nhs east and north hertfordshire annual report and accounts 2008/09

Annual Report and Accounts

2008/09

During the production of this annual report, Pam Handley, Chair of NHS East and North Hertfordshire sadly died following a short illness. The staff and Board of NHS East and North Hertfordshire would like to dedicate this report to Pam Handley in memory of her outstanding contribution to health services in Hertfordshire.

www.enherts-pct.nhs.uk | 3

Contents

Welcome 5About us 9Our history and background How we are managedLocation and type of facilities provided

Keeping Herts healthy 21Planned carePatient experienceMental health and learning disabilitiesMaternity and newbornOur peopleVision and valuesChildren’s healthEnd of lifeStaying healthyChanging services

Quality report 43Operating and financial review 47Our performance 51Strategic objectives and progress Key performance indicatorsAnnual health check

Financial review 61Financial duties and targetsAnalysis of 2008/09 Net ExpenditureFinancial outlookImplementation of International Financial Reporting Standards (IFRS) in 2009/10

Looking to the future 67Governance controls and audit 71The accounts 85Notes to the accounts 96Alternative formats and additional copies 128Contact usAnother language

4 | Annual Report and Accounts 2008/09

Welcome


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


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

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

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

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

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

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

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

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

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

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

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

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

Anne Walker Richard Henry Dr Tony Kostick Chief Executive Chair Chair Professional Executive

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


About us


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


Structure of business, its main services and users

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

We commission services in a number of different ways:

Directly with providers such as hospitals• Practice based commissioning (PBC) – where GPs, •nurses and therapists can design services that meet the needs of their patients in a particular area. Primary care commissioning – this involves services •provided by GPs, community pharmacists, dentists and optometrists Sharing the commissioning of services - this means •that we join together with Hertfordshire County Council and we both contribute some of our budgets to a partnership who then arrange mental health and learning disability services in the county. We use the majority of this money to commission services from Hertfordshire Partnership NHS Foundation Trust and from Adult Care Services.

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

Our history and backgroundAlthough 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.


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

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

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

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.

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.

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

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).

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.

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Dir

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Linda Farrant

Non-executive Director

Chris Learmonth


Elaine Fox


Phil Picton


Richard Henry


Julia Witting


Pam Handley

Chair

Dr Tony Kostick

Joint Chair, Professional Executive Committee

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

How we are managed

Exe

cuti

ve

Dir

ecto

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

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

Anne Walker

Chief Executive

Gareth Jones

Director of Strategic Planning

Pauline Pearce

Director of Public Involvement and Corporate Services

Gloria Barber

Director of Human Resources (HR)

Andrew Parker

Director of Primary Care and Service Redesign

Beverley Flowers

Director of Commissioning

Heather Moulder

Director of Nursing/Interim Chief Operating Officer, HCHS

Jane Halpin

Director of Public Health

Alan Pond

Director of Finance

Clare Hawkins

Interim Director of Nursing


Location and type of facilities provided

The main facilities and community hospitals from which we provide services and at which our clinical staff are based are:

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


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.

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

These projects have included:

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

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

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

To this end, we have completed:

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

In addition, we have:

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

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

This has included:

producing energy certificates for all buildings 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.

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

We work with a large number of partners including:

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

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


Hertfordshire Forward – The countywide LSPHertfordshire 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:

Improving health and wellbeing, life chances, •and access to health care.

The short-term actions include:

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

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.

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

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 partnershipsCommunity safety partnerships are linked to the LAA ‘Safer and Stronger’ strand and set additional local targets based upon the findings of their strategic assessments. In addition to targeting crime and anti-social behaviour, community safety partnerships seek to address the underlying societal problems caused by alcohol and drugs, and the various elements that cause fear of crime in communities. Reducing both crime and fear of crime has an impact on physical and mental health, which helps to promote independent living for vulnerable groups of people and helps to build social cohesion. Children and young people’s partnershipHertfordshire Children’s Trust Partnership, supported by District Children’s Trust Partnerships (DCTPs) supports delivery of the five Every Child Matters outcomes. They are set to become key vehicles to support the delivery of children’s services countywide and in local districts.

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


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

Partnership working on planning for emergenciesThe PCT is an active member of Hertfordshire Resilience, the county’s local resilience forum, and many of its sub-committees, 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 companiesThe PCT works closely with suppliers of gas, electricity and water as well as the Highways agencies in its emergency planning roles. In recognition of the particular effect water supply has on public health, we have developed a strong relationship with Three Valleys Water.

Sustaining a healthy futureHerts 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.


KeepingHertsHealthy


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

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

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

Fast, easy access to your doctorWhen 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.

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

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

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

Pre-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) •

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

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

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

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:

68% of patients were happy with how long they had •to wait for treatment Two-thirds of patients found it easy to make their •first hospital appointment (either by phone, online or within their GP practice) and 91% who were offered a choice of where to be treated, were able to go to their preferred hospital 96% of patients felt that they were treated with •respect and dignity during their treatment.


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

* 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 appointmentsGetting 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 [email protected] to find out the practice nearest to where they live or work that is offering NHS dental appointments.

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

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

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


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

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

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

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

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

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

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

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

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

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:

Say what they think about local health and social care •services – what is working and what is notInfluence 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 groupsA number of local patients are also now supporting the practice based commissioning group in Welwyn Hatfield. This group of eight GP surgeries in the area are responsible for buying and designing health services that best meet the needs of local residents. During the past year the group has begun working with GPs and consultants to introduce some gynaecology services in local surgeries. This means that many women won’t have to go to hospital for their outpatient appointments.

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

Patient experienceWe 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.


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

BrainBox – unlocking the secrets of mental health

We are proud of our innovative and committed approach to caring for people with mental health and learning disabilities. Last year, adults and children with anxiety, anger and addiction issues all benefited from using the BrainBox – the unique creation of our Emotional and Mental Health Advisor Deborah Bone. Deborah explains more:

What inspired you to develop the BrainBox?I wanted a tool that I could use with young people to help deal with anger and anxiety and help remove the stigma surrounding accessing mental health services.

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

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

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

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

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

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

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

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

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

One patient, a retired senior manager suffering from agoraphobia, received psychological therapy on the IAPT programme following unsuccessful drug treatment. After 10 sessions with a psychologist, and attending an anxiety management group, the patient was discharged. In a letter, he wrote:

“Our sessions have encouraged me to build on the lessons from the anxiety management course and the ‘targets’ you have set me have given me something to aim for. All of this has helped me to improve and gradually increase my quality of life. I aim to make the most out of it – thank you.”


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

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

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

The review’s key recommendations include:

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


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

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

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

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

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

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

If you are interested in joining the MSLC please contact NHS East and North Hertfordshire on [email protected]

Our peopleOur 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 MatronNominated 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 NurseKaren 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.”

Unsung Hero

Winner: Dot Lutkin, Communications OfficerDot 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.

Innovation

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

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

Caring• I care about everything I do for colleagues, patients and partners. Confident• I am trusted to make informed and timely decisions and have the confidence to see them through. Creative• I have the freedom to bring forward new ideas and solutions Learning• I take responsibility for my personal development as part of our learning culture Fun• I play my part in making this an enjoyable and rewarding place to work Proud• I am proud to work for NHS East and North Hertfordshire

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


Children’s healthWe 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 child-friendly and we want to take their own views into account when planning services

Where children take centre-stage

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

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

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

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

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

Healthy eating starts young

If national trends continue, 90% of today’s children could be overweight or obese by 2050. That shocking statistic is the motivation behind the Department of Health-led campaign Change4Life

These days, ‘modern life’ can mean that we’re a lot less active. With so many opportunities to watch TV or play computer games, and with so much convenience and fast food available, we don’t move about as much, or eat as well as we used to. Which means that 9 out of 10 kids today could grow up with dangerous amounts of fat in their

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

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

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

You can join Change4Life by visiting www.nhs.uk/changeforlife or by phoning 0300 123 4567* for a chat. Offices are open 9am – 6.30pm, Monday to Friday.


End of lifeBeing 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 receive an effective and supportive service is a key priority for NHS East and North Hertfordshire.

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

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

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


Staying healthy

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

Be a quitter!

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

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

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

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

After 8 hours…Your blood oxygen levels return to normal and your chance of having a heart attack falls

After 24 hours…Carbon monoxide leaves your body. Your lungs start to clear out mucus and debris

After 48 hours…Your body is now nicotine free and your sense of taste and smell should have improved

After 2-12 weeks…Circulation is improved throughout your body. It’s easier for you to walk and exercise now

After 3-9 months…Your lung capacity has increased by 5-10%. Coughing, shortness of breath and wheezing are all steadily diminishing

After 5 years…You now have only half the chance of getting a heart attack compared to a smoker

After 10 years…The chance of you getting lung cancer is now half that of a smoker. Your chances of having a heart attack are now the same as someone who’s never smoked

John Greaves successfully quit using the Hertfordshire Stop Smoking Service “Until I met Liz from the Hertfordshire Stop Smoking Service I had no intention of giving up. I met her by chance at an event where I was working and arranged to meet her again for a chat about quitting. I remember thinking on my way to our first meeting that there was no way I would be giving up but actually during that journey I smoked my last cigarette. Liz and the service supported me to kick a 32 year smoking habit and I have now been a non smoker for 20 weeks. If I can do it then anyone can.”

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


Immunisation

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

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

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

The uptake of the MMR vaccination in Hertfordshire is slightly lower than the national average. There were 37 confirmed cases of measles in Hertfordshire during 2008. It is important that parents immunise their children against measles, mumps and rubella to help prevent measles becoming more widespread.

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

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

For further information on the MMR jab, speak to your health visitor or GP, or call NHS Direct on 0845 4647 or go to: www.immunisation.nhs.uk/vaccines/mmr

FluFlu, or influenza, can be a serious illness, contributing to the deaths of between 3,000 and 4,000 people each year in the UK.

People aged 65 and over are particularly at risk, even if they are otherwise healthy. Flu jabs are also strongly recommended for anyone with a chronic illness, such as diabetes and asthma, and for people living close together in residential care homes.

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

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

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

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


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

Swine fluSince the emergence of a new kind of flu virus (swine flu) in Mexico this year, NHS East and North Hertfordshire has been implementing its plans to make sure we are well placed to manage pandemic flu in Hertfordshire.

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

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

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

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

cover your nose and mouth when coughing or •sneezing, using a tissue when possibledispose 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.

HPVNearly three-quarters of cervical cancers could soon 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.

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

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

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

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

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

Latest figures show that uptake of the HPV vaccine by 12-13 year olds living in East and North Hertfordshire is broadly in line with the national average at around 80%. Uptake by 17-18 year olds is slightly higher than the national average at around 55% although this is still lower compared to the younger age group. This difference is because the vaccination programme for the school aged children is carried out in schools. The older age group receive their vaccination in health clinics. We plan to increase uptake by the older age group next year by offering the vaccination in school and in clinics.


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

cleanyourhands campaign

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

‘Cleanyourhands’ staff champions have been identified at each of our sites, and are responsible for encouraging all staff, patients and visitors, to clean their hands regularly. So far, informal feedback has been very positive and we believe the campaign will play an important role in reducing infection amongst patients.

Healthy weight, healthy lives

Few parents like to admit that their child is overweight, many simply don’t realise what a healthy weight should be. We want to raise awareness amongst parents about what a healthy weight is and how they can help their family to achieve it.

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

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

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

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

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

Bowel Cancer Screening

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

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

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

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

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


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

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

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%.

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.

FAST stands for:

Facial weakness - can the person smile? •Has their mouth or eye drooped?Arm weakness - can the person raise both arms?• Speech problems - can the person speak clearly and •understand what you say?Time to call 999•

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

Dr Declan O’Kane from the QEII Hospital in Welwyn Garden City agrees. He says: “If someone fails the FAST test, you must call 999. Swift action can prevent further damage to the brain and help someone make a full recovery. On the other hand, delay can result in death or major long-term disabilities, such as paralysis, severe memory loss and communication problems. Everyone should remember to think FAST!”

You can find out more about how to spot the symptoms of a stroke and read about how other people have coped with a stroke by visiting www.nhs.uk/stroke

Helping patients to help themselves

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

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

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

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


Decision on site of new local general hospital

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

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

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

Full steam ahead for Lister Surgicentre

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

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

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

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

Changing services

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


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

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

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

Major boost to maternity services

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

The project will expand the Lister’s current maternity unit and will be designed with new delivery rooms – some of which will have water birth facilities – and neonatal cots. The new facility, is expected to assist more than 5,500 births every year.

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

Urgent Care Centres

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

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.

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

Elsewhere in Hertfordshire

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


Quality Report


Quality ReportThis 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.


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

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

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

Quality improvement priorities for 2009/10

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

We consider our quality priorities to be:

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

Quality overview 2008/09

Patient experienceThe 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:

Introduction of revised patient group directions for •Genito Urinary Medicine, reaffirming safe clinical practice. Introduction of specialist speech and language •therapists in children’s services, improving access for children with specific needs. A review of access to the complaints process to improve •access for patients wishing to respond via email. Implementation of specific training and managerial •support for identified bed based intermediate care services to raise awareness of privacy and dignity and communication needs of patients in this care pathway.

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


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

Dental servicesThe 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.

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%.

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%


Operating & financial review

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


Overview

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

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 East and North Hertfordshire is seeking to deliver a more strategic and long-term approach to commissioning services, with a clear focus on improving the health of our population and delivering improved health outcomes. This is guided by our ambitious commissioning strategy which will frame our vision for more patient-centred care, delivered in a variety of community settings.

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

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

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 East and North Hertfordshire has helped the PCT consolidate its financial recovery and embed new ways of working.

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

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

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

While we have much to be proud of and certainly more challenges ahead, ensuring that local people play a greater role in shaping health services is one of our key strategic objectives. Going forward into 2009/2010, as we develop better and more innovative ways of delivering healthcare, we will seek to further strengthen our patient and public involvement processes enabling the people of East and North Hertfordshire to have their say in the way services are provided.


Our Performance

Operating and financial review


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

Objective Progress

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

Clinical leadership roles agreed- PBC commissioning plans agreed-

Implement ‘Delivering quality health care for Hertfordshire’ 38 practices open for extended hours- New ‘out of hours’ GP and dental contract in place covering all of Hertfordshire- Contract awarded for new Spring House Medical Centre in Welwyn Garden City. - County workforce group in place-

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- Long service awards and staff awards scheme now 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- Board 360- o Review undertaken

Deliver on local and national targets and standards See section on Key Performance Indicators on page 54-

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

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

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

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


Objective Progress

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

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

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

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-


Key performance indicatorsIn 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:

1 Improving access, eg:

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

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

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

3 Improving cleanliness and reducing healthcare-associated infections, eg:

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 treatmentThroughout 2008/09 the PCT has been working with service providers to reduce the length of time patients wait for treatment in consultant-led services.

From December 2008, the targets are:

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

Improving access (including at evenings and weekends) to GP services38 GP practices (62.3%) 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) clinicsThe national target is to ensure 100% of patients are offered an appointment to be seen within 48 hours by GUM services. By the end of March 2009 performance was 99.37% - this is close to target and improving further. This figure incorporates performance across a high number of GUM clinics, some of which are local, others further afield. The changes implemented within local services, where we obviously have the greatest influence, are now regularly delivering 100%.

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

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

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

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

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

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

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

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

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

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

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

Q1 – Q3% receiving first definitive treatment in one month

99.734%

Q4% receiving first definitive treatment in one month

97.590%

Q4% subsequent treatment in one month

98.305%

Q1 – Q3Percent treated in 2 months - GP

98.380%

Q4Percent treated in 2 months - GP

84.375%

Q4Percent treated in 2 months - screening

100%

Q4Percent treated in 2 months – consultant upgrade

100%

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

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


limit of 183. Primary care organisations also worked towards targets on cleanliness and reducing healthcare-associated infections during 2008/09. This was constructed on the basis of incidence rates for the population. The target for 2008/09 was to have fewer than 386 incidents of clostridium difficile. NHS East and North Hertfordshire has made excellent progress with 239 reported cases by the end of March 2009.

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

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

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

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

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

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 10%, with 90% of staff saying they felt trusted to do their job, 84% believing their role makes a difference, and 80% saying they found their jobs interesting.

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

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

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

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

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

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

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

National Priorities

Indicators Target 2008/09; Performance

18 week referral to treatment times 3

18-week Referral to Treatment (RTT) target for Admitted pathways 90% 3

18-week Referral to Treatment (RTT) Data Completeness for Admitted pathways 90-110% 3

18-week Referral to Treatment (RTT) target for Non-Admitted pathways 95% 3

18-week Referral to Treatment (RTT) Data Completeness for Non-Admitted pathways 90-110% 3

Access to primary careThis 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

85% –

Access to primary care dental services – the proportion of population visiting an NHS dentist in past 24 months 338,269 3

Existing Commitments


Access to GUM clinics within 48 hours 100% 3

Category A calls meeting 19 minute standard (Ambulance Trust Performance) 95% 3

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.

75% –

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.

95% –

Commissioning of crisis resolution/home treatment servicesHertfordshire 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.

829 7

Commissioning of early intervention in psychosis services 3

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

85% –

Delayed transfers of care (6 per 100,000 pop)We have identified that these delays were the result of poor communication between the various agencies involved and a lack of awareness of the correct process in some cases. We have developed a project to integrate all those involved in the discharge planning process with the objective of reducing the number of delays.

–

Diabetic retinopathy screening 100% 3

Inpatients waiting longer than the 26 week standard 0% 3

Outpatients waiting longer than the 13 week standard 0% 3

Patients waiting longer than three months (13 weeks) for revascularisationThis target was missed under achieved by 0.059% (the equivalent of one patient).

0% –

Time to reperfusion for patients who have had a heart attack 68% –

Total time in AandE (maximum 4 hour wait) 98% 3

National Priorities


All age all cause mortality 640 males - 463 females 3

Reduction in CVD mortality rate in people age under 75 (40% by 2010) 65.441 3

Reduction in cancer mortality rate in people age under 75 (20% by 2010) 105 3

All cancers: one month diagnosis to treatment (including new cancer strategy commitment) 96% 3

All cancers: two month GP urgent referral to treatment (including new cancer strategy commitment) 85%3 Subject to

benchmarking

All cancers: two week wait 93% 3

Breast cancer screening for women aged 53 to 70 years>70% (aged 53-64)>65% (aged 65-70)

3

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

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

7

Chlamydia screening (as a proxy for chlamydia prevalence)This is a challenging target for Hertfordshire and further promotional work will continue to bring about an ongoing increase in screening levels

17% of population 7

Commissioning a comprehensive child and adolescent mental health service (CAMHS) Achieve level 3 3

Experience of patients 60 3

Four week smoking quitters See information on page 34

3,528 7

Incidence of Clostridium difficile 386 3

NHS staff satisfaction 3% 3

Number of drug users recorded as being in effective treatment 1,6523 Subject to

benchmarking

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.

Recorded coverage 85%Prevalence 46%

7

Proportion of individuals who complete immunisation by recommended ages(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

Stroke careThis 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.

25% 7

Teenage conception rates per 1,000 females aged 15-17This target was missed by 7% more than planned figure (Herts-wide figure)

24.6– Subject to

benchmarking

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

Level 2 –

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


FinancialReview

The year ended 31 March 2009 was successful on many fronts. The PCT returned to a strong financial position, recording an underspend of £1.7m, whilst at the same time improving performance on key service targets.


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:

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

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.


1) Costs not to exceed revenue resource limit The PCT’s revenue resource limit was £693m and expenditure was £691m. The PCT had always planned to underspend by £1m and this target was exceeded with expenditure being within the agreed resource limit by £1,683,000. This underspend will be returned to the PCT by the Department of Health, who will increase the PCT’s resource limit by £1,683,000 in 2009/10.(Accounts – Note 2.1)

2) To remain within cash limitAll 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.

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

The target was therefore achieved. (Accounts – Balance Sheet)

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

4) To recover the full cost of provider servicesNHS East and North Hertfordshire both commissions services and also provides them directly. The PCT has to demonstrate that it has received income to cover the full costs of the services it directly provides. In 2008/09, the net cost of services provided was £48m and the funding provided from the PCT’s own allocation was £48m. The PCT therefore achieved an underspend on provider services of £31,000, consequently meeting the target. (Accounts – Note 2.3)

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

The 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 pay rise for Very Senior Managers in 2008/09 was 2.2%. (Accounts – Note 5.5)

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

On invoices from other NHS organisations, the PCT paid 72% of invoices (97% by value) within 30 days. In both cases this is an improvement on 2007/08. Performance on all measures steadily improved during the year and the PCT expects performance in 2009/10 to be better still.(Accounts – Note 6.1)

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

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

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

The Department of Health is regarded as a related party. During the year, the PCT had a significant number of material transactions with the Department, and with other entities for which the Department is regarded as the parent Department. Further details of the amounts and the parties involved are included in the accounts. (Accounts – Note 20)

Where the money was spentAs mentioned above, the PCT is both a commissioner of services and a provider. The majority of the PCT’s funding was spent on commissioning services from other NHS and non-NHS organisations. The largest single element was spent on general and acute services (43.6%). Next came prescribing (10.9%), and primary care general medical services (10.4%). Around 7% of total spending went on services provided directly by the PCT. A more detailed analysis of where the money was spent is shown in the pie chart on the following page.

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


Analysis of 2008/09 Net Expenditure

PCT Provided Services 7.0%

Prescribing 10.9%

General Medical Services 10.4%

Other Family Health Services 6.5%

Maternity 2.0%

General and Acute 43.6%

AandE 2.1%

Learning Disabilities 6.6%

Mental Healthcare 6.8%

Other Healthcare 4%


Financial outlook

Implementation of International Financial Reporting Standards (IFRS) in 2009/10Achieving financial balance in

the last two years has been a major success

In the 2008 budget it was announced that public sector bodies would produce financial statements based on IFRS from 2009/10.

