service development strategy - salisbury · service development strategy ... final version as at...

Salisbury Health CareNHS Trust

Service DevelopmentStrategy

Application NHS Foundation Trust Status

Service Development Strategy

List of Appendices Appendix A Activity and Income by Specialty Appendix B List of Specialties & Departments Appendix C Board Profiles Appendix D SWOT Analysis Appendix E Directorate Service Development Plans Appendix F Five Year Capital Programme Appendix G Three Year Trust Accounts Appendix H Non-Recurrent Income Appendix I Unregulated Income Appendix J Cost Improvement Programme Achievements (3 Years) Appendix K Reference Cost Analysis Appendix L Payment by Results Tariff Analysis Appendix M Trust Benchmarking Exercise Appendix N Budgeted Levels of Activity Appendix O Trust Total Income Appendix P Projected Income by PbR Exercise (October 2005) Appendix Q Basecase Summary PbR Information Appendix R Application of funds Appendix S Basecase Financial Assumptions Appendix T Manpower Planning Appendix U Estimates of Laundry Income Appendix V Capital Programme, 2005/6 Appendix W Cost Improvement Programme, 2005/6 Appendix X Cost Improvement Programme, 2006/7 to 2010/11 Appendix Y Financial Analyses – Basecase Appendix Z List of Protected and Unprotected Assets - Building Appendix AA List of Protected and Unprotected Assets – Land Appendix AB Scenario Inflation Assumptions Appendix AC Activity Summary Information – Medium Scenario Appendix AD Financial Modelling – Medium Scenario Assumptions Appendix AE Financial Analysis – Medium Scenario Appendix AF Activity Summary Information – Low Scenario Appendix AG Financial Modelling – Low Scenario Assumptions Appendix AH Manpower Planning – Low Scenario Appendix AI Financial Analysis – Low Scenario Appendix AJ Activity Summary Information – High Scenario Appendix AK Financial Modelling – High Scenario Assumptions Appendix AL Manpower Planning – High Scenario Appendix AM Financial Analysis – High Scenario Appendix AN Normalised Earnings Appendix AO Finance Committee – Terms of Reference Appendix AP Risk Management Analysis Appendix AQ Risk Methodology Appendix AR

PCT Letters of Support

Salisbury Health Care NHS Trust Appendix AActual Attendances 2004/05Final Version as at 28/06/05

Daycase IP Elective IP Emergency Total

Ref Specialty Spells Spells Spells New Atted.Follow Up

Attend £100 General Surgery 1,949 983 2,178 4,678 6,109 9,664,971101 Urology 1,991 681 382 1,849 2,665 3,420,025110 T&O 1,099 1,344 1,270 6,433 13,105 11,770,778120 ENT 343 341 170 4,062 4,761 1,645,888130 Ophthalmology 1,711 116 37 6,332 17,873 2,895,847140 Oral Surgery 818 163 129 2,826 5,569 1,806,284143 Orthodontics 239 1,391 154,958156 Spinal Injury 29 1,016 0160 Plastic Surgery 1,205 1,545 1,474 4,102 10,182 7,964,622166 Plastics & Burns 0171 Paediatric Surgery 110 120 31,122180 A&E 1 1,780 1,821,066190 Anaesthetics 129 1 29 6 76,086300 General medicine 2,033 128 6,269 3,579 9,998 16,885,452301 Gastroenterology 23 1 8 0 49 35,922302 Endocrinology 6 198 857 138,215303 Clinical Haematology 1,742 108 105 478 2,612 1,550,791307 Diabetic Medicine 142 809 75,843311 Clinical Genetics 7 17 0314 Rehab 186 268 0315 Palliative medicine 0320 Cariology 561 39 5 616 255 701,217330 Dermatology 270 1 3 3,044 4,436 758,152361 Nephrology 82 545 0370 Clinical Oncology 1,986 44 51 158 978 1,954,310400 Neurology 2 508 600 8,278410 Rheumatology 169 8 1 1,219 4,005 754,003420 Paediatrics 23 47 1,848 1,297 3,359 2,549,371421 Paediatric Neurology 0 26 0426 NICU 0430 Elderly medicine 2 58 197 345 1,057 1,409,344501 Obstetrics 1 3 4,595 2,112 3,381 3,887,872502 Gynaecology 997 424 629 2,490 2,455 2,590,907506 Infertility 1 1 221 153 1,665560 Midwifery 371 76 0700 Learning Disabilities 0711 Child & Adolescent Psy. 46 255 0800 Radiotherapy 172 2 3 257 462 271,054810 Radiology 191 144 65 666,394822 Chem. Path 54 253 0950 Nurse Therapy 7,531 7,021 0

Critial Care - Includes Radnor/NICU/Burns & Spinal 10,577,150Ward Attenders 1,093,238Other Non PBR 16,462,931

CLEN Contact Lens Optician 82 109 0MOI XNC - Moire Fringe 39 24 0

MPH Medical Physics 278 138 0OPTM Optometry 345 34 0

ORC Orthotics 1,789 1,858 0VAS Vascular Assessment 603 107 0

Not Defined 6 1 0All Other 0Non- Attributed 0Total 17,415 6,183 21,208 58,772 108,995 103,623,757

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Out Patient

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Abc Appendix B

Appendix B List of Specialties

Surgery General Surgery

Urology

Plastic Surgery*

Burns*

Cleft Lip and Palate*

Maxillo-facial Surgery

Wessex Rehabilitation Centre

Critical Care A&E

Trauma and Orthopaedics

ITU/HDU

Operating Theatres

Anaesthetics

Spinal Injuries( )

Medicine General Medicine

Elderly Care

Gastroenterology

Cardiology

Endocrinology

Respiratory Medicine

Dermatology

Rheumatology

Medical Oncology

Clinical Haematology

Genito-Urinary Medicine

Palliative Care

Ambulatory Care and Child Health Ophthalmology

ENT

Paediatrics

Obstetrics

Gynaecology

CAMHS

NICU

Outpatients

Day Surgery

Endoscopy

Clinical Support Radiology

Histopathology

Biochemistry

Laboratory Haematology

Microbiology

Genetics

Speech and Language

Therapy

Medical Photography

Pharmacy

Medical Physics

(vi) Cancer

Regional

Supra-regional

Abc Appendix C

Appendix C - Trust Board Directors

EXECUTIVE TEAM Frank Harsent – Chief Executive – in position since June 2001 Experience

Executive Director since March 1993 Chief Executive for over 10 years 2 previous Chief Executive posts

Qualifications PhD in Corporate Governance in the NHS from Durham University in 2004

MBA from the London Business School in 1994 Member of the Institute of Healthcare Management

Malcolm Cassells – Finance Director – in position since March 1986 Experience

Executive Director for nearly 20 years Secondment as Interim Director of Resources for National Police Training Governor of Salisbury College

Qualifications Chartered Accountant (CIPFA)

MBA from Bath University in 1990 Member of the Institute of Healthcare Management

Alistair Flowerdew – Medical Director – in position since April 2004 Experience

Consultant in General Surgery since 1990 Clinical Director at West Dorset Hospital for 7 years Member of a number of committees for Royal College of Surgeons

Qualifications Qualified in Medicine in London in 1975

Fellow of the Royal College of Surgeons in 1981 Masters degree from Southampton University in 1987

Abc Appendix C

Tracey Nutter – Director of Nursing – in position since April 2003 Experience

Registered nurse for 25 years Has worked in Newcastle, London and Southampton

Qualifications MSc and BSc (Hons) in Health Services Management from Manchester University

Diploma in Professional Studies of Nursing Further Education Teaching Certificate Certificate in Oncology Nursing

Peter Hill – Director of Operations – in position since April 2001 Experience

Executive Director for over 4 years Has worked in Essex, USA, Newcastle and London Extensive knowledge of operational management of a DGH

Qualifications MBA from the Open University

Registered Nurse NHS Leadership Programme for Executive Directors King’s Fund Sustaining High Performance Programme Currently studying for a Certificate in Performance Management

Alan Denton – Director of Human Resources – in position since 1994 Experience

Over 20 years HR working with 16 years in the NHS Trained job evaluator

Qualifications Chartered Fellow of the Chartered Institute of Personnel and Development

MA in HR Management from Thames Valley University HND in Business Studies

Abc Appendix C

NON-EXECUTIVE DIRECTORS Luke March – Chairman – Appointed Chairman in January 2005 Experience

Over 30 years commercial experience including Director of TSB Bank, Corporate Governance Director of BT, Chief

Executive of Mortgage Code Compliance Board and, currently, Compliance Director of Royal Mail Group Non-Executive of NHS Boards since 1988, most recently Vice Chairman of East London and the City Health Authority

and of Barts and The London NHS Trust

Qualifications Honours Law degree at Durham University Cabinet office Top Management Programme

David Quayle – Vice Chairman and Chair of Clinical Governance – Appointed NED in November 1999 Experience

Senior staff and command appointments in Army, followed by second career as Estate Agents Ombudsman Public interest member of financial regulatory board and charity trustee

Qualifications BA (Hons) in Animal Physiology, Army technical and general staff training (including instructor)

Ruth Blakelock – Appointed NED in 2000 Experience

Lifetime career in family mediation and alternative dispute resolution as a practitioner, manager and professional

practice consultant. Lay member and assessor for the Mental Health Tribunal. Locally involved as a parish councillor, school governor and chairman of governors. Previous career in agricultural education in Africa!

Qualifications MA Cantab (Geography)

Abc Appendix C

Ian Davies – Audit Committee Chair – Appointed NED in 2001 Experience

Audit Partner in large firm, and NED of several private and Plc companies. NHS Trust Director since 1993

Qualifications Chartered Accountant and MBA

Ron Burrows – Appointed NED in 2000 Experience

25 years in senior management appointments in commercial and public operations. Have been Director of Training,

Director of Operations and Director of Finance in aerospace and education sectors

Qualifications Professional management training, post-graduate qualifications in aerospace and education (RAF Group Captain)

Barry Bull – Appointed NED in January 2005 Experience

40 years in business, 30 at Board level, with 25 in Unilever as Senior General Management and Commercial

experience in a wide range of industries, including healthcare, charities and business consultancy

Qualifications BSc (Hons) Geography

Abc Appendix D – SWOT Analysis

Strengths Weaknesses Opportunity Threats Analysis Strengths

Strength Description Evidence How Strengths will be Built On S1 Operational and

financial management

The Trust has an enviable track record of delivery against NHS and DH Performance Targets. Financially the Trust has consistently performed well. We have a stable management team with a change management capability currently working on

• The introduction of electronic patient records and better bookings systems.

• Risk management and integrating this with Service Improvement plans and Service Redesign.

• A PFI capital development coming on stream early in 2006, a recently opened endoscopy / cardiac suite and a new cancer unit opening in 2005.

Trust has achieved financial balance in every one of the 10 years since its inception. Strong record in delivering national targets. The Trust hit all NHS Key Targets and earned three stars in the NHS Performance Ratings for 2004/05. The Trust received High Balanced Scorecard ratings in all three areas of focus: Clinical focus, Patient focus, Capacity and Capability focus. The Trust has delivered a number of major infrastructure schemes in recent years (PFI scheme nearing completion, some £7m of new building schemes, replacement PAS system)

The Trust will carry forward its existing high performance into FT status using the opportunities available to FT’s to the best possible advantage. The Trust will be seeking to achieve the NHS Improvement Plan targets ahead of timescale subject to PCT funding. The opportunities provided by the membership scheme will offer the Trust management team an added insight into patients’ requirements which will assist in delivering a patient-focused service. The Trust's positive reference cost position (see S2) below will enable the Trust to secure financial benefits which can be re-invested to the best possible use for patient benefit. The Trust's excellent track record in delivering schemes will ensure that the funding is used appropriately to secure maximum value. The Trust is well-placed to apply its existing systems to the financial rigours required of a FT.

S2 Reference costs The Reference Costs benchmarking exercise shows the Trust’s costs per procedure to be below the national

Recently published national figures Maintaining a low reference cost position will be essential for the Trust as PbR is implemented to allow the Trust to secure

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Strength Description Evidence How Strengths will be Built On average. It is among the top 20 most cost-effective providers in the NHS in England. When the Payment by Results (PbR) tariff is introduced in 2005, the Trust will benefit financially.

maximum financial benefit to its favourable reference cost position. The Trust is embarking on another cost improvement plan this year to ensure this position is maintained.

S3 Clinical / management working

As with all other NHS providers, our intelligence on comparative clinical performance needs development but where comparable data is available Salisbury Health Care NHS Trust performs well.

Continued improvement High quality of care. Our MRSA infection rate is within the best performing quartile of all NHS hospitals. Clinical governance report cards Dr Foster clinical system benchmarks the Trust's clinical performance.

The Trust will be looking to build on its excellent clinical quality to ensure that SDH remains the hospital of choice for local residents. The Dr Foster system will alert the Trust to areas in which to focus attention to ensure that quality of care remains good. The Trust will be reviewing its clinical performance in light of the Healthcare Standards and is looking to extend its clinical information systems to be able to record more in the way of outcomes data. The Trust is already beginning to work with clinicians to work through which clinical indicators might be publicised to help patients assess the quality of care provided by the hospital.

S4 Established catchment areas

The Trust has a well-established ‘core’ catchment population of approximately 200,000 and wider catchment populations for specialist services:

• Burns & Plastic Surgery, Cleft lip and palate, genetics and rehabilitation services areprovided to a population of 3,000,000.

Whilst established the catchment population does appear to be growing. Increasing referrals from Kennet & West Wiltshire. Even emergency admissions from areas traditionally served by RUH Bath are increasingly coming to Salisbury.

• The Duke of Cornwall Spinal Treatment Centre serves a

Analysis of referral patterns over time.

Established catchment areas provide the foundation for the Trust to grow and develop. The Trust will be looking to ensure that patients from these areas continue to see SDH as their hospital of choice by maintaining high standards of care whilst seeking to make the infrastructure more patient-friendly. The Trust will be looking to build on and extend its existing catchment area in a sustainable way to ensure growth.

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Strength Description Evidence How Strengths will be Built On population of 11,000,000 across southern England and is part of a national network with its nearest neighbours in Stanmore and Oswestry.

The population lives in a predominantly rural catchment area, with the hospital located in the largest population centre, Salisbury.

Market analysis.

S5 Public involvement and local stakeholder support

The Trust’s adopted Values & Beliefs outline our commitment to integrated care pathways, patient-centred care and our ambition to continuously improve the patient’s experience of the National Health Service. We are committed to:

“…putting the interests of patients first …listening to, showing respect for and treating patients fairly……maintaining the welcoming, friendly atmosphere and the sense of community spirit we currently enjoy”

Increasingly close working relationships exist with other local agencies, for instance through the Local Strategic Partnership – the South Wiltshire Alliance. Tangible benefits from closer working relationships include the reduction in delayed discharges as a result of work with Wiltshire County Council and the establishment of a multiple sclerosis specialist post as a result of work with local and national support groups and our

The Trust has a large and active network of volunteer support. Over 550 volunteers give up over 1600 hours per week. This volunteer workforce, equivalent to around 45 WTE staff, support the whole range of services for patients, including the on-site Salisbury Hospice and the fifty year old hospital radio, Radio Odstock. We also have established strong and enduring links with local schools and colleges. Our patient survey response rates are above the national average, reflecting the positive way in which the local community takes an interest in our services. The latest survey reported increased perceptions of: public involvement in decision-making, information received from clinical staff and treatment in terms of privacy and dignity. Patient focus groups are one example of our Public & Patient Involvement work and are used to identify where the Trust can improve services and we have a

The Trust will build on its strengths in PPI to ensure that it uses patient activity to inform service developments and to ensure that the Trust's services become more responsive to pateitn needs. The Trust will embed PPI skills across the organisation to ensure that it becomes the mainstream. For example there are advanced plans to incorporate PPI skills into the KSF process for staff development (see HR strategy for more information).

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Strength Description Evidence How Strengths will be Built On host purchaser, South Wiltshire Primary Care Trust. Neighbouring PCTs acknowledge the contribution made by the Trust to the care of their populations.

• North Dorset PCT, who commission on behalf of all Trusts in Dorset for services to about 30,000 Dorset residents.

• Mid Hampshire PCT, who lead the commissioning of specialist services for Hampshire PCTs and have consistently supported the specialist services provided in Salisbury. This has been witnessed most recently in discussions about the future provision of Cleft Lip & Palate services and Plastic Surgery & Burns services.

New Forest PCT is the Hampshire PCT with largest patient flows to Salisbury and they remain supportive of our service provision to their patients.

growing reputation for service redesign to improve patient access and the patient experience. Our process re-engineering has led to collaborations with: the NHS Modernisation Agency, the Open University and others. The links between our Patient and Public Involvement activities and the development of our Clinical Governance framework are held up as a good practice exemplar by our Strategic Health Authority.

S6 Specialist services The national Burns Review has recommended Burns Unit status for Adults, which is what the Trust aimed to secure. This follows on from confirmation of the continuation of Cleft Lip & Palate services in Salisbury, following the

Designation as cleft lip centre with Oxford. Expected designation as burns unit as part of national burns review

The new PFI building includes improved facilities for burns and cleft lip which will improve the environment for and the function of these services. The development of the CLAP service will continue at a pace as result of the clinical

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Strength Description Evidence How Strengths will be Built On national review of service provision. The Spinal Treatment Centre is purpose-built and receives referrals from an 11,000,000 catchment population. The Trust also has pioneering Genetics and Medical Physics services.

network with the Oxford Radcliffe. The plastic surgery service will be developed and in particular will be looking to increase the free flap work it currently undertakes. The genetics service is rapidly increasing the number of tests which it can provide and its position as one of the two national reference laboratories will ensure it remains at the forefront. The medical physics department is to expand with new facilities and the development of a limited company to promote these technologies.

Weaknesses

Weakness Description Evidence How Weaknesses will be Mitigated W1 Host commissioner

finances South Wiltshire PCT has a recurring revenue shortfall of around £4,000,000. Reduced secondary care intervention rates are sought to reduce the recurring revenue problem. Under Payment by Results the Trust will recover a greater sum per patient than it currently receives. Ultimately this will exacerbate financial pressures in the health economy, although there is initial financial support to smooth the

PCT Local Delivery Plan The Trust is keen to work with South Wiltshire PCT to examine the potential for real reductions in referrals to SDH. There is no benefit to either party in patients attending secondary care services when alternative service provision is available. The Trust will be looking to play its role in demand management by using providing outreach services, eg using some of its consultant and specialist nurse expertise t ti t ff ti l

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Weakness Description Evidence How Weaknesses will be Mitigated introduction of Payment by Results.

to manage patients more effectively outside of the hospital.

W2 Fragmented commissioner base

Less than half of the Trust’s income comes from its host PCT, South Wiltshire PCT and only just over half comes from PCTs in the host Strategic Health Authority (SHA): Avon, Gloucestershire & Wiltshire SHA. Situated at the southern end of the SHA, the Trust has significant patient inflows from Dorset & Somerset SHA and Hampshire & Isle of Wight SHA. This geography, together with a history of relatively strong operational and financial performance, can result in the Trust being only peripherally involved in SHA performance / recovery actions.

Base estimates. The Chief Executive has an important role to play in maintaining the Trust's external focus. As a Foundation Trust Salisbury Health Care Trust will need to work harder still to ensure that its voice is heard. CE attends both AGW and Dorset Chief Executive and Central South Coast meetings to ensure Salisbury issues are heard and to ensure appropriate linkages are made.

W3 Small size of home catchment population

Geography constrains the Trust’s potential to capitalise on opportunities presented by Patient Choice policies. The rurality of the Trust’s surrounding catchment area, which extends over thirty miles from north to south and from east to west, results in a relatively small core catchment population. Salisbury itself is a city of only 40,000 people and the total core catchment population for DGH services is around 200,000.

Map showing patient populations The Trust’s relatively small DGH catchment population would normally raise critical mass issues for some of the smaller surgical specialties. However the presence on site of regional specialist services underpins the Trust's surgical portfolio (see section 6.5.5), for example the Oral and Maxillo-facial surgical department is an integral part of the Cleft Lip and Palate service. As outlined above, the Trust will look to extend its geographical boundaries and to a certain extent this is beginning to happen organically. However there is no expectation that this geographical spread will be anything other than marginal.

W4 ‘Traditional’ models Limited input from the private sector in the Limited private sector provision in the The Trust has undertaken advanced

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Weakness Description Evidence How Weaknesses will be Mitigated of elective and emergency care

locality. Impact of emergency pressures on elective care

locality. Trust suffers from the same problem as many other Trusts in terms of not having ringfenced elective capacity.

discussions to develop a private patient unit / treatment centre on the site. The Trust is working to mitigate the impact of medical outliers on elective work by undertaking more 23 hour surgery (7.3) and by reconfiguring its surgical wards and the Surgical Assessment Unit (7.7).

W5 Limited intermediate and community care infrastructure

The absence of community hospitals and the below average ratio of District Nurses per 1,000 population results in some patient care being undertaken in acute hospital settings which could more appropriately be delivered in community settings. It is also worth noting that with fewer community hospital transfers, Salisbury District Hospital has longer average lengths of stay than would otherwise be the case. This has an adverse financial impact with commissioners dealing in FFCEs and comparing FFCE prices between providers.

