmic Services

171,890

1,193

1,570

Pharmaceutical services

183,693

68,043

69,466

Prescribing costs

Trust led GDS & PDS

68,734

2007/08 ÂŁ000

70,458

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.wherts-pct.nhs.uk | 105

2007/08 Other leases £000

Total

After 5 years

Between 1 and 5 years

Within 1 year

Operating leases which expire:

Note 4.3/2. Operating expenses include:

0

24

117

78

483

507

39

0

432

18

414

0

2007/08 Land & Buildings £000

724

Total

2008/09 Land & Buildings £000

694

724

Other operating lease rentals

144

0

67

77

2007/08 Other leases £000

694

0

0

Hire of plant & machinery

2007/08 £000

2008/09 £000

Note 4.3. Operating Leases Note 4.3/1. Operating expenses include:

Notes to the accounts

106 | Annual Report and Accounts 2008/09 - For the year ended 31 March 2009 5,115 0

2,635 5,115 0

Social security costs Employer contributions to NHSBSA

0 321

234 0 30 1339

35 0 347 261 508 6 249 0 30 1436

Administration and estates Healthcare assistants & other support staff Nursing, midwifery & health visiting staff Nursing, midwifery & health visiting learners Scientific, therapeutic and technical staff Other Total

Social Care staff

Ambulance staff

6

469

254

25

Total Number Medical and dental

2008/09 Permanently Employed Number

Note 5.2. Staff Numbers

Total

50,630

2,635

46,981

Salaries and wages

54,731

42,880

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

97

0

0

15

0

39

7

26

0

10

Other Number

4,101

0

0

0

4,101

Other £000

1319

13

0

243

8

465

237

318

0

35

Total Number

48,384

0

4,689

2,707

40,988

Total £000

1247

13

0

234

8

440

232

300

0

20

2007/08 Permanently Employed Number

47,005

0

4,689

2,707

39,609

2007/08 Permanently Employed £000

72

0

0

9

0

25

5

18

0

15

Other Number

1,379

0

0

0

1,379

Other £000

www.wherts-pct.nhs.uk | 107

478,468

478,468

135,393 88.30%

27,413 86.91%

Total bills paid within target Percentage of bills paid within target

343,158 97.64%

2,053 73.98%

Total bills paid within target

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

351,457

2,775

Total bills paid in the year

NHS Creditors

153,329

31,542

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

46.47%

1,296

2,789

64.37%

15,944

24,768

2007/08 Number

95.20%

296,697

311,665

83.75%

124,829

149,042

2007/08 £000

22.48

10,757

11,101

23.20

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 3 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 £134,440 (2007/08: £68,437).

Note 5.3. Employee benefits There were no employee benefits in 2008/9 or 2007/8

Notes to the accounts

108 | Annual Report and Accounts 2008/09 - For the year ended 31 March 2009 0 0 0 0 0 16

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 0

0 0

Bank loans and overdrafts Other interest and finance costs Total

32

0

0

Loans

29

0

Finance leases

0

2007/08 £000

16

16

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

32

0

0

0

0

0

0

0

0

Fixed Financial Instruments £000

29

Payable:

Note 8. Finance Costs

0

0

Loss or damage from normal operations

16

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

www.wherts-pct.nhs.uk | 109

0 0 0 0 0 0 0

0 0 0 30 0 0 0

Impairments Reversal of impairments Other revaluation

Reclassifications In year transfers to/from NHS bodies Disposals

0

0 0 0

- Donated at 31 March 2009 - Government granted at 31 March 2009 Total at 31 March 2009

0

0

0

0 - Purchased at 31 March 2009

0

0 - Government granted at 1 April 2008

0

0

0 - Donated at 1 April 2008

30

0

30 - Purchased at 1 April 2008

Total at 1 April 2008

0

78

Accumulated amortisation at 31 March 2009

Provided during the year

0

0

0

Disposals

0

0

0

In year transfers to/from NHS bodies

Indexation

0

0

Reclassifications

0

0

0

Other revaluation

48

0

0

Indexation

Accumulated amortisation at 1 April 2008

0

0

Impairments

0

0

0

Additions - government granted

78

0

0

Additions - donated

Gross cost at 31 March 2009

0

0

Additions - purchased

Licences & Trademarks £000 0

Software licences £000 78

Gross cost at 1 April 2008

Note 9. Intangible Fixed Assets

Notes to the accounts

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

Patents £000

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

Development expenditure £000

0

0

0

0

30

0

0

30

78

0

0

0

30

0

0

0

0

48

78

0

0

0

0

0

0

0

0

0

78

Total £000

110 | Annual Report and Accounts 2008/09 - For the year ended 31 March 2009 (1,796) 0 (413) 0 991 0