Growth funding for next year and the year after is 5.5% and 5.8% respectively. However, it is clear that growth funding in the following years will be considerably less. The PCT has therefore developed a five-year financial plan, alongside the Commissioning Strategy. The plan will see increased investment in services, but with £2.6m additional funds held back in reserve for investment after 2009/10 when growth in funding is expected to be smaller. The plan also sees a reduction in the proportion of the PCT’s funding spent on acute services. There will be increased funding in particular for mental health services, prescribing, community and primary care. The strategy also includes the development of a new local general hospital in the Welwyn Hatfield area, with a likely capital cost of around £30m.

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

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.


Looking to the Future

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.


Our strategic objectives

1) Delivering our strategy and national targets

The vision of the PCT is as follows:

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

The strategy has three strategic priorities. These are:

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

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

1. Increase life expectancy2. Reduce the difference in life expectancy between the

most and least deprived communities3. Increase the number of people who give up smoking4. Reduce the prevalence of obesity in year 6 school children5. Increase uptake of the MMR vaccination6. Reduce the mortality rate from cardiovascular disease7. Improve patient satisfaction with access to GP services8. Increase the proportion of people visiting an NHS dentist.9. Reduce the number of babies born by caesarean section10. Increase the number of people who can control

their diabetes11. Reduce the prevalence of chronic obstructive

pulmonary disease12. Increase the number of people with long-term

conditions who have personal health plans13. Increase the number of people who are able to die in

their own homes14. Improve patient experience scores15. Reduce then eliminate Clostridium Difficile within

healthcare settings.

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

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

2) Developing capacity and capability

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

1.Develop a commissioning mindset2. Improve contracting and commercial capabilities3. Develop and utilise a prioritisation framework for all

investment and service redesign4. Development of a data repository and analytical skills5. Assessment of provider market6. Drive clinically led evidence based change 7. Proactively engage public and patients8. Focus on working with all our partners to improve care

and reduce health inequalities9. Develop real and structured processes and an appropriate

workforce to deliver World Class Commissioning10. 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.


3) Making best use of resources

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

Finance•Human Resources•Estates•Information Communication and Technology•Governance•

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

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

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


GovernanceControls and Audit


Policy on managing principal risksThe 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 CommitteeThe 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 GovernanceIn 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.

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

In total there were 36 personal data-related incidents reported to the PCT in 2008/09. This includes seven incidents classified as serious untoward incidents and reported to the SHA.

The table below shows serious untoward incidents that were reported to NHS East and North Hertfordshire from commissioned and Provider Services.

Category Nature of Incident Total

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

5

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

14

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

0

IV Unauthorised disclosure 4

V Other 13

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.

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

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

Role of the Audit CommitteeThe 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 East and North 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) has been active for almost five years.

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

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

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

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

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

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.

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

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.

Provision of information to and consultation with employees

We have a range of mechanisms that encourage two-way dialogue within the PCT. These include:

A monthly team briefing, comprising key messages •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

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.

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

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

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

1 Source: ESR Absence Timeline Analysis2 Source NHS Information Centre iView database


Policy in relation to disabled employeesThe PCT retains the positive (or two ticks) symbol from Jobcentre Plus and actively supports the employment of staff with disabilities.

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

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

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

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

The PCT also has the following staff network groups:

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

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

NHS East and North Hertfordshire works with many partners on the advancement of equal opportunities. Over the past year we have:

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.

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

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

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

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.

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

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

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

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

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

Remuneration report


Remuneration Report

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

2008 - 09 2007 - 08

Name Title

Salary/Fees (bands of

£5,000)

Other Remuneration

(bands of £5,000)

Benefits in kind

(rounded to the nearest

£000)

Salary (bands of

£5,000)

Other Remuneration

(bands of £5,000)

Benefits in kind

(rounded to the nearest

£000)

£000 £000 £000 £000

Pam Handley Chair 35-40 0 0 35-40 0 0

Richard Henry Non Executive Member 5-10 0 0 5-10 0 0

Phil PictonNon Executive Member and Chair of the Joint Remuneration Committee

5-10 0 0 5-10 0 0

Linda FarrantNon Executive Member and Chair of E and N Herts Audit Committee

10-15 0 0 10-15 0 0

Julia WittingNon Executive Member and Chair of Joint Integrated Governance Committee

5-10 0 0 5-10 0 0

Chris Learmonth Non Executive Member 5-10 0 0 5-10 0 0

Elaine Fox Non Executive Member [from 01/09/2008] 0-5 0 0

Anne Walker Chief Executive (50%) 70-75 0 0 65-70 0 0

Alan Pond Director of Finance and Commercial Development (50%) 55-60 0 0 45-50 0 0

Jane Halpin Director of Public Health (50%) 60-65 0 0 55-60 0 0

Gareth Jones Director of Strategic Planning (50%) 50-55 0 0 45-50 0 0

Beverley Flowers Director of Commissioning [from 21/11/2007] (50%) 45-50 0 0 15-20 0 0

Pauline PearceDirector of Public Involvement and Corporate Services (50%)

35-40 0 0 30-35 0 0

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

55-60 0 0 40-45 0 0

Clare Hawkins Interim Director of Nursing from [01/12/2008] (50%) 5-10 0 0

Andrew Parker Director of Primary Care and Service Redesign (50%) 45-50 0 0 40-45 0 0

Gloria Barber Director of Human Resources (50%) 40-45 0 0 35-40 0 0

Dr Tony Kostick Chair of the Professional Executive Committee 65-70 0 0 30-35 0 0


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

Name and title

Real increase In pension at age 60 (bands

of £2,500)

£000

Lump sum at aged 60

related to real

increasein pension

(bands of £2,500)

£000

Total accruedpension at

age 60 at 31 March 2008

(bands of£5,000)

£000

Lump sum at age 60

relatedto accrued

pension at 31 March 2008

(bands of £5,000)

£000

Cash Equivalent

Transfer Valueat 31 March

2009

£000

Cash Equivalent

Transfer Valueat 31 March

2008

£000

Real increase in Cash

EquivalentTransfer Value

funded by PCT

£000

Employer’s contribution

to stakeholder

pension

£000

Anne Walker - Chief Executive 0-2.5 5-7.5 25-30 75-80 474 333 93 0

Alan Pond - Director of Finance and Commercial Development

0-2.5 2.5-5 15-20 45-50 247 173 49 0

Jane Halpin - Director of Public Health 2.5-5 7.5-10 15-20 45-50 245 162 56 0

Gareth Jones - Director of Strategic Planning

0-2.5 0-2.5 15-20 55-60 367 266 66 0

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

0-2.5 2.5-5 5-10 20-25 113 78 23 0

Pauline Pearce - Director of Public Involvement and Corporate Services

0-2.5 2.5-5 10-15 30-35 204 143 40 0

Heather Moulder - Interim Chief Operating Officer Provider Services

2.5-5 12.5-15 20-25 60-65 342 214 86 0

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

0-2.5 0-2.5 10-15 30-35 167 123 10 0

Gloria Barber - Director of Human Resources

0-2.5 2.5-5 15-20 5.-55 392 273 79 0

Andrew Parker - Director of Primary Care and Service Redesign

0-2.5 2.5-5 10-15 40-45 249 173 50 0


NHS East and North Hertfordshire Board Expenses 2008/2009

PositionPeriod Parking

at Office £

Official Mileage

£

Lump Sum

£

Excess Travel

£Subsistence

£Parking

£

Public Transport

£

Course Expenses

£

Telephone Costs

£

Total Expenses

£From To

Chair

Pam Handley 01/04/08 31/03/09 0 3,561 0 3 0 0 1,095 0 0 4,656

Non-Executive Directors

Richard Henry 01/04/08 31/03/09 No Claim

Philip Picton 01/04/08 31/03/09 0 760 0 0 0 65 0 0 0 825

Linda Farrant 01/04/08 31/03/09 0 1,053 0 0 0 131 0 0 0 1,183

Julia Witting 01/04/08 31/03/09 0 675 0 0 0 250 0 0 0 925

Christopher Learmonth 01/04/08 31/03/09 0 225 0 0 0 33 0 0 0 258

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

A Cash Equivalent Transfer Value (CETV) is the •actuarially assessed capital value of the pension scheme benefits accrued by a member at a particularly point in time. The benefits valued are the member’s accrued benefits •and any contingent spouse’s pension payable from the scheme.

A CETV is a payment made by a pension scheme or •arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that •the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies. The CETV figures and the other pension details include •the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit •accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost.

CETVs are calculated within the guidelines and •framework prescribed by the Institute and Faculty of Actuaries.

3. Real Increase in CETVThis 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 BenefitsRepresents 50% of the total amount claimed, the balance being paid by NHS West Hertfordshire.

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


NHS East and North Hertfordshire Board Expenses 2008/2009

PositionPeriod Parking

at Office £

Official Mileage

£

Lump Sum

£

Excess Travel

£Subsistence

£Parking

£

Public Transport

£

Course Expenses

£

Telephone Costs

£

Total Expenses

£From To

Elaine Fox 01/09/08 31/03/09 0 608 0 0 0 139 0 0 0 747

Voting Directors

Anne Walker*Chief Executive

01/04/08 31/03/09 (509) 1,315 700 544 0 145 363 0 (10) 2,548

Alan Pond*Director of Finance

01/04/08 31/03/09 (509) 1,690 917 0 0 114 88 0 0 2,299

Dr Jane Halpin*Director of Public Health

01/04/08 31/03/09 (509) 371 833 0 0 56 39 0 0 789

Non-Voting Directors

Gloria Barber* Director of Human Resources

01/04/08 31/03/09 (509) 0 0 0 0 0 0 0 0 (509)

Gareth Jones* Director of Strategic Planning

01/04/08 31/03/09 (509) 1,643 844 0 0 455 0 0 0 2,433

Pauline Pearce* Director of Public Involvement and Corporate Services

01/04/08 31/03/09 (509) 43 0 0 0 3 7 0 0 (456)

Heather Moulder*Director of Nursing / Interim Chief Operating Officer

01/04/08 31/03/09 0 0 253 0 0 0 0 0 0 253

Clare Hawkins*Interim Director of Nursing

01/12/08 31/03/09 0 0 253 0 0 0 0 0 0 253

Beverley Flowers*Director of Commissioning

01/04/08 31/03/09 No Claim

Andrew Parker*Director of Primary Care and Service Redesign

01/04/08 30/11/08 (509) 683 844 0 0 23 0 0 0 1,041

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


Adherence to principles for remedyThe 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.•

How have we met these principles?

We have incorporated the NHS complaints procedures •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’ 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 workAudit Commission2nd FloorSheffield HouseLytton Way (Off Gates Way)StevenageSG1 3HG

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

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

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

Directors’ disclosure of interests

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

Pam Handley, Chair Chair Watford CVS (unpaid) 18/10/2006

Trustee/Director (unpaid), Nine Lives Furniture (a charity receiving occasional grants from JCPB) 20/6/2007

Director, Choice Shapers (service brokerage for disabled people, with work possibly commissioned by HCC) 24/6/2008

Daughter works for HPFT 24/6/2008

Chair and Director Watford Charity Centre Ltd (unpaid) - a social enterprise 10/2/2009

Hypnotherapist in West Hertfordshire in private practice

Consultancy work for Housing and Support Partnership

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

3/11/2006

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

Richard Henry, NED Councillor for Stevenage Borough Council (Executive member) 18/10/2006

Lecturer North Herts College

Works 1 day/week for HPT specialist mental health team for older people

Chair and Trustee member Group 117 (organises holidays for people with disabilities) 9/1/2008

Wife works for HPT as a manager

Prospective Parliamentary Candidate, NE Hertfordshire Constituency

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

18/10/2006 1/10/2007

Chris Learmonth, NED Parent Governor of Mandeville Primary School in Sawbridgeworth 31/10/2006

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

14/7/2008

Finance Director, The Bridal Path (est. 2006) Limited

Director, Learmonth and Company (accountancy and financial advice – no health links)

Julia Witting, NED Parish Councillor and Chair, Stanstead Abbotts 16/10/2006

Eastern Region Development Officer (part time), National Association of Local Councils 24/6/2008

Independent Member of the Circle Anglia Group Audit Committee (Term of three years beginning 1 Sept 2008) 21/8/2008

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

17/3/2009

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


Directors’ disclosure of interests

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

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

3/9/2008

Anne Walker,Chief Executive

None16/10/2006

Alan Pond, Director of Finance

None4/10/2006

Heather Moulder, Interim Chief Operating Officer, Provider Services

Member of Vitiligo Society (a voluntary organisation that supports people, including a member of her family, with this condition)25/6/2008

Andrew ParkerDirector of Primary Care and Service Redesign

Wife is Bone Marrow Transplant Quality Manager at Royal Free Hospital NHS Trust, (PCT has an Service Level Agreement with RFH)7/2/2007

Beverley Flowers Director of Commissioning

None6/7/2007

Gareth Jones, Director of Strategic Planning

None4/10/2006

Clare HawkinsInterim Director of Nursing

None18/4/2007

Pauline Pearce, Director of Public Involvement and Corporate Services

Son undertakes occasional temporary clerical work in other directorates20/7/2007

Dr Jane HalpinDeputy Chief Executive and Director of Public Health

None16/10/2006

Gloria Barber Director of Human Resources

None25/1/2007

Tony KostickChair, Professional Executive Committee

Principal, Dr Baxani and Partners, Stevenage, Clinical Lead, Stevenage PBC Group 13/12/2006

Club Doctor, Stevenage Borough Football Club, Navigant Consulting Clinical consultancy 10/1/2007

Expert 24 Ltd Health assessment software (clinical consultancy) 26/6/2008


Alan Pond, Director of Finance

The Accounts


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


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:

there 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.

By order of the board.

Statement on internal control 2008/09

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

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

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

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

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

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

Anne Walker Chief Executive

Anne Walker Chief Executive

Alan Pond Financial Director


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

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

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

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

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

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

3. Capacity to handle riskThe 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.

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

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

4. The risk and control framework

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

The full Assurance Framework can be seen on the PCT’s website by following the link below: http://www.enherts-pct.nhs.uk/Documents/publications/AssuranceframeworkFeb09.pdf

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


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 Sub-Committee (IGSC) which is chaired by the PCT’s Caldicott Guardian and is responsible for the monitoring and management of the Information Governance arrangements. The committee monitors trends in data security incidents with a view to improving security measures to protect personal identifiable data. This is achieved via a regular review of the identified gaps or risks in meeting the Information Governance agenda. Work on meeting the requirements of the IG toolkit has been ongoing through out the year with the PCT achieving good levels of compliance by March 2009.

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

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

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

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

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

Declaration on compliance covering 2008/09 was submitted in April 2009. A copy of the PCTs full Declaration can be seen on the PCT’s website by the following link.http://www.enherts-pct.nhs.uk/Content.asp?id=SXC74F-A77F7D62

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

As an employer with staff entitled to membership of the NHS Pension scheme, control measures are in place to ensure all employer obligations contained within the Scheme regulations are complied with. This includes ensuring that deductions from salary, employer’s contributions and payments in to the Scheme are in accordance with the Scheme rules, and that member Pension Scheme records are accurately updated in accordance with the timescales detailed in the Regulations.

Control measures are in place to ensure that all the organisation’s obligations under equality, diversity and human rights legislation are complied with.

5. Review of effectivenessAs 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 declarationHealthcare 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:-

The PCT Board - The Board places reliance upon the •Audit Committee and (Joint) Integrated Governance Committee for assurances on the extent to which the system of internal control is sound. The Audit committee – The Audit Committee’s primary •role is to independently oversee the governance and assurance process on behalf of the PCT and to report to the Board on the soundness and effectiveness of the systems in place for risk management and internal


control. In order to provide this assurance to the Board, both Internal and External Audit undertake systems based reviews providing an opinion to the committee on the processes and controls in place. The (Joint) Integrated Governance Committee – •the (Joint) Integrated Governance Committee is responsible for overseeing the identification and management of risks facing the PCT, including the development and monitoring of the PCT’s Assurance Framework and the self declaration on compliance with core standards as part of the Healthcare Commission’s “Annual Health Check”. Executive Directors – the Executive Directors meet •weekly. Risk-related items feature as agenda items for these meetings. All directors have signed and returned Stewardship Statements to me confirming that as far as they are aware, there is no relevant audit information of which the PCT’s auditors are unaware. They have taken all steps that they ought to have taken as directors in order to make themselves aware of any relevant audit information and to establish that the PCT’s auditors are aware of that information. Internal Audit – Internal Audit reviews the system of •internal control and report their findings to the Audit Committee. This includes specific reports on areas relevant to controls, risk and governance and also a Head of Internal Audit Opinion, which informs this Statement on Internal Control.External Audit – Use of Resources review•

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

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

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

There have been no personal data related serious untoward incidents (as classified by the Department of Health) reported by East and North Hertfordshire PCT.

For Standards for Better Health the Commissioning Arm is ‘fully’ compliant with all standards with the exception of C1b (safety alerts) which was ‘met at year end’ rather than for the full year:

Standard C1b (Safety alerts)

Met at year end – this position is based on a lapse identified during the year whereby safety alerts from the predecessor PCTs and also those received and circulated during 2007/08 and early part of 2008/09 were not actioned within the required timescales.

Action taken: Robust actions were put in place with regular reporting to the Clinical Governance Committee. All outstanding alerts were dealt with and appropriately managed with no recorded lapses since December 2008.

The provider arm declared ‘met at year end’ rather than met for the full year on the following 4 standards:

Standard C1b (Safety alerts)

Met at year end – this position is based on a lapse identified during the year whereby safety alerts from the predecessor PCTs and also those received and circulated during 2007/08 and early part of 2008/09 were not actioned within the required timescales.

Action taken: Robust actions were put in place with regular reporting to the Clinical Governance Committee. All outstanding alerts were dealt with and appropriately managed with no recorded lapses since December 2008.

Standard C4b (Medical devices)

Met at year end – this position is based on a lapse identified during the year regarding lack of inventory for medical devices across all services from predecessor PCTs.

Action taken: Action plan has been progressed in year to meet this lapse with a Medical Devices Policy, detailed inventory in place and an annual report to the Board in March 2009.

Standard C5b (Clinical supervision)

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

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

Standard C13c (Confidential Information)

Met at year end – this is based on a lapse identified through incidents of mislaid records during transfer

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


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.

SignedAnne Walker, Chief Executive OfficerEast and North Hertfordshire Primary Care Trust

Date: 10th June 2009 (on behalf of the Board)

Independent Auditors Report of the Board of Directors of East and North Hertfordshire Primary Care Trust

Opinion on the financial statementsI have audited the financial statements of East and North Hertfordshire Primary Care Trust for the year ended 31 March 2009 under the Audit Commission Act 1998. The financial statements comprise the Operating Cost Statement, the Balance Sheet, the Cashflow Statement, the Statement of Total Recognised Gains and Losses and the related notes. These financial statements have been prepared in accordance with the accounting policies directed by the Secretary of State with the consent of the Treasury as relevant to the National Health Service set out within them. I have also audited the information in the Remuneration Report that is described as having been audited.

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

Respective responsibilities of Directors and auditorThe 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.


Basis of audit opinionI 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:

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.

OpinionIn my opinion:

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, of the state of the PCT’s affairs as at 31 March 2009 and of its net operating costs for the year then ended; the part of the Remuneration Report to be audited •has been properly prepared in accordance with the accounting policies directed by the Secretary of State as being relevant to the National Health Service in England; in all material respects the expenditure and income •have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them; and information which comprises the commentary on the •financial performance included within the Financial Review, included within the Annual Report, is consistent with the financial statements.

Conclusion on arrangements for securing economy, efficiency and effectiveness in the use of resources

Directors’ ResponsibilitiesThe 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 ResponsibilitiesI 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, East and North Hertfordshire Primary Care Trust made proper arrangements to secure economy, efficiency and effectiveness in its use of resources for the year ending 31 March 2009.

CertificateI 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 HodgsonDate: 12 June 2009Officer of the Audit CommissionRegus House, 1010 Cambourne Business Park, Cambourne, Cambridge, CB23 6DP

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650,

142

Incr

ease

/(dec

reas

e) in

cas

h16

.30

0

The

note

s on

pag

es 9

6 to

127

for

m p

art

of t

his

acco

unt.


The

finan

cial

sta

tem

ents

hav

e be

en p

repa

red

in a

ccor

danc

e w

ith t

he 2

008/

09 F

inan

cial

Rep

ortin

g M

anua

l (FR

eM) i

ssue

d by

HM

Tre

asur

y. T

he p

artic

ular

acc

ount

ing

polic

ies

adop

ted

by t

he P

rimar

y C

are

Trus

t (P

CT)

are

des

crib

ed b

elow

. The

y ha

ve b

een

appl

ied

in d

ealin

g w

ith it

ems

cons

ider

ed m

ater

ial

in r

elat

ion

to t

he a

ccou

nts.

Thes

e ac

coun

ts h

ave

been

pre

pare

d un

der

the

hist

oric

al

cost

con

vent

ion,

mod

ified

to

acco

unt

for

the

reva

luat

ion

of

fixed

ass

ets,

and

sto

ck w

here

mat

eria

l, at

the

ir va

lue

to t

he

busi

ness

by

refe

renc

e to

cur

rent

cos

ts. T

his

is in

acc

orda

nce

with

dire

ctio

ns is

sued

by

the

Secr

etar

y of

Sta

te a

nd a

ppro

ved

by H

M T

reas

ury.

a) In

com

e an

d F

un

din

gTh

e m

ain

sour

ce o

f fu

ndin

g fo

r th

e PC

T is

allo

catio

ns

(Par

liam

enta

ry f

undi

ng) f

rom

the

Dep

artm

ent

of H

ealth

with

in

an a

ppro

ved

cash

lim

it, w

hich

is c

redi

ted

to t

he G

ener

al F

und

of t

he P

CT.

Par

liam

enta

ry f

undi

ng is

reco

gnis

ed in

the

fina

ncia

l pe

riod

in w

hich

the

cas

h is

rece

ived

.