Figures from the PCT LOS benchmarking information.

The Trust will work closely with community service providers. With a review of the configuration of local PCTs in Wiltshire currently ongoing, it is possible that the provider arm of South Wiltshire PCT may revert to SHCT management. The view of the Trust will be that the care of patients will be undertaken in the setting which is most appropriate for the individual needs of the patient.

W6 Condition of the capital estate

Over 20% of the hospital estate predates the National Health Service and is over fifty five years old. A similar proportion of the estate is below estate condition B and the backlog maintenance cost is estimated at £6.2 million over the next ten years. It is likely that the physical environment will be a key factor in patients’ choice of

Trust Estates Strategy – ERIC returns. Patient surveys Patient Forum reports

The Trust has a two phase site redevelopment project underway. The first phase sees a £24m PFI scheme due to complete in January 2006. The business case for the second phase, which will see women's and children’s services and cancer services reprovided, is currently under development but will not be operational until after 2011 (see 6.5.4).

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Weakness Description Evidence How Weaknesses will be Mitigated provider.

The PFI scheme will clear a significant amount of the worst quality accommodation. Much of the poor quality infrastructure which remains has had recent investment which will see the facilities through until the Phase 3. However the Trust will take the opportunities offered by FT status to use surpluses to improve the patient environment where possible and with its proven track record in PFI is confident of bringing a scheme forward to agreed timescales.

W7 Booking infrastructure and ICT linkages with PCTs

Fully integrated version of Choose and Book software not implemented in the Trust

Choose and Book PMB PID / Minutes Interim Booking solution introduced in July 2005 enabling all PCTs to send referrals via the Choose and Book system. Patients then telephone the hospital call centre to agree an appointment date and time. The fully integrated solution will be implemented in 2006 following the upgrade of the Trust PAS system (see section 6.9).

W8 Cost of Living Salisbury is relatively affluent and expensive, resulting in cost of living issues for staff and potential recruits to the Trust.

Market forces factor The relatively high cost of living reflects that Salisbury is also an attractive location to live and work and this is reflected in recruitment advertising. The Trust will seek to ensure that the Trust is competitive nationally both in terms of financial remuneration and especially non-financial benefits - training offered, continuous development, career progression (see 7.5 and HR strategy). In

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Weakness Description Evidence How Weaknesses will be Mitigated addition it will continue to offer subsidised leisure centre membership, staff nursery and free staff car park – all known to be advantageous in recruiting and retaining staff. It will also look to improve key worker housing (see 9.6.2)

Opportunities

Opportunity Description Evidence How Opportunity will be Capitalised On

O1 Payment by Results tariff – potential for surpluses

When the Payment by Results (PbR) tariff is introduced in 2005, the Trust will benefit financially, with income relating to tariff procedures exceeding expenditure by approximately 5%.

Most recent reference cost indices published in March show the Trust has a reference cost of 88.

The Trust will use the surpluses to reinvest in its services to promote high quality care. The surpluses will be used to justify raising of loans under the Borrowing Ratio to invest in capital infrastructure to improve patient care.

O2 Land availability for related diversification

Following the completion of the Trust's phase 2 PFI scheme (December 2005), the Trust will have approximately 1.6 hectares available for alternative uses.

Trust Estates Strategy (2005-2010) shows land which will become available.

The Trust is keen to explore the potential to provide or collaborate in the provision of low complexity secondary care or sub-acute care. There are plans locally for a Primary Care LIFT project, which would provide a centre for Children’s Services. This presents an opportunity for the relocation of some of the Trust Paediatric outpatient services into more suitable facilities. Nursing home provision is in short supply locally. Following the completion of Phase 2 of the Trust’s site redevelopment, land may be available for onsite nursing home provision.

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O3 Extended role in patient care

The prioritisation of Public Health activity and Chronic Disease Management improvements offers new opportunities for Secondary Care providers to extend their involvement in patients beyond the acute episode.

Creating a Patient-led NHS: “make sure that all services and all parts of the NHS contribute to health promotion, protection and improvement.”

The Trust is well placed locally to develop outreach services further. As medical technology advances, certain tertiary work is becoming more dispersed and the Trust expects in the next 3-5 years to be preparing to perform therapeutic angioplasty work in Cardiology – this will be undertaken in the proposed new cardiac catheter lab (see 7.7).

O4 Growth from advances in treatment

New treatments are being introduced into the Trust’s specialist services and more aggressive interventions and treatment regimes are being practiced for instance in Cleft Lip & Palate services and Plastic Surgery & Burns

CSAG standards for Cleft. Increase in micro-vascular technologies, particularly for complicated hand trauma cases. Use of integra for Burns

The Trust will be reviewing its theatre capacity to ensure there is adequate theatre time for the extra level of complexity which some of these procedures requires. The opening of a burns theatre as part of its PFI scheme will offer the Trust further opportunities to expand capacity.

O5 Patient Choice Geographical constraints limit the scale of the opportunity presented to the Trust from the Choice initiatives despite the good access times and clinical effectiveness credentials.

Limited take up of Patient Choice in first year.

In Ophthalmology, patients are relatively mobile and willing to travel and the Trust has additional capacity which it hopes to capitalise upon. Trust will develop marketing expertise and techniques to promote the quality of SDH services to GPs and patients.

O6 Catchment area growth

At the northern boundary of our core catchment area, the Trust has recently experienced an increased flow of patients from Warminster, Westbury and Devizes, indicating that the Trust is becoming the emergency centre of choice for patients

Attendances at A&E. Growth in emergency admissions

The Trust will liase with GPs in the patch and will establish clinics in these areas to further promote the Trust’s services.

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with options to travel to Bath’s Royal United Hospital or Salisbury District Hospital.

O7 Foundation Trust Status

Foundation Trust status will strengthen the Trust’s local focus and accountability to the local community.

Consultation documentation FT status will provide the opportunities to take further steps towards delivering patient-focused services that meet the needs of the catchment population and to engage local people more closely in the running of the hospital.

O8 Demand exceeds supply

National capacity constraints result in greater demand for specialist Spinal Injury services than is available. Salisbury’s service has high occupancy rates and regularly has to turn down requests for patient transfers from non-specialist hospitals. Similar problems exist for plastic surgery

High occupancy rates on the spinal unit and waiting list for admission to the unit. .

Potential for the Trust to increase its capacity to meet the excess demand. Improved discharge planning through use of hub and spoke models will enable the Trust to treat more patients and reduce waiting times.

O9 Marketing Opportunities

There are a number of discrete marketing opportunities available to the Trust, including: • Providing a commercial laundry

service to neighbouring large NHS and non-NHS organisations.

• Private Patient services, including Fertility services.

• Medical Physics products, including the Odstock Foot Drop Stimulator which is sold in the UK and has a potential international market.

• Providing services to meet unmet need, for instance for Acquired Brain Injury and Obesity patients

Trust is currently tendering for a number of NHS and non-NHS laundry contracts. Infertility services are being provided on the site with referrals on the increase and with opportunities likely following publication of NICE guidance. Medical physics already generates significant income from some of its services.

The Trust will continue to take opportunities to expand services where this can be achieved with minimal extra investment. There are pre-existing plans to expand the Medical Physics department during 2006 which will further increase the opportunities to promote this service. Business cases will be brought forward during the first 12 months of FT status to determine the viability of the new services, These developments will not happen without a clear understanding of expected income and detail of the costs to

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Injury and Obesity patients.

be incurred.

O10 Consolidation of clinical links with Universities and Teaching Hospitals

The Trust has thriving research and specialist services portfolios, with close academic and clinical links. The Trust hosts the former regional Research and Development Support Unit and has a strong research base in Genetics and Medical Physics. It has close clinical linkages with Southampton University Hospitals NHS Trust (notably for Cardiac and Neonatal Intensive Care services) and other providers of specialist services – for example, the Central South Coast Cancer network. The Trust has telemedicine links that offer Salisbury’s Plastic Surgery expertise to dispersed clinicians and links that bring neuro-radiology expertise to Salisbury.

The recently completed national review of Cleft Lip & Palate services has confirmed these specialist services will be retained and expanded at the Trust for a population across eight Wessex and South Coast counties.

RDSU Annual Report The promotion of clinical networks as a cornerstone of specialist service modernisation (initially in Cancer care and more recently across other specialist services) and the more formal recognition of these networks in service planning projects, provides an opportunity for the Trust to consolidate its role in the future provision of specialist services across the Central South Coast area. Expanding the provision of tele-medicine and the plastic surgeon’s role in providing remote expertise to surrounding DGH’s could reduce inappropriate referrals to SDH thereby assisting with issues relating to emergency surgery.

O11 Developing clinical, training and research practice

Salisbury expects to be at the forefront of clinical advances in Spinal Injury services as the collaboration with the Medical Physics team continues. The Cleft Lip & Palate service aspires to undertaking further research and training,

Development of functional electronic stimulation (FES) offering hand movement to tetraplegics. Expanded range of genetics tests being developed and being brought into

The Trust will place great emphasis on its specialist services, for example the ODFS spin out company, biomedical centre and the National Reference Laboratory for genetics.

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as happens in three of the other national Cleft Lip & Palate centres in England & Wales. Salisbury also expects to be in the forefront of advances in Genetics.

mainstream diagnostics.

Threats

Threat Description Evidence How Will Impact of Threats be Mitigated

T1 Payment by Results guidance

The ‘rules’ associated with PbR are still under development and subject to change. It is possible that the ‘rules’ will disadvantage the Trust by not being sensitive to:

• The true costs associated with specialist procedures.

• The length of spells which are single spells in Salisbury (because of the limited community hospital and intermediate care infrastructure) but which would be multiple spells in other health economies

.

Sudden change to rules for PbR in January and ongoing uncertainty about how systems will be implanted for unplanned care.

The Trust has included a contingency sum in its financial plans for the medium and low scenarios (section 8).

T2 Alternative Models of Care

The potential for community alternatives to some treatment currently provided by the Trust could lead to some current workload being lost to community-based

Practice based commissioning will see more services provided within community settings as per SWPCT recovery plan. Community-based diagnostic testing is

The Trust will work with PCT’s to jointly secure benefits from these initiatives. Trust working with PCT on LIFT scheme

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providers. likely to meet current gaps in demand and could lead to changes in patient flows away from secondary care for a proportion of x-ray, ultrasound and other imaging, as well as for colposcopies and other examinations. Alternative care models are expected after the Independent Sector Treatment Centre in Shepton Mallet has opened in July 2005. It is planned for instance that hip replacement patients will benefit from US-trialled parting of muscle fibre instead of cutting fibre. This offers the potential for more rapid recovery and a reduced rehabilitation requirement.

(see 6.9). There are a number of areas where reduced referrals to secondary care will enable hospital clinicians to focus on cases most appropriate to their skills and expertise, particularly in ENT, Dermatology and Oral Surgery.

T3 The impact of competition and demand management initiatives

The requirement on NHS commissioners to purchase Independent Sector provision threatens current patient flows to Salisbury, as does the ambition of Dorset & Somerset SHA for greater self-sufficiency. Changes in booking procedures and shifting purchasing to the (GP Practice) level where referrals are made provide strong levers for demand management. Demand management initiatives are less advanced in Wiltshire but are beginning to be explored more actively by local PCTs

See also T4 below. North Dorset PCT envisage a scenario where commissioning negotiations confirm the number of available appointment slots for patients and only this number are ever booked, with all other patient demand being directed to other providers. ‘Slot management’ will be introduced in 2005. The inability to agree a three month maximum wait for elective surgery for Dorset residents treated in Salisbury, places Salisbury at a disadvantage with other Dorset providers.

The Trust is seen as “part of the extended family” in Dorset & Somerset, the Trust needs to maintain a close and supportive relationship with North Dorset PCT. Knowledge of the Trust’s Foundation The Trust will work with local PCTs to understand fully the implications of demand management initiatives. The Trust will ensure that any capacity which is freed up by demand management initiatives either results in cost reduction or is used to generate additional income (eg ENT have indicated that they receive inappropriate referrals which would be more appropriately treated in primary care which take up vital new OP appointment slots).

November 2005 14



T4 ISTCs and excess elective surgery capacity- T4

The Independent Sector Treatment Centre (ISTC) at Shepton Mallet threatens current elective referrals from North Dorset. .

Shepton Mallet will increase local capacity by 13,000 procedures p.a. Ophthalmology is now over-provided for in Dorset & Somerset and it is notable that East Somerset NHS Trust have excluded Ophthalmology from their list of guaranteed services as a Foundation Trust. Elective referral flows are threatened by a potential ISTC at Ringwood. Commissioners’ obligations to commitments made in the Concordat with the Independent Sector mean that further independent sector provision should be expected, either in the provision of elective surgery or the provision of diagnostic services

Current thinking is that Shepton Mallet will be used to deliver extra capacity to achieve waiting list targets. Some assumptions for the reduction in activity as a result of the Shepton Mallet development have been included in the Trust's activity planning (section 8). North Dorset PCT remain supportive of the Trust's efforts and the Trust will be looking to maintain its performance to offer North Dorset residents an acceptable NHS provider (see letter of support from North Dorset).

T5 Infrastructure required for Modernisation

Improvements in the coding and accuracy of patient activity datasets need to be achieved in order for the Trust to maintain its financial stability in the era of Payment by Results and Foundation Trust status. Electronic sharing of available capacity will be required for Patient Choice policies such as e-booking. If the Trust is harder to book with than other providers, it is likely that patient referrals will move away from the Trust. It is critical for the Trust to establish effective operational working arrangement with the Patient Care Centre at Bridgewater in order to maintain the historical flow of Dorset residents to the

Current coding rates for activity submitted to Clearnet is circa 98%, but there remains a timelag of some 6-8 weeks in achieving this. Data quality problems still exist, but the Trust has significantly improved this aspect in recent years to the extent that the Trust's latest HES submission achieved a higher data quality score than the national average.

Continued efforts must be made to maintain coding accuracy whilst improving on the time taken to code patient activity. Outpatient based procedures need to be coded more extensively. The role of clinicians in ensuring the accuracy of coding will be bolstered whilst preserving the clinical coders’ expertise. A project o process map the Trust's approach to clinical coding with a view to improve the speed of coding, whilst maintaining quality standards, is currently underway. (section 9.3).

November 2005 15



Trust.

T6 Disruption associated with changes to commissioning arrangements

There is a short term risk that the Trust and other specialist service providers will suffer if Payment by Results guidance or Trust coding is insufficiently sophisticated to be able to take account of the true costs associated with low volume, high cost episodes of care.

There remains uncertainty about the approach to be adopted in relation to PbR and specialist services.

Trust is working with Central South Coast Commissioners to ensure the impact of PbR on specialist services is fully recognised and funded. Check with BR if anything in financial plans.

T7 Satisfying public expectations

The Trust has embraced the NHS Modernisation agenda and is progressing major change initiatives, however it is conscious of the public demand for better access to healthcare and to an improved patient experience once in the care of the NHS.

Salisbury is no different in witnessing increased public expectations not unreasonably given increases in investment in health care expenditure.

The Trust will work with its governors and members to ensure that the local public agenda is understood and acted upon. (section 11.3)

T8 Impact on specialist services of any future acute services reviews

Specialist services such as Cleft Lip & Palate have close and essential inter-relationships with non-specialist acute services including: Paediatrics, ENT, Oral & Maxillo-facial Surgery and Orthodontics.

The Trust's DGH specialties serve a limited catchment area of 200,000. As a result the viability of some services could be challenged which, in turn, could create issues regarding the sustainability of specialist services (eg the involvement of the maxillo-facial consultants is essential to the care of children with a cleft lip.

Having secured their place in national networks of specialist services, clinical threats to specialist services are limited to the adverse impact of the removal of DGH services from Salisbury. This is not expected but is a hypothetical threat. Local commissioners and Strategic Health Authorities expect their management focus in the next 3-5 years to be on major specialties such as Orthopaedics and General Surgery, not small specialties. The Trust works closely with other surrounding hospitals within clinical networks to sustain its smaller specialties, eg ENT are assessing with Southampton

November 2005 16


Threat Description Evidence How Will Impact of Threats be Mitigated and Winchester the provision of emergency care.

November 2005 17

Abc Appendix E – Directorate Plans

November 2005 1

Directorate Plans

Corporate Directorates 1. Performance The Trust is committed to the continuous improvement in its performance across a range of indicators to ensure that it maintains its high level of operational efficiency. It will be looking to ensure that it delivers a level of performance which is in the top 25% of hospitals in the country for the main performance measures. 2. Key Developments Planned (Link to SWOT analysis) The key priorities outlined below reflect the requirements set out in the Better Healthcare Standards which will be the blueprint for the development of the Trust's services. Delivery of Patient Focused Care & Services Link to SWOT

analysis Ensure that the key national waiting time targets (18 week wait from referral to treatment, CHD & cancer waiting times, A&E 4 hour waits) are all achieved. [Ongoing]

S: 1,3 W: 1 T: 4,5

Offer all patients booked appointments for all surgery, all new outpatients appointments and ultimately for follow up attendances. [December 2005]

S: 1,3 W: 7, T: 5

Work with the local PCTs to ensure that services are delivered from locations close to the patient’s home which meet the required standards for quality and cost effectiveness. [Ongoing]

S: 3 W: 2, O: 3, T: 6

Increase the proportion of elective theatre sessions and outpatient clinics which take place in the evenings and at weekends. To provide choice for patients who work or have family commitments for whom hospital visits in normal working hours are problematic to arrange. [Ongoing]

S: 1,3 W: 3,7 O: 5,6

Improvement of Organisational Effectiveness Link to SWOT

analysis Take all opportunities to review, benchmark and improve upon the Trust's length of stay. [Ongoing]

S: 1,3 W: 4,5 O: 2


November 2005 2

Link to SWOT analysis

Improve discharge planning so that no patient stays in hospital beyond the time he or she is medically fit for discharge and appropriate arrangements have been made at home. This will require continued and close working relationships with PCTs and social services departments. [Ongoing]

S: 1,3 W: 5 T: 6

Replace all the Trust’s main radiological equipment (including MRI and CT) to secure the organisational benefits of the more powerful, faster diagnostic technologies. [To 2007]

S: 1,3 W: 6,7 T: 5

Delivery of Effective Risk Management Systems Link to SWOT

analysis Build upon achievement of attaining CNST Level 2. [Ongoing]

S: 1,3 O: 5,9,11

Use benchmarking system to identify outliers in terms of performance. [Ongoing]

S:1,3, W:4,5

Improve record management processes. [Ongoing] S:1,3

T: 5 Develop an Excellent Workforce Link to SWOT

analysis Invest in additional nursing and consultant staff to deliver high-quality services within the context of the changes in junior doctors’ hours and the European Working Time Directive. To include a review of skill mix. [Ongoing]

S: 3, W: 8 O: 10,11

Generate New Income Streams Link to SWOT

analysis Seek to generate additional income from the Patient Choice initiative by offering high quality, patient focused services to patients in the local and

S: 1,2,3,6 W: 1,4,6,7 O: 6


November 2005 3


surrounding areas. [Ongoing] T: 3,4,5

Develop the Hospital’s Infrastructure Link to SWOT

analysis Use the land to be freed up on SDH South to secure additional income and develop Trust services, eg development of nursing home facilities on the site. [Business case to be developed in 2006]

S: 1,5 O: 2,7 T: 2,3

Work with the local council to finalise a Development Brief setting out the longer term opportunities for development of the site. [Ongoing – final version to be agreed early 2006]

S: 1,5 O: 2

4. Implications for capital planning The following developments require commitments from the five year capital programme. These have been identified and are included within the programme attached at appendix G.