(2,847) 0 281 0 972 0

0

0 - Government Granted at 1 April 2008

0

- Government Granted at 31 March 2009

23,964

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

435

0

2

433

340

0

6

334

667

0

0

0

0

0

0

0

0

0

0

20

0

0

0

0

0 0

0

0

0

0

20

20

0

0

0

0

0

0

0

0

0

20

0

0

0

123

544

1,102

0

0

0

0

0

0

0

0

218

884

Of the totals at 31 March 2009, £490,000 related to land valued at open market value.

Total at 31 March 2009

22,028

0

0 - Donated at 31 March 2009

0

23,964 - Purchased at 31 March 2009

22,028

Net book value

Total at 1 April 2008

25,529

0

0 - Donated at 1 April 2008

23,622

25,529 - Purchased at 1 April 2008

23,622

Net book value

1,039

0

0 Disposals Accumulated depreciation at 31 March 2009

0

0

0

(64)

In year transfers to/from NHS bodies

0

0

0

0

16

0

0

0

0

1,087

0

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

Reclassifications

Indexation

25,003

0

0

Additions - government granted

22,028

0

0

Additions - donated

Impairments

692

Land £000 0

Buildings excluding dwellings £000

Additions - purchased

Dwellings £000 0

Assets under construction and payments on account £000

0

Plant & machinery £000

25,529

2,112

0

0

2,112

1,478

0

0

1,478

2,531

0

0

0

0

0

0

535

1,996

4,643

0

0

0

0

0

0

0

1,169

3,474

Information technology £000 Transport equipment £000

23,622

0

0

2,125

0

1,963

0

(48)

0

4,426

0

0

0

0

(48)

0

16

1,781

2,677

0

6

0

2

231 48,770

0

0

231 48,768

153 51,122

0

0

153 51,116

169

0

0

0

0

16

0

0

36

117

400 53,196

0

0

0

84

0

0 (4,643)

0

0

46

270 53,799

Furniture & 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

www.wherts-pct.nhs.uk | 111

0

0 23,622

PFI residual interests Total 1 April 2008

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

340

0

0

0

340

435

0

0

0

435

0

0

0

0

0

0

0

0

0

0

1,478

0

0

0

1,478

2,112

0

0

0

2,112

153

0

0

0

153

231

0

0

0

231

33

Depreciation 31 March 2008

0

0

0

0

0

0

0

0 Short Leasehold

0

0

5,599 Long Leasehold

45,992

0

40,393

Total

Donated £000

Purchased £000 Freehold

2008/09

2008/09

0

0

0

0

Government Granted £000

2008/09

45,992

0

5,599

40,393

Total £000

2008/09

49,151

0

1,747

47,404

Total £000

2007/08

0

0

0

0

Assets under construction and payments Plant & Transport Information Furniture Dwellings on account machinery equipment technology & fittings £000 £000 £000 £000 £000 £000

Note 10.2/3 The net book value of land, buildings and dwellings at 31 March 2009 comprises:

60

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:

* Lease held in respect of Langley House for £1,215,000 was incorrectly disclosed in the prior year as a Finance Lease.