Mis

cella

neou

s in

com

e is

inco

me

whi

ch r

elat

es d

irect

ly t

o th

e op

erat

ing

activ

ities

of

the

PCT.

It p

rinci

pally

com

pris

es

fees

and

cha

rges

for

ser

vice

s pr

ovid

ed o

n a

full

cost

bas

is

to e

xter

nal c

usto

mer

s, a

s w

ell a

s pu

blic

rep

aym

ent

wor

k. It

in

clud

es b

oth

inco

me

appr

opria

ted-

in-a

id o

f th

e Vo

te a

nd

inco

me

to t

he C

onso

lidat

ed F

und

whi

ch H

M T

reas

ury

has

agre

ed s

houl

d be

tre

ated

as

oper

atin

g in

com

e.

Inco

me

is a

ccou

nted

for

app

lyin

g th

e ac

crua

ls c

onve

ntio

n.

Inco

me

is r

ecog

nise

d in

the

per

iod

in w

hich

ser

vice

s ar

e pr

ovid

ed. W

here

inco

me

has

been

rec

eive

d fo

r a

spec

ific

activ

ity t

o be

del

iver

ed in

the

fol

low

ing

finan

cial

ye

ar, t

hat

inco

me

will

be

defe

rred

.

b)

Taxa

tio

nTh

e PC

T is

not

liab

le t

o pa

y co

rpor

atio

n ta

x. M

ost

of t

he

activ

ities

of

the

PCT

are

outs

ide

the

scop

e of

VA

T an

d,

in g

ener

al, o

utpu

t ta

x do

es n

ot a

pply

and

inpu

t ta

x on

pu

rcha

ses

is n

ot r

ecov

erab

le. I

rrec

over

able

VA

T is

cha

rged

to

the

rel

evan

t ex

pend

iture

cat

egor

y or

incl

uded

in t

he

capi

talis

ed p

urch

ase

cost

of

fixed

ass

ets.

Whe

re o

utpu

t ta

x is

ch

arge

d or

inpu

t VA

T is

rec

over

able

, the

am

ount

s st

ated

are

ne

t of

VA

T.

c) F

ixed

Ass

ets

Cap

ital

isat

ion

i.

All

asse

ts f

allin

g in

to t

he f

ollo

win

g ca

tego

ries

are

capi

talis

ed:

Inta

ng

ible

ass

ets

whi

ch c

an b

e va

lued

, are

cap

able

of

bein

g us

ed in

the

PCT’

s ac

tiviti

es fo

r mor

e th

an o

ne y

ear

and

have

a c

ost e

qual

to o

r gre

ater

than

£5,

000;

In

tang

ible

fixe

d as

sets

hel

d fo

r ope

ratio

nal u

se a

re v

alue

d at

hist

oric

al c

ost a

nd a

re d

epre

ciat

ed o

ver t

he e

stim

ated

lif

e of

the

asse

t on

a st

raig

ht li

ne b

asis.

The

car

ryin

g va

lue

of in

tang

ible

ass

ets

is re

view

ed fo

r im

pairm

ent a

t the

end

of

the

first

full

year

follo

win

g ac

quisi

tion

and

in o

ther

pe

riods

if e

vent

s or

cha

nges

in c

ircum

stan

ces

indi

cate

the

carr

ying

val

ue m

ay n

ot b

e re

cove

rabl

e.

Purc

hase

d co

mpu

ter s

oftw

are

licen

ces

are

capi

talis

ed

as in

tang

ible

fixe

d as

sets

whe

re e

xpen

ditu

re o

f at l

east

£5

,000

is in

curr

ed.T

hey

are

amor

tised

ove

r the

sho

rter

of

the

term

of t

he li

cenc

e an

d th

eir u

sefu

l eco

nom

ic li

ves

Tan

gib

le a

sset

s w

hich

are

cap

able

of

bein

g us

ed f

or a

pe

riod

whi

ch e

xcee

ds o

ne y

ear

and

whi

ch:

- in

divi

dual

ly h

ave

a co

st e

qual

to

or g

reat

er t

han

£5,0

00; o

r -

colle

ctiv

ely

have

a c

ost

equa

l to

or g

reat

er t

han

£5,0

00 a

nd in

divi

dual

ly c

ost

mor

e th

an £

250,

whe

re

the

asse

ts a

re f

unct

iona

lly in

terd

epen

dent

, the

y ha

d br

oadl

y si

mul

tane

ous

purc

hase

dat

es a

nd a

re

antic

ipat

ed t

o ha

ve s

imul

tane

ous

disp

osal

dat

es; a

nd

are

unde

r si

ngle

man

ager

ial c

ontr

ol; o

r

- fo

rm p

art

of t

he in

itial

equ

ippi

ng a

nd s

ettin

g-up

cos

t of

a n

ew b

uild

ing,

war

d or

uni

t irr

espe

ctiv

e of

the

ir in

divi

dual

or

colle

ctiv

e co

sts;

or

- fo

rm p

art

of a

n I.T

. net

wor

k w

hich

col

lect

ivel

y ha

s a

cost

of

mor

e th

an £

5,00

0 an

d in

divi

dual

ly h

ave

a co

st

of m

ore

than

£25

0. V

alu

atio

nii.

Inta

ngib

le fi

xed

asse

ts h

eld

for

oper

atio

nal u

se

are

valu

ed a

t hi

stor

ical

cos

t, e

xcep

t Re

sear

ch a

nd

Dev

elop

men

t w

hich

is v

alue

d us

ing

appr

opria

te in

dex

figur

es. S

urpl

us in

tang

ible

ass

ets

are

valu

ed a

t th

e ne

t re

cove

rabl

e am

ount

. Ta

ngib

le fi

xed

asse

ts a

re s

tate

d at

the

low

er o

f re

plac

emen

t co

st a

nd r

ecov

erab

le a

mou

nt. O

n in

itial

rec

ogni

tion

they

are

mea

sure

d at

cos

t (f

or

leas

ed a

sset

s, f

air

valu

e) in

clud

ing

any

cost

s su

ch a

s in

stal

latio

n di

rect

ly a

ttrib

utab

le t

o br

ingi

ng t

hem

into

w

orki

ng c

ondi

tion.

The

car

ryin

g va

lues

of

tang

ible

fixe

d as

sets

are

rev

iew

ed f

or im

pairm

ent

in p

erio

ds if

eve

nts

or c

hang

es in

circ

umst

ance

s in

dica

te t

he c

arry

ing

valu

e m

ay n

ot b

e re

cove

rabl

e.

Lan

d a

nd

Bu

ildin

gs

and

Dw

ellin

gs

Land

and

bui

ldin

gs a

re r

esta

ted

at c

urre

nt c

ost

usin

g pr

ofes

sion

al v

alua

tions

at

five-

year

ly in

terv

als

in a

ccor

danc

e w

ith F

RS 1

5. B

etw

een

valu

atio

ns p

rice

indi

ces

appr

opria

te

to t

he c

ateg

ory

of a

sset

are

app

lied

to a

rriv

e at

the

cur

rent

va

lue.

The

bui

ldin

gs in

dexa

tion

is b

ased

on

the

All

in T

ende

r Pr

ice

Inde

x pu

blis

hed

by t

he B

uild

ing

Cos

t In

form

atio

n Se

rvic

e (B

CIS

). Th

e la

nd in

dex

is b

ased

on

the

resi

dent

ial

build

ing

and

land

val

ues

repo

rted

in t

he P

rope

rty

Mar

ket

Repo

rt p

ublis

hed

by t

he V

alua

tion

Offi

ce. P

rofe

ssio

nal

valu

atio

ns a

re c

arrie

d ou

t by

Val

uers

on

a fiv

e-ye

arly

bas

is.

The

prev

ious

val

uatio

n w

as c

arrie

d ou

t as

at

1 A

pril

2006

.

In v

iew

of

the

sign

ifica

nt f

alls

in t

he U

K p

rope

rty

mar

ket,

Ea

st a

nd N

orth

Her

tfor

dshi

re P

CT

inst

ruct

ed B

oshi

er a

nd

Com

pany

an

inde

pend

ent

firm

of

char

tere

d su

rvey

ors

(RIC

S),

to p

rovi

de a

dvic

e in

acc

orda

nce

with

FRS

11

in r

espe

ct

of v

ario

us f

reeh

old

prop

ertie

s fo

rmin

g pa

rt o

f th

e PC

T’s

esta

te a

s at

31

Mar

ch 2

009.

The

rev

alua

tion

resu

lted

in a

ne

t re

duct

ion

of £

10,9

95,0

00 o

n La

nd a

nd £

266,

000

on

Build

ings

tot

allin

g £1

1,26

1,00

0.

The

valu

atio

ns w

ere

carr

ied

out

in a

ccor

danc

e w

ith t

he

Roya

l Ins

titut

e of

Cha

rter

ed S

urve

yors

(RIC

S) A

ppra

isal

and

Va

luat

ion

Man

ual i

nsof

ar a

s th

ese

term

s ar

e co

nsis

tent

with

th

e ag

reed

req

uire

men

ts o

f th

e D

epar

tmen

t of

Hea

lth a

nd

Not

es t

o th

e ac

cou

nts


HM

Tre

asur

y. T

here

are

dep

artu

res

from

the

RIC

S A

ppra

isal

an

d Va

luat

ions

Sta

ndar

ds a

gree

d be

twee

n H

M T

reas

ury

and

the

NH

S Ex

ecut

ive

whi

ch a

re n

oted

in t

he v

alua

tion

repo

rt.

The

valu

atio

ns h

ave

been

car

ried

out

prim

arily

on

the

basi

s of

Dep

reci

ated

Rep

lace

men

t C

ost

for

spec

ialis

ed o

pera

tiona

l pr

oper

ty a

nd E

xist

ing

Use

Val

ue f

or n

on-s

peci

alis

ed

oper

atio

nal p

rope

rty.

In r

espe

ct o

f no

n-op

erat

iona

l pro

pert

ies,

incl

udin

g su

rplu

s la

nd, t

he v

alua

tions

hav

e be

en c

arrie

d ou

t at

Ope

n M

arke

t Va

lue.

The

val

ue o

f la

nd f

or e

xist

ing

use

purp

oses

is a

sses

sed

to E

xist

ing

Use

Val

ue.

Add

ition

al a

ltern

ativ

e O

pen

Mar

ket

Valu

e fig

ures

hav

e on

ly

been

sup

plie

d fo

r op

erat

iona

l ass

ets

sche

dule

d fo

r im

min

ent

clos

ure

and

subs

eque

nt d

ispo

sal.

Gai

ns m

ade

from

inde

xatio

n an

d re

valu

atio

ns a

re t

aken

to

the

rev

alua

tion

rese

rve.

Los

ses

aris

ing

from

rev

alua

tions

ar

e re

cogn

ised

as

impa

irmen

ts a

nd a

re c

harg

ed t

o th

e re

valu

atio

n re

serv

e to

the

ext

ent

that

a b

alan

ce e

xist

s in

re

latio

n to

the

rev

alue

d as

set.

Los

ses

in e

xces

s of

tha

t am

ount

are

cha

rged

to

the

curr

ent

year

’s O

pera

ting

Cos

t St

atem

ent

(OC

S), u

nles

s it

can

be d

emon

stra

ted

that

the

re

cove

rabl

e am

ount

is g

reat

er t

han

the

reva

lued

am

ount

in

whi

ch c

ase

the

impa

irmen

t is

tak

en t

o th

e re

valu

atio

n re

serv

e. Im

pairm

ents

res

ultin

g fr

om p

rice

chan

ges

are

char

ged

to t

he S

tate

men

t of

Rec

ogni

sed

Gai

ns a

nd L

osse

s.

As

a re

sult

of t

his

reva

luat

ion,

a t

otal

of

£33,

000

was

ch

arge

d to

the

OC

S in

200

8/9

finan

cial

yea

r. Fa

lls in

val

ue

whe

n ne

wly

con

stru

cted

ass

ets

are

brou

ght

into

use

are

ch

arge

d in

ful

l to

the

OC

S. T

hese

fal

ls in

val

ue r

esul

t fr

om

the

adop

tion

of id

eal c

ondi

tions

as

the

basi

s fo

r de

prec

iate

d re

plac

emen

t co

st v

alua

tions

.

Land

and

bui

ldin

gs h

eld

unde

r fin

ance

leas

es a

re c

apita

lised

at

ince

ptio

n at

the

fai

r va

lue

of t

he a

sset

but

may

be

subs

eque

ntly

rev

alue

d by

the

Dis

tric

t Va

luer

. The

val

uatio

ns

do n

ot in

clud

e no

tiona

l dire

ctly

att

ribut

able

acq

uisi

tion

cost

s no

r ha

ve s

ellin

g co

sts

been

ded

ucte

d, s

ince

the

y ar

e re

gard

ed a

s no

t m

ater

ial.

Fixe

d a

sset

inve

stm

ents

On

1st

July

200

8 Ea

st a

nd N

orth

Her

tfor

dshi

re P

CT

acqu

ired

both

loan

not

es a

nd 4

00 s

hare

s to

the

val

ue o

f £2

7,57

0 an

d £4

00 r

espe

ctiv

ely

in “

Ass

embl

e C

omm

unity

Par

tner

ship

” th

e na

me

of t

he n

ewly

for

med

par

tner

ship

com

pany

. Thi

s 25

ye

ar p

artn

erin

g ag

reem

ent

arra

ngem

ent

is w

ith B

edfo

rdsh

ire

PCT,

Milt

on K

eyne

s PC

T, G

uild

hous

e (a

priv

ate

deve

lopm

ent

com

pany

) and

loca

l pub

lic s

ecto

r au

thor

ities

cov

ered

by

the

thre

e pa

rtic

ipan

t PC

T ar

eas.

This

typ

e of

arr

ange

men

t is

for

mal

ly k

now

as

LIFT

(Loc

al

Impr

ovem

ent

Fina

nce

Trus

t) a

nd t

he v

alue

is s

how

n at

the

hi

stor

ical

cos

t to

acq

uire

the

loan

not

es a

nd s

hare

s as

at

1st

July

200

8. F

ixed

ass

et in

vest

men

ts a

re r

ecor

ded

at M

arke

t Va

lue

and

will

be

valu

ed a

nnua

lly. A

ny in

crea

se in

val

ue is

ta

ken

in f

ull t

o th

e re

valu

atio

n re

serv

e. A

ny im

pairm

ent

in

valu

e is

cha

rged

to

oper

atin

g ex

pend

iture

.

Equ

ipm

ent

Ope

ratio

nal e

quip

men

t is

car

ried

at c

urre

nt v

alue

. Whe

re

asse

ts a

re a

t lo

w v

alue

, and

/or

have

sho

rt u

sefu

l eco

nom

ic

lives

, the

se a

re c

arrie

d at

dep

reci

ated

his

toric

cos

t as

a p

roxy

fo

r cu

rren

t va

lue.

Equ

ipm

ent

surp

lus

to r

equi

rem

ents

is

valu

ed a

t ne

t re

cove

rabl

e am

ount

and

ass

ets

held

und

er

finan

ce le

ases

are

cap

italis

ed a

t th

e fa

ir va

lue

of t

he a

sset

s.

Ass

ets

in t

he

cou

rse

of

con

stru

ctio

nA

sset

s in

the

cou

rse

of c

onst

ruct

ion

are

valu

ed a

t cu

rren

t co

st u

sing

the

inde

x as

for

land

and

bui

ldin

gs (s

eeab

ove)

. The

se a

sset

s in

clud

e an

y ex

istin

g la

nd o

r bu

ildin

gs

unde

r th

e co

ntro

l of

a co

ntra

ctor

.

Res

idu

al in

tere

sts

in o

ff-b

alan

ce

shee

t Pr

ivat

e Fi

nan

ce In

itia

tive

pro

per

ties

Resi

dual

inte

rest

s in

off

-bal

ance

she

et P

rivat

e Fi

nanc

e In

itiat

ive

prop

ertie

s ar

e in

clud

ed in

tan

gibl

e fix

ed a

sset

s un

der

‘’ass

ets

unde

r co

nstr

uctio

n an

d pa

ymen

ts o

n ac

coun

t’ w

here

th

e PF

I con

trac

t sp

ecifi

es t

he a

mou

nt a

t w

hich

the

ass

ets

will

be

tran

sfer

red

to t

he P

CT

at t

he e

nd o

f th

e co

ntra

ct.

The

resi

dual

inte

rest

is b

uilt

up d

urin

g th

e lif

e of

the

con

trac

t by

cap

italis

ing

the

unita

ry c

harg

e so

tha

t at

the

end

of

the

cont

ract

the

bal

ance

she

et v

alue

of

the

resi

dual

val

ue p

lus

the

spec

ified

am

ount

equ

al t

he e

xpec

ted

valu

e of

the

resi

dual

as

set

at t

he e

nd o

f th

e co

ntra

ct. T

he e

stim

ated

fai

r va

lue

of

the

asse

t on

reve

rsio

n is

det

erm

ined

by

the

Dis

tric

t Va

luer

ba

sed

on D

epar

tmen

t of

Hea

lth g

uida

nce.

iii

. Dep

reci

atio

n, a

mo

rtis

atio

n a

nd

imp

airm

ents

Ta

ngib

le fi

xed

asse

ts a

re d

epre

ciat

ed a

t ra

tes

calc

ulat

ed

to w

rite

them

dow

n to

est

imat

ed r

esid

ual v

alue

on

a st

raig

ht li

ne b

asis

ove

r th

eir

estim

ated

use

ful l

ives

. Fr

eeho

ld la

nd a

nd la

nd a

nd b

uild

ings

sur

plus

to

requ

irem

ents

are

not

dep

reci

ated

. Ass

ets

in t

he c

ours

e of

con

stru

ctio

n an

d re

sidu

al in

tere

sts

in o

ff-b

alan

ce

shee

t Pr

ivat

e Fi

nanc

e In

itiat

ive

cont

ract

ass

ets

are

not

depr

ecia

ted

until

the

ass

et is

bro

ught

into

use

or

reve

rts

to t

he P

CT,

res

pect

ivel

y.

Build

ings

, ins

talla

tions

and

fitt

ings

are

dep

reci

ated

on

thei

r cu

rren

t va

lue

over

the

est

imat

ed r

emai

ning

life

of

the

asse

t as

adv

ised

by

the

Dis

tric

t Va

luer

. Le

aseh

olds

are

dep

reci

ated

ove

r the

prim

ary

leas

e te

rm.

Equi

pmen

t is

dep

reci

ated

on

curr

ent

cost

eve

nly

over

th

e es

timat

ed li

fe o

f th

e as

set.

In

tang

ible

ass

ets

are

amor

tised

ove

r th

e es

timat

ed li

ves

of t

he a

sset

s.

Whe

re t

he u

sefu

l eco

nom

ic li

fe o

f an

ass

et is

red

uced

fr

om t

hat

initi

ally

est

imat

ed d

ue t

o th

e re

valu

atio

n of

an

ass

et f

or s

ale,

dep

reci

atio

n is

cha

rged

to

brin

g th

e va

lue

of t

he a

sset

to

its v

alue

at

the

poin

t of

sal

e.

Purc

hase

d co

mpu

ter s

oftw

are

licen

ces

are

amor

tised

ove

r th

e sh

orte

r of t

he te

rm o

f the

lice

nse

and

thei

r use

ful

econ

omic

live

s. T

hey

are

amor

tised

ove

r the

sho

rter

of

the

term

of t

he li

cenc

e an

d th

eir u

sefu

l eco

nom

ic li

ves.

In

form

atio

n Te

chno

logy

equ

ipm

ent i

s de

prec

iate

d ov

er 4

ye

ars

in li

ne w

ith it

s re

plac

emen

t pol

icy.

iv

. Do

nat

ed A

sset

s D

onat

ed t

angi

ble

fixed

ass

ets

are

capi

talis

ed a

t th

eir

valu

atio

n on

rec

eipt

and

thi

s va

lue

is c

redi

ted

to t

he

dona

ted

asse

t re

serv

e. D

onat

ed a

sset

s ar

e re

valu

ed

and

depr

ecia

ted

as d

escr

ibed

abo

ve f

or p

urch

ased

as

sets

. Gai

ns a

nd lo

sses

on

reva

luat

ions

are

tak

en


Not

es t

o th

e ac

cou

nts

to t

he D

onat

ed A

sset

Res

erve

and

, eac

h ye

ar, a

n am

ount

equ

al t

o th

e de

prec

iatio

n ch

arge

on

the

asse

t is

rel

ease

d fr

om t

he D

onat

ed A

sset

Res

erve

to

the

Ope

ratin

g C

ost

Stat

emen

t. S

imila

rly, a

ny im

pairm

ent

on d

onat

ed a

sset

s ch

arge

d to

the

Ope

ratin

g C

ost

Stat

emen

t is

mat

ched

by

a tr

ansf

er f

rom

the

don

ated

as

set

rese

rve.

On

sale

of

dona

ted

asse

ts, t

he v

alue

of

the

sale

pro

ceed

s is

tra

nsfe

rred

fro

m t

he d

onat

ed

asse

t re

serv

e to

the

gen

eral

fun

d.

Go

vern

men

t G

ran

tsv.