November 2005 4

Surgical Directorate 5. Key Developments Planned (Link to SWOT analysis) Delivery of Patient Focused Care & Services Link to SWOT

analysis Develop a local lithotripsy service so that patients do not need to travel to Portsmouth. [Develop business case in 2007]

S: 1,2,3,4 W: 1,2,3 O: 5,6,9 T: 4,6

Increase the proportion of patients whose breast reconstructions are carried out using the TRAM (transverse rectus abdominus myocutaneum) method. This technique significantly reduces the requirement for subsequent revision surgery. [Review cost benefit analysis of this approach during 2006]

S: 2,6 W: 1,2 O: 4,5 T: 1,7,8

Expansion of hand trauma service including the development of brachial plexus supraregional service. [Develop business case in 2006]

S: 2,6 W: 1,2 O:4 T: 1,8

Develop service for the insertion of stents for patients requiring renal dialysis. This will support the development of a satellite renal dialysis service on site. [Subject to start of on site dialysis service]

S: 2,4,5 W: 1 O: 6 T: 6

Develop one stop haematuria service to include outpatient appointment, ultrasound and flexible cystoscopy at the same attendance. [2006]

S: 1,2,3,4 W: 1,2 O: 4,56 T: 2

Development of nurse led services in plastics to build on additional capacity available following move into phase 2. To include: dressings clinics, nurse and physio led follow ups. [Capacity available in 2006 when Phase 2 opens]

S: 1,2,3,6 W: 1,2 O: 4 T: 2

Co-ordinate the surgical side of the skin cancer service with the Dermatology department to reflect the predicted growth in incidence of this condition. [Ongoing]

S: 3,4,6 W: 1,2 O: 4,5,6

Set up minimally invasive gall bladder and hernia centre – to promote a local service using the latest

S: 2,3,4 W: 1,2,3,7


November 2005 5


laparoscopic techniques. [Aspiration – develop business case in 2007]

O: 1,4,5,6 T:3,4,6

Set up two site centre for the provision of head and neck cancer with SUHT. Ensure current locally provided service is maintained. [Subject to agreement of Cancer Network – timescale not clear]

S: 3,6 W: 2 O: 4,5 T: 3,6,8

Build on the new vascular assessment / leg ulcer service. Development of one stop services. [Ongoing]

S: 2,3,4 W: 1,2,3 O: 3,4,5,6 T: 1,2,3

Work with commissioners to provide improve facilities for the rehabilitation of patients with head injuries. [Aspiration – develop business case in 2008]

S: 1,2,3,6 W: 1,2,3


analysis Develop fast track recovery service in order to reduce post-operative stays for major colo-rectal surgery from 11 days to 4 days. [2006]

S: 1,3 O: 4

Develop concept of 23 hour surgery service to increase the range of procedures carried out on a day case basis. [Ongoing]

S: 1,3,4 W: 6 O: 4,5,9 T: 3,4

Increase the number of procedures which are performed using laparoscopic techniques (eg TURP’s, colo-rectal surgery). [Ongoing] Use of green lasers for TURP’s significantly reduces blood loss to patient allowing most patients to be treated as a daycase. [2006] Ureteroscopy move to DSU dependent on availability of radiographer support there [2006].

S: 1,3 O: 4,5


analysis Move to consultant led service delivery, particularly in relation to emergency surgery. [Ongoing]

S: 3 W: 1 O: 5


November 2005 6

Develop an Excellent Workforce Link to SWOT

analysis Train urology staff to undertake some radiological procedures (eg prostate biopsies, kidney ultrasounds). This will prevent a significant current bottle-neck in the availability of radiographers. [2006/7]

S: 3, O: 4

Develop extended roles for specialist nurses to include initial assessment, pre-operative assessment and follow ups. [Ongoing]

S: 3 T: 3


analysis The Trust will produce a business case to develop a morbid obesity service in the first year of its existence as a Foundation Trust. [2006]

S: 1,2,3,6 W: 1,2,3 T: 6

Employ the additional capacity offered by the new laser treatment centre to increase the volume and range of treatments offered. [2006/7]

S: 3,4,6 W: 1 O: 6 T: 6


analysis Develop a Surgical Admissions Lounge so that patients requiring elective surgery are admitted to a calm and reassuring environment. The SAL will be located in a ward close to main theatres which will be freed up once the new PFI development is operational. [2006]

S: 1,3 O: 5

6. Implications for capital planning The following developments require commitments from the five year capital programme. These have been identified and are included within the programme attached at appendix G. Green light laser for urological procedures - Laparoscopic equipment for general surgery Development of Surgical Assessment Unit ICAT image modelling system for oral surgery


November 2005 7

Ambulatory Care Directorate 7. Key Developments Planned (Link to SWOT analysis) Delivery of Patient Focused Care & Services Link to SWOT

analysis Work with the PCT to develop the child health centre in the LIFT facility which is currently being planned. This will include a considerable number of clinics for children being provided within the LIFT scheme rather than on the DGH site. [2006]

S: 3 W: 5,7 T: 6

Develop shared care arrangements for patients with glaucoma between consultant ophthalmologists and optometrists. [Ongoing]

S: 3

Reduce waiting times further for ophthalmology to seek benefit from Patient Choice – Trust has been down as low as 6 weeks between outpatient appointment and surgery. [Ongoing]

S: 1,3 W: 1 O: 5,6 T: 3,4

Development of paediatric home care teams. [Review with commissioners]

S: 1,3,4 W: 5 O: 3


analysis Develop concept of 23 hour surgery service to increase the range of procedures carried out on a day case basis. Vast majority of ENT and gynaecology surgery to be undertaken on a 23 hour basis. [Ongoing]

S: 1,2,3 W: 3 O: 4,5 T: 3,4

Undertake more endoscopic work and more outpatient based procedures within ENT. [Ongoing]

S: 1,2,3 W: 3 O: 4,5 T: 3,4

Telephone follow up for paediatric outpatients. [Ongoing]

S: 1,3 O: 3

Expand range of one stop clinics for ophthalmology. [Ongoing]

S: 1,2,3 W: 3 O: 4,5,6 T: 3,4


November 2005 8

Work with GP’s with specialist interests (GPSI’s) to manage a proportion of ENT referrals in primary care. This will require considerable input from secondary care services particularly in the short term. [ENT starting in December 2005]

S: 3 W: 2,5 T:5,6


analysis Work with PCT to resolve issue of increasing paediatric admissions, particularly out of hours. [Ongoing]

S: 3, W: 1,2 T: 6

Develop business case to enable obstetric theatre to operate 7 days a week. [2007]

S: 3 W: 1 O: 1 T: 1


analysis Greater orthoptist input into the management of squints. [2007]

S: 3 O: 6

Develop scheme for optometrists to undertake follow up appointments in the community for patients who have had cataract surgery. [2006/7]

S: 1,3,4 W: 2 O: 5,6 T: 2,3,4

Train midwives to do sonography. [2008] S: 1,3

O: 6,9,11 Generate New Income Streams Link to SWOT

analysis Increase the volume and range of assisted conception services provided in accordance with NICE guidance. [Incremental development over 3 year period starting 2006/7]

S: 5 W: 3 O: 5,6,9,11 T: 4,6


analysis Bring forward plans for the reprovision of women’s S: 2,3,5


November 2005 9

and children’s services in the final phase of the Trust's redevelopment project. [Outline Business Case in 2006]

W: 1 O: 1,2,7 T: 1,6,7

8. Implications for capital planning The following developments require commitments from the five year capital programme. These have been identified and are included within the programme attached at appendix G. Soundproof booth for audiology department Diagnostic tympanometers Replacement programme for nasoendsocopes Laser for gynaecological procedures


November 2005 10

Critical Care Directorate 9. Key Developments Planned (Link to SWOT analysis) Delivery of Patient Focused Care & Services Link to SWOT

analysis Develop lower back pain service comprising Wessex Rehab, community services, and anaesthetics. One stop service receiving triaged referrals from spinal consultants, physiotherapy, GPs. [Pilot underway in 3 GP surgeries]

S: 1,2,3,6 W: 1,2 O: 3,6,9 T: 2

Extend the hub and spoke principle for spinal service with increasingly patients supported closer to their homes with specialist support in the form of nurse led clinics from the Duke of Cornwell hub. This will also include increasing use of telemedicine technologies. [Pilot in 2006]

S: 1,3,6 W: 5,

Introduce computer guided surgery for orthopaedic procedures to improve alignment (eg for knee replacements). Technology is still unproven in terms of outcome. [Keep under review]

S: 1,3 O: 4,7,9 T: 7

Increased Clinical Psychology input into the Spinal Unit. [Develop business case in 2006]

S: 1,2,3 W: 1


analysis Develop step down unit for orthopaedic patients to promote rehabilitation prior to discharge (nurse/physio led) [Being reviewed as part of planning for move into Phase 2. Impact of potential transfer of community services].

S: 1,3 W: 4 T: 4

Develop minimally invasive approach to hip and knee replacements, ultimately to reduce length of stay by 50%. [Start training 2006/7]

S: 1,3 O: 5,6 T: 3,4

Improved joint working between the Emergency Department and primary care services to include common triage of patients, co-location of services (see below) and joint publicity of services all aimed at reducing the number of patients attending ED. [2006]

S: 1,3 W: 5 T: 7


November 2005 11

The investment the Trust will make in radiological infrastructure will assist with delivery of A&E targets through access to faster diagnostic information for clinical staff. [2006-8]

S: 1,3

Review use and efficiency of theatres. Emergency surgical capacity particularly in relation to plastic surgery trauma, to be reviewed with opening of burns theatre. [2006]

S: 1,3


analysis Develop high dependency area within theatres to reduce cancellations due to lack of HDU beds. [Ongoing]

S: 1,3


analysis 24 hour cover from middle grades with senior cover within Emergency Department. [2006/7]

S: 2 W: 1

Radiological procedures (eg ultrasound) to be undertaken by ED staff. [2007]

S: 1,3

Extend the range of multidisciplinary team led discharges on the orthopaedic wards. [Ongoing]

S: 1,3 W: 4

Review skill mix within theatres – develop anaesthetic nurses, advance healthcare workers role. [Ongoing]

S: 1,3

Role development for healthcare support workers. [Ongoing]

S: 1,3

Develop nurse consultant role in spinal injuries unit, to lead on liaison with spoke hospitals. [2007]

S: 1,3


analysis Develop new lower arm service in collaboration with the plastic surgery service. Develop ankle surgery sub-specialty to include lower limb reconstruction service, again in conjunction with the regional plastic

S: 1,3,6 W: 2,3 O: 6


November 2005 12

surgery service. [Develop business case 2007] Subject to NICE guidance, advance the cartilage replacement surgical technique (one of the Trust's existing consultants is already trained in the technique). [Develop business case 2006]

S: 1,3,6 W: 2,3 O: 5,6,9 T: 4


analysis Redesign the A&E department to offer: improved waiting area, better separation of different streams of patients, improved observation . To include a minor injuries service linked to a primary care out of hour service. [Work started November ’05]

S: 1,3 W: 4

10. Implications for capital planning The following developments require commitments from the five year capital programme. These have been identified and are included within the programme attached at appendix G. Computer guided surgery to be installed in orthopaedic theatres – gives improved alignment during surgery. Also requires additional investment in radiological infrastructure (eg image intensifiers)


November 2005 13

Medicine Directorate 11. Key Developments Planned (Link to SWOT analysis) Delivery of Patient Focused Care & Services Link to SWOT

analysis Extend the range of cardiological interventions carried out, eg more angiographies, develop PCI (percutaneous cardiological intervention) service. Reduce referrals onto SUHT providing more local service for patients. [Develop detailed business case 2006]

S: 1,2,3 W: 2,3 O: 5,6 T: 3,4,5

Work with primary care to improve chronic disease management providing outreach services to help patients stabilise their condition and reduce the number of patients having ‘crises’ requiring admission to hospital. Development of expert patient programme. [Ongoing]

S: 1,3 W: 5 O: 3 T: 2,6

Development of district wide heart failure service. Trust to provide secondary care support to a primary care led service. [Develop service model with PCT]

S: 1,3 W: 1,5 O: 3,6

Set up complementary therapy services for patients with cancer. [Ongoing]

S: 3,5 W: 1 O: 5,9

Extend range of services offering patient passports giving patients ready access to follow up appointments. [Ongoing]

S: 3,5 O: 3,

Improved integration between GU and family planning services. GU service to be reprovided within the LIFT scheme. [Ongoing – LIFT scheme in 2009/10]

S: 3,4 W: 5,6

Following the opening of phase 2 all elderly care facilities will be co-located around the Nunton Unit. An elderly care assessment facility will be created enabling prompt access to clinician input which will determine which sub-specialty area is most appropriate for the patient’s needs. A similar approach is to be introduced for adult medicine which will include sub-speciatly areas linked to surgery (eg gastroenterology and diabetes/vascular). [2006]

S: 1,3 W: 4


November 2005 14

Work with Central South Coast Commissioners and Wessex Renal Unit to establish on the SHCT site a satellite renal dialysis unit. This development is part of the CSSC’s renal strategy and is dependent on securing a suitable site. [Review following opening of phase 2]

S: 3,5 O: 3 O: 2,5,6,10 T: 6


analysis More chemotherapy treatments to be provided on an outpatient basis rather than Daycase (oral rather than intravenous application). [Ongoing]

S: 3,5 O: 4 T: 2

With elderly care and orthopaedics to be located in the new phase 2, there will be increasing opportunities for the development of shared care between the orthopaedic and older people’s services. This should reduce length of stay for orthopaedics. [2006]

S: 1,3 W: 4

Work with GP’s with specialist interests (GPSI’s) to manage more dermatology referrals in primary care. This will require considerable input from secondary care services particularly in the short term. [2006/7]

S: 3,4 W: 2,5

COPD admission avoidance and assisted discharge to improve management of COPD is community setting, reducing admissions and need for non-invasive ventilation on wards. [2006/7]

S: 1,3 W:1,5 O: 3,4,6 T: 2,,3


analysis Expand neurology services in collaboration with SUHT to mitigate risk from single-handed practitioner and risk to achievement of OP waiting time targets. [2006]

S:3 W: 1,2 O: 10

Audit of falls, with review by Falls Group of trends. [Ongoing]

S: 3 O: 11


analysis Promote and extend nurse led care within rheumatology service. Nurse led clinics to see follow up patients in dermatology and to take on some procedures (eg biopsies). [Ongoing]

S: 3 O: 3,6 T: 2,3,7


November 2005 15

Investment in additional nurse endoscopists to perform flexible sigmoidoscopies and colonoscopies. [2006-7]

S: 3 W: 8


analysis Purchase own bone densitometry scanner to provide local service and reduce need to refer patients away for this test. Promote the service to other organisations. [Business case 2006]

S: 3,5 W: 2,3 O: 5,6,9 T: 5

Promote the community palliative care service to extended geographical area. Andover GPs have commissioned this service during 2005. The service is extremely popular with GPs and could extend to Warminster, Westbury & Gillingham. [Ongoing]

S: 3,5 W: 3 O: 3,6 T: 2,6


analysis Build new cardiac investigation suite, with two intervention rooms (50% increase). [2007/8]

S: 1,2,5 W: 2,3 O: 2,5,8 T: 3,4,6

Creation of new cardiac investigation suite will free up space for an additional endoscopy theatre increasing capacity to accommodate the additional demand from the introduction of screening for colo-rectal cancer. [2007/8]

S: 3,4 W: 1,2 T: 2,3

12. Implications for capital planning The following developments require commitments from the five year capital programme. These have been identified and are included within the programme attached at appendix G. Extended cardiac investigation suite (location already identified and indicative costs and design developed) Reprovide GU medicine to the LIFT scheme Diabetes centre


November 2005 16

Clinical Support Directorate 13. Key Developments Planned (Link to SWOT analysis) Delivery of Patient Focused Care & Services Link to SWOT

analysis Improve performance within the pharmacy dispensing service – patients can currently wait 40 minutes or more for their medication. [2006]

W: 6 T: 5

Develop radiology services to make them more patient focused. Extend the working day – 8:00am to 8:00pm. Implementation of PACS and RIS systems. [Ongoing]

S: 3 W: 4 O: 4 T: 4,5,7

Expansion in interventional radiological procedures. Largely palliative and prophylactic. [Ongoing]

S: 3 O: 4


analysis Expand the range of robotic equipment within laboratory medicine to increase automation. Invest in robotic system for the pharmacy department for automatic preparation of prescriptions. [2007/8]

S: 1

Improve stock control within pharmacy department. [Ongoing]

S:1

Significant investment in the Trust's radiological infrastructure required due to age of much of the radiology equipment. This will be combined with process re-engineering, which is already started, to ensure the new equipment is backed up by efficient processes. Many specialities have identified diagnostic bottlenecks – these need to be resolved if the Trust is to achieve waiting time targets. [2006 onwards]

S: 3 W: 4 O: 4, T: 4,5

Harness the benefits of the new diagnostic opportunities arising from mapping of human genome. Salisbury, as one of two national reference laboratories, is well placed. [Ongoing]

S: 3,6 W: 2 O: 4,9


analysis Develop rolling replacement programme for medical S: 3


November 2005 17

equipment. [Ongoing] Improve information provided to patients about their drugs to reduce medication errors and readmissions. [Ongoing]

S: 1,3 O: 3

Introduce mandatory training of staff handling blood products as part of KSF. Appoint second transfusion specialist nurse to improve staff training and to provide advice and expertise. [2006]

S: 3 W: 1,8

Improve radiology reporting system as a result of the implementation of the RIS. [2005 onwards]

S: 1,3


analysis Extend range of nurse and pharmacist led prescribing. [Ongoing – subject to government’s latest proposals]

S: 3 O: 11

Expand responsibilities of radiographers – career development for hard to recruit staffing group. [Ongoing]

S: 3 O: 11

Recruitment plan required for radiologists and radiographers. [Ongoing]

S: 3 W: 8 O: 11


analysis Set up an expanded dispensing service for pharmacy. Trust can charge cheaper prices for medicines than high street pharmacies. [2007]

O: 9

Promote the spin out company set up for the marketing of the Odstock Drop Foot Service. Trust has a world wide patent for this technology which gives with neurological conditions (MS, stroke) additional movement. [Company set up October 2005]

S: 3,6 O: 8,9

Build on the Medical Physics worldwide reputation. [Ongoing]

S: 3,6 O: 8,9,11

Build on the success of the National Reference Laboratory (genetics) to develop international and private sector income streams. [Ongoing]

S: 3,6 W: 2 O: 9,11


November 2005 18


analysis Create medical physics campus on south end of the site. [2006]

S: 3,6 O: 8,9

Improve IT systems within laboratory medicine – update Telepath system as part of NpfIT [2008].

S: 3 W: 7 T: 5

Increasing throughput for genetic testing – requires investment in IT systems and array readers to boost efficiency of diagnostic procedures. [2008]

S: 3,6 O: 4,9,10,11 T: 5,6

Introduce mass spectomotry test (PCR) for chlamydia. Test is quicker and less invasive for patients. [2008]

14. Implications for capital planning The following developments require commitments from the five year capital programme. These have been identified and are included within the programme attached at appendix X. Investment in radiology equipment Medical physics campus Robotic technology in pharmacy and laboratory medicine Update IT systems, eg telepath

Salisbury Healthcare NHS Trust Appendix F

Strategic Capital Programme

Year Ending 31-Mar-07 31-Mar-08 31-Mar-09 31-Mar-10 31-Mar-11

Capital Funding .Depreciation 5,854 5,755 6,054 6,244 6,826Capital Income - Sale of Old Manor 1,000Repayment of Brokerage Laundry -1,700Repayment of Brokerage PACS -275 -275Sub-Total 5,154 5,755 5,779 5,969 6,826

PFI Capital Element -64 -68 -72 -77 -82

Funds Available 5,090 5,687 5,707 5,892 6,744

Application of FundsReplacement X-Ray equipment 1,834 1,608 948 820 110Cardiac Catheter Lab 1,300Emergency Department 400 600Replacement Programme for scopes 200 150 60 90 70Medical equipment < £40k 300 300 300 300 300Medical equipment > £40k 300 300 300 300 300Grouped items 200 200 200 200 200Efficiency schemes eg urology 200 300 300 300 300Pharmacy robot 500South side of site

Biomedical campus 300Reuse of plastics out-patients 300

Telephone exchange 200Reuse of old med physics area 100 200

IT systemsUpgrade to iPMUpgrade to SAN 200 200 300Computer refresh 300 300 300 300 300Choose and book impact 150Finance/Information 50 50 50

New cancer unit contribution 500

Building/H&S/DDA/Maintenance 500 500 500 500 500Facilities equipment 100 100 100 100 100

Laundry items 50 100 150 200 200

Development of Day Surgery Unit 1,000 1,000Genetics 0 200 200 200 200

Unidentified Capital Project 26 169 490 1,883 3,583

Application of Funds 5,510 6,477 6,198 6,193 6,463

Capital Spend Slippage/Unallocated Funding -420 -790 -491 -301 281

Total Capital Expenditure 5,090 5,687 5,707 5,892 6,744

DPFCS 400 1,100 2,300 1,000 0IOE 2,334 2,508 1,648 1,520 810

DERMS 200 650 60 90 70DEW 0 0 0 0 0GNIS 650 100 150 200 200DHI 1,900 1,950 1,550 1,500 1,800

OTHER 26 169 490 1,883 3,583

Total 5,510 6,477 6,198 6,193 6,463

Generate New Income StreamsDevelop the Hospital's InfrastructirOther

Delivery of Patient Focused Care aImprovement of Organisational EffDelivery of Effective Risk ManagemDevelop an Excellent Workforce

Salisbury Health Care NHS Trust Appendix G

Income and Expenditure Account

Year Ending 31-Mar-03 31-Mar-04 31-Mar-05

IncomeService Agreements 89,650 100,813 109,723Specialised Services Income 2,633 2,541 1,844Other income for patient care 2,828 2,458 3,378Other Non-Patient Income 11,584 11,693 11,856Total 106,695 117,505 126,801

ExpenditurePay Expenditure - NHS employees 67,254 74,780 83,780Non Pay Expenditure 29,625 33,881 34,068Provisions - not back to backed 0 0 0Total 96,879 108,661 117,848

EBITDA 9,816 8,844 8,953

Depreciation 4,838 5,656 5,738

Operating Surplus (EBIT) 4,978 3,188 3,215

Costs of fundamental reorganisation/restructuring(-) 0 0 0Net profit(+)/loss(-) on disposal of assets -6 0 0Interest Receivable (+) 143 141 234Interest Payable (-) 0 0 0Interest Element of Finance Lease Rental Payments(-) 0 0 0Other finance costs - Unwinding of discount (-) -22 -14 -14Other Finance costs -change in discount rate on provision (-) 0 -27