25,529

0

533

1,214 0

24,996

22,408

23,964

On balance sheet PFI contracts

Finance Leased

Owned

Net book value 1 April 2008

22,028

0

0

PFI residual interests Total 31 March 2009

0

567

0* 0

23,397

22,028

On balance sheet PFI contracts

Finance Leased

Owned

Net book value 31 March 2009

Assets under Buildings construction excluding and payments Plant & Transport Information Furniture Land dwellings Dwellings on account machinery equipment technology & fittings £000 £000 £000 £000 £000 £000 £000 £000

Note 10.2/1 Asset Financing

Notes to the accounts

33

60

Total £000

51,122

0

0

1,747

49,375

48,770

0

0

567

48,203

Total £000

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

0 0 0 0 44 0 32 0 4 15

0 0 0 0 7 0 4 0 4 4

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

1,289 0 3,099 0 0 0 1,216 10,616

2,157 (39) 2,328 0 0 0 1,103 12,849

Non NHS trade debtors Provision for impairment of debtors Prepayments and accrued income Capital debtors - NHS Capital debtors - Non NHS Current part of PFI prepayments Other debtors

5,012

31 March 2008 £000

7,300

31 March 2009 £000

NHS debtors

Amounts falling due within one year:

Note 12. Debtors

Total

1,535

0

0

Work-in-progress

2,339

1,535

2,339

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 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 The PCT did not hold any fixed asset investments in 2008/9 or 2007/8.

Notes to the accounts

www.wherts-pct.nhs.uk | 113

181 0 0 0 0 181

165 0 0 0 0 165

Capital debtors - NHS Capital debtors - Non NHS Current part of PFI prepayments Other debtors

2,501 1,803 1,107 5,411

By 3 to 6 months By more than 6 months Total

31 March 2009 £000 By up to 3 months

Note 12.2 Debtors past due date but not impaired:

(39)

Balance at 31 March

0 Amount recovered during the year

(39)

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

10,797

0

0

Provision for impairment of debtors

13,014

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

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

0 0 11,431 0 19,500 9,326 151 198 0 409 25 1,329 119 0 42,488

0 0 11,591 0 23,520 9,711 645 489 1 439 29 1,523 56 0 48,004

Interest payable Payments received on account NHS creditors - revenue NHS creditors - capital Family Health Services (FHS) creditors Non - NHS trade creditors - revenue Non - NHS trade creditors - capital Tax VAT

0 76 394

0 91 380

Imputed finance leases element of on balance sheet PFI contracts

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; - £181,788 for payments due in future years under arrangements to buy out the liability for 5 early retirements over 5 years (2007/08 £114,684); and - £701,000 outstanding pensions contributions at 31 March 2009 (£583,014 at 31 March 2008)

Total

Other

42,882

0

0

NHS creditors

48,384

318

Obligations under finance leases and hire purchase contracts

289

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

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

www.wherts-pct.nhs.uk | 115

216 486 (143)

162 432 (114)

After five years Subtotal

3,104 54 (337) 0 64 0 2,885 476 2,408 0

7 0 0 0 0 0 7 7 0 0

At 1 April 2008 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

876 1,790

7 0

1 - 5 years Over 5 years

0

13

0

0

0

0

13

0

0

0

0

0

13

0

0

469

0

0

0

469

0

0

0

0

469

0

Legal claims Restructurings £000 £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. £123,336 is included in the provisions of the NHSLA at 31.3.2009 in respect of clinical negligence provisions of the PCT (31.3.2008 £286,917)

219

0 Within 1 year

Expected timing of cash flows:

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

55

44

529

0

88

22

628

0

3

0

(11)

336

300

Other £000

1,845

940

1,217

0

2,496

505

4,002

0

67

0

(348)

859

3,424

Total £000

343

162

162

In more than 2 years but no longer than 5 years

318

54

54

In more than 1 year but no longer than 2 years

Less finance charges allocated to future periods

54

31 March 2008 £000

54

31 March 2009 £000

In not more than 1 year or in demand

Payable:

Note 13.2. Finance lease obligations

Notes to the accounts

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

Other movements on reserves

10,827

0

13,507

0

2

0

0

Transfers to/(from) other NHS Bodies

0

(4)

0

0

Depreciation and disposal of donated/Government granted assets

0

Transfer of realised profits (losses)

3,242

0

0

6

0

1,963

Surplus/(deficit) on other revaluations/indexation of fixed assets

0

10,265

Receipt of donated/ Government granted assets

(4,643)

0

13,507

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

6

0

0

(5)

0

0

0

0

11

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

4,755

563

908

0

0

0

3,665

0

0

0

(714,868) (656,774)