Gov

ernm

ent

gran

ts a

re g

rant

s fr

om G

over

nmen

t bo

dies

oth

er t

han

fund

s fr

om N

HS

bodi

es o

r fu

nds

awar

ded

by P

arlia

men

tary

Vot

e. G

over

nmen

t gr

ants

in

res

pect

of

capi

tal e

xpen

ditu

re a

re c

redi

ted

to a

go

vern

men

t gr

ant

rese

rve

and

are

rele

ased

to

the

OC

S ov

er t

he e

xpec

ted

usef

ul li

ves

of t

he r

elev

ant

asse

ts

by e

qual

ann

ual i

nsta

lmen

ts. G

rant

s of

a r

even

ue

natu

re a

re c

redi

ted

to m

isce

llane

ous

inco

me

in t

he

Ope

ratin

g C

ost

Stat

emen

t so

as

to m

atch

the

m w

ith

the

expe

nditu

re t

o w

hich

the

y re

late

.

d)

Cas

h, B

ank

and

Ove

rdra

ft:

Cas

h, b

ank

and

over

draf

t ba

lanc

es a

re r

ecor

ded

at c

urre

nt

valu

es. I

nter

est

earn

ed o

n ba

nk a

ccou

nts

and

inte

rest

ch

arge

d on

ove

rdra

fts

are

reco

rded

as,

res

pect

ivel

y, ‘I

nter

est

rece

ivab

le’ a

nd ‘

Inte

rest

pay

able

’ in

the

perio

ds t

o w

hich

th

ey r

elat

e. B

ank

char

ges

are

reco

rded

as

oper

atin

g ex

pend

iture

in t

he p

erio

ds t

o w

hich

the

y re

late

.

e) P

oo

led

bu

dg

ets

The

PCT

has

ente

red

into

a p

oole

d bu

dget

with

Her

tfor

dshi

re

Cou

nty

Cou

ncil.

Und

er t

he a

rran

gem

ent

fund

s ar

e po

oled

un

der

S75

of t

he N

HS

Act

200

6 fo

r M

enta

l Hea

lth, L

earn

ing

Dis

abili

ties

and

cert

ain

othe

r se

rvic

es.

The

pool

is h

oste

d by

Her

tfor

dshi

re C

ount

y C

ounc

il. T

he P

CT

mak

es c

ontr

ibut

ions

to

the

pool

for

ser

vice

s to

be

prov

ided

as

par

t of

its

com

mis

sion

ing

role

.

In a

ccor

danc

e w

ith F

RS9,

the

PC

T’s

shar

e of

the

ass

ets

and

liabi

litie

s of

the

poo

l will

be

acco

unte

d fo

r in

the

boo

ks o

f ac

coun

ts a

s de

term

ined

in t

he p

oole

d bu

dget

agr

eem

ent.

f) L

ease

sW

here

sub

stan

tially

all

risks

and

rew

ards

of

owne

rshi

p of

a

leas

ed a

sset

are

bor

ne b

y th

e PC

T, t

he a

sset

is r

ecor

ded

as a

ta

ngib

le fi

xed

asse

t an

d a

debt

is r

ecor

ded

to t

he le

ssor

of

the

min

imum

leas

e pa

ymen

t di

scou

nted

by

the

inte

rest

rat

e im

plic

it in

the

leas

e. T

he in

tere

st e

lem

ent

of fi

nanc

e le

ase

paym

ents

is c

harg

ed t

o th

e O

pera

ting

Cos

t St

atem

ent

over

th

e pe

riod

of t

he le

ase

at a

con

stan

t ra

te in

rel

atio

n to

the

ba

lanc

e ou

tsta

ndin

g.

Oth

er le

ases

are

reg

arde

d as

ope

ratin

g le

ases

and

the

ren

tals

ar

e ch

arge

d to

the

Ope

ratin

g C

ost

Stat

emen

t on

a s

trai

ght

line

basi

s ov

er t

he t

erm

of

the

leas

e.

g)

Priv

ate

Fin

ance

Init

iati

veTh

e N

HS

follo

ws

HM

Tre

asur

y’s

‘Tec

hnic

al N

ote

1 (r

evis

ed)

How

to

Acc

ount

for

PFI

tra

nsac

tions

‘ w

hich

pro

vide

s pr

actic

al g

uida

nce

for

the

appl

icat

ion

of t

he A

pplic

atio

n

Not

e F

FRS5

am

endm

ent

and

the

guid

ance

‘Lan

d an

d Bu

ildin

gs in

PFI

sch

emes

Ver

sion

2’.

Whe

re t

he b

alan

ce o

f th

e ris

ks a

nd re

war

ds o

f ow

ners

hip

of t

he P

FI p

rope

rty

are

born

e by

the

PFI

ope

rato

r, th

e PF

I pa

ymen

ts a

re re

cord

ed a

s an

ope

ratin

g ex

pens

e. W

here

the

PC

T ha

s co

ntrib

uted

ass

ets,

a p

repa

ymen

t fo

r th

eir

fair

valu

e is

reco

gnis

ed a

nd a

mor

tised

ove

r th

e lif

e of

the

PFI

con

trac

t by

a c

harg

e to

the

OC

S. W

here

, at

the

end

of a

PFI

con

trac

t,

a pr

oper

ty re

vert

s to

the

PC

T, t

he d

iffer

ence

bet

wee

n th

e ex

pect

ed f

air

valu

e of

the

resi

dual

ass

et o

n re

vers

ion

and

any

agre

ed p

aym

ent

on re

vers

ion

is b

uilt

up o

ver

the

life

of t

he

cont

ract

by

capi

talis

ing

part

of

the

unita

ry c

harg

e ea

ch y

ear,

as a

tan

gibl

e fix

ed a

sset

.Und

er U

K G

AA

P, t

he c

urre

nt H

erts

an

d Es

sex

hosp

ital i

s an

off

bal

ance

she

et s

chem

e. T

he P

CT

is

capi

talis

ing

part

of

the

annu

al u

nita

ry p

aym

ent

to re

ach

the

resi

dual

inte

rest

of

appr

ox £

7m in

the

yea

r 20

33. T

his

resi

dual

in

tere

st is

sho

wn

as a

n as

set

unde

r co

nstr

uctio

n w

ithin

fixe

d as

sets

and

the

val

ue a

s at

31s

t M

arch

200

9 is

£95

6,00

0.

h)

Sto

cks

and

wo

rk-i

n-p

rog

ress

Stoc

ks c

ompr

ise

raw

mat

eria

ls a

nd c

onsu

mab

les

and

are

valu

ed a

t th

e lo

wer

of

cost

and

net

rea

lisab

le v

alue

.

i) R

esea

rch

an

d d

evel

op

men

tEx

pend

iture

on

rese

arch

is n

ot c

apita

lised

. Exp

endi

ture

on

deve

lopm

ent

is c

apita

lised

if it

mee

ts t

he f

ollo

win

g cr

iteria

;-

ther

e is

a c

lear

ly d

efine

d pr

ojec

t-

the

rela

ted

expe

nditu

re is

sep

arat

ely

iden

tifiab

le-

the

outc

ome

of t

he p

roje

ct h

as b

een

asse

ssed

with

re

ason

able

cer

tain

ty a

s to

;-

its t

echn

ical

fea

sibi

lity

- its

res

ultin

g in

a p

rodu

ct o

r se

rvic

e w

hich

will

ev

entu

ally

be

brou

ght

into

use

- ad

equa

te r

esou

rces

exi

st, o

r ar

e re

ason

ably

exp

ecte

d to

be

ava

ilabl

e, t

o en

able

the

pro

ject

to

be c

ompl

eted

and

to

prov

ide

any

cons

eque

ntia

l inc

reas

e in

wor

king

cap

ital.

Expe

nditu

re s

o de

ferr

ed is

lim

ited

to t

he v

alue

of

futu

re

bene

fits

expe

cted

and

is a

mor

tised

thr

ough

the

Ope

ratin

g C

ost

Stat

emen

t on

a s

yste

mat

ic b

asis

ove

r th

e pe

riod

expe

cted

to

bene

fit f

rom

the

pro

ject

. It

is r

eval

ued

on t

he

basi

s of

cur

rent

cos

t. T

he a

mor

tisat

ion

char

ge is

cal

cula

ted

on t

he s

ame

basi

s as

for

dep

reci

atio

n i.e

. on

a qu

arte

rly

basi

s. E

xpen

ditu

re w

hich

doe

s no

t m

eet

the

crite

ria f

or

capi

talis

atio

n is

tre

ated

as

an o

pera

ting

cost

in t

he y

ear

in

whi

ch it

is in

curr

ed.

PCTs

are

una

ble

to d

iscl

ose

the

tota

l am

ount

of

rese

arch

and

de

velo

pmen

t ex

pend

iture

cha

rged

to

the

Ope

ratin

g C

ost

Stat

emen

t be

caus

e so

me

rese

arch

and

dev

elop

men

t ac

tivity

ca

nnot

be

sepa

rate

d fr

om p

atie

nt c

are

activ

ity.

Fixe

d as

sets

acq

uire

d fo

r us

e in

res

earc

h an

d de

velo

pmen

t ar

e am

ortis

ed o

ver

the

life

of t

he a

ssoc

iate

d pr

ojec

t.

j) P

rovi

sio

ns

The

PCT

prov

ides

for

lega

l or

cons

truc

tive

oblig

atio

ns t

hat

are

of u

ncer

tain

tim

ing

or a

mou

nt a

t th

e ba

lanc

e sh

eet

date

on

the

bas

is o

f th

e be

st e

stim

ate

of t

he e

xpen

ditu

re r

equi

red

to s

ettle

the

obl

igat

ion.

Whe

re t

he e

ffec

t of

the

tim

e va

lue

of m

oney

is s

igni

fican

t, t

he e

stim

ated

ris

k-ad

just

ed c

ash


Not

es t

o th

e ac

cou

nts

flow

s ar

e di

scou

nted

usi

ng t

he T

reas

ury’

s di

scou

nt r

ate

of

2.2%

in r

eal t

erm

s.

k) C

linic

al N

eglig

ence

Co

sts

The

NH

S Li

tigat

ion

Aut

horit

y (N

HSL

A) o

pera

tes

a ris

k po

olin

g sc

hem

e un

der

whi

ch t

he P

CT

pays

an

annu

al c

ontr

ibut

ion

to t

he N

HSL

A w

hich

in re

turn

set

tles

all c

linic

al n

eglig

ence

cl

aim

s. A

lthou

gh t

he N

HSL

A is

adm

inis

trat

ivel

y re

spon

sibl

e fo

r al

l clin

ical

neg

ligen

ce c

ases

the

lega

l lia

bilit

y re

mai

ns w

ith t

he

PCT.

The

tot

al v

alue

of

clin

ical

neg

ligen

ce p

rovi

sion

s ca

rrie

d by

th

e N

HSL

A o

n be

half

of t

he P

CT

is d

iscl

osed

at

Not

e 14

.

l) N

on

-clin

ical

ris

k p

oo

ling

The

PCT

part

icip

ates

in t

he P

rope

rty

Expe

nses

Sch

eme

and

the

Liab

ilitie

s to

Thi

rd P

artie

s Sc

hem

e. B

oth

are

risk

pool

ing

sche

mes

und

er w

hich

the

PC

T pa

ys a

n an

nual

con

trib

utio

n to

the

NH

S Li

tigat

ion

Aut

horit

y an

d, in

ret

urn,

rec

eive

s as

sist

ance

with

the

cos

ts o

f cl

aim

s ar

isin

g. T

he a

nnua

l m

embe

rshi

p co

ntrib

utio

ns, a

nd a

ny ‘e

xces

ses’

pay

able

in

res

pect

of

part

icul

ar c

laim

s ar

e ch

arge

d to

ope

ratin

g ex

pens

es a

s an

d w

hen

they

bec

ome

due.

m)

Loss

es a

nd

Sp

ecia

l Pay

men

tsLo

sses

and

spe

cial

pay

men

ts a

re it

ems

that

Par

liam

ent

wou

ld

not

have

con

tem

plat

ed w

hen

it ag

reed

fun

ds f

or t

he h

ealth

se

rvic

e or

pas

sed

legi

slat

ion.

By

thei

r na

ture

the

y ar

e ite

ms

that

idea

lly s

houl

d no

t ar

ise.

The

y ar

e th

eref

ore

subj

ect

to

spec

ial c

ontr

ol p

roce

dure

s co

mpa

red

with

the

gen

eral

ity o

f pa

ymen

ts. T

hey

are

divi

ded

into

diff

eren

t ca

tego

ries,

whi

ch

gove

rn t

he w

ay e

ach

indi

vidu

al c

ase

is h

andl

ed.

Loss

es a

nd s

peci

al p

aym

ents

are

cha

rged

to

the

rele

vant

fu

nctio

nal h

eadi

ngs,

incl

udin

g lo

sses

whi

ch w

ould

hav

e be

en m

ade

good

thr

ough

insu

ranc

e co

ver

had

PCTs

not

be

en b

earin

g th

eir

own

risks

(with

insu

ranc

e pr

emiu

ms

then

be

ing

incl

uded

as

norm

al r

even

ue e

xpen

ditu

re).

How

ever

, th

e lo

sses

not

e is

com

pile

d di

rect

ly f

rom

the

loss

es a

nd

com

pens

atio

ns r

egis

ter

whi

ch is

pre

pare

d on

a c

ash

basi

s.

n)

Pen

sio

n C

ost

sPa

st a

nd p

rese

nt e

mpl

oyee

s ar

e co

vere

d by

the

pro

visi

ons

of

the

NH

S Pe

nsio

ns S

chem

e. D

etai

ls o

f th

e be

nefit

s pa

yabl

e un

der

thes

e pr

ovis

ions

can

be

foun

d on

the

NH

S Pe

nsio

ns

web

site

at

ww

w.n

hspa

.nhs

.uk/

pens

ions

. The

Sch

eme

is

an u

nfun

ded,

defi

ned

bene

fit s

chem

e th

at c

over

s N

HS

empl

oyer

s, G

ener

al P

ract

ices

and

oth

er b

odie

s, a

llow

ed

unde

r th

e di

rect

ion

of t

he S

ecre

tary

of

Stat

e, in

Eng

land

an

d W

ales

. The

sch

eme

is n

ot d

esig

ned

to b

e ru

n in

a w

ay

that

wou

ld e

nabl

e N

HS

bodi

es t

o id

entif

y th

eir

shar

e of

th

e un

derly

ing

Sche

me

asse

ts a

nd li

abili

ties.

The

refo

re, t

he

Sche

me

is a

ccou

nted

for

as

if it

wer

e a

defin

ed c

ontr

ibut

ion

sche

me:

the

cos

t to

the

NH

S bo

dy o

f pa

rtic

ipat

ing

in t

he

Sche

me

is t

aken

as

equa

l to

the

cont

ribut

ions

pay

able

to

the

Sche

me

for

the

acco

untin

g pe

riod.

The

sche

me

is s

ubje

ct t

o a

full

actu

aria

l val

uatio

n ev

ery

four

ye

ars

(unt

il 20

04, b

ased

on

a fiv

e ye

ar v

alua

tion

cycl

e), a

nd

a FR

S17

acco

untin

g va

luat

ion

ever

y ye

ar. A

n ou

tline

of

thes

e fo

llow

: a.

Fu

ll ac

tuar

ial (

fun

din

g)

valu

atio

n

The

purp

ose

of t

his

valu

atio

n is

to

asse

ss t

he le

vel

of li

abili

ty in

res

pect

of

the

bene

fits

due

unde

r th

e

sche

me

(tak

ing

into

acc

ount

its

rece

nt d

emog

raph

ic

expe

rienc

e), a

nd t

o re

com

men

d th

e co

ntrib

utio

n ra

tes

to b

e pa

id b

y em

ploy

ers

and

sche

me

mem

bers

. The

last

su

ch v

alua

tion,

whi

ch d

eter

min

ed c

urre

nt c

ontr

ibut

ion

rate

s w

as u

nder

take

n as

at

31 M

arch

200

4 an

d co

vere

d th

e pe

riod

from

1 A

pril

1999

to

that

dat

e.

The

conc

lusi

on f

rom

the

200

4 va

luat

ion

was

tha

t th

e Sc

hem

e ha

d ac

cum

ulat

ed a

not

iona

l defi

cit

of £

3.3

billi

on a

gain

st t

he n

otio

nal a

sset

s as

at

31 M

arch

200

4.

How

ever

, aft

er t

akin

g in

to a

ccou

nt t

he c

hang

es in

the

be

nefit

and

con

trib

utio

n st

ruct

ure

effe

ctiv

e fr

om 1

A

pril

2008

, the

Sch

eme

actu

ary

repo

rted

tha

t em

ploy

er

cont

ribut

ions

cou

ld c

ontin

ue a

t th

e ex

istin

g ra

te o

f 14

% o

f pe

nsio

nabl

e pa

y. O

n ad

vice

fro

m t

he S

chem

e ac

tuar

y, s

chem

e co

ntrib

utio

ns m

ay b

e va

ried

from

tim

e to

tim

e to

refl

ect

chan

ges

in t

he s

chem

e’s

liabi

litie

s. U

p to

31

Mar

ch 2

008,

the

vas

t m

ajor

ity o

f em

ploy

ees

paid

co

ntrib

utio

ns a

t th

e ra

te o

f 6%

of

pens

iona

ble

pay.

Fr

om 1

Apr

il 20

08, e

mpl

oyee

s co

ntrib

utio

ns a

re o

n a

tiere

d sc

ale

from

5%

up

to 8

.5%

of

thei

r pe

nsio

nabl

e pa

y de

pend

ing

on t

otal

ear

ning

s.

b

. FR

S17

Acc

ou

nti

ng

val

uat

ion

In

acc

orda

nce

with

FRS

17, a

val

uatio

n of

the

Sch

eme

liabi

lity

is c

arrie

d ou

t an

nual

ly b

y th

e Sc

hem

e A

ctua

ry

as a

t th

e ba

lanc

e sh

eet

date

by

upda

ting

the

resu

lts o

f th

e fu

ll ac

tuar

ial v

alua

tion.

Be

twee

n th

e fu

ll ac

tuar

ial v

alua

tions

at a

two-

year

m

idpo

int,

a fu

ll an

d de

taile

d m

embe

r dat

a-se

t is

prov

ided

to

the

Sche

me

Act

uary

. At t

his

poin

t the

ass

umpt

ions

re

gard

ing

the

com

posit

ion

of th

e Sc

hem

e m

embe

rshi

p ar

e up

date

d to

allo

w th

e Sc

hem

e lia

bilit

y to

be

valu

ed.

The

valu

atio

n of

the

Sch

eme

liabi

lity

as a

t 31

Mar

ch

2009

, is

base

d on

det

aile

d m

embe

rshi

p da

ta a

s at

31

Mar

ch 2

006

(the

late

st m

idpo

int)

upd

ated

to

31 M

arch

20

09 w

ith s

umm

ary

glob

al m

embe

r an

d ac

coun

ting

data

. The

late

st a

sses

smen

t of

the

liab

ilitie

s of

the

Sc

hem

e is

con

tain

ed in

the

Sch

eme

Act

uary

rep

ort,

w

hich

for

ms

part

of

the

annu

al N

HS

Pens

ion

Sche

me

(Eng

land

and

Wal

es) R

esou

rce

Acc

ount

, pub

lishe

d an

nual

ly. T

hese

acc

ount

s ca

n be

vie

wed

on

the

NH

S Pe

nsio

ns w

ebsi

te. C

opie

s ca

n al

so b

e ob

tain

ed f

rom

Th

e St

atio

nery

Offi

ce.

Sch

eme

Pro

visi

on

s as

at

31 M

arch

200

9.Th

e sc

hem

e is

a ‘fi

nal s

alar

y’ s

chem

e.

For e

arly

retir

emen

ts o

ther

than

thos

e du

e to

ill h

ealth

the

addi

tiona

l pen

sion

liabi

litie

s ar

e no

t fun

ded

by th

e sc

hem

e. T

he

full

amou

nt o

f the

liab

ility

for t

he a

dditi

onal

cos

ts is

cha

rged

to

the

Ope

ratin

g C

ost S

tate

men

t at t

he ti

me

the

PCT

com

mits

its

elf t

o th

e re

tirem

ent,

rega

rdle

ss o

f the

met

hod

of p

aym

ent.

The

Sche

me

prov

ides

the

opp

ortu

nity

to

mem

bers

to

incr

ease

the

ir be

nefit

s th

roug

h m

oney

pur

chas

e A

dditi

onal

Vo

lunt

ary

Con

trib

utio

ns (A

VC

s) p

rovi

ded

by a

n ap

prov

ed

pane

l of

life

com

pani

es. U

nder

the

arr

ange

men

t th

e em

ploy

ee/m

embe

r ca

n m

ake

cont

ribut

ions

to

enha

nce

an

empl

oyee

’s pe

nsio

n be

nefit

s. T

he b

enefi

ts p

ayab

le r

elat

e di

rect

ly t

o th

e va

lue

of t

he in

vest

men

ts m

ade.

Fro

m 1


Not

es t

o th

e ac

cou

nts

Apr

il 20

08 a

vol

unta

ry a

dditi

onal

pen

sion

fac

ility

bec

omes

av

aila

ble,

und

er w

hich

mem

bers

may

pur

chas

e up

to

£5,0

00

per

annu

m o

f ad

ditio

nal p

ensi

on a

t a

cost

det

erm

ined

by

the

actu

ary

from

tim

e-to

-tim

e.

Early

pay

men

t of

a p

ensi

on is

ava

ilabl

e to

mem

bers

of

the

Sche

me

who

are

per

man

ently

inca

pabl

e of

ful

fillin

gth

eir

dutie

s ef

fect

ivel

y th

roug

h ill

ness

or

infir

mity

. A d

eath

gr

atui

ty o

f tw

ice

final

yea

r’s p

ensi

onab

le p

ay f

or d

eath

in s

ervi

ce, a

nd fi

ve t

imes

the

ir an

nual

pen

sion

for

dea

th a

fter

re

tirem

ent,

less

pen

sion

alre

ady

paid

, sub

ject

to

am

axim

um a

mou

nt e

qual

to

twic

e th

e m

embe

r’s fi

nal y

ear’s

pe

nsio

nabl

e pa

y le

ss t

heir

retir

emen

t lu

mp

sum

for

thos

e w

ho d

ie a

fter

ret

irem

ent,

is p

ayab

le.