Surplus After Interest 5,093 3,288 3,435

PDC dividends payable (-) -5,093 -3,288 -3,435

Retained Surplus/(Deficit) for period 0 0 0

Cumulative Retained Surplus 0 0 0


Balance Sheet


Fixed AssetsIntangible fixed assets 0 0 0Assets under construction (purchased) 3,585 3,005 5,195Other tangible fixed assets 89,586 97,327 97,846Fixed Assets Investments 0 0 0Total Fixed Assets NBV 93,171 100,332 103,041

Current AssetsStocks & WIP 641 747 698Debtors due < 1 year - NHS : Other 2,784 3,565 4,527Debtors due < 1 year - Non-NHS 2,000 2,062 2,779Debtors due > 1 year - NHS : Provisions/Early Retirement 94 118 100Debtors due > 1 year - Other 1,059 1,093 1,149Investments 0 0 0Cash in hand and at bank 315 336 339Total current assets 6,893 7,921 9,592

Creditors: Amounts falling due within one yearBank Overdrafts 0 0 0Creditors - NHS -2,652 -3,386 -5,280Creditors - Non NHS: Revenue -5,169 -6,095 -5,477Creditors - Non NHS: Capital -971 -341 -279Total current liabilities -8,792 -9,822 -11,036

Net current assets/(liabilities) -1,899 -1,901 -1,444Creditors : Amounts falling due after one year 0 0 0Provisions for Liabilities & Charges -486 -831 -1,465

Net Tangible Assets 90,786 97,600 100,132

Financed By

Public Dividend Capital 51,855 51,016 51,969Revaluation reserve 33,875 41,555 43,019Donated Asset reserve 1,155 1,022 1,137Government Grant Reserve 0 0 0Other reserves 0 0 0Income and expenditure reserve 3,901 4,007 4,007Total Taxpayers Equity 90,786 97,600 100,132

Note to Balance SheetBreakdown of cash in hand and at bank (Line 13)Cash held in OPG accounts 210 294 205Other cash in hand and at bank 105 42 134Cash in hand and at bank 315 336 339

Calculation of CCA Duty %Assets held under finance leases 0 0 0Finance lease creditors 0 0 031st March revaluation movements 0 0 0NBV of asset purchases/(sales) effective - OpeningNBV of asset sales/(purchases) effective - Closing

Relevant net assets 89,421 96,284 98,790PDC Dividends payable 5,093 3,288 3,435Capital Cost Absorption Duty % 6.5% 3.7% 3.4%

CCA calc line 5,093 3,288 3,435CCA calc line (ARNA - Average Net Relevant Assets) 84,465 92,853 97,537CCA calc line (Net Relevant Assets - Closing) 89,421 96,284 98,790CCA calc line (Net Relevant Assets - Opening) 79,508 89,421 96,284


Cashflow


Operating CashflowTotal Operating Surplus/(Deficit) 4,978 3,188 3,215Depreciation and Amortisation 4,838 5,656 5,738Fixed asset impairments and reversals (+/-) (not included at line 2) 0 0 0Transfer from the donated asset reserve (-) -148 -171 -161Transfer from the government grant reserve (-) 0 0(Increase)/Decrease in Stocks -127 -106 49(Increase)/Decrease in Debtors 1,245 -901 -1,717Increase/(decrease) in creditors -1,252 1,660 1,276Increase/(decrease) in provisions 345 620Net Cash Inflow/(Outflow) from Operating Activities 9,534 9,671 9,020

Returns on Investments and Servicing of FinanceInterest received (+) 143 141 234Interest paid (-) 0 0 0Interest element of finance lease rental payments (-) 0 -41 0Net Cash Inflow/(Outflow) from Returns on Investments and S 143 100 234

Capital ExpenditurePayments to acquire tangible fixed assets (-) -5,379 -5,890 -6,769Receipts from sale of tangible fixed assets (+) 1,380 267 0(Payments)/receipts for intangible fixed assets (+/-) 0 0 0(Payments)/Receipts for fixed asset investments 0 0 0Net Cash Inflow/(Outflow) from Capital Expenditure -3,999 -5,623 -6,769

Dividends Paid (-) -5,093 -3,288 -3,435

Net Cash Inflow/(Outflow) before Management of Liquid Resou 585 860 -950

Management of Liquid ResourcesPurchase of investments (-) 0 0 0Sale of investments (+) 0 0 0Net Cash Inflow/(Outflow) from Management of Liquid Resourc 0 0 0

Net Cash Inflow/(Outflow) before Financing 585 860 -950

FinancingNew public dividend capital received (+) 0 0 953Public dividend capital repaid (not previously accrued) (-) -1,530 -839 0Public dividend capital repaid (accrued in prior period) (-) 0 0 0Loans received (+) 0 0 0Loans repaid (-) 0 0 0Other capital receipts (+) 360 0 0Capital element of finance lease rental payments (-) 0 0 0Cash transferred from/(to) other NHS bodies* (+/-) 0 0 0Net Cash Inflow/(Outflow) from Financing -1,170 -839 953

Increase/(Decrease) in Cash -585 21 3

EFL NoteExternal Financing limit forecast outturn at year end (T04) -945 -859 953Cash flow financing -945 -860 953Finance leases taken out in the year 0 0 0Other capital receipts 0 0 0External Financing requirement -945 -860 953Under/(Overshoot) 0 1 0

Salisbury Healthcare NHS Trust No Impact A Appendix HLikely to Recur B

Non-Recurring Income 2004/05 Not likely to recur C

DirectorateDescription of Non-Recurring Reason Amount Code Comments - Likeliness of Recurring in the Future

Clinical Support FES Income from overperformance 71 B Likely to continueMisc 12 CGenetics research income from DoH re.National Reference lab 481 B To continue 05/06 and 06/07, though will then finish

Genetics Income, monies recharged to Southampton 336 BMedicine Rheumatology 14 C

Dermatology Nurse - Wessex cancer trust funding 37 Monies to continue from Wessex Cancer TrustHOPE Hospice Recharge 104 B To continue, monies may reduce in years, but no less

than £100KSurgery Recharge of Plastics Consultant 12 C Was one-off charge

Burns Unit Nurse recharge (AF) for Teaching Bournemouth 16 A Two days per week to continueBreast Implant Register 73 BPlastic Consultant recharged for work at Dorset (DS) 46 C Consultant to retire in due course

Nursing Recharge of Secondment to WDC (MP) 47 C To finish September 2005Clinical Effectiveness Library income 3 B

Debtors 6 CICID project 56 C Project finishedBournemouth National Institute Library 23 B Unknown for how long, income to reduce in timeMMC recharge 10 CRecharge of Consultant (EW) 120 C Consultant retired, treatments finishedBournemouth recharge 16 C Project finished

Critical Care Income received from courses in resus 26 BRecharge of Secondment Costs (TA) to PCT 43 A/C Secondment finishedRecharge of Physio/OT to Social Services from Spinal Unit 27 B Project due to finish within first part of 05/06Recharge of Radnor Bournemouth Practitioner 15 B To continue

Ambulatory Care Monies from Wiltshire for pregnancy - family planning 17 BPortage Service Funding 21 BCAMHS 5 BBournemouth Nurse Practitioners recharge 37 C Project finishedIncome from CAMS for Social Services 11 B

Chief Executive Dental Sector - Education Section 63 10 B So long as continue to provide service, could change from 07/08 due to on-line training

Hire of Room - Education 1 BCourses - Education 29 B Depend on courses held centrally (similar section 63)

Courses - IT 6 C Not guareented as adhocMisc - Education 8 C Depend on courses held centrally (similar section 63)

Misc - IT 1 C Not guareented as adhocOther - Education 180 C 86 - supported staff - end 05/06

94 - specific training projects - not knownOther 9 C Not guareented as adhocSecondment to Deanery 10 A Project finished, no staff costs nowSIFT GKT 40 C Dependent on student numbersLegal Services 13 C One-off amount

FinanceMisc 19 B ISOFT systems performance finishes July 2007 07/08

Intellectual Property Hub income 116 B Until mid 07/08Human Resources Secondment of Personnel (SW) 13 B Finishes Oct 2005Prior Yr Adjustments Income Other 180 B Income carry over to 2005/06Subtotal Direct Credits Budget Income Total 2320Other Income Donor Liason Scheme 32 B

SIFT monies (surplus) 4 CCulyer income 6 CNurse training 1 CTrainees 36 B

Subtotal Total Budget Income 2399Health Authority 372 BTrust 17 CPCT Income 2191 C

Total Non-recurring Income 2005/06 4979

PCT Income Breakdown PCT Cost and Volume 277PCT Social Services 8PCT Other Income 1484PCT Cancer Fund 70PCT Information 255FES Cost Per Case 32PFI 56Other 9

2191

Non-Recurring Income 2005/06 as at M7

Private Patient Income Private patients inpatients -11 N/R Reduction in PPI in preparation for FT ApplicationDirect Credits Income Internal Income -15

Dental Section 20 Rec For services providedTrainees Other 22Hire of Room 3 RecDay Nursery -24 Rec £59K for whole yearPlayscheme 3 N/RStaff dining room 51 N/R Income allocated from prior year adjustmentsFES equipment 47 N/R Lost income through the new companyCourses 30 N/R Not guaranteed course incomeMisc 79 Rec Family planning, Portage etcOther authorities 50 N/R Project monies, finance and modernisationMacmillian Lead Consultants 3 N/R DACS RechargeResearch Grant 292 Rec National Research LabroratoryRecharges 1064Other NHS -827 N/R Laundry income reduced targetOther Trusts 4 Rec SIFT monies GKTOther 27 N/R AfC financial monitoring income

Subtotal 829Health Authority Income Health authority income 729 N/RHealthcare Income HA - Other 5 N/R

HA - Other 1003 N/RClinical sessions 3 N/R Urology (Lugershall sessions)PCT - Cost & Volume 1193 RecPCT - Cost per case 30 N/RPCT - Other income 105 RecPCT - Information 349 RecPCT - FES Cost per case 29 N/RPCT - PFI 569 RecPCT - Other income 1765 N/RIncome other NHS 28 RecTrainees Other 22 Rec

Subtotal 5101Total 6659

Salisbury Healthcare NHS Trust Appendix I

Non-SLA Income and Unregulated Income 2004/05 Breakdown

Non-SLA IncomePrivate Patient Income Inpatients 321

Out-patients 444Day Cases 60X-ray Private 117Path Private 15Assisted Concessions 7IVF Unit Block 12IVF Unit Lease 2IVF Unit variable 5Orthopeadics 8

Subtotal 991

Overseas patients 55

Road Traffic Act 660

Patient Transport Services 0

Education, training and research Dental Section 11PGME - working paper 4,119SIFT Income 139R&D Income 86Culyer Income 810Training Nursing Other 1Trainees Other 376Training & Education 1Courses 150Clinical Trials 7Research Grant 481Other 29

Subtotal 6,210

Other Prescriptions 41Healthcare Act 1,087Donar Liason Scheme 16Meals on Wheels 16Welfare food income 88

Subtotal 1,248

Total 9,164

Unregulated Income Charitable and other contributions to expenditure 0

Transfers from government grant reserve 0

Non-patient care services to other b Internal Income 78Laundry Nursing 27Ministry of Defence 152Mortuary 50New Hall 369Nursing Homes 2Other Authorities 241Turning Point 13District Council 15Salisbury College 5Occupational Health 4Recharges 1,291Other NHS 7Other Trusts 5Other 58

Subtotal 2,317

Other income Rent Hairdressers 8Other rental 2Room Hire 2Board & Lodgings 590Visitor accomodation 1B&L Student Nurse 164Rent 27Day Nursery 285Subsidy 14Playsheme 31Emergency sessions 1Electricity 1Gas 1Staff Meals Deductions 12Functions Non-NHS 33Staff Dining 342Coffee Lounge 114Vending Machines 1Beverages 3SSD P&O Cruises 2Sale of silver 1Sale FES equipment 264Physio sales 2OT sales 1Sales Excl VAT 14Category II 8Continence 2ADCH Private Patients 4Bus passes 12Car leasing 41AA membership 2Courier Service 16SSD MODS 7SSD General Practioners 10Misc 469Newsletters 3Photography 3Subject Access 40Designated Spaces 31Ticket Machine 303Taxis 1Shop taxable 205Seating 59Uniforms 7Other 1Licence fee 6Social Services 10Legal Service 12

Subtotal 3,168

Total 5,485

Non-SLA Income and Unregulated Income 2005/06 Breakdown

Non SLA IncomePrivate Patients 1,040Other - DOH/RTA 1,892SIFT/R&D 5,778(Funding to SHA) -1,000Total 7,710

Unregulated Income 5,402Total 5,402

Salisbury Healthcare NHS Trust Appendix J

Cost Improvement Target

2002/03

target rec

£000Total£000

actualrec

£000non-rec

£000Reduction in maternity expenditure 75 75 75Defer developments 319 319 319Technical (VAT) and income 750 750 750Technical inc capital to revenue 480 500 500Procurment savings 350 485 385 1001% CRES target across budgets 900 400 200 200Demand management/additional income 1,300 750 750Ward environment budgets withdrawn 200 200Nurse eductaion budgets 150 150IVF income 50 50Close ITU bed 130 130Reduce training budgets 20 20Hillcote income 20 20

Total 2002/03 4,174 3,849 1,500 2,349

2003/04

target rec

£000Total£000

actualrec

£000non-rec

£0001.75% reductions on Directorates net budgets 1,600 1,103 1,103Delay contamination work 130 130 130Withdrawal of environment fund 205 205 20524hr catering 140 140 140Procurement savings 300 347 347Non-recurring savings linked to capital 250 250 250Technical savings 200 200 200New car park and other income above inflation 100 100 100New NUPT contract 40 40 40Rebate on x-ray consumables contract 80 80 80VAT and other rebates 50 50 50Delay security work 20 20 20Implement joint drugs formulary 40 40 40Additional net income 200 200

Total 2003/04 3,155 2,905 1,630 1,275

2004/05

target rec

£000Total£000

actualrec

£000non-rec

£0001.75% reductions on Directorates net budgets 2,085 2,032 1,032 1,000Cost Pressure Reduction 200 200 20024hr catering 140 140 140Ward Environment 160 160 160Slippage in developments 100 100 100Capital Charges Phasing 150 150 150Revenue to Capital 300 300 300Technical nr 750 750 750Other technical-stocks nr 551 551 551Total 2004/05 4,436 4,383 1,632 2,751

Salisbury Healthcare NHS Trust Appendix K

Reference Cost Analysis

Salisbury Healthcare NHS Trust MARKET ORGANISATION-WIDE ORGANISATION-WIDEFORCES INDEX INCLUDING INDEX EXCLUDING ELECT. / DC NON-ELECTIVE CRITICAL CARE OUT PATIENT OTHER ACUTE COMMUNITY MENTALFACTOR EXCESS BED DAYS EXCESS BED DAYS CARE INPATIENT SERVICES SERVICES SERVICES SERVICES HEALTH

2004/05 RNZ SALISBURY HEALTH CARE NHS TRUST 0.982466 90 90 82 86 62 104 115 76 1142003/04 RNZ SALISBURY HEALTH CARE NHS TRUST 0.978129 88 89 90 83 73 110 86 68 672002/03 RNZ SALISBURY HEALTH CARE NHS TRUST 0.986239 90 90 88 86 68 123 95 38 83

Local Reference Cost Comparison MARKET ORGANISATION-WIDE ORGANISATION-WIDEFORCES INDEX INCLUDING INDEX EXCLUDING ELECT. / DC NON-ELECTIVE CRITICAL CARE OUT PATIENT OTHER ACUTE COMMUNITY MENTALFACTOR EXCESS BED DAYS EXCESS BED DAYS CARE INPATIENT SERVICES SERVICES SERVICES SERVICES HEALTH

2003/04 Local average 0.982427 97 97 95 98 101 94 109 112 942003/04 RA4 EAST SOMERSET NHS TRUST 0.931407 101 102 106 102 95 96 100 1552003/04 RVJ NORTH BRISTOL NHS TRUST 1.007109 110 109 106 114 111 124 89 109 1532003/04 RD3 POOLE HOSPITALS NHS TRUST 0.981463 88 89 83 92 93 85 85 1242003/04 RHU PORTSMOUTH HOSPITALS NHS TRUST 0.996792 96 97 81 94 137 105 101 1852003/04 RDZ ROYAL BOURNEMOUTH & CHRISTCHURCH HOSPITALS NHS TRU 0.959990 91 93 95 91 90 81 117 622003/04 RD1 ROYAL UNITED HOSPITAL, BATH NHS TRUST 1.001689 93 95 96 97 97 88 1012003/04 RHM SOUTHAMPTON UNIVERSITY HOSPITALS NHS TRUST 1.005585 96 95 96 89 103 88 112 1322003/04 RN3 SWINDON & MARLBOROUGH NHS TRUST 1.029296 103 103 102 100 110 93 151 62 992003/04 RBA TAUNTON & SOMERSET NHS TRUST 0.929362 91 90 98 74 100 106 106 702003/04 RA7 UNITED BRISTOL HEALTHCARE NHS TRUST 1.008020 104 104 98 123 83 79 130 139 662003/04 RBD WEST DORSET GENERAL HOSPITALS NHS TRUST 0.921575 90 90 77 90 108 87 116 99 862003/04 RN1 WINCHESTER AND EASTLEIGH HEALTHCARE NHS TRUST 1.016828 99 98 99 105 86 92 103 90 67

Salisbury Healthcare NHS Trust Appendix L

Payment by Results Tariff Analysis

Top Elective cases by FCE cost

Pat type HRG HRG DescriptionSHCT No of FCE's 04/05 SHCT cost per FCE's SHCT cost by FCE

SHCT value by FCE after Inc/

Exp factor MFF, Inflation and Revaluation

Nat. Average cost per FCE's

National Average by cost by SHCT

FCE's spells 04/05 Trans tariff

Spells x Transitional

tarriff Net Benefitdcel H04 Primary Knee Replacement 293 4,965 1,454,676 1,371,296 5,774 1,691,765 271 5,387 1,459,919 88,623dcel C58 Intermediate Mouth or Throat Procedures 1,072 811 869,541 819,700 802 860,167 1,064 798 849,386 29,686dcel B13 Phakoemulsification Cataract Extraction and Insertion of Le 1,397 572 799,216 753,406 750 1,048,069 1,397 686 958,417 205,011dcel H81 Primary Hip Replacement Uncemented 175 4,350 761,278 717,643 5,187 907,706 175 4,799 839,825 122,182dcel J50 Other Major Breast Surgery 275 2,578 709,042 668,401 2,457 675,693 275 2,232 613,927 -54,474dcel H10 Arthroscopies 741 884 654,998 617,454 1,119 829,008 737 998 735,505 118,051dcel F35 Large Intestine - Endoscopic or Intermediate Procedures 1,308 416 543,698 512,534 505 660,217 1,290 472 608,608 96,074dcel H80 Primary Hip Replacement Cemented 99 4,696 464,947 438,297 5,396 534,174 94 4,993 469,342 31,045dcel M07 Upper Genital Tract Major Procedures 206 2,117 436,091 411,095 2,703 556,730 205 2,461 504,505 93,410dcel J37 Minor Skin Procedures - Category 1 w/o cc 648 614 397,652 374,859 613 397,266 640 591 378,059 3,200dcel L21 Bladder Minor Endoscopic Procedure w/o cc 676 550 371,729 350,422 465 314,441 674 418 281,897 -68,525dcel L20 Bladder Minor Endoscopic Procedure w cc 583 580 338,353 318,959 541 315,301 574 456 261,530 -57,429dcel F06 Diagnostic Procedures, Oesophagus and Stomach 1,448 233 338,031 318,656 421 609,508 1,406 386 542,558 223,902dcel C57 Major Mouth or Throat Procedures 171 1,911 326,789 308,058 2,111 361,053 171 2,325 397,562 89,504dcel J05 Intermediate Breast Surgery w/o cc 189 1,633 308,601 290,912 1,004 189,748 187 882 164,906 -126,006dcel M05 Upper Genital Tract Minor Procedures 378 688 260,118 245,209 635 240,015 371 569 210,938 -34,271dcel M03 Lower Genital Tract Major Procedures 143 1,766 252,470 237,998 2,103 300,701 140 1,941 271,767 33,769dcel L25 Bladder Neck Open Procedures Male 70 3,596 251,692 237,265 3,932 275,231 70 3,623 253,610 16,345dcel J35 Minor Skin Procedures - Category 2 w/o cc 301 786 236,539 222,981 757 227,913 194 697 135,220 -87,761dcel J30 Major Skin Procedures >49 or w cc 114 2,009 228,979 215,854 2,185 249,054 112 1,932 216,347 493