506

711,605 655,121

0

3,665

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

www.wherts-pct.nhs.uk | 117

563 0 0 182 (5) 0 16 8,908 (5,666) (2,977)

506 16 0 926 (4) 0 (804) (2,217) 5,033 (348)

Cost of capital charge Fixed asset impairments

Non-cash movement in provisions Transfer from donated asset reserve

(Increase)/decrease in stocks (Increase)/decrease in debtors Increase/(decrease) in creditors Increase/(decrease) in provisions Net cash inflow/(outflow) from operating activities

Transfer from the Government grant reserve

(653,697)

2,024

1,811

Depreciation charge

(709,920)

(656,742)

(714,839)

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

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

23

25

Cash outflow from finance lease payments

(318)

Net debt at 31 March 2009

(4) 29

(29) (289)

Finance leases due within one year Finance leases due after one year

This PCT does not hold any Patients’ money (£0 at 31 March 2008).

Total

25

0

0

Bank overdrafts

(318)

0

0

Cash at bank and in hand

Current asset investments

0

0

OPG cash at bank

At 31 March Cash flows in 2009 year £000 £000

(343)

Net debt at 1 April 2008

Note 16.3 Analysis of changes in net debt

0

0

Non - cash changes in debt

0

0

0

0

0

0

0

0

0

(343)

(318)

(25)

0

0

0

Non-cash changes in Transfers to/ year from NHS bodies At 1 April 2008 £000 £000 £000

(343)

(366)

23

25

Change in net debt resulting from cash flows

0

0

0

Increase/(decrease) in cash in the period

Cash (inflow)/outflow from (decrease)/increase in liquid resources

2007/08 £000

2008/09 £000

Note 16.2. Reconciliation of net cash flow to movement in net debt

Notes to the accounts

www.wherts-pct.nhs.uk | 119

(237) 0 (237)

(470) 0 (470)

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 £1,217,000 (2007/08: £0).

Note 17. Capital Commitments

Notes to the accounts

120 | Annual Report and Accounts 2008/09 - For the year ended 31 March 2009 983 1,810 1,387

Dr Richard Walker - Partner at Manor Street Surgery Dr Roger Sage - Partner at Dr Sage & Partners, Parkbury House Dr Mark Sandler - Partner at Davenport House Surgery

137 8 18,245 15 0 999 0 0 72 31 120 2 2,153

25,832 10,942 861 24,792 15,440 106,664 5,848 11,733 10,386 8,860 40,290 10,354 175,470

Barnet & Chase Farm Hospitals NHS Trust Buckinghamshire Hospital NHS Trust

East & North Hertfordshire NHS Trust East of England Ambulance Service NHS Trust

Imperial College Healthcare NHS Trust Luton & Dunstable NHS Foundation Trust Royal Free Hampstead South East Essex PCT University College London NHS Foundation Trust

6,989

130

829

128

8

176

489

3,880

6

320

0

243

795

Amounts owed to Related Party £000

2,165

0

120

27

17

0

0

2,022

0

4

3,835

8

304

Amounts due from 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.

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 Hospitals NHS Trust

HM Revenue & Customs

Hertfordshire County Council

East & North Hertfordshire PCT

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;

Dr M Edwards is also a director of Herts Health Limited to whom the PCT paid £474,000 for patient diagnostic services.

1,705

Dr M Edwards - Partner at Fairbrook Medical Centre

£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 PCT. Payments are made to all practices in the PCTs 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.

West 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

www.wherts-pct.nhs.uk | 121

941 1,632

Dr Richard Walker - Manor Street Surgery Dr Roger Sage - Dr Sage & Partners, Parkbury House

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 on the following page.

1,509

Dr M Edwards - Fairbrook Medical Centre

£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 PCT. Payments are made to all practices in the PCTs 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 West Herfordshire PCT is a body corporate established by order of the Secretary of State for Health.

Notes to the accounts

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

751

16 3 1,399 588 1,003

20,038 14,004 14 946 84,038

East & North Hertfordshire NHS Trust East of England Ambulance Service NHS Trust

368 43 583 64 880 413

2,459 561 4,689 1,377 9,565 11,461

National Insurance Fund

NHS Pension Scheme Oxford Radcliffe NHS Trust Royal Brompton & Harefield NHS Trust

4,757

167,678

2,235

1,026

9,154

142

14,771

116

111

5,110

20

52

3,633

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.