Exis

tin

g m

emb

ers

at 1

Ap

ril 2

008

Ann

ual p

ensi

ons

are

norm

ally

bas

ed o

n 1/

80th

of

the

best

of

the

last

3 y

ears

pen

sion

able

pay

for

eac

h ye

ar o

f se

rvic

e. A

lu

mp

sum

nor

mal

ly e

quiv

alen

t to

3 y

ears

pen

sion

is p

ayab

le

on r

etire

men

t. F

rom

1 A

pril

2008

the

re is

the

opp

ortu

nity

of

giv

ing

up s

ome

of t

he p

ensi

on t

o in

crea

se t

he r

etire

men

t lu

mp

sum

. Ann

ual i

ncre

ases

are

app

lied

to p

ensi

on

paym

ents

at

rate

s de

fined

by

the

Pens

ions

(Inc

reas

e) A

ct

1971

, and

are

bas

ed o

n ch

ange

s in

ret

ail p

rices

in t

he t

wel

ve

mon

ths

endi

ng 3

0 Se

ptem

ber

in t

he p

revi

ous

cale

ndar

ye

ar. O

n de

ath,

a p

ensi

on o

f 50

% o

f th

e m

embe

r’s p

ensi

on

is n

orm

ally

pay

able

to

the

surv

ivin

g sp

ouse

or

elig

ible

un

mar

ried

part

ner.

New

en

tran

ts f

rom

1 A

pri

l 200

8A

nnua

l pen

sion

s fo

r ne

w e

ntra

nts

from

1 A

pril

2008

w

ere

base

d on

1/6

0th

of t

he b

est

thre

e-ye

ar a

vera

ge o

f pe

nsio

nabl

e ea

rnin

gs in

the

ten

yea

rs b

efor

e re

tirem

ent.

M

embe

rs w

ishi

ng t

o ob

tain

a re

tirem

ent

lu p

sum

may

giv

e up

som

e of

thi

s pe

nsio

n to

obt

ain

a re

tirem

ent

lum

p of

up

to

25%

of

the

tota

l val

ue o

f th

eir

retir

emen

t be

nefit

s. S

urvi

vor

pens

ions

will

be

avai

labl

e to

mar

ried

and

unm

arrie

d pa

rtne

rs

and

will

be

equa

l to

37.5

% o

f th

e m

embe

r’s p

ensi

on.

o)

Fore

ign

Cu

rren

cyTr

ansa

ctio

ns in

for

eign

cur

renc

ies

are

tran

slat

ed in

to

ster

ling

at t

he r

ates

of

exch

ange

cur

rent

at

the

date

s of

the

tr

ansa

ctio

ns.R

esul

ting

exch

ange

gai

ns a

nd lo

sses

are

tak

en

into

the

Ope

ratin

g C

ost

Stat

emen

t.

p)

Thir

d P

arty

Ass

ets

Ass

ets

belo

ngin

g to

thi

rd p

artie

s (s

uch

as m

oney

hel

d on

be

half

of P

atie

nts)

are

not

rec

ogni

sed

in t

he a

ccou

nts

sinc

e th

e Pr

imar

y C

are

Trus

t ha

s no

ben

efici

al in

tere

st in

the

m.

Det

ails

of

third

par

ty a

sset

s ar

e gi

ven

in N

ote

23 t

o th

e ac

coun

ts a

nd N

ote

16.3

for

Pat

ient

s m

onie

s.

q)

Co

st o

f C

apit

al C

har

ge

The

trea

tmen

t of

fixe

d as

sets

in t

he a

ccou

nts

is in

ac

cord

ance

with

the

prin

cipa

l cap

ital c

harg

es o

bjec

tive

to

ensu

re t

hat

such

cha

rges

are

ful

ly r

eflec

ted

in t

he c

ost

of

capi

tal.

The

inte

rest

rat

e ap

plie

d to

the

cos

t of

cap

ital c

harg

e in

the

fina

ncia

l yea

r 20

08/2

009

was

3.5

% (2

007/

2008

: 3.

5%) o

n al

l ass

ets

less

liab

ilitie

s, e

xcep

t fo

r ca

shba

lanc

es

with

the

Offi

ce o

f th

e Pa

ymas

ter

Gen

eral

(OPG

) and

for

D

onat

ed a

sset

s w

here

the

cha

rge

is n

il.

r) F

inan

cial

Inst

rum

ents

Fin

anci

al a

sset

sFi

nanc

ial a

sset

s ar

e re

cogn

ised

on th

e ba

lanc

e sh

eet w

hen

the

PCT

beco

mes

par

ty to

the

finan

cial

inst

rum

ent c

ontr

act o

r, in

th

e ca

se o

f tra

de d

ebto

rs, w

hen

the

good

s or

ser

vice

s ha

ve b

een

deliv

ered

. Fin

anci

al a

sset

s ar

e de

reco

gnise

d w

hen

the

cont

ract

ual

right

s ha

ve e

xpire

d or

the

asse

t has

bee

n tr

ansf

erre

d.

Fina

ncia

l ass

ets

are

initi

ally

rec

ogni

sed

at f

air

valu

e.

Fina

ncia

l ass

ets

are

clas

sifie

d in

to t

he f

ollo

win

g ca

tego

ries:

fin

anci

al a

sset

s ‘a

t fa

ir va

lue

thro

ugh

profi

t an

d lo

ss’;

‘hel

d to

mat

urity

inve

stm

ents

’; ‘a

vaila

ble

for

sale

’ fina

ncia

l ass

ets,

an

d ‘lo

ans

and

rece

ivab

les’

. The

cla

ssifi

catio

n de

pend

s on

the

nat

ure

and

purp

ose

of t

he fi

nanc

ial a

sset

s an

d is

de

term

ined

at

the

time

of in

itial

rec

ogni

tion.

Fin

anci

al a

sset

s at

fai

r va

lue

thro

ug

h p

rofi

t an

d lo

ss

Embe

dded

der

ivat

ives

tha

t ha

ve d

iffer

ent

risks

and

ch

arac

teris

tics

to t

heir

host

con

trac

ts, a

nd c

ontr

acts

with

em

bedd

ed d

eriv

ativ

es w

hose

sep

arat

e va

lue

cann

ot b

e as

cert

aine

d, a

re t

reat

ed a

s fin

anci

al a

sset

s at

fai

r va

lue

thro

ugh

profi

t an

d lo

ss. T

hey

are

held

at

fair

valu

e, w

ith a

ny

resu

ltant

gai

n or

loss

rec

ogni

sed

in t

he O

CS.

The

net

gai

n or

lo

ss in

corp

orat

es a

ny in

tere

st e

arne

d on

the

fina

ncia

l ass

et.

Hel

d t

o m

atu

rity

inve

stm

ents

H

eld

to m

atur

ity in

vest

men

ts a

re n

on-d

eriv

ativ

e fin

anci

al

asse

ts w

ith fi

xed

or d

eter

min

able

pay

men

ts a

nd fi

xed

mat

urity

, and

the

re is

a p

ositi

ve in

tent

ion

and

abili

ty t

o ho

ld t

o m

atur

ity. A

fter

initi

al re

cogn

ition

, the

y ar

e he

ld a

t am

ortis

ed

cost

usi

ng t

he e

ffec

tive

inte

rest

met

hod,

less

any

impa

irmen

t.

Inte

rest

is re

cogn

ised

usi

ng t

he e

ffec

tive

inte

rest

met

hod.

Ava

ilab

le f

or

sale

fin

anci

al a

sset

sA

vaila

ble

for

sale

fina

ncia

l ass

ets

are

non-

deriv

ativ

e fin

anci

al

asse

ts t

hat

are

desi

gnat

ed a

s av

aila

ble

for

sale

or

that

do

not

fal

l with

in a

ny o

f th

e ot

her

thre

e fin

anci

al a

sset

cl

assi

ficat

ions

. The

y ar

e m

easu

red

at f

air

valu

e w

ith c

hang

es

in v

alue

tak

en t

o th

e re

valu

atio

n re

serv

e, w

ith t

he e

xcep

tion

of im

pairm

ent

loss

es. A

ccum

ulat

ed g

ains

or

loss

es a

re

recy

cled

to

the

inco

me

stat

emen

t on

de-

reco

gniti

on.

Loan

s an

d r

ecei

vab

les

Loan

s an

d re

ceiv

able

s ar

e no

n-de

rivat

ive

finan

cial

ass

ets

with

fix

ed o

r de

term

inab

le p

aym

ents

whi

ch a

re n

ot q

uote

d in

an

activ

e m

arke

t. A

fter

initi

al r

ecog

nitio

n, t

hey

are

mea

sure

d at

am

ortis

ed c

ost

usin

g th

e ef

fect

ive

inte

rest

met

hod,

less

any

im

pairm

ent.

Inte

rest

is r

ecog

nise

d us

ing

the

effe

ctiv

e in

tere

st

met

hod.

Fai

r va

lue

is d

eter

min

ed b

y re

fere

nce

to q

uote

d m

arke

t pr

ices

whe

re p

ossi

ble,

oth

erw

ise

by v

alua

tion

tech

niqu

es.

The

effe

ctiv

e in

tere

st r

ate

is t

he r

ate

that

exa

ctly

dis

coun

ts

estim

ated

fut

ure

cash

rec

eipt

s th

roug

h th

e ex

pect

ed li

fe

of t

he fi

nanc

ial a

sset

, to

the

net

carr

ying

am

ount

of

the

finan

cial

ass

et.

At

the

bala

nce

shee

t da

te, t

he P

CT

asse

sses

whe

ther

any

fin

anci

al a

sset

s, o

ther

tha

n th

ose

held

at

‘fai

r va

lue

thro

ugh

profi

t an

d lo

ss’ a

re im

paire

d. F

inan

cial

ass

ets

are

impa

ired

and

impa

irmen

t lo

sses

rec

ogni

sed

if th

ere

is o

bjec

tive

evid

ence

of

impa

irmen

t as

a r

esul

t of

one

or

mor

e ev

ents


Not

es t

o th

e ac

cou

nts

whi

ch o

ccur

red

afte

r th

e in

itial

rec

ogni

tion

of t

he a

sset

and

w

hich

has

an

impa

ct o

n th

e es

timat

ed f

utur

e ca

sh fl

ows

of

the

asse

t.

For

finan

cial

ass

ets

carr

ied

at a

mor

tised

cos

t, t

he a

mou

nt o

f th

e im

pairm

ent

loss

is m

easu

red

as t

he d

iffer

ence

bet

wee

n th

e as

set’s

car

ryin

g am

ount

and

the

pre

sent

val

ue o

f th

e re

vise

d fu

ture

cas

h flo

ws

disc

ount

ed a

t th

e as

set’s

orig

inal

ef

fect

ive

inte

rest

rat

e. T

he lo

ss is

rec

ogni

sed

in t

he in

com

e st

atem

ent

and

the

carr

ying

am

ount

of

the

asse

t is

red

uced

di

rect

ly, o

r th

roug

h a

prov

isio

n fo

r im

pairm

ent

of r

ecei

vabl

es.

If, in

a s

ubse

quen

t pe

riod,

the

am

ount

of

the

impa

irmen

t lo

ss d

ecre

ases

and

the

dec

reas

e ca

n be

rel

ated

obj

ectiv

ely

to

an e

vent

occ

urrin

g af

ter

the

impa

irmen

t w

as r

ecog

nise

d, t

he

prev

ious

ly r

ecog

nise

d im

pairm

ent

loss

is r

ever

sed

thro

ugh

the

inco

me

stat

emen

t to

the

ext

ent

that

the

car

ryin

g am

ount

of

the

rece

ivab

le a

t th

e da

te o

f th

e im

pairm

ent

is

reve

rsed

doe

s no

t ex

ceed

wha

t th

e am

ortis

ed c

ost

wou

ld

have

bee

n ha

d th

e im

pairm

ent

not

been

rec

ogni

sed.

Fin

anci

al li

abili

ties

Fina

ncia

l lia

bilit

ies

are

reco

gnis

ed o

n th

e ba

lanc

e sh

eet

whe

n th

e Tr

ust

beco

mes

par

ty t

o th

e co

ntra

ctua

l pro

visi

ons

of t

he

finan

cial

inst

rum

ent

or, i

n th

e ca

se o

f tr

ade

cred

itors

, whe

n th

e go

ods

or s

ervi

ces

have

bee

n re

ceiv

ed. F

inan

cial

liab

ilitie

s ar

e de

-rec

ogni

sed

whe

n th

e lia

bilit

y ha

s be

en d

isch

arge

d,

that

is, t

he li

abili

ty h

as b

een

paid

or

has

expi

red.

Fina

ncia

l lia

bilit

ies

are

initi

ally

rec

ogni

sed

at f

air

valu

e.Fi

nanc

ial l

iabi

litie

s ar

e cl

assifi

ed a

s ei

ther

fina

ncia

l lia

bilit

ies

‘at

fair

valu

e th

roug

h pr

ofit a

nd lo

ss’ o

r oth

er fi

nanc

ial l

iabi

litie

s.

Fin

anci

al li

abili

ties

at

fair

val

ue

thro

ug

h p

rofi

t an

d lo

ssEm

bedd

ed d

eriv

ativ

es t

hat

have

diff

eren

t ris

ks a

nd

char

acte

ristic

s to

the

ir ho

st c

ontr

acts

, and

con

trac

ts w

ith

embe

dded

der

ivat

ives

who

se s

epar

ate

valu

e ca

nnot

be

asce

rtai

ned,

are

tre

ated

as

finan

cial

liab

ilitie

s at

fai

r va

lue

thro

ugh

profi

t an

d lo

ss. T

hey

are

held

at

fair

valu

e, w

ith a

ny

resu

ltant

gai

n or

loss

rec

ogni

sed

in t

he in

com

e st

atem

ent.

Th

e ne

t ga

in o

r lo

ss in

corp

orat

es a

ny in

tere

st e

arne

d on

the

fin

anci

al a

sset

.

Oth

er fi

nan

cial

liab

iliti

esA

fter

initi

al re

cogn

ition

, all

othe

r fina

ncia

l lia

bilit

ies

are

mea

sure

d at

am

ortis

ed c

ost u

sing

the

effe

ctiv

e in

tere

st m

etho

d.

The

effe

ctiv

e in

tere

st ra

te is

the

rate

that

exa

ctly

disc

ount

s es

timat

ed fu

ture

cas

h pa

ymen

ts th

roug

h th

e lif

e of

the

asse

t,

to th

e ne

t car

ryin

g am

ount

of t

he fi

nanc

ial l

iabi

lity.

Inte

rest

is

reco

gnise

d us

ing

the

effe

ctiv

e in

tere

st m

etho

d.

s) G

oin

g c

on

cern

The

PCT

is f

unde

d by

the

Dep

artm

ent

of H

ealth

and

th

eref

ore

rem

ains

a g

oing

con

cern

.


Not

es t

o th

e ac

cou

nts

No

te 2

.2. C

apit

al R

esou

rce

Lim

itTh

e PC

T is

req

uire

d to

kee

p w

ithin

its

Cap

ital R

esou

rce

Lim

it

2008

/09

£000

2007

/08

£000

Gro

ss C

apita

l Exp

endi

ture

2,59

41,

751

Add

: Los

s in

res

pect

of

disp

osal

s of

don

ated

ass

ets

00

less

: Net

boo

k va

lue

of a

sset

s di

spos

ed o

f0

0

less

: Cap

ital g

rant

s0

0

less

: Don

atio

ns0

0

Char

ge A

gain

st t

he C

apit

al R

esou

rce

Lim

it2,

594

1,75

1

Capi

tal R

esou

rce

Lim

it2,

660

2,07

7

(Ove

r) /

Und

er s

pend

aga

inst

Cap

ital

Res

ourc

e Li

mit

6632

6

Not

e 2:

Fin

anci

al P

erfo

rman

ce T

arge

ts

No

te 2

.1 R

even

ue R

esou

rce

Lim

it20

08/0

9 £0

0020

07/0

8 £0

00

The

PCTs

’ per

form

ance

for

2008

/09

is a

s fo

llow

s:

Tota

l net

ope

ratin

g co

st f

or t

he fi

nanc

ial y

ear

695,

563

647,

045

Less

: Non

-dis

cret

iona

ry E

xpen

ditu

re4,

234

4,28

2

Ope

rati

ng C

osts

less

non

-dis

cret

iona

ry e

xpen

ditu

re69

1,32

964

2,76

3

Fina

l Rev

enue

Res

ourc

e Li

mit

for

year

693,

012

642,

763

Und

er/(o

ver)

spe

nd a

gain

st R

even

ue R

esou

rce

Lim

it1,

683

20

The

reve

nue

Reso

urce

Lim

it a

bove

has

bee

n ar

rive

d at

as

follo

ws:

Initi

al R

even

ue R

esou

rce

Lim

it70

4,19

967

1,06

5

(less

): Tr

ansf

ers

to t

he S

HA

Rev

enue

res

erve

(7,5

20)

0

Plus

: RRL

in-y

ear

incr

ease

s/(d

ecre

ases

)(3

,667

)(2

8,28

2)

Plus

: RRL

in-y

ear

incr

ease

s fu

nded

by

the

NH

S ba

nk0

0

Plus

: RRL

in-y

ear

incr

ease

s fu

nded

by

the

NH

S ba

nk (o

ther

)0

0

Fina

l Rev

enue

Res

ourc

e Li

mit

for

year

693,

012

642,

783

Cash

Man

agem

ent

Cas

h lim

it re

tain

ed c

entr

ally

in r

espe

ct o

f lo

cal r

eser

ve(7

,520

)0

Cas

h lim

it -

subs

eque

ntly

red

uced

in-y

ear

(17,

250)

(5,7

50)

Cas

h lim

it -

subs

eque

ntly

incr

ease

d in

-yea

r0

0

Net

cas

h m

anag

emen

t po

sitio

n fr

om p

rior

perio

ds17

,250

23,0

00

Net

cas

h m

anag

emen

t po

sitio

n at

31

Mar

ch 2

009

(7,5

20)

17,2

50


Not

es t

o th

e ac

cou

nts

No

te 2

.3. P

rovi

der

full

cost

rec

over

y du

tyTh

e PC

T is

req

uire

d to

rec

over

ful

l cos

ts in

rel

atio

n to

its

prov

ider

fun

ctio

ns. T

he p

erfo

rman

ce f

or 2

008/

09 is

as

follo

ws:

2008

/09

£000

2007

/08

£000

Prov

ider

gro

ss o

pera

ting

cost

56,3

8951

,102

less

: Mis

cella

neou

s in

com

e re

latin

g to

pro

vide

r fu

nctio

ns(8

,377

)(9

,141

)

Net

Ope

ratin

g C

ost

48,0

1241

,961

less

: Cos

ts m

et f

rom

PC

T’s

own

allo

catio

n(4

8,04

3)(4

3,22

2)

Und

er /

(ove

r) r

ecov

ery

of c

osts

(31)

(1,2

61)

No

te 3

. Mis

cella

neou

s In

com

e

£0

00

App

ropr

iate

d in

Aid

£000

N

ot A

ppro

pria

ted

in A

id

2008

/09

£000

2007

/08

£000

Fees

and

Cha

rges

9191

88

Den

tal C

harg

e in

com

e fr

om c

ontr

acto

r le

d G

DS

and

PDS

6,83

36,

833

6,77

4

Den

tal C

harg

e in

com

e fr

om t

rust

led

G

DS

and

PDS

00

0

Pres

crip

tion

Cha

rge

Inco

me

256

256

229

Stra

tegi

c H

ealth

Aut

horit

ies

4,84

44,

844

352

NH

S Tr

usts

4,82

64,

826

5,05

6

Foun

datio

n Tr

usts

882

882

1,14

0

Prim

ary

Car

e Tr

usts

for

Dru

g A

ctio

n Te

ams

00

0

Prim

ary

Car

e Tr

usts

- o

ther

1,95

61,

956

2,73

2

Prim

ary

Car

e Tr

usts

- L

ead

Com

mis

sion

ing

Inco

me

00

20

Engl

ish

RAB

Spec

ial H

ealth

Aut

horit

ies

9898

0

Oth

er E

nglis

h Sp

ecia

l Hea

lth

Aut

horit

ies/

CG

A B

odie

s0

00

Dep

artm

ent

of H

ealth

- S

MPT

B0

00

Dep

artm

ent

of H

ealth

- o

ther

240

240

1

Inco

me

for

Trus

t Im

pairm

ent

00

00

Loca

l Aut

horit

ies

1,23

21,

232

513

Patie

nt T

rans

port

Ser

vice

s0

00

0

Educ

atio

n, T

rain

ing

and

Rese

arch

232

023

247

9

Non

NH

S: P

rivat

e Pa

tient

s0

01

Non

-NH

S: O

vers

eas

Patie

nts

(non

-rec

ipro

cal)

00

0

NH

S In

jury

Cos

ts R

ecov

ery

00

0

Oth

er N

on-N

HS

patie

nt c

are

serv

ices

218

218

753

Cha

ritab

le a

nd o

ther

con

trib

utio

ns

to e

xpen

ditu

re0

00

15

Tran

sfer

fro

m t

he d

onat

ed a

sset

res

erve

058

5858

Tran

sfer

fro

m t

he g

over

nmen

t gr

ant

rese

rve

00

00

Rent

al in

com

e fr

om fi

nanc

e le

ases

00

00

Rent

al in

com

e fr

om o

pera

ting

leas

es0

00

0

Oth

er in

com

e10

293

91,

041

1,44

7

Tota

l mis

cella

neou

s in

com

e8,

964

13,8

4322

,807

19,6

58


Not

es t

o th

e ac

cou

nts

Not

e 4.