Sub total 10,004,440 9,430,999 11,243,760 10,153,828 722,829

Excess Bed Days - Elective

No. of Excess Bed

daysCost of each excess bed

dayCost to SHCT of excess

bed days

Value to SHCT OF each bed day after Inc/


National average cost of excess bed

days

SHCT bed days at National average

costNo. of spell

excess bed daysPbR value of

excess bed daysPBR Excess bed

day income Net benefitdcel HRG Description BD £ £ £ £ £ £dcel J36 Minor Skin Procedures - Category 1 w cc 139 148 20,625 18,745 227 31,557 264 188 49,632 30,887dcel J05 Intermediate Breast Surgery w/o cc 122 148 18,102 16,453 228 27,812 291 204 59,364 42,911dcel F31 Large Intestine - Complex Procedures 138 126 17,389 15,805 222 30,663 233 207 48,231 32,426dcel H32 Musculoskeletal Signs and Symptoms <70 w/o cc 117 148 17,360 15,778 214 25,058 156 193 30,108 14,330dcel H24 Soft Tissue Disorders <70 w/o cc 123 126 15,486 14,075 221 27,135 158 201 31,758 17,683dcel H81 Primary Hip Replacement Uncemented 103 150 15,423 14,018 137 14,155 224 157 35,168 21,150dcel H28 Non-Inflammatory Bone or Joint Disorders <70 w/o cc 101 148 14,986 13,621 202 20,432 116 201 23,316 9,695dcel H17 Soft Tissue or Other Bone Procedures - Category 1 <70 w/ 89 150 13,327 12,112 232 20,629 6 216 1,296 -10,816dcel H04 Primary Knee Replacement 81 150 12,129 11,024 198 16,000 239 189 45,171 34,147dcel H71 Revisional Procedures to Hips 63 150 9,434 8,574 234 14,715 83 198 16,434 7,860dcel S36 Diagnostic Extraction of Bone Marrow 73 115 8,369 7,607 389 28,391 187 299 55,913 48,306dcel J44 Minor Dermatological Conditions or Benign Tumours 56 148 8,309 7,552 198 11,089 78 183 14,274 6,722dcel H18 Soft Tissue or Other Bone Procedures - Category 2 >69 or 51 150 7,637 6,941 212 10,813 55 189 10,395 3,454dcel H27 Non-Inflammatory Bone or Joint Disorders >69 or w cc 48 144 6,933 6,301 176 8,460 102 173 17,646 11,345dcel J31 Major Skin Procedures <50 w/o cc 41 148 6,084 5,529 250 10,257 39 209 8,151 2,622dcel J33 Minor Skin Procedures - Category 3 41 148 6,084 5,529 250 10,235 141 195 27,495 21,966dcel A34 Miscellaneous Disorders of Nervous System 41 140 5,740 5,217 223 9,133 175 171 29,925 24,708dcel H30 Infections of Bones or Joints 38 149 5,677 5,160 193 7,351 67 173 11,591 6,431dcel R16 Thoracic or Lumbar Spinal Disorders <70 w/o cc 40 124 4,974 4,521 195 7,814 277 187 51,799 47,278dcel L17 Bladder Major Endoscopic Procedure 36 132 4,758 4,325 199 7,177 30 181 5,430 1,105

1,541 218,827 198,885 323,885 2,921 573,097 374,212



Top Non - Elective cases by FCE cost

Pat type HRG HRG DescriptionSHCT No of FCE's 04/05 SHCT cost per FCE's SHCT cost by FCE

SHCT value by FCE after Inc/


Nat. Average cost per FCE's

National Average by cost by SHCT

FCE's spells 04/05 Trans tariff

Spells x Transitional

tarriff Net Benefitne N12 Antenatal Admissions not Related to Delivery Event 2,476 661 1,636,289 1,532,199 533 1,319,926 2,476 464 1,148,864 -383,335ne N07 Normal Delivery w/o cc 1,162 939 1,090,857 1,021,464 935 1,086,949 1,162 855 993,510 -27,954ne H99 Complex Elderly with a Musculoskeletal System Primary Di 230 4,592 1,056,062 988,883 4,977 1,144,606 214 6,467 1,383,938 395,055ne N11 Caesarean Section w/o cc 504 2,036 1,026,235 960,953 2,109 1,062,941 504 1,947 981,288 20,335ne D99 Complex Elderly with a Respiratory System Primary Diagno 401 1,973 791,250 740,916 1,974 791,629 250 3,103 775,750 34,834ne J29 Major Reconstructive Surgery 159 3,750 596,268 558,338 4,934 784,459 146 4,953 723,138 164,800ne A99 Complex Elderly with a Nervous System Primary Diagnosis 185 3,142 581,184 544,213 3,280 606,788 115 5,166 594,090 49,877ne L09 Kidney or Urinary Tract Infections >69 or w cc 315 1,628 512,762 480,143 1,682 529,798 219 2,372 519,468 39,325ne H36 Closed Pelvis or Lower Limb Fractures >69 or w cc 150 3,300 495,052 463,561 3,622 543,251 100 4,124 412,400 -51,161ne H19 Soft Tissue or Other Bone Procedures - Category 2 <70 w/ 303 1,600 484,766 453,929 1,627 493,095 303 1,505 456,015 2,086ne F46 General Abdominal Disorders >69 or w cc 479 870 416,927 390,405 1,189 569,491 302 1,236 373,272 -17,133ne E99 Complex Elderly with a Cardiac Primary Diagnosis 205 2,015 412,979 386,708 2,022 414,409 120 2,998 359,760 -26,948ne D13 Lobar, Atypical or Viral Pneumonia w cc 222 1,829 406,049 380,219 1,870 415,059 152 3,142 477,584 97,365ne A22 Non-Transient Stroke or Cerebrovascular Accident >69 or w 234 1,616 378,098 354,047 2,382 557,407 140 4,160 582,400 228,353ne F47 General Abdominal Disorders <70 w/o cc 547 639 349,772 327,522 763 417,494 444 733 325,452 -2,070ne H37 Closed Pelvis or Lower Limb Fractures <70 w/o cc 190 1,829 347,559 325,450 2,364 449,135 173 2,365 409,145 83,695ne H45 Minor Fractures or Dislocations 219 1,307 286,273 268,062 1,327 290,718 213 1,254 267,102 -960ne E22 Ischaemic Heart Disease without intervention >69 or w cc 328 868 284,727 266,615 969 317,854 226 1,518 343,068 76,453ne H71 Revisional Procedures to Hips 36 7,875 283,512 265,477 5,500 197,993 36 6,146 221,256 -44,221ne H88 Other Neck of Femur Fracture w cc 63 4,489 282,832 264,840 4,254 267,978 29 6,026 174,754 -90,086ne J41 Major Skin Infections >69 or w cc 181 1,553 281,023 263,146 1,555 281,390 128 2,062 263,936 790ne S99 Complex Elderly with a Haematology, Infectious Disease, P 138 2,015 278,071 260,382 2,263 312,289 98 3,634 356,132 95,750ne N09 Assisted Delivery w/o cc 226 1,230 277,869 260,193 1,306 295,066 226 1,262 285,212 25,019ne E18 Heart Failure or Shock >69 or w cc 201 1,266 254,465 238,278 1,606 322,868 128 2,267 290,176 51,898ne H50 Multiple Injury <70 139 1,756 244,085 228,558 2,683 372,913 101 2,745 277,245 48,687ne F36 Large Intestinal Disorders >69 or w cc 160 1,513 242,113 226,711 1,669 266,972 112 1,974 221,088 -5,623ne D25 Respiratory Neoplasms 138 1,707 235,574 220,588 1,971 271,990 97 2,796 271,212 50,624ne H86 Neck of Femur Fracture with Hip Replacement w cc 36 6,520 234,714 219,783 6,225 224,097 36 7,267 261,612 41,829ne L20 Bladder Minor Endoscopic Procedure w cc 134 1,654 221,658 207,558 2,151 288,219 66 2,109 139,194 -68,364ne F82 Appendicectomy Procedures <70 w/o cc 149 1,484 221,101 207,036 1,984 295,669 147 2,045 300,615 93,579

Sub total 14,210,127 13,306,178 15,192,451 14,188,676 882,498

Excess Bed Days - Non Elective

HRG HRG Description

No. of Excess Bed

daysCost of each excess bed

dayCost to SHCT of excess

bed days

Value to SHCT OF each bed day after Inc /

Cost factorMFF,

Inflation and Revaluation

National average cost of excess bed

days

SHCT bed days at National average

costNo. of spell

excess bed daysPbR value of

excess bed daysPBR Excess bed

day incomeNet benefit to

SHCTne A20 Transient Ischaemic Attack >69 or w cc 725 198 143,507 133,096 169 122,643 757 162 122,634 -10,462ne L09 Kidney or Urinary Tract Infections >69 or w cc 633 190 120,179 111,460 147 92,825 1,083 139 150,537 39,077ne D99 Complex Elderly with a Respiratory System Primary Diagno 620 179 111,122 103,060 125 77,585 587 120 70,440 -32,620ne H36 Closed Pelvis or Lower Limb Fractures >69 or w cc 417 199 83,157 77,124 206 85,979 541 188 101,708 24,584ne S31 Admission for Unexplained Symptoms 455 171 77,782 72,140 157 71,586 329 151 49,679 -22,461ne D13 Lobar, Atypical or Viral Pneumonia w cc 534 132 70,542 65,424 159 84,846 210 151 31,710 -33,714ne L99 Complex Elderly with a Urinary Tract or Male Reproductive 400 165 65,988 61,201 168 67,298 215 156 33,540 -27,661ne H39 Closed Upper Limb Fractures or Dislocations >69 or w cc 331 196 64,950 60,239 206 68,031 295 189 55,755 -4,484ne L20 Bladder Minor Endoscopic Procedure w cc 336 180 60,330 55,953 170 57,070 1,066 164 174,824 118,871ne A34 Miscellaneous Disorders of Nervous System 370 157 58,033 53,823 177 65,665 202 171 34,542 -19,281ne E22 Ischaemic Heart Disease without intervention >69 or w cc 426 126 53,478 49,598 171 72,763 464 162 75,168 25,570ne E31 Syncope or Collapse >69 or w cc 293 181 52,963 49,121 132 38,788 60 126 7,560 -41,561ne E99 Complex Elderly with a Cardiac Primary Diagnosis 273 189 51,687 47,937 142 38,859 534 136 72,624 24,687ne A99 Complex Elderly with a Nervous System Primary Diagnosis 283 169 47,877 44,403 155 43,739 161 146 23,506 -20,897ne S35 Other Specified Admissions and Counselling 236 181 42,709 39,610 169 39,782 161 159 25,599 -14,011ne Q17 Non-Surgical Peripheral Vascular Disease w cc 215 176 37,791 35,049 187 40,186 51 180 9,180 -25,869ne N12 Antenatal Admissions not Related to Delivery Event 197 184 36,159 33,536 279 54,990 319 258 82,302 48,766ne S19 Complications of Procedures 210 163 34,215 31,733 212 44,533 144 202 29,088 -2,645ne F46 General Abdominal Disorders >69 or w cc 151 226 34,176 31,696 182 27,495 62 175 10,850 -20,846ne A28 Headache or Migraine <70 w/o cc 217 150 32,641 30,273 177 38,486 26 168 4,368 -25,905

Sub total 1,279,285 1,186,478 1,233,148 1,165,614 -20,864



Outpatients: First Attendances

Specialty Specialty descriptionSHCT

AttendancesSHCT Cost per

attendanceSHCT total cost per

attendance

Value to SHCT OF each

attendance after Inc/ cost factor MFF, Inflation and Revaluation

National average cost per

attendance

National average cost per attendance

x SHCT attendances National Tariff

PbR activity at Nat Tarriff

Net Benefit to SHCT

outp fst 110N Trauma & Orthopaedics: Non-Trauma 6,614 196 1,298,130 1,205,849 134 888,029 137 905,885 -299,964outp fst 100 General Surgery 10,680 91 969,317 900,410 142 1,518,358 144 1,543,098 642,688outp fst 300 General Medicine 6,170 148 915,813 850,710 199 1,225,367 195 1,201,927 351,217outp fst 120 ENT 4,528 141 638,765 593,357 106 480,660 108 490,216 -103,141outp fst 502 Gynaecology 2,655 236 626,978 582,408 128 339,722 136 361,566 -220,842outp fst 130 Ophthalmology 6,733 84 568,737 528,306 96 644,460 98 659,040 130,734outp fst 410 Rheumatology 2,131 237 505,665 469,718 212 451,401 214 455,884 -13,834outp fst 160 Plastic Surgery 5,137 98 501,936 466,255 111 572,557 123 634,039 167,784outp fst 420 Paediatrics 2,602 181 471,717 438,183 219 569,363 233 606,266 168,083

Sub total 6,497,057 6,035,196 6,689,916 6,857,921 822,725

Outpatients: Followup Attendances

Specialty DescriptionSHCT



attendance


attendance after MFF,



attendance




Net Benefit to SHCT

outp fu 110N Trauma & Orthopaedics: Non-Trauma 12,984 131 1,698,956 1,582,370 82 1,060,487 69 900,252 -682,118outp fu 300 General Medicine 13,634 99 1,349,084 1,256,507 111 1,513,289 87 1,184,549 -71,958outp fu 160 Plastic Surgery 18,998 65 1,237,530 1,152,608 72 1,364,070 61 1,151,334 -1,274outp fu 130 Ophthalmology 18,098 56 1,019,098 949,166 59 1,063,158 49 879,846 -69,320outp fu 420 Paediatrics 7,225 121 873,214 813,292 146 1,055,274 122 881,450 68,158outp fu 410 Rheumatology 5,334 158 843,785 785,883 124 663,626 98 523,107 -262,776

Sub total 7,021,668 6,539,826 6,719,905 5,520,538 -1,019,288

Accident and Emergency




attendance





attendance




Net Benefit to SHCT

a&e DOA Dead on Arrival 48 11 530 483 59 2,813 60 2,880 2,397a&e V01 High Cost Imaging (Died / Admitted) 3,650 149 542,573 494,783 158 577,530 95 346,750 -148,033a&e V02 High Cost Imaging (Referred / Discharged) 8,104 61 494,992 451,394 115 933,676 95 769,880 318,486a&e V07 No Investigation (Died / Admitted) 6,685 149 993,725 906,199 112 749,674 60 401,100 -505,099a&e V08 No Investigation (Referred / Discharged) 17,942 61 1,095,897 999,372 62 1,119,704 60 1,076,520 77,148

Sub total 3,127,717 2,852,231 3,383,397 2,597,130 -255,101

Ward attenders




attendance





attendance



PbR activity at Nat Tariff

Net Benefit to SHCT

wa 420 Paediatrics 2,600 150 390,000 361,991 123 319,962 122 317,000 -44,991

Salisbury Healthcare NHS Trust Appendix M

Trust Benchmarking Exercise with Four Surrounding Trusts

SLA Income Budget £145m £125m £126m £90m £100m

Medical Staffing WTE £m Per WTE £000s WTE £m Per WTE £000s WTE £m Per WTE £000s WTE £m Per WTE £000s WTE £m Per WTE £000sConsultants 137.2 16 118.8 104.2 11.5 110.4 131.4 14.7 111.8 88 10.1 114.8 86.7 11.5 132.6Training Grades 202.4 13 61.8 140 9 64.3 194.3 11 56.6 113.8 7.5 65.9 130.3 8.4 64.5Non Training 48.2 3 62.2 14.3 1.2 83.9 30.1 1.7 56.8 26.7 2.0 74.9 19.2 1.3 67.7Inpatients & Daycases Spells 61,473 45,690 59,437 42,996 44,880 Cost per Spell 517 475 461 456 472

Ancillary StaffCatering 65.6 1,012 15.4 73.3 1103 15.0 40.7 709 17.4 42.9 680 15.9 45.3 845 18.7Cleaning 165.0 2,330 14.1 87.1 1097 12.6 21.7 269 12.4 0 0 0 120.5 1706 14.2Porters 96.1 1,376 14.3 38.6 684 17.7 44.4 699 15.7 44.6 677 15.2 76.1 1227 16.1Maintenance 31.3 698 22.3 30.2 689 22.8 28.7 634 22.1 21.7 576 26.5 39.0 870 22.3

Admin & Clerical Staff 598 10.8 18,060 452 8 17,699 N/A N/A N/A 370 6.7 18,108

£000s Attendance Per Attendance £000s Attendance Per Attendance £000s Attendance Per Attendance £000s Attendance Per Attendance £000s Attendance Per Attendance A&E 3,348 68,522 48.86 1,420 36,522 38.88 1,606 47,079 34.12 1,588 33,025 48.08 1,856 41,829 44.37

Cost per Bed for Ward Expenditure

04/05 Expenditur

e £000s BedsCost per Bed

£

04/05 Expenditure

£000s BedsCost per Bed

£

04/05 Expenditure

£000s BedsCost per Bed

£

04/05 Expenditur


£

04/05 Expenditur


£Medical Wards 716 23/21 31,130 611 22 27,773 866 25.3 34,229 936 27 34,666 693 24 28,875 CCU 750 8 93,750 455 5 91,000 841 9 93,445 345 6 57,500 N/A N/A N/AMAU 2,050 32 64,063 952 26 36,615 1,342 22 61,018 N/A N/A N/A 1,425 26 54,807 Care of the Elderly Wards 850 28 30,357 559 22 25,409 891 27 33,009 768 25 30,356 826 27 30,593 Surgical Wards 771 26 29,654 995 36 27,639 735 25 29,400 1,147 32 35,844 754 25 30,160 Orthopaedic Wards 780 27 28,889 730 27 27,037 793 28 28,321 1,039 31 33,516 805 27 29,815 ITU & HDU 2474 11 224,909 2,030 8 253,750 2,480 11 225,455 1,881 9.9 190,000 2,034 10 203,400

NICU 1379

21 (4 ITU, 3 HDU & 14

SCBU) 65667 711

14 (2 ITU, 2 HDU, 10

SCBU) 50786 1,376

18 (4 ITU, 4 HDU, 10

SCBU) 76,444 761 9 (SCBU) 84,556 1,060 16 (2 ITU, 2 HDU, 12 SCBU) 66,250

Paediatrics 1566 38 41211 647 16 40438 1,644 30 54,800 774 21 36,857 966 23 42,000

Cost per Theatre for Main & Day Theatres2004/05

£000s TheatresPer Theatre

£000s 2004/05 £000s TheatresPer Theatre

£000s 2004/05 £000s TheatresPer Theatre

£000s2004/05


£000s2004/05


£000sDay Theatre 1,691 5 338 1,921 5 384 N/A N/A N/A 1,295 3 432 589 2 295Main Theatre 6,281 11 571 4,018 7 574 3,847 11 350 3,705 7 529 3,576 4 894

Cases Per Case Cases Per Case Cases Per Case Cases Per Case Cases Per Case£000s £000s £000s £000s £000s

Day Theatre 7825 216 9,238 208 7,486 N/A 6,038 214 5,446 108Main Theatre 12647 497 9,390 427 14,807 260 8,261 448 5,482 652

WTE2004/05

£000s Theatre CasesPer Case

£000s WTE2004/05


£000s WTE2004/05


£000s WTE 2004/05 £000sTheatre

CasesPer Case

£000s WTE 2004/05 £000s Theatre CasesPer Case

£000sDSDU 38.5 929 12647 73 32 574 9390 61 35.0 1,298 14,807 88 17.6 274 8261 33 17.5 288 5,482 53

WTE £000s WTE £000s WTE £000s WTE £000s WTE £000sAnaesthetics 51.7 5,054 37.0 3,000 50.1 4,214 30.8 2,704 43.7 3,368 Theatre Cases 12,647 9,238 14,807 8,261 6,098 Per Case 400 325 285 327 552

Pathology 130.5 8,685 99.5 7,700 148.7 8,400 95.8 10,100 121.6 11,000Radiology 154.8 5,818 72.8 5,000 111.9 5,600 80.0 5,800 78.89 5,400Pharmacy Services 85.2 2,073 38.7 1,270 48.3 1,500 33.6 1,700 47.7 1,900

WINCHESTERRUH SALISBURY TAUNTON & SOMERSET WEST DORSET

Salisbury Healthcare NHS Trust Appendix M

Trust Benchmarking Exercise with Four Surrounding Trusts

RUH SalisburyTaunton & Somerset West Dorset Winchester

£'000s £'000s £'000s £'000s £'000s

Capital Charges 9,907 10,700 10,400 10,600 11,300

Non PayDrugs Issued 6,860 5,916 6,162 9,428 6,741 Blood 2,126 1,392 1,938 1,766 1,354 MSE (General) 4,356 4,580 5,423 5,496 3,476 Prosthesis (Hips & Knees) 1,980 1,677 2,356 1,661 1,053 Xray Film 390 378 352 502 286 Xray Maintenance 365 N/A 115 425 260 Patient Appliances 323 1,508 1,228 681 428 Lab Chemicals/reagents 1,025 1,189 818 927 813 Provisions 1,095 1,160 1,646 1,048 1,479 Stationery 638 708 705 707 734 Postage 152 155 196 232 455 Staff advertising 324 313 185 353 590 Patient Transport 1,098 233 1,053 937 887 Electricity 644 688 574 547 800 Gas 573 914 488 462 700 Water & Sewerage 210 329 324 219 326 Cleaning Materials 338 69 389 382 310 Insurance & CNST 2,524 1,926 2,528 2,185 2,582 Rates 817 957 796 997 883 Waste 298 232 281 425 325 Legal Costs 141 79 121 68 103 Audit Services 270 254 228 169 439 Laundry 530 N/A 780 456 423

Total 27,077 24,657 28,686 30,073 25,447

Direct IncomeCar Park Income 713 387 631 464 770 Lodging Income 469 873 242 328 452 Meals & Beverages 617 410 449 947 786 Atrium Coffee Bar 382 132 197 - 247 Private Patients 1,037 1,160 2,430 623 363 RTAs 610 766 677 884 577

Total 3,828 3,728 4,626 3,246 3,195

Salisbury Healthcare NHS Trust Appendix N

Planned Activity 2005/06

Income TotalDaycase Elective Non elective TOTAL Initial Follow-Up Cost & Volume Contract Income

Wiltshire PCTs £'000 £'000

Kennet & North Wilts 1367 396 2210 3973 3683 6439 6,274 7,861

South Wiltshire 10319 2886 11079 24284 30217 60076 35,595 61,068

West Wilts 816 282 953 2051 2021 1884 3,494 4,323

Swindon 0 0 0 0 0 0 0 156Sub-Total 12502 3564 14242 30308 35921 68399 45363 73408

North Dorset 2008 764 2030 4802 6109 12005 8,028 11,263Bournemouth 91 80 137 308 109 717 662 929Poole 68 102 101 271 113 599 716 1,005SE Dorset 200 144 331 675 686 2029 1,704 2,391S W Dorset 84 68 71 223 55 517 582 817Mendip 15 11 30 56 71 266 151 212Somerset Coast 0 0 5 5 0 0 2 3South Somerset 19 28 33 80 52 187 136 191Taunton Deane 2 1 2 5 0 18 81 114Sub-total Dorset & Somerset 2487 1198 2740 6425 7195 16338 12062 16923

New Forest 1589 597 1794 3980 4657 9906 7,857 9,526Eastleigh/Test Valley 99 87 90 276 200 614 585 668Southampton City 87 150 81 318 343 903 844 889North Hampshire 44 111 58 213 113 225 471 498Mid Hants 328 165 322 815 780 1655 1,628 1,721Blackwater Valley 6 16 17 39 15 39 103 109Portsmouth City 43 93 40 176 173 497 334 337Fareham & Gosport 34 71 45 150 106 333 285 322Isle of Wight 51 128 15 194 72 259 443 443East Hampshire 32 84 28 144 142 397 275 311Sub-Total 2313 1502 2490 6305 6601 14828 12825 14824

Subtotal main commissioners 17302 6264 19472 43038 49717 99565 70250 105155

OATS & Other commissioners 218 188 652 1058 219 1000 4,259 8,572

Total commissioned activity 17520 6452 20124 44096 49936 100565 74509 113727

Note:Activity above excludes obstetrics and learning disabilities and well babiesAbove includes all acute activity undertaken at Salisbury District Hospital.