West Hertfordshire Hospitals NHS Trust

University College London NHS Foundation Trust

South East Essex PCT

Royal National Orthopaedic Hospital NHS Trust

Royal Free Hampstead

NHS Business Services Authority

31

206

2,300

North West London Hospitals NHS Trust

45

90

1,193

Moorfield Eye Hospital NHS Trust

31

29

475

38

9,213

Imperial College Healthcare NHS Trust Luton & Dunstable NHS Foundation Trust

225 8

198

5,704

HM Revenue & Customs

476

219

328

46

18

10,806

254

2,111

106

1,927

33

The Hillingdon Hospital NHS Trust

Herts County Council

Hertfordshire Partnership Foundation Trust

743

65

16,443

651

East & North Hertfordshire PCT

East of England Strategic Health Authority

4

568

Chelsea and Westminster Hospital Foundation Trust

851

901

9

2

Central & North West London Mental Health Foundation Trust

Cambridgeshire PCT

2

8

284

8

10,144

Buckinghamshire Hospital NHS Trust

75

854

2

166

Barts & the London NHS Trust

26

647

Amounts due from Related Party £000

502

187

22,979

Amounts owed to Related Party £000

Barnet PCT

Barnet & Chase Farm NHS Trust

Receipts from Related Party £000

Payments to Related Party £000

Notes to the accounts

www.wherts-pct.nhs.uk | 123

0

0 0

0 198

Other Gross financial assets

0

198

0

0 181

0

181

Total £000

Floating rate £000

Sterling

At 31 March 2008

Gross financial assets

Other

Sterling

At 31 March 2009

Currency

Note 22.1 Financial Assets

0

0

0

0

0

0

Fixed rate £000

198

0

198

181

0

181

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

12

0

0

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. West 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.

West 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

There are no Private Finance Transactions in 2008/9 or 2007/8.

Note 21. Private Finance Transactions

Notes to the accounts

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

0 0

0 458

0

458

0

0 380

0

380

Total £000

Floating rate £000

458

0

458

380

0

380

Fixed rate £000

0

0

0

0

0

0

Non-interest bearing £000

0

0

0

0

0 0 0 181

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 0 289 91

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

380

Available f or sale £000

0

0

0

0

0

0

Available for sale £000

0

12

0

0

At fair value through profit and loss £000

Note 22.5 Financial Liabilities

0

0

Embedded derivatives

181

Loans and receivables £000

At fair value through profit and loss £000

Note 22.4 Financial Assets

Non-interest bearing

380

91

289

0

0

0

0

Total £000

181

181

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.

Gross financial assets

Other

Sterling

At 31 March 2008

Gross financial assets

Other

Sterling

At 31 March 2009

Currency

Note 22.2 Financial Liabilities

Notes to the accounts

www.wherts-pct.nhs.uk | 125

0 0 165 165 0 0 0 0 181

2,061 2,774 0 3,208 12,849 849 476 4,402 0 4,889

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

181

0

4,806

Balances with other central government bodies

10,616

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.

42,488

26,313

0

14,178

422

1,575

48,004

30,786

0

10,355

3,999

2,864

Creditors Amounts falling due within one year £000

394

394

0

0

0

0

380

380

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 20 cases of losses and special payments (2007/08: 66 cases) totalling £56,137 (2007/08: £10,470) approved during 2008/09.

Note 23. Third party assets The PCT did not hold any cash at bank and in hand at 31.2.2009 which related to monies held by the PCT on behalf of patients (£0 at 31.3.2008). Any such monies held would have been excluded from cash at bank and in hand figure reported in the accounts.

Notes to the accounts

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Communications Team Hertfordshire Primary Care Trusts Charter House Parkway Welwyn Garden City Hertfordshire AL8 6JL Telephone: 01707 390855 Email: enquiries@herts-pcts.nhs.uk

NHS West 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.wherts-pct.nhs.uk

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Published September 2009