Op

erat

ing

Cos

ts

No

te 4

.1. A

naly

sis

of g

ross

ope

rati

ng c

osts

:

2008

/09

£000

2007

/08

£000

Goo

ds a

nd s

ervi

ces

from

oth

er P

rim

ary

Care

Tru

sts

Hea

lthca

re61

,842

35,4

32

Non

Hea

lthca

re59

042

8

Tota

l62

,432

35,8

60

Goo

ds a

nd s

ervi

ces

from

oth

er N

HS

bodi

es e

xclu

ding

Fou

ndat

ion

Trus

ts

Hea

lthca

re26

2,55

825

8,79

8

Non

Hea

lthca

re71

523

4

Tota

l26

3,27

325

9,03

2

Goo

ds a

nd S

ervi

ces

from

Fou

ndat

ion

Trus

ts32

,186

36,2

67

Purc

hase

of

heal

thca

re f

rom

non

-NH

S pr

ovid

ers

96,3

7791

,294

Soci

al C

are

from

inde

pend

ent

prov

ider

s0

0

Expe

nditu

re o

n D

rugs

Act

ion

Team

s0

0

Non

-GM

S se

rvic

es f

rom

GPs

1,50

71,

185

Con

trac

tor

led

GD

S an

d PD

S30

,663

28,9

37

Trus

t le

d G

DS

and

PDS

179

0

PCT

Boar

d m

embe

rs’ c

osts

422

385

PCT

Exec

utiv

e C

omm

ittee

non

-offi

cer

mem

bers

’ cos

ts13

967

Staf

f co

sts

47,4

0143

,622

Con

sulta

ncy

serv

ices

886

569

GM

S/PM

S/A

PMS/

PCTM

S70

,413

65,6

05

Pres

crib

ing

cost

s75

,535

73,5

65

Phar

mac

eutic

al S

ervi

ces

2,61

92,

179

Loca

l Pha

rmac

eutic

al S

ervi

ce P

ilots

00

New

Pha

rmac

y C

ontr

act

6,96

53,

233

Gen

eral

Oph

thal

mic

Ser

vice

s4,

234

4,28

2

Supp

lies

and

serv

ices

- c

linic

al2,

901

2,61

9

Supp

lies

and

serv

ices

- g

ener

al2,

058

1,45

8

Esta

blis

hmen

t2,

965

3,10

0

Tran

spor

t3

1

Prem

ises

8,27

66,

341

Impa

irmen

t of

deb

tors

491

Dep

reci

atio

n1,

559

2,11

5

Am

ortis

atio

n0

0

Tang

ible

fixe

d as

set

impa

irmen

ts a

nd r

ever

sals

330

Inta

ngib

le fi

xed

asse

t im

pairm

ents

and

rev

ersa

ls0

0

Impa

irmen

ts a

nd r

ever

sals

of

finac

ial a

sset

s (b

y cl

ass)

00


Not

es t

o th

e ac

cou

nts

Not

e 4.

Op

erat

ing

Cos

ts

No

te 4

.1. A

naly

sis

of g

ross

ope

rati

ng c

osts

:

2008

/09

£000

2007

/08

£000

Cha

nge

in t

he f

air

valu

e of

fina

ncia

l ins

trum

ents

00

NH

S Tr

ust

Impa

irmen

ts0

0

(Pro

fit)/l

oss

on d

ispo

sal o

f fix

ed a

sset

s0

0

Cos

t of

cap

ital c

harg

e14

831

7

Aud

it fe

es27

822

7

Oth

er a

udito

r’s r

emun

erat

ion

00

Clin

ical

neg

ligen

ce c

osts

00

Oth

er fi

nanc

e co

sts

- un

win

ding

of

disc

ount

5285

Redu

ndan

cies

273

216

Educ

atio

n an

d tr

aini

ng68

370

8

Oth

er3,

843

3,41

1

Tota

l71

8,35

266

6,68

1

PCT

Boar

d m

embe

rs’ c

osts

abo

ve in

clud

e £0

for

ear

ly r

etire

men

ts p

rior

to 6

/3/9

5 (2

007/

08 £

0).

Staf

f co

sts

abov

e in

clud

e £0

for

ear

ly r

etire

men

ts p

rior

to 6

/3/9

5 (2

007/

08 £

0).


Not

es t

o th

e ac

cou

nts

No

te 4

.2. A

naly

sis

of o

pera

ting

exp

endi

ture

by

expe

ndit

ure

clas

sific

atio

nN

ote

4.2

. Pur

chas

e of

Hea

lth

Care

by

PCT

2008

/09

£000

2007

/08

£000

Purc

hase

of P

rim

ary

Hea

lth

Care

GM

S / P

MS/

APM

S / P

CTM

S70

,413

65,6

05

Pres

crib

ing

cost

s75

,535

73,5

65

Phar

mac

eutic

al s

ervi

ces

2,61

92,

179

Con

trac

tor

led

GD

S an

d PD

S30

,663

27,8

83

Trus

t le

d G

DS

and

PDS

677

0

Gen

eral

Oph

thal

mic

Ser

vice

s4,

234

4,28

2

Dep

artm

ent

of H

ealth

Initi

ativ

e Fu

ndin

g0

0

Loca

l Pha

rmac

eutic

al S

ervi

ces

Pilo

ts0

0

New

Pha

rmac

y C

ontr

act

6,96

53,

233

Non

-GM

S Se

rvic

es f

rom

GPs

1,50

71,

185

Oth

er0

0

Tota

l Pri

mar

y H

ealt

hcar

e pu

rcha

sed

192,

613

177,

932

Purc

hase

of S

econ

dary

Hea

lthc

are

Lear

ning

Diffi

culti

es45

,774

42,7

22

Men

tal I

llnes

s47

,098

45,8

67

Mat

erni

ty13

,602

11,9

26

Gen

eral

and

Acu

te30

1,13

428

1,30

3

Acc

iden

t A

nd E

mer

genc

y14

,321

13,4

49

Com

mun

ity H

ealth

Ser

vice

s41

,767

36,3

73

Oth

er C

ontr

actu

al33

,203

29,4

73

Tota

l Sec

onda

ry H

ealt

hcar

e Pu

rcha

sed

496,

899

461,

113

Impa

irmen

ts in

Tru

sts

00

Gra

nts

(rev

enue

) to

fund

Cap

ital P

roje

cts

- G

MS

00

Gra

nts

(rev

enue

) to

LAs

to f

und

Cap

ital P

roje

cts

013

6

Gra

nts

(rev

enue

) to

priv

ate

sect

or t

o fu

nd C

apita

l Pro

ject

s40

31,

272

Gra

nts

(rev

enue

) to

fund

Cap

ital P

roje

cts

- D

enta

l0

0

Gra

nts

(rev

enue

) to

fund

Cap

ital P

roje

cts

- ot

her

00

Tota

l hea

lthc

are

purc

hase

d by

PCT

689,

915

640,

453

Am

ount

of

self-

com

mis

sion

ed s

econ

dary

hea

lthca

re in

clud

ed a

bove

*48

,043

43,2

22

Hea

lthca

re p

urch

ased

fro

m F

ound

atio

n Tr

usts

incl

uded

abo

ve32

,186

35,8

47

Soci

al C

are

from

Inde

pend

ent

Prov

ider

s

* Th

is is

the

tot

al o

f se

cond

ary

heal

thca

re t

hat

the

PCT

com

mis

sion

ed f

rom

itse

lf

Expe

nditu

re o

n m

enta

l hea

lth a

nd le

arni

ng d

isab

ilitie

s in

clud

e th

e co

ntrib

utio

ns m

ade

by t

he P

CT

to t

heco

unty

-wid

e po

oled

bud

get

with

Her

tfor

dshi

re C

ount

y C

ounc

il.


Not

es t

o th

e ac

cou

nts

No

te 4

.3. O

pera

ting

Lea

ses

No

te 4

.3/1

. Ope

rati

ng e

xpen

ses

incl

ude:

2008

/09

£000

2007

/08

£000

Hire

of

plan

t an

d m

achi

nery

00

Oth

er o

pera

ting

leas

e re

ntal

s1,

146

1,11

8

Tota

l1,

146

1,11

8

No

te 4

.3/2

. Ope

rati

ng e

xpen

ses

incl

ude:

2008

/09

Land

and

Bui

ldin

gs

£000

2007

/08

Oth

er le

ases

£0

00

2007

/08

Land

and

Bui

ldin

gs

£000

2007

/08

Oth

er le

ases

£0

00

Ope

ratin

g le

ases

whi

ch e

xpire

:

With

in 1

yea

r0

280

54

Betw

een

1 an

d 5

year

s79

467

2632

Aft

er 5

yea

rs26

20

950

0

Tota

l1,

056

9597

686


Not

es t

o th

e ac

cou

nts

Not

e 5.

Sta

ff n

um

ber

s an

d r

elat

ed c

osts

No

te 5

.1. S

taff

cos

ts

Tota

l £0

00

2008

/09

Perm

anen

tly

Empl

oyed

£0

00O

ther

£0

00To

tal

£000

2007

/08

Perm

anen

tly

Empl

oyed

£0

00O

ther

£0

00

Sala

ries

and

wag

es39

,847

37,6

202,

227

36,6

6935

,650

1,01

9

Soci

al s

ecur

ity c

osts

2,87

52,

875

02,

638

2,63

80

Empl

oyer

con

trib

utio

ns t

o N

HSB

SA5,

101

5,10

10

4,70

04,

700

0

Oth

er p

ensi

on c

osts

00

00

00

Tota

l47

,823

45,5

962,

227

44,0

0742

,988

1,01

9

No

te 5

.2. S

taff

Num

bers

Tota

l N

umbe

r

2008

/09

Perm

anen

tly

Empl

oyed

N

umbe

rO

ther

N

umbe

rTo

tal

Num

ber

2007

/08

Perm

anen

tly

Empl

oyed

N

umbe

rO

ther

N

umbe

r

Med

ical

and

den

tal

1615

111

83

Am

bula

nce

staf

f0

00

00

0

Adm

inis

trat

ion

and

esta

tes

488

444

4441

840

018

Hea

lthca

re a

ssis

tant

s an

d ot

her

supp

ort

staf

f22

622

33

209

209

0

Nur

sing

, mid

wife

ry a

nd h

ealth

vi

sitin

g st

aff

425

419

641

541

05

Nur

sing

, mid

wife

ry a

nd h

ealth

vi

sitin

g le

arne

rs8

80

99

0

Scie

ntifi

c, t

hera

peut

ic a

nd

tech

nica

l sta

ff26

526

14

269

261

8

Soci

al C

are

staf

f0

00

00

0

Oth

er20

200

1313

0

Tota

l14

4813

9058

1344

1310

34


Not

es t

o th

e ac

cou

nts

No

te 5

.3. E

mpl

oyee

ben

efits

Ther

e w

ere

no e

mpl

oyee

ben

efits

in 2

008/

9 or

200

7/8

No

te 5

.4. R

etire

men

ts d

ue to

ill-h

ealth

D

urin

g 20

08/0

9 th

ere

wer

e 6

early

ret

irem

ents

fro

m t

he P

rimar

y C

are

Trus

t ag

reed

on

the

grou

nds

of il

l-hea

lth (2

007/

08:

2). T

he e

stim

ated

add

ition

al p

ensi

on li

abili

ties

of t

hese

ill-h

ealth

ret

irem

ents

(cal

cula

ted

on a

n av

erag

e ba

sis

and

born

e by

th

e N

HS

Pens

ion

Sche

me)

will

be

£220

,527

(200

7/08

: £87

,111

).

No

te 5

.5. M

anag

emen

t co

sts

2008

/09

2007

/08

Man

agem

ent

cost

s (£

000s

)10

,829

10,9

90

Wei

ghte

d po

pula

tion

(Num

ber)

490,

489

490,

489

Man

agem

ent

cost

per

hea

d of

wei

ghte

d po

pula

tion

(£)

22.0

822

.41

The

PCT

mea

sure

s it

s m

anag

emen

t co

sts

acco

rdin

g to

the

defi

niti

ons

prov

ided

by

the

Dep

artm

ent

of H

ealt

h

Not

e 6.

Bet

ter

Pay

men

t P

ract

ice

Cod

e

No

te 6

.1. B

ette

r Pa

ymen

t Pr

acti

ce C

ode

- mea

sure

of c

ompl

ianc

e

2008

/09

Num

ber

2008

/09

£000

2007

/08

Num

ber

2007

/08

£000

Non

-NH

S Cr

edit

ors

Tota

l bill

s pa

id in

the

yea

r19

,935

126,

210

15,1

6812

3,53

7

Tota

l bill

s pa

id w

ithin

tar

get

17,5

0411

4,01

310

,720

108,

334

Perc

enta

ge o

f bi

lls p

aid

with

in t

arge

t87

.81%

90.3

4%70

.68%

87.6

9%

NH

S Cr

edit

ors

Tota

l bill

s pa

id in

the

yea

r2,

007

333,

943

1,89

332

3,09

9

Tota

l bill

s pa

id w

ithin

tar

get

1,44

832

4,51

41,

136

308,

396

Perc

enta

ge o

f bi

lls p

aid

with

in t

arge

t72

.15%

97.1

8%60

.01%

95.4

5%

The

Bett

er P

aym

ent

Prac

tice

Cod

e re

quire

s th

e PC

T to

aim

to

pay

all v

alid

invo

ices

by

the

due

date

or

with

in 3

0 da

ys o

f re

ceip

t of

a v

alid

invo

ice,

whi

chev

er is

late

r.

No

te 6

.2. T

he L

ate

Paym

ent o

f Com

mer

cial

Deb

ts (I

nter

est)

Act

199

8N

o pa

ymen

ts w

ere

mad

e in

res

pect

of

clai

ms

unde

r th

is le

gisl

atio

n in

200

8/9

or 2

007/

8.


Not

es t

o th

e ac

cou

nts

No

te 7

.2. A

naly

sis

of Im

pair

men

ts c

harg

ed t

o op

erat

ing

cost

s

Inta

ngib

le

Ass

ets

£000

Tang

ible

A

sset

s £0

00

Fixe

d Fi

nanc

ial

Inst

rum

ents

£0

00

Curr

ent

Fina

ncia

l In

stru

men

ts

£000

Tota

l Im

pair

men

ts

£000

Loss

or

dam

age

from

nor

mal

ope

ratio

ns0

00

00

Loss

as

a re

sult

of c

atas

trop

he0

00

00

Aba

ndon

men

t of

ass

ets

in c

ours

e of

co

nstr

uctio

n0

00

00

Unf

orse

en o

bsol

esce

nce

00

00

0

Ove

r sp

ecifi

catio

n of

ass

ets

00

00

0

Oth

er (d

etai

l bel

ow)

00

00

0

Cha

nges

in M

arke

t Pr

ice

033

00

33

Tota

l0

330

033

Not

e 8.

Fin

ance

Cos

ts

2008

/09

£000

2007

/08

£000

Paya

ble:

Fina

nce

leas

es18

17

Late

pay

men

t of

com

mer

cial

deb

t pe

nalti

es0

0

Loan

s0

0

Bank

loan

s an

d ov

erdr

afts

00

Oth

er in

tere

st a

nd fi

nanc

e co

sts

05

Tota

l18

22

Not

e 7.

1. O

ther

Gai

ns

and

Los

ses

Ther

e w

as n

o pr

ofit

or lo

ss o

n th

e di

spos

al o

f ta

ngib

le, i

ntan

gibl

e an

d in

vest

men

t as

sets

, in

2008

/9 a

nd 2

007/

8.

Not

e 9

Inta

ngi

ble

Fix

ed A

sset

s

The

PCT

did

not

hold

any

inta

ngib

le fi

xed

asse

ts in

200

8/9

or 2

007/

8.


Not

es t

o th

e ac

cou

nts

Not

e 10

. Tan

gib

le F

ixed

Ass

ets

No

te 1

0.1.

Tan

gibl

e fix

ed a

sset

s at

the

bal

ance

she

et d

ate

com

pris

e th

e fo

llow

ing

elem

ents

:

Land£000

Buildings excluding dwellings

£000

Dwellings£000

Assets under construc-tion and payments on

account £000

Plant and machinery£000

Transport equipment

£000

Information technology

£000

Furniture and fittings

£000

Total £000

Cost

or

valu

atio

n

at 1

Apr

il 20

0827

,328

14,7

770

803

729

05,

431

619

49,6

87

Add

ition

s -

purc

hase

d0

1,14

40

277

241

060

732

52,

594

Add

ition

s -

dona

ted

00

00

00

00

0

Add

ition

s -

gove

rnm

ent

gran

ted

00

00

00

00

0

Impa

irmen

ts(1

2,02

6)(1

,351

)0

00

00

0(1

3,37

7)

Inde

xatio

n0

00

00

00

00

Recl

assi

ficat

ions

41(1

74)

00

00

013

30

In y

ear

tran

sfer

s to

/fro

m N

HS

bodi

es0

00

00

00

00

Oth

er in

yea

r re

valu

atio

n1,

031

1,11

80

00

00

02,

149

Dis

posa

ls0

00

00

00

00

At

31 M

arch

200

916

,374

15,5

140

1,08

097

00

6,03

81,

077

41,0

53

Acc

umul

ated

dep

reci

atio

n

at 1

Apr

il 20

0849

60

3,69

340

04,

589

Prov

ided

dur

ing

the

year

852

060

060

443

1,55

9

Impa

irmen

ts0

330

00

00

33

Reve

rsal

of

Impa

irmen

ts0

00

00

00

Recl

assi

ficat

ions

(8)

00

80

Inde

xatio

n0

00

0

Oth

er in

yea

r re

valu

atio

n0

00

00

00

In y

ear

tran

sfer

s to

/fro

m N

HS

bodi

es0

00

00

00

Dis

posa

ls0

00

00

00

Acc

umul

ated

dep

reci

atio

n at

31

Mar

ch 2

009

087

70

055

60

4,29

745

16,

181

Net

boo

k va

lue

- Pu

rcha

sed

at 1

Apr

il 20

0827

,328

13,0

220

803

219

01,

738

209

43,3

19

- D

onat

ed a

t 1

Apr

il 20

080

1,75

50

014

00

101,

779

- G

over

nmen

t G

rant

ed a

t 1

Apr

il 20

080

00

00

00

00

Tota

l at

1 A

pril

2008

27,3

2814

,777

080

323

30

1,73

821

945

,098

Net

boo

k va

lue

- Pu

rcha

sed

at 3

1 M

arch

200

916

,374

13,0

400

1,08

040

10

1,74

161

733

,253

- D

onat

ed a

t 31

Mar

ch 2

009

01,

597

00

130

09

1,61

9

- G

over

nmen

t G

rant

ed

at 3

1 M

arch

200

90

00

00

00

00

Tota

l at

31 M

arch

200

916

,374

14,6

370

1,08

041

40

1,74

162

634

,872

Of

the

tota

ls a

t 31

Mar

ch 2

009,

£50

0,00

0 re

late

d to

land

val

ued

at o

pen

mar

ket

valu

e.


Not

es t

o th

e ac

cou

nts

No

te 1

0.2/

1 A

sset

Fin

anci

ng Land

£000

Build

ings

ex

clud

ing

dwel

lings

£000

Dw

ellin

gs£0

00

Ass

ets

unde

r co

nstr

ucti

on

and

paym

ents

on

acc

ount

£000

Plan

t an

d m

achi

nery

£000

Tran

spor

t eq

uipm

ent

£000

Info

rmat

ion

tech

nolo

gy

£000

Furn

itur

e an

d fit

ting

s £0

00To

tal

£000

Net

boo

k va

lue

31

Mar

ch 2

009

Ow

ned

16,0

7514

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012

441

40

1,74

162

633

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nce

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ed29

916

70

00

00

046

6

On

bala

nce

shee

t PF

I co

ntra

cts

00

00

00

00

0

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esid

ual i

nter

ests

00

095

60

00

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6

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l 31

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ch 2

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16,3

7414

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01,

080

414

01,

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34,8

72

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boo

k va

lue

1

Apr

il 20

08

Ow

ned

27,2

2914

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00

233

01,

738

219

43,9

65

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nce

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ed99

231

00

00

00

330

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bala

nce

shee

t PF

I co

ntra

cts

00

00

00

00

0

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ual i

nter

ests

00

080

30

00

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3

Tota

l 1 A

pril

2008

27,3

2814

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080

323

30

1,73

821

945

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No

te 1

0.2/

2 Th

e to

tal a

mou

nt o

f dep

reci

atio

n ch

arge

d to

the

inco

me

and

expe

ndit

ure

in r

espe

ct o

f ass

ets

held

und

er

finan

ce le

ases

and

hir

e pu

rcha

se c

ontr

acts

:

Land

£000

Build

ings

ex

clud

ing

dwel

lings

£000

Dw

ellin

gs£0

00

Ass

ets

unde

r co

nstr

ucti

on

and

paym

ents

on

acc

ount

£000

Plan

t an

d m

achi

nery

£000

Tran

spor

t eq

uipm

ent

£000

Info

rmat

ion

tech

nolo

gy

£000

Furn

itur

e an

d fit

ting

s £0

00To

tal

£000

Dep

reci

atio

n

31 M

arch

200

964

00

00

064

Dep

reci

atio

n

31 M

arch

200

813

00

00

013

No

te 1

0.3

The

net

book

val

ue o

f lan

d, b

uild

ings

and

dw

ellin

gs a

t 31

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ch 2

009

com

pris

es:

2008

/09

Purc

hase

d£0

00

2008

/09

Don

ated

£000

2008

/09

Gov

ernm

ent

Gra

nted

£000

2008

/09

Tota

l£0

00

2007

/08

Tota

l£0

00

Free

hold

28,9

481,

597

030

,545

41,7

75

Long

Lea

seho

ld46

60

046

633

0

Shor

t Le

aseh

old

00

00

0

Tota

l29

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1,59

70

31,0

1142

,105


Not

es t

o th

e ac

cou

nts

Not

e 11

. Sto

ck a

nd

wor

k i

n p

rogr

ess

31 M

arch

200

9£0

0031

Mar

ch 2

008

£000

Raw

mat

eria

ls a

nd c

onsu

mab

les

119

119

Wor

k-in

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s0

0

Fini

shed

goo

ds0

0

Tota

l11

911

9

Not

e 12

. Deb

tors

31 M

arch

200

9£0

0031

Mar

ch 2

008

£000

Am

ount

s fa

lling

due

wit

hin

one

year

:

NH

S de

btor

s4,

883

4,48

5

Non

NH

S tr

ade

debt

ors

1,25

395

6

Prov

isio

n fo

r im

pairm

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of d

ebto

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9)0

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aym

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and

acc

rued

inco

me

4,29

92,

442

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ital d

ebto

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NH

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NH

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Cur

rent

par

t of

PFI

pre

paym

ents

00

Oth

er d

ebto

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801

1,97

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879,

859

No

te 1

0.4

Fixe

d a

sset

s in

vest

men

tsO

n 1s

t Ju

ly 2

008,

the

PC

T ac

quire

d lo

an n

otes

and

sha

res

to t

he v

alue

of

£27,

570

and

£400

res

pect

ivel

y.Th

is is

in r

espe

ct o

f th

e A

ssem

ble

Com

mun

ity P

artn

ersh

ip, t

he n

ame

of t

he n

ewly

for

med

par

tner

ship

com

pany

bet

wee

n Be

dfor

dshi

re P

CT,

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on K

eyne

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uild

hous

e (a

priv

ate

deve

lopi

ng c

ompa

ny) a

nd lo

cal p

ublic

sec

tor

auth

oriti

es

cove

red

by t

he t

hree

par

ticip

ant

PCT

area

s.