Inpatients Outpatients

Activity volumes for 2005/06 have been agreed with all PCT's.

Salisbury Healthcare NHS Trust Appendix O

SLA Income 2005/06

Wiltshire PCTs Hampshire PCTs Dorset PCTsS Wilts KNW W Wilts Swindon Wiltshire

TotalETVS New Forest Soton City Mid Hants North Hants Blackwater Subtotal

Mid HantsFareham & Gosport

Portsmouth City

East Hants Subtotal Portsmouth

Hampshire Specialised

IOW Hampshire Total

N Dorset Bournemouth Poole SE Dorset S&W Dorset

Mendip S Somerset Taunton Deane

Somerset Coast

Dorset & Somerset Total

5DJ00 5K400 5DH00 5K300 Wilts 5LY00 5A100 5L100 5E900 5DF00 5G600 5LX00 5FE00 5FD00 5DG00 5CD00 5CE00 5CV00 5FN00 5FP00 5FX00 5K100 5K200 5FW00£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

PBR Elective National tariff rates excluding MFF 05/06 prices 11180 1419 798 13397 268 1935 428 524 269 37 830 151 182 161 494 0 292 4,247 2559 192 198 352 214 28 77 26 1 3647

Deferred PBR local rates 04/05 price base 0 0Non elective 0/1 length of stay 4,303 605 261 5,169 22 531 17 113 16 2 131 10 9 6 25 0 2 728 534 48 53 140 36 12 6 8 837Non elective other 17,395 1,802 1,009 20,206 123 2,676 140 500 82 35 617 52 64 29 145 0 30 3,731 2,938 238 270 705 185 65 29 40 4,470Outpatient (first attendance) 3,595 477 262 4,334 26 657 46 101 12 2 115 13 22 18 53 0 9 906 628 56 62 163 43 15 7 9 983Outpatient ( follow up attendances) 6,000 675 204 6,879 64 1,044 95 156 17 4 177 32 52 38 122 0 29 1,531 998 94 105 254 77 26 12 16 1,582Critical care 0 0 0 0 0 0A&E 3,521 559 251 4,331 0 0 0 0 0Subtotal deferred PBR at 04/05 price base 34,814 4,118 1,987 0 40,919 235 4,908 298 870 127 43 1,040 107 147 91 345 0 70 6,896 5,098 436 490 1,262 341 118 54 73 0 7,872Revaluation deferred PBR 747 84 28 0 859 6 125 7 21 2 1 24 3 3 2 8 0 1 171 66 15 14 23 11 1 5 1 0 136Subtotal including revaluation at 04/05 prices 35,561 4,202 2,015 0 41,778 241 5,033 305 891 129 44 1,064 110 150 93 353 0 71 7,067 5,164 451 504 1,285 352 119 59 74 0 8,008Inflation at 5.84% 2,077 245 118 0 2,440 14 294 18 52 8 3 62 6 9 5 21 0 4 413 302 26 29 75 21 7 3 4 0 468

Total deferred PBR at 05/06 price base 37,638 4,447 2,133 0 44,218 255 5,327 323 943 137 47 1,126 116 159 98 374 0 75 7,480 5,466 477 533 1,360 373 126 62 78 0 8,47644,218 0 0 8,476

Non PBR local rates 04/05 price base 10,763 993 797 12,553 158 1,806 132 291 71 21 383 53 59 69 181 4,000 5 6,665 4,268 13 13 62 1 4 0 2 4,363Revaluation 518 74 36 0 628 4 46 3 7 2 0 9 2 1 2 5 0 0 67 151 8 8 13 5 0 2 0 1 188Subtotal at 04/05 price base 11,281 1,067 833 0 13,181 162 1,852 135 298 73 21 392 55 60 71 186 4,000 5 6,732 4,419 21 21 75 6 4 2 2 1 4,551Inflation at 5.84% 659 62 49 0 770 9 108 8 17 4 1 23 3 4 4 11 234 0 393 258 1 1 4 0 0 0 0 0 266

Total non PBR at 05/06 price base 11,940 1,129 882 0 13,951 171 1,960 143 315 77 22 415 58 64 75 197 4,234 5 7,125 4,677 22 22 79 6 4 2 2 1 4,817415 197 612 4,817

Total SLA 05/06 price base before any activity changes 60,758 6,996 3,812 0 71,566 695 9,222 894 1,782 483 106 2,371 326 404 335 1,064 4,234 372 18,852 12,702 692 754 1,791 593 158 142 106 2 16,939

Activity adjustments 771 445 1,216 0 0 179 179 0

Other variations MPET - 04/05 value (reduction) 0 0 0 0 -41 -41MPET inflation at 5.84% (reduction) 0 0 0 0 -2 -2Speech & language therapy 0 19 0 0 19 0Digital hearing aids 0 0 0 0 0Retinal screening 0 7 0 0 7 0Agenda for Change 0 0 0 0 0Agenda for Change plus 5.84% 0 0 0 0 0Genetics Counselling incl 5.84% 0 0 0 0 49 4928 day prescribing incl 5.84% 0 0 0 0 45 45Rolling Average Changes Spinal Incl 5.84% 0 0 0 0 0Rolling Average Changes Burns Incl 5.84% 0 0 0 0 0Portsmouth Clinics (-47455 * 1.0584) 0 0 -13 -21 -16 -50 -50 0Bank Funding 0 0 0 0 0Westbury 13 13 0 0 0 0Other 0 0 0 0 0

0 0Revised total 61,529 7,441 3,825 0 72,795 695 9,248 894 1,782 483 106 2,371 313 383 319 1,014 4,413 372 19,007 12,753 692 754 1,791 593 158 142 106 2 16,990

cfwd total cfwd total bfwd108,792 19,007 19,007

Income at risk - 0.84% on Deferred PBR (non elective and outpatients) and Non PBRIncome as per LDP Submission 05/06

Footnote Total revaluation 0 0Included in elective tariff 222 27 12 261 5 50 11 13 5 1 4 5 5 0 6 72 30 7 7 11 6 0 2 0 2 65Deferred PBR 747 84 28 859 6 125 7 21 2 1 3 3 2 0 1 139 66 15 14 23 11 1 5 1 136Non PBR 518 74 36 628 4 46 3 7 2 0 2 1 2 0 0 53 151 8 8 13 5 2 1 188Total revaluation 1487 185 76 0 1748 15 221 21 41 9 2 0 9 9 9 0 0 7 264 247 30 29 47 22 1 9 1 3 389

1487 185 76 15 221 21 41 9 2 9 9 9 0 7 247 30 29 47 22 1 9 1 3 389SLA 04/05 values 54737 6280 3490 302 64809 599 8538 883 1663 402 123 2188 315 406 347 1068 4000 325 17,601 15473

Agenda for change is included in the figures already - £155k.

Analysed byInflation 2736 308 166 0 3210 24 402 26 69 12 4 85 10 12 10 31 234 4 806 560 28 31 79 21 7 4 4 0 733Revaluation 1265 158 64 0 1487 10 171 10 28 4 1 33 5 4 4 13 0 1 238 217 23 22 36 16 1 7 1 1 324MPET Adjustment 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 -43 0 0 0 0 0 0 0 0 -43Speech & language therapy 0 0 0 0 0 0 19 0 0 0 0 0 0 0 0 0 0 0 19 0 0 0 0 0 0 0 0 0 0Retinal Screening 0 0 0 0 0 0 7 0 0 0 0 0 0 0 0 0 0 0 7 0 0 0 0 0 0 0 0 0 0Genetics Counselling 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 49 0 0 0 0 0 0 0 0 4928 day prescribing 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 45 0 0 0 0 0 0 0 0 45Digital hearing aids 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Activtiy adjustments 771 445 0 0 1216 0 0 0 0 0 0 0 0 0 0 0 179 0 179 0 0 0 0 0 0 0 0 0 0Rolling averages spinal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Rolling averages burns 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Portsmouth Clinics 0 0 0 0 0 0 0 0 0 0 0 0 -13 -21 -16 -50 0 0 -50 0 0 0 0 0 0 0 0 0 0Transition gainWestbury 0 0 13 0 13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Other/NICE/Library non rec 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0Subtotal 4,772 911 243 0 5,926 34 599 36 97 16 5 118 2 -5 -2 -6 413 5 1,199 828 51 53 115 37 8 11 5 1 1,108

Inflation amendmentPay 2.8%Non pay 0.6%Inflation other - to balance to 5.84%Clinical negligence 0.1%Secondary drugs 0.4%Revenue cost of capital 0.2%Efficiency -1.7%Consultant contract/ junior doctorsAgenda for changeNICE Appraisals and guidelinesInvestment in new capital0.84% ( year on year tariff changes)Total

Salisbury Healthcare NHS Trust Appendix O

SLA Income 2005/06

Avon PCTsSouth Gloucester

North Bristol

S & W Bristol

Avon Total BANES North Somerset

Berkshire South & West Devon

North & East Devon

Cornwall West Sussex

East Sussex

Surrey/Kent S W Thames

WMSSA London SCG

Eastern Region

Channel Islands

Bank Other OATS Hospice Other Income non patient

Private income & other pt

Other Trusts

WDC Grand Total

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

PBR Elective National tariff rates excluding MFF 05/06 prices 5 1 1 7 15 0 14 24 10 9 54 9 8 0 0 0 0 0 0 21,441

Deferred PBR local rates 04/05 price base 0 0 0 0 0 0 0Non elective 0/1 length of stay 1 0 1 2 0 0 3 1 0 1 0 1 16 0 0 0 0 0 0 6,758Non elective other 9 8 7 24 29 0 55 28 35 11 37 12 70 0 0 0 0 0 0 28,708Outpatient (first attendance) 0 0 0 0 1 0 0 1 1 0 1 0 1 0 0 0 0 0 0 6,228Outpatient ( follow up attendances) 2 1 0 3 4 0 4 1 0 1 4 0 4 0 0 0 0 0 0 10,013Critical care 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0A&E 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4,331Subtotal deferred PBR at 04/05 price base 12 9 8 29 34 0 62 31 36 13 42 13 91 0 0 0 0 0 0 56,038Revaluation deferred PBR 0 0 0 0 2 0 3 1 1 0 1 0 4 0 0 0 0 0 0 1,178Subtotal including revaluation at 04/05 prices 12 9 8 29 36 0 65 32 37 13 43 13 95 0 0 0 0 0 0 57,216Inflation at 5.84% 1 1 0 2 2 0 4 2 2 1 3 1 6 0 0 0 0 0 0 3,341

Total deferred PBR at 05/06 price base 13 10 8 31 38 0 69 34 39 14 46 14 101 0 0 0 0 0 0 60,557

Non PBR local rates 04/05 price base 77 103 20 200 218 77 79 323 147 153 69 22 32 1,027 219 120 54 101 1,125 8,900 1,128 390 3,897 41,862Revaluation 1 5 0 6 6 0 2 4 6 3 9 10 10 0 0 0 0 0 0 939Subtotal at 04/05 price base 78 108 20 206 224 77 81 327 153 156 78 32 42 1,027 219 120 54 101 0 1,125 0 8,900 1,128 390 3,897 42,801Inflation at 5.84% 5 6 1 12 13 4 5 19 9 9 5 2 2 60 13 7 3 6 0 66 0 520 66 23 228 2,500

Total non PBR at 05/06 price base 83 114 21 218 237 81 86 346 162 165 83 34 44 1,087 232 127 57 107 0 1,191 0 9,420 1,194 413 4,125 45,301

Total SLA 05/06 price base before any activity changes 100 125 31 256 290 81 169 404 211 188 182 57 153 1,087 232 127 57 107 0 1,191 0 9,420 1,194 413 4,125 127,299

Activity adjustments 0 537 1,932

Other variations MPET - 04/05 value (reduction) 0 -41MPET inflation at 5.84% (reduction) 0 -2Speech & language therapy 0 19Digital hearing aids 0 0Retinal screening 0 7Agenda for Change 0 0Agenda for Change plus 5.84% 0 0Genetics Counselling incl 5.84% 0 4928 day prescribing incl 5.84% 0 45Rolling Average Changes Spinal Incl 5.84% 0 0Rolling Average Changes Burns Incl 5.84% 0 0Portsmouth Clinics (-47455 * 1.0584) 0 -50Bank Funding 0 0Westbury 0 13Other 0 600 945 658 495 2,698

0Revised total 100 125 31 256 290 81 169 404 211 188 182 57 153 1,087 232 127 57 107 600 0 1,191 0 10,365 2,389 413 4,620 131,969

bfwd cfwd bfwd Total108,792 112,392 112,392 131,969

Income at risk - 0.84% on Deferred PBR (non elective and outpatients) and Non PBR 840Income as per LDP Submission 05/06 131,129

Footnote Total revaluationIncluded in elective tariff 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 398Deferred PBR 0 0 0 0 2 0 3 1 1 0 1 0 4 0 0 0 0 0 0 1,146Non PBR 1 5 0 6 6 0 2 4 6 3 9 10 10 0 0 0 0 0 0 925Total revaluation 1 5 0 6 8 0 5 5 7 3 10 10 14 0 0 0 0 0 0 2,469

SLA 04/05 values 234 272 77 160 373 190 177 1337 219 120 54 168 101,264(All Sussex)

Analysed byInflation 5 7 2 14 15 4 9 21 11 10 7 3 8 60 13 7 3 6 1366 0 66 0 520 66 23 228 7,207Revaluation 1 5 0 6 8 0 5 5 7 3 10 10 14 0 0 0 0 0 594 0 0 0 0 0 0 0 2,711MPET Adjustment 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 -43Speech & language therapy 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 19Retinal Screening 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7Genetics Counselling 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4928 day prescribing 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 45Digital hearing aids 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Activtiy adjustments 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 537 0 0 1,932Rolling averages spinal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Rolling averages burns 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Portsmouth Clinics 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 -50Transition gain 415 415Westbury 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 13Other/NICE/Library non rec 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 600 0 0 0 945 658 0 495 2,698

0 0Subtotal 6 12 2 20 23 4 14 26 18 13 17 13 22 60 13 7 3 6 2,975 0 66 0 1,465 1,261 23 723 15,003

Inflation amendmentPay 2.8% 3,455 2.80%Non pay 0.6% 740 0.60%Inflation other - to balance to 5.84% 123 0.10%Clinical negligence 0.1% 123 0.10%Secondary drugs 0.4% 494 0.40%Revenue cost of capital 0.2% 247 0.20%Efficiency -1.7% -2,098 -1.70%Consultant contract/ junior doctors 494 0.40%Agenda for change 1,234 1.00%NICE Appraisals and guidelines 864 0.7%Investment in new capital 494 0.40%0.84% ( year on year tariff changes) 1,037 0.84%Total 7207 5.84%

Salisbury Healthcare NHS Trust Appendix P

Projected Income from Payment by Results Exercise October 2005

PCT Local JH- 04-05

Local Value04-05

Exclusions Local PBR Value

Inflation Uplift

Local Value05-06

Original Revaluation

Adjusted with

Original Revaluation Adjusted o/s

Total Revised Net

Local

Local Rate excl.

MFF

PbR Activity at NT

MFF Adjusted 1.093745

Total PBR at NT

Gain/loss estimate

Difference local value

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000South Wilts PCT 5DJ 54,376,958 54,380 -10,245 44,135 2,207 46,342 969 518 47,311 43,217 46,918 4,445 51,363 4,052 -3KNW 5K4 6,525,384 6,526 -916 5,610 281 5,891 111 74 6,002 5,482 7,298 691 7,989 1,988 -1W Wilts 5DH 3,664,994 3,664 -487 3,177 159 3,336 40 36 3,376 3,084 3,637 345 3,982 606 1New Forest 5A1 8,697,416 8,696 -1,973 6,723 336 7,059 176 46 7,235 6,609 6,887 652 7,539 304 1ETVS 5LY 610,184 610 -133 477 24 501 11 4 512 468 477 45 522 10 0Soton City 5L1 982,268 982 -142 840 42 882 18 3 900 822 701 66 767 -133 0Mid Hants 5E9 1,636,807 1,637 -222 1,415 71 1,486 34 7 1,520 1,388 1,346 128 1,474 -46 0North Hants 5DF 447,414 447 -36 411 21 432 7 2 439 401 445 42 487 49 0Blackwater 5G6 148,890 149 -14 135 7 142 2 144 131 105 10 115 -29 0subtotal North & Mid Hants 2,233,111 2,233 -272 1,961 98 2,059 43 9 2,102 1,920 1,896 0 180 2,076 -26 0Fareham & Gosport 5LX 262,634 263 -43 220 11 231 7 2 238 217 207 20 227 -11 0Portsmouth City 5FE 283,240 284 -47 237 12 249 8 1 257 235 262 25 287 30 -1East Hants 5FD 336,256 337 -69 268 13 281 7 2 288 263 254 24 278 -10 -1subtotal Portsmouth 882,130 884 -159 725 36 761 22 5 783 715 723 0 68 791 8 -2IOW 5DG 331,297 332 -48 284 14 298 7 305 279 386 37 423 117 -1North Dorset 5CD 10,264,015 10,263 -1,901 8,362 418 8,780 96 151 8,876 8,108 9,086 861 9,947 1,071 1SE Dorset 5FN 1,826,886 1,827 -348 1,479 74 1,553 34 13 1,587 1,450 1,361 129 1,490 -97 0SW Dorset 5FP 991,030 990 -562 428 21 449 17 5 466 426 613 58 671 205 1Bournemouth 5CE 878,015 876 -402 474 24 498 22 8 520 475 785 74 859 340 2Poole 5KV 913,934 914 -284 630 32 662 21 8 683 623 702 67 769 86 0Mendip 5FX 156,755 157 -18 139 7 146 1 147 134 109 10 119 -28 0S Somerset 5K1 144,077 143 -12 131 7 138 7 2 145 132 126 12 138 -7 1Taunton 5K2 126,099 126 -116 10 1 11 1 12 11 19 2 21 9 0Somerset Coast 5FW 100,820 101 -90 11 1 12 2 1 14 12 41 4 45 31 0Subtotal Dorset & Somerset 15,401,631 15,397 -3,733 11,664 583 12,247 201 188 12,448 11,371 12,842 0 1,217 14,059 1,610 5OATs 1,124,880 1,125 -333 792 40 832 832 760 847 80 927 96 0Remainder 6,657,978 6,658 -5,628 1,030 52 1,082 13 217 1,095 1,000 1,860 176 2,036 942 0