No

te 1

0.5

Oth

er F

inan

cial

Ass

ets

Apa

rt f

rom

Not

e 10

.4 a

bove

, the

PC

T di

d no

t ho

ld a

ny fi

xed

or c

urre

nt fi

nanc

ial a

sset

whi

ch is

not

sep

arat

ely

disc

lose

d el

sew

here

on

the

finan

cial

sta

tem

ents

in 2

008/

9 or

200

7/8.

No

te 1

0.6.

Eco

nom

ic L

ives

of F

ixed

Ass

ets

Min

imum

Life

(yea

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imum

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(yea

rs)

Soft

war

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cenc

es0

0

Lice

nces

and

Tra

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arks

00

Pate

nts

00

Dev

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men

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pend

iture

00

Build

ings

exc

l. D

wel

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540

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gs0

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Plan

t an

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achi

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515

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spor

t Eq

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00

Info

rmat

ion

Tech

nolo

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4

Furn

iture

and

Fitt

ings

528


Not

es t

o th

e ac

cou

nts

Not

e 12

. Deb

tors

31 M

arch

200

9£0

0031

Mar

ch 2

008

£000

Am

ount

s fa

lling

due

aft

er m

ore

than

one

yea

r:

NH

S de

btor

s0

0

Non

NH

S tr

ade

debt

ors

00

Prov

isio

n fo

r im

pairm

ent

of d

ebto

rs0

0

Prep

aym

ents

and

acc

rued

inco

me

1,63

61,

714

Cap

ital d

ebto

rs -

Non

NH

S0

0

Oth

er d

ebto

rs0

0

1,63

61,

714

Tota

l13

,823

11,5

73

NH

S D

ebto

rs in

clud

e;-

£0 p

repa

id p

ensi

on c

ontr

ibut

ions

at

31 M

arch

200

9 (3

1 M

arch

200

8 £0

); an

d-

£0 p

repa

ymen

ts f

rom

the

buy

out

of e

arly

ret

irem

ents

(31

Mar

ch 2

008

£0).

No

te 1

2.1

Prov

isio

n fo

r im

pair

men

t of

deb

tors

31 M

arch

200

9£0

00

Bala

nce

at 1

Apr

il0

Am

ount

writ

ten

off

durin

g th

e ye

ar0

Am

ount

rec

over

ed d

urin

g th

e ye

ar0

(Incr

ease

)/dec

reas

e in

deb

tors

impa

ired

(49)

Bala

nce

at 3

1 M

arch

(49)

No

te 1

2.2

Deb

tors

pas

t du

e da

te b

ut n

ot im

pair

ed:

31 M

arch

200

9£0

00

By u

p to

3 m

onth

s4,

821

By 3

to

6 m

onth

s61

0

By m

ore

than

6 m

onth

s40

5

Tota

l5,

836


Not

es t

o th

e ac

cou

nts

Oth

er c

redi

tors

incl

ude;

- £4

9,12

7 fo

r pa

ymen

ts d

ue in

fut

ure

year

s un

der

arra

ngem

ents

to

buy

out

the

liabi

lity

for

one

early

ret

irem

ents

ove

r 5

year

s (2

007/

08 £

98,2

54);

and

- £6

59,0

00 o

utst

andi

ng p

ensi

ons

cont

ribut

ions

at

31 M

arch

200

9 (£

582,

900

at 3

1 M

arch

200

8)

No

te 1

3.1/

1 O

ther

Fin

anci

al L

iabi

litie

sTh

ere

are

no fi

nanc

ial l

iabi

litie

s ca

rrie

d at

fai

r va

lue

thro

ugh

profi

t an

d lo

ss f

or 2

008/

9.

Not

e 13

Cre

dit

ors

No

te 1

3.1.

Cre

dito

rs a

t th

e ba

lanc

e sh

eet

date

are

mad

e up

of:

31 M

arch

200

9£0

0031

Mar

ch 2

008

£000

Am

ount

s fa

lling

due

wit

hin

one

year

:

Bank

ove

rdra

fts

00

Inte

rest

pay

able

00

Paym

ents

rec

eive

d on

acc

ount

00

NH

S cr

edito

rs -

rev

enue

10,7

288,

088

NH

S cr

edito

rs -

cap

ital

00

Fam

ily H

ealth

Ser

vice

s (F

HS)

cre

dito

rs25

,152

20,9

34

Non

- N

HS

trad

e cr

edito

rs -

rev

enue

7,95

67,

615

Non

- N

HS

trad

e cr

edito

rs -

cap

ital

656

704

Tax

517

229

VAT

10

Soci

al S

ecur

ity c

osts

472

440

Obl

igat

ions

und

er fi

nanc

e le

ases

and

hire

pur

chas

e co

ntra

cts

1616

Oth

er c

redi

tors

1,60

12,

007

Acc

rual

s an

d de

ferr

ed in

com

e15

289

Cur

rent

par

t of

fina

nce

leas

e el

emen

t of

on

bala

nce

shee

t PF

I con

trac

ts0

0

Am

ount

s fa

lling

due

aft

er m

ore

than

one

yea

r:

Obl

igat

ions

und

er fi

nanc

e le

ases

and

hire

pur

chas

e co

ntra

cts

3248

NH

S cr

edito

rs0

0

Impu

ted

finan

ce le

ases

ele

men

t of

on

bala

nce

shee

t PF

I con

trac

ts0

0

Oth

er0

49

3297

Tota

l47

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40,2

19


Not

es t

o th

e ac

cou

nts

No

te 1

3.2.

Fin

ance

leas

e ob

ligat

ions

31 M

arch

200

9£0

0031

Mar

ch 2

008

£000

Paya

ble:

In n

ot m

ore

than

1 y

ear

or in

dem

and

3333

In m

ore

than

1 y

ear

but

no lo

nger

tha

n 2

year

s5

33

In m

ore

than

2 y

ears

but

no

long

er t

han

5 ye

ars

1414

Aft

er fi

ve y

ears

268

273

Subt

otal

320

353

Less

fina

nce

char

ges

allo

cate

d to

fut

ure

perio

ds(2

72)

(289

)

Tota

l48

64

No

te 1

3.3

Fina

nce

Leas

e Co

mm

itmen

tsTh

e PC

T ha

s no

fina

nce

leas

e co

mm

itmen

ts, o

ther

tha

n th

ose

in n

ote

13.2

.

* Pr

ovis

ions

rel

atin

g to

the

PC

T’s

own

prov

ider

fun

ctio

ns a

re s

how

n gr

oss

with

the

exp

ecte

d re

imbu

rsem

ents

fro

m t

he N

HSL

A in

clud

ed in

deb

tors

.Pe

nsio

ns re

latin

g to

oth

er s

taff

is th

e es

timat

ed fu

ll am

ount

of t

he P

CT’

s lia

bilit

y fo

r the

add

ition

al c

ost t

o th

e N

HS

Pens

ions

sch

eme

of e

mpl

oyee

s re

tirin

g ea

rly. T

he

liabi

lity

has

been

cal

cula

ted

follo

win

g ac

tuar

ial a

dvic

e, b

ut is

by

its n

atur

e on

ly a

n es

timat

e.

Rest

ruct

urin

g pr

ovis

ions

rel

ate

to t

he P

rovi

der

Serv

ices

arm

of

the

PCT

and

the

man

agem

ent

stru

ctur

e ch

ange

s re

quire

d, a

s it

mov

es t

o be

com

e a

sepa

rate

org

anis

atio

n.

The

Oth

er P

rovi

sion

s re

late

to

the

PCT’

s fu

ture

liab

ility

for

Con

tinui

ng C

are

unde

r th

e C

ough

lan

agre

emen

t an

d in

jury

ben

efit.

£2

80,2

18 is

incl

uded

in t

he p

rovi

sion

s of

the

NH

SLA

at

31.3

.200

9 in

res

pect

of

clin

ical

neg

ligen

ce p

rovi

sion

s of

the

PC

T (3

1.3.

2008

£15

,609

)

Not

e 14

. Pro

visi

ons

for

liab

ilit

ies

and

ch

arge

s

Pens

ions

re

lati

ng t

o fo

rmer

di

rect

ors/

mem

bers

£0

00

Pens

ions

re

lati

ng t

o ot

her

staf

f £0

00Le

gal c

laim

s £0

00Re

stru

ctur

ings

£0

00O

ther

£0

00To

tal

£000

At

1 A

pril

2008

01,

915

80

879

2,80

2

Aris

ing

durin

g th

e ye

ar*

054

048

137

290

7

Util

ised

dur

ing

the

year

0(2

37)

00

(40)

(277

)

Reve

rsed

unu

sed

00

00

00

Unw

indi

ng o

f di

scou

nt0

350

017

52

Tran

sfer

in-y

ear

00

00

00

At

31 M

arch

200

90

1,76

78

481

1,22

83,

484

Futu

re P

aym

ents

to

NH

S tr

usts

051

20

070

01,

212

Futu

re P

aym

ents

to

NH

S

Foun

datio

n Tr

usts

01,

173

00

01,

173

Futu

re P

aym

ents

to

Prim

ary

C

are

Trus

ts0

00

00

0

Expe

cted

tim

ing

of c

ash

flow

s:

With

in 1

yea

r0

263

048

156

21,

306

1 -

5 ye

ars

039

58

012

853

1

Ove

r 5

year

s0

1,10

90

053

81,

647


Not

es t

o th

e ac

cou

nts

Not

e 15

Mov

emen

ts o

n R

eser

ves

Mov

emen

ts o

n re

serv

es in

the

yea

r co

mpr

ised

the

fol

low

ing:

Reva

luat

ion

rese

rve

Don

ated

as

set

rese

rve

Gov

ernm

ent

gr

ant

rese

rve

Oth

er r

eser

ves

Gen

eral

Fun

d

2008

/09

£000

2007

/08

£000

2008

/09

£000

2007

/08

£000

2008

/09

£000

2007

/08

£000

2008

/09

£000

2007

/08

£000

2008

/09

£000

2007

/08

£000

At

1 A

pril

20,0

4317

,582

1,77

91,

697

00

00

(8,0

53)

(11,

483)

PPA

: elim

inat

ion

of

nega

tive

reva

luat

ion

rese

rves

in r

espe

ct o

f ch

ange

in p

olic

y

on im

pairm

ents

00

00

Net

Par

liam

enta

ry

Fund

ing

691,

009

650,

158

Cos

t of

Cap

ital C

harg

e14

831

7

Tran

sfer

fro

m t

he O

CS

(695

,563

)(64

7,04

5)

Fixe

d as

set

impa

irmen

ts(1

3,26

0)0

(117

)0

00

Surp

lus/

(defi

cit)

on

othe

r re

valu

atio

ns/in

dexa

tion

of

fixe

d as

sets

2,13

42,

461

1514

00

0

Tran

sfer

of

real

ised

pro

fits

(loss

es)

00

00

00

00

Rece

ipt

of d

onat

ed/

Gov

ernm

ent

gran

ted

asse

ts0

00

0

Dep

reci

atio

n an

d di

spos

al

of d

onat

ed/G

over

nmen

t gr

ante

d as

sets

(58)

(58)

00

Tran

sfer

s to

/(fro

m) o

ther

N

HS

Bodi

es0

00

00

0

Oth

er m

ovem

ents

on

rese

rves

00

00

00

00

(1)

0

At

31 M

arch

8,91

720

,043

1,61

91,

779

00

00

(12,

460)

(8,0

53)


Not

es t

o th

e ac

cou

nts

No

te 1

6.1.

Rec

onci

liati

on o

f ope

rati

ng c

osts

to

net

cash

flow

from

ope

rati

ng a

ctiv

itie

s:

2008

/09

£000

2007

/08

£000

Net

ope

ratin

g C

ost

(695

,545

)(6

47,0

23)

Dep

reci

atio

n ch

arge

1,55

92,

115

Cos

t of

cap

ital c

harg

e14

831

7

Fixe

d as

set

impa

irmen

ts33

0

(Pro

fit)/l

oss

on d

ispo

sal o

f fix

ed a

sset

s0

0

Non

-cas

h m

ovem

ent

in p

rovi

sion

s95

915

1

Tran

sfer

fro

m d

onat

ed a

sset

res

erve

(58)

(58)

Tran

sfer

fro

m t

he G

over

nmen

t gr

ant

rese

rve

00

(Incr

ease

)/dec

reas

e in

sto

cks

057

(Incr

ease

)/dec

reas

e in

deb

tors

(2,2

50)

15,0

58

Incr

ease

/(dec

reas

e) in

cre

dito

rs7,

128

(16,

523)

Incr

ease

/(dec

reas

e) in

pro

visi

ons

(277

)(3

,167

)

Net

cas

h in

flow

/(out

flow

) fro

m o

pera

ting

act

ivit

ies

(688

,303

)(6

49,0

73)

Not

e 16

Not

es t

o th

e ca

sh fl

ow s

tate

men

t


Not

es t

o th

e ac

cou

nts

No

te 1

6.2.

Rec

onci

liati

on o

f net

cas

h flo

w t

o m

ovem

ent

in n

et d

ebt

2008

/09

£000

2007

/08

£000

Incr

ease

/(dec

reas

e) in

cas

h in

the

per

iod

00

Cas

h ou

tflow

fro

m fi

nanc

e le

ase

paym

ents

1616

Cas

h (in

flow

)/out

flow

fro

m (d

ecre

ase)

/incr

ease

in li

quid

res

ourc

es0

Chan

ge in

net

deb

t re

sult

ing

from

cas

h flo

ws

1616

Non

- c

ash

chan

ges

in d

ebt

00

Net

deb

t at

1 A

pril

2008

(64)

(80)

Net

deb

t at

31

Mar

ch 2

009

(48)

(64)

No

te 1

6.3

Ana

lysi

s of

cha

nges

in n

et d

ebt

At

31 M

arch

20

09£0

00

Cash

flow

s in

ye

ar£0

00

Non

-cas

h ch

ange

s in

ye

ar£0

00

Tran

sfer

s to

/ fr

om N

HS

bodi

es£0

00A

t 1

Apr

il 20

08£0

00

OPG

cas

h at

ban

k0

00

0

Cas

h at

ban

k an

d in

han

d0

00

0

Bank

ove

rdra

fts

00

00

Fina

nce

leas

es d

ue w

ithin

one

yea

r(1

6)0

00

(16)

Fina

nce

leas

es d

ue a

fter

one

yea

r(3

2)16

00

(48)

Cur

rent

ass

et in

vest

men

ts

Tota

l(4

8)16

00

(64)

Excl

uded

abo

ve: £

1,90

6 he

ld in

PC

T ac

coun

ts r

elat

ing

to P

atie

nts’

mon

ey (£

1,90

2 at

31

Mar

ch 2

008)

Patie

nts’

mon

ies

are

excl

uded

fro

m c

redi

tors

.


Not

es t

o th

e ac

cou

nts

Not

e 17

. Cap

ital

Com

mit

men

ts

Com

mitm

ents

und

er c

apita

l exp

endi

ture

con

trac

ts a

t th

e ba

lanc

e sh

eet

date

wer

e £2

77,0

00 (2

007/

08: £

0).

Not

e 18

. Pos

t B

alan

ce S

hee

t E

ven

ts

Ther

e ar

e no

pos

t ba

lanc

e sh

eet

even

ts h

avin

g a

mat

eria

l eff

ect

on t

he fi

nanc

ial s

tate

men

ts.

The

maj

ority

of

cont

inge

nt li

abili

ty r

elat

es t

o cl

aim

s fo

r th

e re

imbu

rsem

ent

of c

ontin

uing

car

e ex

pend

iture

, fol

low

ing

the

deci

sion

of

the

Hea

lth S

ervi

ce O

mbu

dsm

an. W

here

a r

easo

nabl

e es

timat

e of

the

PC

T’s

liabi

lity

can

be m

ade,

base

d on

exp

erie

nce

to d

ate,

it h

as b

een

incl

uded

as

a pr

ovis

ion

(Not

e 14

). H

owev

er, g

iven

the

unc

erta

inty

reg

ardi

ngth

e fin

al o

utco

me

of in

divi

dual

cas

es, a

con

tinge

nt li

abili

ty h

as b

een

incl

uded

to

refle

ct t

he p

oten

tial c

ost

of t

hose

clai

ms

to t

he P

CT.

Not

e 19

. Con

tin

gen

cies

The

Prim

ary

Car

e Tr

ust

has

the

follo

win

g co

ntin

gent

(los

ses)

/gai

ns w

hich

hav

e no

t be

en in

clud

ed in

the

acc

ount

s:

2008

/09

£000

2007

/08

£000

Gro

ss v

alue

(479

)(2

44)

Am

ount

s re

cove

rabl

e (if

any

)0

0

Net

Con

tinge

nt L

iabi

lity

(479

)(2

44)


Not

es t

o th

e ac

cou

nts

The

Dep

artm

ent

of H

ealth

is r

egar

ded

as a

rel

ated

par

ty. D

urin

g th

e ye

ar t

he P

CT

has

had

a si

gnifi

cant

num

ber

of m

ater

ial t

rans

actio

ns w

ith t

he D

epar

tmen

t, a

nd w

ith o

ther

ent

ities

for

whi

ch t

he D

epar

tmen

t is

reg

arde

d as

the

pare

nt D

epar

tmen

t. T

he P

CT

has

adop

ted

a di

sclo

sure

leve

l of

£5m

illio

n in

200

8/09

. The

se e

ntiti

es a

re li

sted

bel

ow;

In a

dditi

on, t

he P

CT

has

had

a si

gnifi

cant

num

ber

of m

ater

ial t

rans

actio

ns w

ith o

ther

Gov

ernm

ent

Dep

artm

ents

and

oth

er

cent

ral a

nd lo

cal G

over

nmen

t bo

dies

. Whe

re a

ppro

pria

te, t

hese

tra

nsac

tions

hav

e be

en r

eflec

ted

in t

he a

bove

tab

le.

The

PCT

has

also

rec

eive

d re

venu

e an

d ca

pita

l pay

men

ts f

rom

a n

umbe

r of

cha

ritab

le f

unds

, cer

tain

of

the

Trus

tees

for

w

hich

are

als

o m

embe

rs o

f th

e PC

T Bo

ard.

East

and

Nor

th H

ertf

ords

hire

PC

T is

a b

ody

corp

orat

e es

tabl

ishe

d by

ord

er o

f th

e Se

cret

ary

of S

tate

for

Hea

lth.

Dur

ing

the

year

non

e of

the

Boa

rd M

embe

rs o

r m

embe

rs o

f th

e ke

y m

anag

emen

t st

aff

or p

artie

s re

late

d to

the

m h

as

unde

rtak

en a

ny m

ater

ial t

rans

actio

ns w

ith t

he P

CT.

Dur

ing

the

year

loca

l GPs

sat

on

the

Boar

d an

d Ex

ecut

ive

Com

mitt

ee o

f th

e PC

T. P

aym

ents

are

mad

e to

all

prac

tices

in t

he

PCT

unde

r th

e ne

w G

P co

ntra

ct f

or t

he p

rovi

sion

of

GP

serv

ices

and

rei

mbu

rsem

ent

expe

nses

for

sta

ffing

and

com

putin

g.Th

e G

Ps o

n th

e Bo

ard

and

Prof

essi

onal

Exe

cutiv

e C

omm

ittee

had

no

dire

ct c

ontr

ol o

ver

how

the

se f

unds

wer

e al

loca

ted.

Det

ails

of

paym

ents

dur

ing

the

year

to

GP’

s on

the

Boa

rds

and

Prof

essi

onal

Exe

cutiv

e C

omm

ittee

wer

e as

fol

low

s.