Total 101,488,231 101,487 -24,069 77,418 3,871 81,289 1,611 1,100 82,900 75,726 84,472 0 8,002 92,474 9,575 1

Salisbury Healthcare NHS Trust Appendix Q

Base Case Summary PbR Information

This seeks to understand the level of PbR gain phased over the projection period

Elective included in Model Plan£m 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11IncomeTotal income at full tariff 23.5 25.4 25.9 25.5 25.5 25.6PbR clawback -2.2 -1.8 -1.4 0.0 0.0 0.0Clinical income - NHS 21.3 23.6 24.6 25.5 25.5 25.6

Income exc. PbR transition gain 20.9 22.8 23.3 22.9 22.9 23.0PbR transition gain (incl. Insurance & smothing) 0.4 0.8 1.2 2.6 2.6 2.6Clinical income - NHS 21.3 23.6 24.6 25.5 25.5 25.6

Assumes full PbR gainPhased 25% in 05/06, 50% in 06/07, 75% in 07/08 and 100% in 08/09

Activity included as per October 2005 PbR Exercise Plan£m 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11IncomeTotal income at full tariff 84.5 84.5 84.5 84.5 84.5PbR clawback -6.3 -4.8 0.0 0.0 0.0Clinical income - NHS 78.2 79.7 84.5 84.5 84.5

Income exc. PbR transition gain 75.2 75.2 75.2 75.2 75.2PbR transition gain (incl. Insurance & smothing) 3.0 4.5 9.3 9.3 9.3Clinical income - NHS 78.2 79.7 84.5 84.5 84.5

Assumes full PbR gainPhased 25% in 05/06, 50% in 06/07, 75% in 07/08 and 100% in 08/09

Salisbury Healthcare NHS Trust Appendix R

Application of FundsBudget

Income 131,129

Base Estimates 110,422

Add sums not in base estimates:

Additional Activity CostsAccess monies (inpatients/daycases/outpatients) 693(S Wilts PCT replacing 750k withdrawn 2004/05)Cancer,CHD ,etc 78Dorset (contingency) 513 1,284

Mandatory Cost Pressures:Pay inflation @ 3.23% 2,700Non Pay inflation @ 2% including energy 1,250Agenda for Change 2005/06 1,300Agenda for Change 2004/05 costs above funds 450Secondary Care Drugs 283NICE appraisals and guidelines 700Clinical changes in practice 90Capital Charges Indexation , revaluation,and depreciation 2,792Consultant Contract 290SPR incremental Drift 90EU Working Time Directive 220PFI Revenue Expenditure & Commissioning 1,065Decontamination 245PACS 288CNST Premium 153

11,916

Directorate Cost Pressures -baseline activity 728

Developments 526

Non recurring items (as per income schedule) 5,408

Sub Total 130,284

Add Expenditure supported by Directorate Income 8,734

Total Application of Funds 139,018

Shortfall 7,889

Deficit to be met by:Savings Programme

New Directorate Target 2005/06 @ 2.43 % -2,384Directorate Target B/fwd 2004/05 -1,172Cost pressure reduction -162Capital items removed from revenue -500Planned Budget Management -1,721Reduction in use of private sector -340Trust cost of repatriating private sector work 20028day prescribing income -100

Other non recurring efficiency savings:South Wiltshire PCT brokerage -500Payment By Results Gain -410NHS Bank PFI Support -600PACS -200

Sub Total Savings -7,889

Balance 0

Salisbury Healthcare NHS Trust Appendix S

Base Case Assumptions

Activity assumptions: as per PCT LDP requirements

Financial Analysis 2006/07 2007/08 2008/09 2009/10 2010/11Income AssumptionsInflation

SLA 6.00% 6.00% 6.00% 4.70% 4.70%Non-SLA 2.00% 2.00% 2.00% 2.00% 2.00%

Other £'000 £'000 £'000 £'000 £'000SLA New born screening -140Non-SLA Brokerage 1,000

Hillcote monies 491Unregulated Bank 711 -285 -142 -142 -142

Laundry 837 1,374 689 90Odstock Medical Ltd 100

Subtotal 2,899 1,089 647 -52 -142Expenditure AssumptionsInflation

Pay 3.23% 3.23% 3.23% 3.23% 3.23%Non-Pay 2.00% 2.00% 2.00% 2.00% 2.00%Other 3.26% 3.26% 3.26% 1.96% 1.96%Total 6.00% 6.00% 6.00% 4.70% 4.70%

Other £'000 £'000 £'000 £'000 £'000Activity Reduction in Costs (due to activity and efficiency) -1680 -827 -657 -405 -553

Cost Improvement Programme -1673 -2301 -2975 -3604 -3553Total CIP -3353 -3128 -3632 -4009 -4106CIP % 2.00% 2.00% 2.50% 2.70% 2.70%

Pay Senior Medical developments 400 200 -110 -100On site impact of out of hours service on A&E -60 -100Cardiology 30Savings on scientists from New Born Screening -70Non-recurring expenditure related to income 1,615NPFiT Additional Implementation Staff 300 -200Agenda for Change 300 300 300 300 300

Non-Pay PFI 1,605IT service developments 150 100 -50 -200Training 250 -50 -200Information Services & Medical Records 100 -100Modernisation 100 100 -100 -100PFI savings on south side facilities -395Energy price increase above 2% 250 200Reuse of south side 100PACS 483Drugs 250 250 250 250 250Decomtamination/MRSA 200 200 200 200 200Cardiology 40Pathology 135Laundry activity 823 1,069 608 87NPFiT support 100Review of Radiology & revenue consequences of ca 50 -20 -20 -20 -20Non-recurring expenditure related to income 817 -250

Generic CP Medical consumables 250 250 200 200 200Drugs 250 250 200 200 200Change in clinical practice 300 300 300 300Loss of non-SLA agreements 200PbR contingency & tariff deflation 600 200Other tariff uplift costs (awaiting DH guidance) 1,930 2,344 2,956 2,544 2,607

11,103 5,343 4,434 3,661 3,537Net of CIP 7,750 2,215 802 -348 -569

Salisbury Healthcare NHS Trust Appendix T

Manpower Plan

05/06 05/06 06/07 06/07 06/07 06/07 07/08 07/08 07/08 07/08 08/09 08/09 08/09 08/09 09/10 09/10 09/10 09/10 10/11 10/11 10/11 10/11Activity Change WTE Recurring WTE Recurring WTE Recurring WTE Recurring WTE Recurring WTE Recurring WTE Recurring WTE Recurring WTE Recurring WTE Recurring WTE RecurringInpatient - Ward Budget Budget Budget Budget Budget Budget Budget Budget Budget Budget Budget Budget Budget Budget Budget Budget Budget Budget Budget Budget Budget BudgetStaff Group £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

Executives / Senior Managers 99.74 4,306 99.74 4,306 99.74 4,306 99.74 4,306 99.74 4,306 99.74 4,306

Medical & Dental 261.13 22,220 261.13 22,220 261.13 22,220 261.13 22,220 261.13 22,220 261.13 22,220

Nursing 1105.78 30,274 -27.00 -640 1078.78 29,634 -10.00 -237 1068.78 29,397 -17.00 -403 1051.78 28,994 -10.00 -237 1041.78 28,757 -17.00 -403 1024.78 28,354

Professions Allied to Medicine 92.16 3,062 92.16 3,062 92.16 3,062 92.16 3,062 92.16 3,062 92.16 3,062

Professional & Technical (Scientists) 67.46 2,808 67.46 2,808 67.46 2,808 67.46 2,808 67.46 2,808 67.46 2,808

Pharmacists 15.53 679 15.53 679 15.53 679 15.53 679 15.53 679 15.53 679

Other Scientific 2.00 109 2.00 109 2.00 109 2.00 109 2.00 109 2.00 109

Professional & Technical (other) 226.17 5,745 -1.00 -33 225.17 5,712 -0.57 -19 224.60 5,693 224.60 5,693 -0.57 -19 224.03 5,674 224.03 5,674

Administrative & Clerical 446.82 8,051 -1.00 -14 445.82 8,037 -0.50 -7 445.32 8,030 -0.50 -7 444.82 8,023 -0.50 -7 444.32 8,016 -0.50 -7 443.82 8,009

Ancillary 274.20 4,329 -1.00 -13 273.20 4,316 -0.50 -6.5 272.70 4,310 -1.50 -19.5 271.20 4,290 -0.50 -6.5 270.70 4,284 -1.50 -19.5 269.20 4,264

Maintenance 32.55 656 32.55 656 32.55 656 32.55 656 32.55 656 32.55 656

Ambulance 14.00 235 14.00 235 14.00 235 14.00 235 14.00 235 14.00 235

Other 776 0.00 776 0.00 776 0.00 776 0.00 776 0.00 776

Total Pay 2637.54 83,250 -30.00 -700 2607.54 82,550 -11.57 -270 2595.97 82,281 -19.00 -430 2576.97 81,851 -11.57 -270 2565.40 81,582 -19.00 -430 2546.40 81,152

Non Pay 33,069 -210 32,859 33 32,892 -57 32,835 -30 32,805 -23 32,782

Total Inpatient - Ward 2637.54 116,319 -30.00 -910 2607.54 115,409 -11.57 -237 2595.97 115,173 -19.00 -487 2576.97 114,686 -11.57 -300 2565.40 114,387 -19.00 -453 2546.40 113,934

Out PatientsMedical -1.00 -95 -0.77 -74 -0.92 -88 -0.68 -65 -0.68 -65

Nursing -1.50 -35 -1.17 -26 -1.43 -32 -1.04 -20 -1.04 -25

Non Pay -140 10 -50 -20 -10

Total Out Patients -2.50 -270 -1.94 -90 -2.35 -170 -1.72 -105 -1.72 -100

Medical Manpower Developments

Medical & Dental 4.00 400 2.00 200 -1.00 -110 -1.00 -100

Total Medical Manpower Developments 4.00 400 2.00 200 -1.00 -110 -1.00 -100 0.00 0

RevisedChanges Revised Changes Revised Changes Revised Changes Revised Changes

Salisbury Healthcare NHS Trust Appendix U

Laundry Proposal - New Build SDH Site - PFI Build and Purchased Equipment

Proposed per Week (Commercial in Confidence)

Staff Costs

Laundry Services £ wte £ wte £ wte £ wte £ wte £ wte £ wte £ wte £ wte

Laundry Staff Costs 501,373 35.03 378,572 19.71 578,411 30.98 680,193 36.72 808,652 43.50 928,958 50.17 1,068,281 57.84 1,327,732 72.17 1,568,168 85.50

Transport Drivers 12,000 0.89 15,664 0.89

Maintenance StaffTechnician 30,036 1.00 30,036 1.00 30,036 1.00 30,036 1.00 30,036 1.00 30,036 1.00 30,036 1.00 30,036 1.00Electrician 23,400 1.00 23,400 1.00 23,400 1.00 23,400 1.00 35,100 1.50 46,800 2.00 58,500 2.50 70,200 3.00

Linen Staff Costs 100,023 7.00 102,880 6.64 118,374 7.64 118,374 7.64 133,868 8.64 133,868 8.64 149,362 9.64 164,856 10.64 180,350 11.64

Total Staff Costs 613,396 42.03 550,552 29.24 750,222 40.62 852,003 46.36 995,956 54.14 1,127,963 61.31 1,294,479 70.48 1,581,125 86.31 1,848,754 101.14

Laundry Non Pay - Direct Costs 93,969 276,726 350,568 389,723 439,278 478,833 527,488 616,873 694,908

Linen - Non Pay - Direct Costs 54,633 53,933 81,933 101,433 120,933 140,433 159,933 198,933 237,933

Total - Non Pay - Direct Costs 148,602 330,659 432,501 491,156 560,211 619,266 687,421 815,806 932,841

Total Direct Costs 761,998 881,211 1,182,723 1,343,159 1,556,167 1,747,229 1,981,900 2,396,931 2,781,595

Indirect costs 384,635 450,093 523,081 573,681 625,381 674,981 725,681 826,981 928,281

Total Costs 1,146,633 1,331,304 1,705,804 1,916,840 2,181,548 2,422,210 2,707,581 3,223,912 3,709,876

Income

External Sales Non NHS -166,447 -166,447 -166,447 -166,447 -166,447 -166,447 -166,447 -166,447 -166,447External Sales NHS -77,473 -54,545 -597,211 -896,211 -1,195,211 -1,494,211 -1,793,211 -2,391,211 -2,989,211

Total Income -243,920 -220,992 -763,658 -1,062,658 -1,361,658 -1,660,658 -1,959,658 -2,557,658 -3,155,658

Cost to SHCT / Contribution 902,713 1,110,312 942,146 854,183 819,891 761,552 747,923 666,254 554,219Existing SHCT Laundry Funds Available -902,713 -902,713 -902,713 -902,713 -902,713 -902,713 -902,713 -902,713Assumed Inflation funding Utilites/fuel -48,000 -48,000 -48,000 -48,000 -48,000 -48,000 -48,000 -48,000Marketing Funds -5,000 -5,000 -5,000 -5,000 -5,000 -5,000 -5,000 -5,000

Net Cost/Saving 902,713 154,599 -13,567 -101,530 -135,822 -194,161 -207,790 -289,459 -401,494

Laundry Proposal - New Build SDH Site - PFI Build and Purchased Equipment

Cash Flow from April 2006Period 2007/08 2009/10

April-Sept Oct-March Total April-Sept Oct-March Total

Total Items per Week (Commercail in Confidence)

Costs £ £ £ £ £ £ £ £

Pay 383,611 506,478 890,089 1,466,698 877,616 932,127 1,809,743 1,863,754

Non Pay

Direct operational costs 120,751 184,606 305,357 575,998 353,373 370,921 724,294 741,841

Capital charges - New Equipment 87,000 87,000 174,000 174,000 87,000 87,000 174,000 174,000

Capital charges - existing Equipment 8,691 8,691 17,382 17,382 8,691 8,691 17,382 17,382

Utilities 100,850 152,000 252,850 475,000 288,000 303,450 591,450 606,900

Unitary Charge 124,500 124,500 249,000 249,000 124,500 124,500 249,000 249,000

Portering SDH 12,000 12,000 24,000 24,000 12,000 12,000 24,000 24,000

Management 2,000 2,000 4,000 4,000 2,000 2,000 4,000 4,000

Other overheads 13,500 13,500 27,000 27,000 13,500 13,500 27,000 27,000

Total Non Pay 469,292 584,297 1,053,589 1,546,380 889,064 922,062 1,811,126 1,844,123

Total Costs 852,903 1,090,775 1,943,678 3,013,078 1,766,680 1,854,189 3,620,869 3,707,877

Funding :Existing SHCT Laundry Funds -451,087 -451,087 -902,173 -902,173 -451,087 -451,087 -902,173 -902,173Assumed Inflation funding Utilities/fuel -24,000 -24,000 -48,000 -48,000 -24,000 -24,000 -48,000 -48,000Marketing Funds -2,500 -2,500 -5,000 -5,000 -2,500 -2,500 -5,000 -5,000

Total Funding -477,587 -477,587 -955,173 -955,173 -477,587 -477,587 -955,173 -955,173

Income from Sales

Income -322,029 -680,829 -1,002,858 -2,378,258 -1,488,129 -1,577,829 -3,065,958 -3,155,658

Total Income & Funding -799,615 -1,158,415 -1,958,031 -3,333,431 -1,965,715 -2,055,415 -4,021,131 -4,110,831

(Surplus) / Deficit 53,288 -67,640 -14,353 -320,353 -199,035 -201,226 -400,262 -402,954

New DevelopmentExisting Current Activity

Activity G

2006/07 2008/09

Activity C Activity D Activity E Activity FActivity A Activity B

Appendicies FinAppendix U23/11/200516:58

Salisbury Healthcare NHS Trust Appendix V

Capital Expenditure 2005/06

Source of Funds Planned Revised Forecast SpendBlock 3,909,000.00 3,909,000 3,909,000 Laundry Brokerage 700,000 700,000 700,000 Resources from 2004/05 250,000 159,000 159,000 Accident & Emergency 100,000 100,000 Brokerage 2004/2005 500,000 500,000 Southern Cluster - Pac'S 617,000 617,000 National Programme For Information Technology 450,000 450,000 Agwsha Loan - Pac'S 550,000 550,000 Genetics Scobec 395,000 395,000 Salisbury Hospice Cancer Project - Donated Income 250,000 250,000 AGWSHA - Biochmical Analyser 250,000 250,000 AGWSHA - Wessex Laser 40,000 40,000 SWPCT - Hearing Aid Services 110,000 110,000 Negative Pressure Isolation Room 30,000- 30,000- Genetics Reference Library 100,000 100,000 Site Improvements 300,000 300,000 Pathology Modernisation 60,000 60,000 AGW Brokerage 05-06 200,000 200,000

Total Funds Available 4,859,000 8,660,000 8,660,000

Allocation of FundsAccident & Emergency Redevelopment Phase 1 R Perry 100,000 100,000 100,000 Ace Of Hearts S Garner 51,906 51,906 Alarm Indicator Board -Telephone Switchboard - Sdh R Perry 7,000 7,000 7,000 Amesbury/Chilmark - Refurbishment R Perry 30,000 - - Art Work Phase 11 R Perry 100,000 123,338 123,338 Audiology Testing Room (Ent) R Perry 51,000 51,000 51,000 Avon And Tamar Wards - Refurbishment Toilets/Showers R Perry 10,000 10,000 10,000 Blood Bank Analyser - Pathology N House 63,000 63,000 63,000 Capital Minor 2005/2006 M Cassells 29,000 29,000 Cleft Lip And Palate L Arnold 6,213 6,213 Decontamination S Garner 367,000 194,094 194,094 Dermatology Expansion - Equipment & Furniture 04-05 C Gwyther 2,901 2,901 Diabetic Retinal Screening Camera S Garner 5,431 5,431 Disabled Discrimination Act 05-06 R Perry 40,000 49,773 49,773 Fire Alarms Various R Perry 80,000 80,000 80,000 Gamma Camera N House 350,000 227,700 227,700 Genetics Development S Garner 86,912 86,912 Genetics National Reference Laboratory S Garner 79,000 79,000 Genetics Scobec "White Paper" S Garner 699,782 699,782 Grouped Medical Equipment 04-05 N House - - Grouped Medical Items/Beds S Garner 150,000 150,000 150,000 Hearing Aid Services - Modernisation S Garner 20,037 20,037 Hearing Aid Services - 05-06 P Russell 110,000 110,000 Information Technology P Russell 250,000 34,467 34,467 Installation Technician P Russell 15,533 15,533 Instrument Trays - Orthopaedics N House 44,000 1,451 1,451 It Hub Room P Russell 655,000 655,000 Laundry Equipment R Perry 867,000 723,168 723,168 Laundry Pallets R Perry 20,000 20,000 20,000 Level 4 Air Conditioning M Cripps 9,700 9,700 Main Biochemistry Analyser N House 250,000 250,000 250,000 Medical Compressed Air Plant Level 2 Sdh R Perry 10,000 - - Medical Device Storage Relocation R Perry 9,000 9,000 9,000 Medical Equipment <£40K N House 250,000 109,866 109,866 Medical Equipment <£40K 06-07 N House 12,365 12,365 Medical Gas Manifold Rooms - Improve Access R Perry - - Medical Gas Plant Overhaul R Perry 24,000 16,015 16,015 Medical Physics To Old Burns/Durrington R Perry 20,000 20,000 20,000 Negative Pressure Isolation Room P Hill - - Noise Reduction Pitton Ward R Perry 18,000 18,000 On Call Doctors' Facilities - Improvements R Perry 11,000 21,000 21,000 Paediatric Colonoscope N House 32,916 32,916 Pathology Modernisation P Hill 60,000 60,000 Pathology Steriliser Safety Valve R Perry 9,000 1,246 1,246 Phase 11 Equipment L Arnold 1,111,000 1,111,000 1,111,000 Phase 11 - Medical Air Supply L Arnold 117,875 117,875 Phls Equipment N House 22,000 22,000 Picture Archiving Computer System P Russell 400,000 2,151,513 2,151,513 Plaster Room Upgrade R Perry - 84,197 84,197 Pool Filters - Hydrotherapy Pool (Spinal Unit) - Refurb R Perry 19,000 5,166 5,166 Project Costs 05-06 P Hill 10,000 10,000 10,000 Security Arrangements R Perry 7,510 7,510 Spinal Boiler - Heating Services From Central Sdh R Perry 59,000 59,000 59,000 Telephone Exchange Sdh R Perry 160,000 160,000 160,000 Ultrasound - Vascular Assessment Unit N House 115,000 112,177 112,177 Vascular Assessment Unit P Hill 35,460 35,460 Ventilators Clean R Perry 40,000 48,393 48,393 Ward Reconfiguration 04/05 P Hill 302,289 302,289 Waste Stores - Sdh North R Perry 23,000 23,000 Water Tanks - Raw And Soft - Sdh North R Perry 48,000 48,000 48,000 Wessex Laser M Cripps 34,563 34,563 Wessex Rehab - Replace Gym Floor R Perry 12,000 16,500 16,500