£000

’s

Dr

M A

ndre

ws:

Par

tner

at

Dr

Hen

ders

on a

nd P

artn

ers

1,10

2

Dr

T K

ostic

k: P

artn

er a

t D

r Ba

xani

and

Par

tner

s1,

333

Dr

M H

offm

an:P

artn

er a

t D

r H

offm

an a

nd P

artn

ers

1,91

0

Dr

P Sh

illid

ay: P

artn

er a

t G

arde

n C

ity P

ract

ice

1,17

7

Paym

ents

to

Rela

ted

Part

y£0

00

Rece

ipts

from

Rela

ted

Part

y£0

00

Am

ount

s ow

ed t

o Re

late

d Pa

rty

£000

Am

ount

s du

e fr

om

Rela

ted

Part

y £0

00

Barn

et a

nd C

hase

Far

m H

ospi

tals

NH

S Tr

ust

20,3

820

320

0

Cam

brid

ge U

nive

rsity

Hos

pita

ls N

HS

Foun

datio

n Tr

ust

17,6

580

762

0

East

and

Nor

th H

erts

NH

S Tr

ust

177,

700

4,02

82,

862

1,15

7

East

of

Engl

and

Stra

tegi

c H

ealth

Aut

horit

y47

95,

128

3299

7

East

of

Engl

and

Am

bula

nce

Serv

ices

NH

S Tr

ust

14,4

3932

709

0

Her

tfor

dshi

re C

ount

y C

ounc

il87

,574

1,62

20

0

HM

Rev

enue

and

Cus

tom

s6,

092

051

837

8

NH

S Pe

nsio

n Sc

hem

e5,

101

065

90

Sout

h Ea

st E

ssex

PC

T41

,779

088

10

The

Prin

cess

Ale

xand

ra H

ospi

tal N

HS

Trus

t35

,794

837

486

837

Uni

vers

ity C

olle

ge L

ondo

n N

HS

Foun

datio

n Tr

ust

8,76

40

133

0

Wes

t H

ertf

ords

hire

PC

T18

,245

861

3,83

50

Not

e 20

. Rel

ated

Par

ty T

ran

sact

ion

s


Not

es t

o th

e ac

cou

nts

No

te 2

0A. R

elat

ed P

arty

Tra

nsa

ctio

ns

2007

/08

East

and

Nor

th H

erfo

rdsh

ire P

CT

is a

bod

y co

rpor

ate

esta

blis

hed

by o

rder

of

the

Secr

etar

y of

Sta

te f

or H

ealth

.

Dur

ing

the

year

non

e of

the

Boa

rd M

embe

rs o

r m

embe

rs o

f th

e ke

y m

anag

emen

t st

aff

or p

artie

s re

late

d to

the

m h

asun

dert

aken

any

mat

eria

l tra

nsac

tions

with

the

PC

T

Dur

ing

the

year

loca

l GPs

sat

on

the

Boar

d an

d Ex

ecut

ive

Com

mitt

ee o

f th

e PC

Ts. P

aym

ents

are

mad

e to

all

prac

tices

in t

he

PCT

unde

r th

e ne

w G

P co

ntra

ct f

or t

he p

rovi

sion

of

GP

serv

ices

and

rei

mbu

rsem

ent

expe

nses

for

sta

ffing

and

com

putin

g.Th

e G

Ps o

n th

e Bo

ard

and

Prof

essi

onal

Exe

cutiv

e C

omm

ittee

had

no

dire

ct c

ontr

ol o

ver

how

the

se f

unds

wer

e al

loca

ted.

Det

ails

of

paym

ents

dur

ing

the

year

to

GPs

on

the

Boar

ds a

nd E

xecu

tive

Com

mitt

ee o

r th

eir

prac

tices

.

£000

’s

Dr

M A

ndre

ws:

Par

tner

at

Dr

Hen

ders

on a

nd P

artn

ers

1,00

3

Dr

T K

ostic

k: P

artn

er a

t D

r Ba

xani

and

Par

tner

s1,

210

Dr

M H

offm

an: P

artn

er a

t D

r H

offm

an a

ndPa

rtne

rs1,

656

Dr

P Sh

illid

ay: P

artn

er a

t G

arde

n C

ity P

ract

ice

1,00

4


Not

es t

o th

e ac

cou

nts Pa

ymen

ts t

o Re

late

d Pa

rty

£000

Rece

ipts

from

Rela

ted

Part

y£0

00

Am

ount

s ow

ed t

o Re

late

d Pa

rty

£000

Am

ount

s du

e fr

om

Rela

ted

Part

y £0

00

Barn

et a

nd C

hase

Far

m H

osp

NH

ST19

,949

439

Bart

s an

d Th

e Lo

ndon

NH

S Tr

ust

3,23

916

6

Basi

ldon

and

Thu

rroc

k U

nive

rsity

Hos

pita

ls

NH

S Fo

unda

tion

Trus

t63

136

9

Bedf

ords

hire

PC

T17

155

028

25

Cam

brid

ge U

nive

rsity

Hos

pita

ls N

HS

Foun

datio

n Tr

ust

19,0

0015

85

Cam

brid

gesh

ire P

CT

768

49

East

and

Nor

th H

erts

NH

S Tr

ust

168,

733

4,18

43,

351

628

East

of

Engl

and

Stra

tegi

c H

ealth

Aut

horit

y16

974

7433

0

East

of

Engl

and

Am

bula

nce

Serv

ices

NH

S Tr

ust

12,8

3351

751

9

Guy

’s an

d St

Tho

mas

’ NH

S Fo

unda

tion

Trus

t1,

083

79

Her

tfor

dshi

re P

artn

ersh

ip N

HS

Foun

datio

n Tr

ust

243

994

1,15

21,

043

Her

tfor

dshi

re C

ount

y C

ounc

il80

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513

119

270

HM

Rev

enue

and

Cus

tom

s6,

106

1,36

222

953

6

Impe

rial C

olle

ge H

ealth

care

NH

S Tr

ust

2,27

295

Luto

n an

d D

unst

able

Hos

pita

l NH

S Fo

unda

tion

Trus

t2,

238

184

Mid

Ess

ex H

ospi

tal S

ervi

ces

NH

S Tr

ust

701

101

Moo

rfiel

ds E

ye H

ospi

tal N

HS

Foun

datio

n Tr

ust

628

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th E

ssex

Par

tner

ship

NH

S Fo

unda

tion

Trus

t35

235

120

620

0

Nor

th M

iddl

esex

Uni

vers

ity H

ospi

tal N

HS

Trus

t2,

581

52

Nor

th W

est

Lond

on H

ospi

tals

NH

S Tr

ust

458

29

Nat

iona

l Ins

uran

ce F

und

2,63

842

3

NH

S Bu

sine

ss S

ervi

ces

Aut

horit

y48

346

NH

S Pe

nsio

n Sc

hem

e4,

700

583

Papw

orth

Hos

pita

l NH

S Fo

unda

tion

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t3,

168

157

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l Bro

mpt

on a

nd H

arefi

eld

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S Tr

ust

6,24

118

4

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l Fre

e H

amps

tead

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S Tr

ust

6,09

023

0

Roya

l Nat

. Ort

hopa

edic

Hos

pita

l NH

S Tr

ust

2,17

645

9

Sout

h Ea

st E

ssex

PC

T14

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2320

23

The

Prin

cess

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xand

ra H

ospi

tal N

HS

Trus

t32

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814

115

611

Uni

vers

ity C

olle

ge L

ondo

n N

HS

Foun

datio

n Tr

ust

7,59

01,

065

Wel

wyn

Hat

field

Dis

tric

t C

ounc

il63

638

Wes

t Es

sex

PCT

3,84

11,

820

5035

3

Wes

t H

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ords

hire

PC

T16

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651

65

Wes

t H

ertf

ords

hire

NH

S Tr

ust

575

168

172

154

The

Dep

artm

ent

of H

ealth

is r

egar

ded

as a

rel

ated

par

ty. D

urin

g th

e ye

ar t

he P

CT

has

had

a si

gnifi

cant

num

ber

of m

ater

ial

tran

sact

ions

with

the

Dep

artm

ent,

and

with

oth

er e

ntiti

es f

or w

hich

the

Dep

artm

ent

is r

egar

ded

as t

he p

aren

t D

epar

tmen

t.

Thes

e en

titie

s ar

e lis

ted

belo

w;


Not

es t

o th

e ac

cou

nts

In a

dditi

on, t

he P

CT

has

had

a si

gnifi

cant

num

ber

of m

ater

ial t

rans

actio

ns w

ith o

ther

Gov

ernm

ent

Dep

artm

ents

and

oth

er

cent

ral a

nd lo

cal G

over

nmen

t bo

dies

. Whe

re a

ppro

pria

te, t

hese

tra

nsac

tions

hav

e be

en re

flect

ed in

thi

s ta

ble.

The

PCT

has

also

rec

eive

d re

venu

e an

d ca

pita

l pay

men

ts f

rom

a n

umbe

r of

cha

ritab

le f

unds

, cer

tain

of

the

Trus

tees

for

w

hich

are

als

o m

embe

rs o

f th

e PC

T Bo

ard.

Not

e 21

. Pri

vate

Fin

ance

Tra

nsa

ctio

ns

No

te 2

1.1.

PFI

sch

emes

dee

med

to

be

off

-bal

ance

sh

eet

2008

/09

£000

2007

/08

£000

Am

ount

s in

clud

ed w

ithin

ope

ratin

g ex

pens

es in

res

pect

of

PFI t

rans

actio

ns d

eem

ed t

o be

off

-bal

ance

she

et -

gros

s.2,

415

2,32

1

Am

ortis

atio

n of

PFI

def

erre

d as

set

(153

)(1

50)

Net

ch

arg

e to

op

erat

ing

co

sts

2,26

22,

171

The

PCT

is c

omm

itted

to

mak

e th

e fo

llow

ing

paym

ents

dur

ing

the

next

yea

r, in

whi

ch t

he P

FI s

chem

e ex

pire

s

2008

/09

£000

2007

/08

£000

With

in o

ne y

ear

00

2 to

5 y

ears

(inc

lusi

ve)

00

6 to

10

year

s (in

clus

ive)

00

11 t

o 15

yea

rs (i

nclu

sive

)0

0

16 t

o 20

yea

rs (i

nclu

sive

)0

0

21 t

o 25

yea

rs (i

nclu

sive

)2,

415

2,32

1

The

PFI s

chem

e is

a r

edev

elop

men

t on

the

Her

ts a

nd E

ssex

Hos

pita

l site

to

prov

ide

mod

ern

upda

ted

Hea

lth S

ervi

ces

to

incl

ude

Elde

rly M

edic

ine

and

Men

tal H

ealth

.Out

patie

nt f

acili

ties

for

a ra

nge

of s

peci

aliti

es a

re a

lso

bein

g pr

ovid

ed. T

he d

e-ve

lopm

ent

also

incl

udes

a M

inor

inju

ries

unit

and

acco

mm

odat

ion

for

com

mun

ity s

ervi

ces.

The

sch

eme

has

been

dev

elop

ed

in c

onju

nctio

n w

ith a

nur

sing

hom

e de

velo

pmen

t si

tuat

ed a

t H

arlo

w.

£000

The

estim

ated

cap

ital v

alue

of

the

PFI s

chem

e14

,200

Con

trac

t st

art

date

28/0

4/20

03

Con

trac

t en

d da

te28

/04/

2033


Not

es t

o th

e ac

cou

nts

Not

e 22

. Fin

anci

al I

nst

rum

ents

FRS

29, F

inan

cial

Inst

rum

ents

: Dis

clos

ures

, req

uire

s di

sclo

sure

of

the

role

tha

t fin

anci

al in

stru

men

ts h

ave

had

durin

g th

e pe

riod

in c

reat

ing

or c

hang

ing

the

risks

an

entit

y fa

ces

in u

nder

taki

ng it

s ac

tiviti

es. B

ecau

se o

f th

e w

ay P

CTs

are

fina

nced

, th

ey a

re n

ot e

xpos

ed t

o th

e de

gree

of

finan

cial

ris

k fa

ced

by b

usin

ess

entit

ies.

Als

o fin

anci

al in

stru

men

ts p

lay

a m

uch

mor

e lim

ited

role

in c

reat

ing

or c

hang

ing

risk

than

wou

ld b

e ty

pica

l of

the

liste

d co

mpa

nies

to

whi

ch F

RS 2

9 m

ainl

y ap

plie

s. T

he

PCT

has

limite

d po

wer

s to

bor

row

or

inve

st s

urpl

us f

unds

and

fina

ncia

l ass

ets

and

liabi

litie

s ar

e ge

nera

ted

by d

ay-t

o-da

y op

erat

iona

l act

iviti

es r

athe

r th

an b

eing

hel

d to

cha

nge

the

risks

fac

ing

the

PCT

in u

nder

taki

ng it

s ac

tiviti

es.

As

allo

wed

by

FRS

29, d

ebto

rs a

nd c

redi

tors

tha

t ar

e du

e to

mat

ure

or b

ecom

e pa

yabl

e w

ithin

12

mon

ths

from

the

bal

ance

sh

eet

date

hav

e be

en o

mitt

ed f

rom

all

disc

losu

res

othe

r th

an t

he c

urre

ncy

profi

le.

Liqu

idity

risk

Mos

t of

the

PC

T’s

net

oper

atin

g co

sts

are

incu

rred

und

er a

nnua

l ser

vice

agr

eem

ents

with

loca

l PC

Ts, N

HS

Trus

ts a

nd N

HS

Foun

datio

n Tr

usts

and

are

fina

nced

fro

m r

esou

rces

vot

ed a

nnua

lly b

y Pa

rliam

ent

or d

irect

ly fi

nanc

ed f

rom

res

ourc

es v

oted

an

nual

ly b

y Pa

rliam

ent.

The

PC

T al

so la

rgel

y fin

ance

s its

cap

ital e

xpen

ditu

re f

rom

fun

ds m

ade

avai

labl

e fr

om G

over

nmen

t.

East

and

Nor

th H

ertf

ords

hire

PC

T is

not

, the

refo

re, e

xpos

ed t

o si

gnifi

cant

liqu

idity

ris

ks.

Inte

rest

-Rat

e Ri

sk10

0% o

f th

e PC

T’s

finan

cial

ass

ets

and

100%

of

its fi

nanc

ial l

iabi

litie

s ca

rry

nil o

r fix

ed r

ates

of

inte

rest

. Eas

t an

d N

orth

H

ertf

ords

hire

PC

T is

not

, the

refo

re, e

xpos

ed t

o si

gnifi

cant

inte

rest

-rat

e ris

k. T

he f

ollo

win

g tw

o ta

bles

sho

w t

he in

tere

st r

ate

profi

les

of t

he P

CT’

s fin

anci

al a

sset

s an

d lia

bilit

ies:

No

te 2

2.1

Fina

ncia

l Ass

ets

Fixe

d Ra

teN

on-in

tere

st

bear

ing

Curr

ency

Tota

l £0

00

Floa

ting

rate

£0

00Fi

xed

rate

£0

00

Non

-inte

rest

be

arin

g£0

00

Wei

ghte

d av

e in

tere

st

rate

%

Wei

ghte

d av

e pe

riod

for

whi

ch fi

xed

Year

s

Wei

ghte

d av

erag

e te

rm

Year

s

At

31 M

arch

200

9

Ster

ling

1,63

60

01,

636

00

22

Oth

er0

00

00

00

Gro

ss fi

nanc

ial a

sset

s1,

636

00

1,63

6

At

31 M

arch

200

8

Ster

ling

1,79

20

01,

792

00

23

Oth

er0

00

00

00

Gro

ss fi

nanc

ial a

sset

s1,

792

00

1,79

2


Not

es t

o th

e ac

cou

nts

No

te 2

2.2

Fina

ncia

l Lia

bilit

ies

Fixe

d Ra

teN

on-in

tere

st

bear

ing

Curr

ency

Tota

l £0

00

Floa

ting

rate

£0

00Fi

xed

rate

£0

00

Non

-inte

rest

be

arin

g£0

00

Wei

ghte

d av

e in

tere

st

rate

%

Wei

ghte

d av

e pe

riod

for

whi

ch fi

xed

Year

s

Wei

ghte

d av

erag

e te

rm

until

mat

urity

Ye

ars

At

31 M

arch

200

9

Ster

ling

810

810

062

0

Oth

er0

00

00

00

Gro

ss fi

nanc

ial a

sset

s81

081

0

At

31 M

arch

200

8

Ster

ling

162

016

20

067

0

Oth

er0

00

00

00

Gro

ss fi

nanc

ial a

sset

s16

20

162

0

Fore

ign

Curr

ency

Ris

kTh

e PC

T ha

s ne

glig

ible

for

eign

cur

renc

y in

com

e or

exp

endi

ture

.

No

te 2

2.3

Fair

Valu

esTh

e fa

ir va

lues

of

finan

cial

ass

ets

and

liabi

litie

s in

Not

es 2

2.4

and

22.5

opp

osite

do

not

defe

r m

ater

ially

fro

m t

heir

carr

ying

am

ount

s.

No

te 2

2.4

Fina

ncia

l Ass

ets

At f

air v

alue

th

roug

h pr

ofit

and

loss

£000

Loan

s an

d

rece

ivab

les

£000

Avai

labl

e

for s

ale

£000

Tota

l£0

00

Embe

dded

der

ivat

ives

00

00

NH

S de

btor

s0

00

0

Non

NH

S de

btor

s0

00

0

Cas

h at

ban

k an

d in

han

d0

00

0

Oth

er fi

nanc

ial a

sset

s0

1,63

60

1,63

6

Tota

l at 3

1 M

arch

200

90

1,63

60

1,63

6

No

te 2

2.5

Fina

ncia

l Lia

bilit

ies

At f

air v

alue

th

roug

h pr

ofit

and

loss

£000

Avai

labl

e f

or s

ale

£000

Tota

l£0

00

Embe

dded

der

ivat

ives

00

0

NH

S cr

edito

rs0

00

Non

NH

S cr

edito

rs0

00

Borr

owin

gs0

00

Priv

ate

Fina

nce

Initi

ativ

e an

d fin

ance

leas

e ob

ligat

ions

032

32

Oth

er fi

nanc

ial l

iabi

litie

s0

4949

Tota

l at 3

1 M

arch

200

90

8181


Not

es t

o th

e ac

cou

nts

No

te 2

3. T

hir

d p

arty

ass

ets

The

PCT

held

£1,

906

cash

at

bank

and

in h

and

at 3

1/3/

2009

whi

ch r

elat

es t

o m

onie

s he

ld o

n be

half

of p

atie

nts

(£1,

902

at

31/3

/08)

. Thi

s ha

s be

en e

xclu

ded

from

cas

h at

ban

k an

d in

han

d fig

ure

repo

rted

in t

he a

ccou

nts.

No

te 2

4. L

oss

es a

nd

Sp

ecia

l Pay

men

tsTh

ere

wer

e 26

cas

es o

f lo

sses

and

spe

cial

pay

men

ts (2

007/

08: 2

5 ca

ses)

tot

allin

g £7

0,69

5 (2

007/

08: £

34,8

30)

appr

oved

dur

ing

2008

/09.

Ther

e w

ere

no c

linic

al n

eglig

ence

cas

es w

here

the

net

pay

men

t ex

ceed

ed £

100,

000

in 2

008/

9 or

200

7/8.

Ther

e w

ere

no f

raud

cas

es w

here

the

net

pay

men

t ex

ceed

ed £

100,

000

in 2

008/

9 or

200

7/8.

Ther

e w

ere

no p

erso

nal i

njur

y ca

ses

whe

re t

he n

et p

aym

ent

exce

eded

£10

0,00

0 in

200

8/9

or 2

007/

8.

Ther

e w

ere

no c

ompe

nsat

ion

unde

r le

gal o

blig

atio

n ca

ses

whe

re t

he n

et p

aym

ent

exce

eded

£10

0,00

0 in

200

8/9

or 2

007/

8.

Ther

e w

ere

no f

ruitl

ess

paym

ent

case

s w

here

the

net

pay

men

t ex

ceed

ed £

100,

000

in 2

008/

9 or

200

7/8.

Not

e: T

he t

otal

cos

ts in

clud

ed in

thi

s no

te a

re o

n an

acc

rual

s ba

sis.

Not

e 25

. In

tra-

gove

rnm

ent

bal

ance

s

Deb

tors

Am

ount

s fa

lling

due

with

in

one

year

£000

Deb

tors

Am

ount

s fa

lling

due

aft

er

mor

e th

an o

ne

year

£000

Cred

itors

A

mou

nts

fa

lling

due

w

ithin

on

e ye

ar£0

00

Cred

itors

Am

ount

s fa

lling

due

aft

er

mor

e th

an o

ne y

ear

£000

Bala

nces

with

oth

er c

entr

al

gove

rnm

ent

bodi

es2,

237

07,

004

0

Bala

nces

with

loca

l aut

horit

ies

851

018

30

Bala

nces

with

NH

S Tr

usts

/FTs

3,02

40

5,37

30

Bala

nces

with

pub

lic c

orpo

ratio

ns

and

trad

ing

fund

s0

00

0

Bala

nces

with

bod

ies

exte

rnal

to

Gov

ernm

ent

6,07

51,

636

34,6

9132

At 3

1 M

arch

200

912

,187

1,63

647

,251

32

Bala

nces

with

oth

er c

entr

al

gove

rnm

ent

bodi

es1,

574

01,

731

0

Bala

nces

with

loca

l aut

horit

ies

288

044

60

Bala

nces

with

NH

S Tr

usts

/FTs

3,44

70

10,0

270

Bala

nces

with

pub

lic c

orpo

ratio

ns

and

trad

ing

fund

s0

00

0

Bala

nces

with

bod

ies

exte

rnal

to

Gov

ernm

ent

4,55

01,

714

27,9

1897

At 3

1 M

arch

200

89,

859

1,71

440

,122

97


Alternative formats and additional copies

For people who may have difficulty reading the print in this report, a large print version can be made available by contacting our communications team:

Communications TeamHertfordshire Primary Care TrustsCharter HouseParkwayWelwyn Garden CityHertfordshireAL8 6JL

Telephone: 01707 390855Email: [email protected]

The communications team can also arrange to provide the following on request:

Additional copies of this document •(hard copy or electronic version) An audio-cassette or CD version •(arranged on request only) Help in understanding the document in languages other than English•

Please note that this Report is also available to download from the NHS East and North Hertfordshire website as follows:

www.enherts-pct.nhs.uk

Contact us

You can write to us at:

NHS East and North HertfordshireCharter HouseParkwayWelwyn Garden CityHertfordshireAL8 6JL

You can telephone us on: 01707 390855 (Switchboard open 8am – 6pm)

You can email us at: [email protected] visit our website: www.enherts-pct.nhs.uk


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01707 369705 - Urdu

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We would like to pay tribute to the outstanding contribution and dedication of our staff. Everyone has a played their part in helping people in Hertfordshire to remain healthy and stay active.

Published September 2009