Total Allocation of Funds 5,086,000 8,505,457 8,505,457

Difference -227000 154543 154543

Salisbury Healthcare NHS Trust Appendix W

Cost Improvement Plan by Directorate 2005/06

Identified & Implemented

Identified & Likely

Possibility Unidentified Total Expected as at Month 7

Achieved at Month 7

Variance

Directorate Saving PlansAmbulatory Care 94 48 65 250 457 267 252 -15Critical Care 497 148 128 111 884 436 212 -224Corporate Directorates 3 202 205 118 100 -18Facilities 116 156 272 145 78 -67Medicine 62 302 227 591 299 146 -153Surgery 41 228 91 77 437 219 195 -24Clinical Support 152 248 31 80 511 288 216 -72Cancer 2 2 1 0 -1Nursing 10 10 6 6 0Clinical Effectivness 12 12 7 7 0

Sub Total 988 1,130 315 947 3,379 1,786 1,212 -574

Other Savings PlansCost Pressure Reduction 162 162 95 95 0Capital Items removed from revenue 250 250 0 0 0Other Technical 250 250 0 0 0Budget Management/Further Cost Pressures Phasing 298 298 174 174 0Laundry Income 475 475 178 178 0Closure of South Site 40 40 0 0 0Tariff Income 678 678 396 396 0Reduction in use of private sector 140 140 82 82 028 day prescribing income 100 100 100 100 0South Wiltshire PCT brokerage 750 750 750 750 0Payments By Results Gain 415 415 415 415 0NHS Bank PFI Support 569 569 569 569 0PACS Cluster Income 200 200 200 200 0PACS Savings 255 255 96 96 0

Sub Total 1,925 2,182 475 0 4,582 3,055 3,055 0

Total 2,913 3,312 790 947 7,961 4,841 4,267 -574

Salisbury Healthcare NHS Trust Appendix X

Cost Improvement Programme 2006/07 to 2010/11

Cost Improvement Programme Responsible 2006/07 2007/08 2008/09 2009/10 2010/11

Pharmacy Automation (MTO Post) Chief Pharmacist -15

Pharmacy Automation (Elimination of Overtime) Chief Pharmacist -15

Review of unprotected assets Head of Estates -300 -100 -100

Nursing - Ward Skill Mix Director of Nursing -350 -150

Materials Management Head of Procurement -20

Print Project Head of Procurement -10

Reduction in Private Patient Income Director of Operations -300

Efficiency & Activity Director of Operations -1680 -827 -657 -405 -553

IT use to reduce administration Director of Operations -100 -100

Containment of Agenda for Change Director of HR -200 -200 -250 -250 -250

Car Park Charges Head of Facilities -30 -10

% Increase on Non SLA Income Director of Finance -193 -225 -266 -339 -313

Rental of South Site Head of Estates -50

Specialist Services in PBR Director of Finance -850 -1000

Utilisation of PBR reserve Director of Finance -400

Procurement Savings Head of Procurement -100 -100

Sale of SDU Services Head of Facilities -100 -100

Reduction in medical locum expenditure Medical Director -100

Reduction in Bank & Agency Staff Director of Nursing -100 -100

IVF Services Business Manager -20

Private Patients Clinical Directors -24 -20 -15 -15

Oracle Savings Director of Finance -40

Efficiency Schemes Re: Capital Programmes Director of Finance -20 -30 -30 -30

Energy Savings Head of Facilities -42 -58

Replacement MRI Director of Finance -80

CIP to Departments Director of Operations -680 -100 -428 -500 -500

Travel Claims Director of Finance -20

To be identified -2333 -2305

Total Cost Improvement Programme -3863 -3088 -3509 -3972 -4066

Salisbury Healthcare NHS Trust Appendix Y

Annual Income & Expenditure Account - Base Case

Year Ending 31-Mar-06 31-Mar-07 31-Mar-08 31-Mar-09 31-Mar-10 31-Mar-11

IncomeRegulated Income 132,380 135,138 138,745 141,737 145,418 149,326Unregulated Income 5,867 6,509 7,772 8,614 8,730 8,748PBR Transitional Relief/Income Guarantee (2,182) (1,843) (1,471) 0 0 0Transfer From Donations Reserve 160 157 135 120 86 88Total 136,225 139,961 145,181 150,471 154,234 158,162

ExpenditureOperating Costs (125,089) (129,710) (135,737) (140,430) (144,026) (147,471)Net Movement In Provisions 0 0 0 0 0 0PBR Transitional Contribution 0 0 0 0 0 0Bank Fees 0 0 0 0 0 0Total (125,089) (129,710) (135,737) (140,430) (144,026) (147,471)

EBITDA 11,136 10,251 9,444 10,041 10,208 10,690

Depreciation (7,490) (5,854) (5,755) (6,054) (6,244) (6,826)

Operating Surplus (EBIT) 3,646 4,397 3,689 3,987 3,964 3,865

Net Interest 64 117 153 164 168 161

Surplus After Interest 3,710 4,514 3,841 4,152 4,133 4,026

Dividends (3,372) (3,558) (3,578) (3,648) (3,708) (3,768)

Retained Surplus/(Deficit) 338 956 263 504 425 258

Cumulative Retained Surplus 4,345 5,301 5,564 6,068 6,493 6,751

Profitability Ratios

Gross Surplus % (EBITDA/Income) 8.2% 7.3% 6.5% 6.7% 6.6% 6.8%Operating Surplus % (EBIT/Income) 2.7% 3.1% 2.5% 2.6% 2.6% 2.4%Net Margin % (Surplus After Interest/Income) 2.7% 3.2% 2.6% 2.8% 2.7% 2.5%


Annual Balance Sheet - Base Case


Protected Fixed Assets NBVLand 5,948 5,195 5,455 5,727 6,014 6,315Buildings 83,420 83,520 83,444 84,942 86,442 88,663Equipment 13,463 14,891 17,302 18,007 18,838 19,485Information Technology 263 207 178 160 159 158Sub-Total 103,093 103,813 106,379 108,836 111,453 114,620

Unprotected Fixed Assets NBVLand 0 0 0 0 0 0Buildings 0 0 0 0 0 0Equipment 0 0 0 0 0 0Information Technology 0 0 0 0 0 0Sub-Total 0 0 0 0 0 0

Donated Fixed Assets NBVLand 0 0 0 0 0 0Buildings 690 695 699 704 709 714Equipment 574 437 321 217 144 68Information Technology 0 0 0 0 0 0Sub-Total 1,264 1,132 1,020 920 852 782

Total Fixed Assets NBV 104,357 104,945 107,399 109,756 112,305 115,401

Current AssetsStock 697 760 796 833 871 910Debtors (NHS) 4,946 5,049 5,184 5,296 5,434 5,580Debtors (Other) 2,973 3,298 3,938 4,364 4,423 4,432Debtors (Brokerage) (0) (0) (0) (0) (0) (0)Debt Service Reserve 0 0 0 0 0 0Cash 358 2,002 2,200 2,339 2,233 1,740Sub-Total 8,973 11,109 12,118 12,832 12,960 12,661

Current LiabilitiesCreditors (Pay) (479) (478) (490) (504) (519) (535)Creditors (Other) (11,010) (12,375) (13,447) (14,087) (14,321) (14,510)Creditors (Brokerage) 0 0 0 0 0 0Dividend Payable 0 0 0 0 0 0Overdraft 0 0 0 0 0 0Sub-Total (11,489) (12,853) (13,937) (14,591) (14,841) (15,044)

Net Current Assets (2,515) (1,744) (1,819) (1,759) (1,881) (2,384)Long Term LiabilitiesLong Term Debtors 1,249 1,249 1,249 1,249 1,249 1,249Provisions (1,465) (1,465) (1,465) (1,465) (1,465) (1,465)Commercial Loan Account 0 0 0 0 0 0NHS Bank Loan Account 0 0 0 0 0 0Finance Lease Account 0 0 0 0 0 0Sub-Total (216) (216) (216) (216) (216) (216)

Net Tangible Assets 101,626 102,985 105,364 107,781 110,209 112,802

Financed By

Public Dividend Capital 51,969 50,269 50,269 49,995 49,720 49,719Revaluation Reserve 44,058 46,293 48,521 50,808 53,154 55,560Donation Reserve 1,254 1,122 1,010 910 842 772I&E Reserves 4,345 5,301 5,564 6,068 6,493 6,751

Taxpayers Equity 101,626 102,985 105,364 107,781 110,209 112,802

Difference (0) (0) (0) (0) (0) (0)

Validation Check OK OK OK OK OK OK


Annual Cashflow - Base Case


Operating CashflowTotal Income 137,634 141,219 145,742 149,812 153,951 157,919Operating Costs (124,635) (128,409) (134,689) (139,813) (143,814) (147,307)PBR Transitional Relief/Income Guarantee (2,182) (1,843) (1,471) 0 0 0PBR Transitional Contribution 0 0 0 0 0 0Cash From Operations (EBITDA) 10,817 10,966 9,582 9,999 10,137 10,612

Capital Expenditure (7,490) (4,181) (5,958) (6,103) (6,429) (7,498)Debt Issuance Fees 0 0 0 0 0 0Less PDC Funding 0 0 0 0 0 0Less Donations 0 0 0 0 0 0Cash Brokerage 0 (1,700) (0) (275) (275) (1)

Cashflow Before Finance 3,327 5,085 3,624 3,622 3,433 3,113

Financial CascadeCommercial Loan Drawdown 0 0 0 0 0 0Commercial Loan Repayment 0 0 0 0 0 0Commercial Loan Interest 0 0 0 0 0 0Commercial Loan Debt Service Reserve 0 0 0 0 0 0

NHS Bank Loan Drawdown 0 0 0 0 0 0NHS Bank Loan Repayment 0 0 0 0 0 0NHS Bank Loan Interest 0 0 0 0 0 0NHS Bank Loan Debt Service Reserve 0 0 0 0 0 0

Finance Lease Drawdown 0 0 0 0 0 0Finance Lease Repayment 0 0 0 0 0 0Finance Lease Interest 0 0 0 0 0 0

Change In Overdraft 0 0 0 0 0 0Interest On Overdraft 0 0 0 0 0 0

Sub-Total 0 0 0 0 0 0

Cashflow To Taxpayers Equity 3,327 5,085 3,624 3,622 3,433 3,113

Funded ByDividends (3,372) (3,558) (3,578) (3,648) (3,708) (3,768)Change In Cash (19) (1,644) (199) (139) 106 494Interest 64 117 153 164 168 161Total (3,327) (5,085) (3,624) (3,622) (3,433) (3,113)

Difference 0 0 0 0 0 0

PBL RatiosMaximum Debt Service to Revenue n/a n/a n/a n/a n/a n/aMinimum Debt Service Cover n/a n/a n/a n/a n/a n/aMinimum Interest Cover n/a n/a n/a n/a n/a n/aMinimum Dividend Cover 3.30 2.85 2.62 2.74 2.74 2.82Maximum Debt Capital Ratio 0.82% 0.85% 0.84% 0.84% 0.83% 0.83%

Cashflow & Liquidity Ratios

EBITDA/Total Debt (Excludes PDC) 5155.5% 4745.8% 4372.1% 4648.6% 4725.9% 4949.2%EBITDA/Total Debt (Includes PDC) 25.2% 20.3% 18.7% 20.0% 20.4% 21.4%Total Debt/Income (Excludes PDC) 0.2% 0.2% 0.1% 0.1% 0.1% 0.1%Total Debt/Income (Includes PDC) 32.2% 35.7% 34.6% 33.5% 32.4% 31.6%Income/Debt (Excludes PDC) 63719.3% 65378.9% 67473.1% 69357.4% 71273.7% 73110.5%Income/Debt (Includes PDC) 1147.7% 1253.9% 1192.8% 1304.0% 1210.8% 1297.5%Acid Test 0.03 0.16 0.16 0.16 0.15 0.12Current Ratio 0.78 0.86 0.87 0.88 0.87 0.84

Salisbury Healthcare NHS Trust Appendix Z

Protected and Unprotected Buildings

Asset Code Asset Title CCA NCRC Protected Unprotected003246 SDH - Central Corridor 430,487 Protected 430,487003250 SDH -SpinaL/CT Scam/X-Ray 521,089 Protected 521,089003251 SDH - Former Main Kitchen 1 Unprotected 1003255 SDH - Clinical Waste Str 100,863 Unprotected 100,863003256 SDH - Mortuary 326,522 Protected 326,522003264 SDH - Midwifery School 52,009 Protected 52,009003265 SDH - Calorifier Room 15,025 Protected 15,025003266 SDH -Porters Ldge/Post Rm 23,613 Unprotected 23,613003268 SDH - Cancer Support 4,536 Unprotected 4,536003269 SDH - Housekeeping Office 51,906 Unprotected 51,906003270 SDH - Salisbury Ward 118,966 Protected 118,966003271 SDH - Woodford Ward & Li 125,078 Protected 125,078003272 SDH - Amesbury Ward 32,190 Protected 32,190003273 SDH - Sarum Ward A/B/Link 206,755 Protected 206,755003274 SDH - Childrens Unit 153,587 Protected 153,587003275 SDH - Beatrice Ward 5 29,270 Protected 29,270003276 SDH - Beatrice Ward 6 46,857 Protected 46,857003277 SDH - BeatrIce Ward 3 85,589 Protected 85,589003278 SDH - Beatrice Ward 4 55,553 Protected 55,553003279 SDH - Neonatal Int Care 120,893 Protected 120,893003280 SDH - Wilton Ward A 64,198 Protected 64,198003281 SDH - Wilton Ward B 42,799 Protected 42,799003284 SDH - Obstetrics & Gynae 443,197 Protected 443,197003285 SDH - Day Surgery Unit 1,193,355 Protected 1,193,355003289 SDH - Spinal Unit 4,140,579 Protected 4,140,579003291 SDH - District Gen Hosp 28,184,204 Protected 28,184,204003292 SDH - South Corridor 246,937 Protected 246,937003293 SDH - Wards 57,778 Protected 57,778003294 SDH - Daily Living Bung 87,144 Unprotected 87,144003295 SDH - Rehab Hostel 46,316 Unprotected 46,316003296 SDH - South Boiler House 39,190 Unprotected 39,190003297 SDH - Allington Ward 53,556 Protected 53,556003298 SDH - GUM Clinic 43,845 Protected 43,845003299 SDH - Farley Ward 44,914 Unprotected 44,914003300 SDH - Burns Unit 482,928 Protected 482,928003304 SDH - Rehabilitation Ctr 1,149,798 Protected 1,149,798003305 SDH - Carpenters Store 93,230 Unprotected 93,230003306 SDH - Plastic Surgery 145,952 Protected 145,952003307 SDH - Boiler Hse Speech 33,093 Unprotected 33,093003308 SDH - Speech Therapy 19,532 Unprotected 19,532003309 SDH - Winterslow Ward 97,586 Unprotected 97,586003310 SDH - Laser Clinic 22,945 Unprotected 22,945003311 SDH - Plastic Archive 57,963 Protected 57,963003313 SDH - Boiler House Burns 56,454 Unprotected 56,454003314 SDH - Durrington Ward 457,901 Protected 457,901003335 Hillcote - Hillcote House 129,881 Protected 129,881003336 Hillcote - Hillcote Exten 122,215 Protected 122,215003337 Hillcote - The Coach Hse 36,266 Protected 36,266003355 SDH - Central Corridor 19,937 Protected 19,937003357 SDH - Dining /Coffee Lnge 34,576 Unprotected 34,576003359 SDH - Spinal/CT Scan/XRay 159,716 Protected 159,716003362 SDH - Main Boiler House 198,217 Unprotected 198,217003364 SDH - Clinical Waste Strs 7,356 Unprotected 7,356003365 SDH - Mortuary 263,276 Protected 263,276003366 SDH - Generator Building 31,606 Unprotected 31,606003373 SDH - Midwifery School 16,650 Unprotected 16,650003374 SDH - Calorifier Room 101,195 Unprotected 101,195003375 SDH - Porters Ldg/Post Rm 6,436 Unprotected 6,436003377 SDH - Cancer Support 1,512 Unprotected 1,512003378 SDH - Housekeeping Office 19,684 Unprotected 19,684003379 SDH - Salisbury Ward 17,931 Protected 17,931003380 SDH - Woodford Ward & Li 18,526 Protected 18,526003381 SDH - Amesbury Ward 12,207 Protected 12,207003382 SDH - Sarum Ward A/B/Link 61,773 Protected 61,773003383 SDH - Childrens Unit 99,819 Protected 99,819003384 SDH - Beatrice Ward 5 8,886 Protected 8,886003386 SDH - Beatrice Ward 6 14,227 Protected 14,227003387 SDH - Beatrice Ward 3 26,575 Protected 26,575003388 SDH - Beatrice 4 20,550 Protected 20,550003389 SDH - Neonatal Int Care 55,909 Protected 55,909003390 SDH - Wilton Ward A 19,979 Protected 19,979003391 SDH - Wilton Ward B 13,319 Protected 13,319003394 SDH - Obstetrics & Gynae 132,916 Protected 132,916003395 SDH - Day Surgery Unit 580,166 Protected 580,166003399 SDH - Spinal Unit 1,342,514 Protected 1,342,514003401 SDH - District Gen Hosp 22,308,183 Protected 22,308,183003402 SDH - South Corridor 11,436 Protected 11,436003403 SDH - Wards 37,727 Protected 37,727003404 SDH - Daily Living Bung 35,622 Unprotected 35,622003405 SDH - Rehabilitation Hos 39,007 Unprotected 39,007003406 SDH - South Boiler House 14,116 Protected 14,116

003407 SDH - Allington Ward 34,970 Protected 34,970003408 SDH - GUM Clinic 18,646 Protected 18,646003409 SDH - Farley Ward 29,311 Unprotected 29,311003410 SDH - Burns Unit 198,352 Protected 198,352003414 SDH - Rehabilitation Ctre 352,162 Protected 352,162003416 SDH - Plastic Surgery 69,432 Protected 69,432003417 SDH - Boiler House Speech 73,039 Unprotected 73,039003418 SDH - Speech Therapy 13,036 Unprotected 13,036003419 SDH - Winterslow Ward 31,900 Unprotected 31,900003420 SDH - Laser Clinic 15,314 Unprotected 15,314003421 SDH - Plastic Archive 36,649 Protected 36,649003423 SDH - Boiler House Burns 25,776 Unprotected 25,776003424 SDH - Durrington Ward 226,251 Protected 226,251003445 Hillcote House 99,366 Protected 99,366003446 Hillcote Extension 48,475 Protected 48,475003447 Hillcote The Coach House 40,093 Protected 40,093003464 SDH 901 2,634,997 Protected 2,634,997003563 Obstetrics Theatre 125,346 Protected 125,346003563/001 O&G Theatre 77,037 Protected 77,037004274 7494C DERMATOLOGY EXPANSION 1,506,635 Protected 1,506,635004471 EXT WORKS HILLCOTE 47,629 Protected 47,629003547 Baby Day Nursery 442,526 Unprotected 442,526003247 SDH - Trust Offices 55,007 Unprotected 55,007003249 SDH - Finance Dept 1 & 2 77,403 Unprotected 77,403003252 SDH Engineers Dept 13,686 Unprotected 13,686003253 SDH - Main Boiler House 186,392 Unprotected 186,392003254 SDH - District Works Offs 20,072 Unprotected 20,072003257 SDH - Generator Building 13,968 Unprotected 13,968003258 SDH - Social Block 36,049 Unprotected 36,049003261 SDH - Radio Odstock 8,367 Unprotected 8,367003263/637 SDH - Wylye House 164,553 Unprotected 164,553003267 SDH Hair D/Comm Child Hth 43,213 Unprotected 43,213003283 SDH - Supplies Dept 324,719 Unprotected 324,719003301 SDH - Facilities HQ 62,644 Unprotected 62,644003302 SDH - Durnford/Personnel 62,112 Unprotected 62,112003303 SDH - Occ Health & Safety 39,111 Unprotected 39,111003312 SDH Med Physics Workshop 252,158 Unprotected 252,158003318 OMH Laundry Compressor Rm 321,740 Unprotected 321,740003319 OMH - Linen St/Sewing Rm 38,130 Unprotected 38,130003320 OMH Boiler Hse/Oil T Bunk 21,579 Unprotected 21,579003321 OMH - Wkshops/Stores/Gas 7,911 Unprotected 7,911003322 OMH - Works/Laundry Store 32,129 Unprotected 32,129003323 OMH - Workshop / Stores 3,209 Unprotected 3,209003330 OMH - Garages & Stores 12,577 Unprotected 12,577003334 OMH - 32 Wilton Road 101,198 Unprotected 101,198003356 SDH - Trust Offices 24,920 Unprotected 24,920003358 SDH - Finance Dept 1 & 2 35,065 Unprotected 35,065003361 SDH - Engineers Dept 1,406 Unprotected 1,406003363 SDH - District Works Offs 13,169 Unprotected 13,169003367 SDH - Social Block 16,331 Unprotected 16,331003370 SDH - Radio Odstock 47 Unprotected 47003376 SDH Hair'D/Comm Child Hth 24,605 Unprotected 24,605003392 SDH - Day Nursery 214,132 Unprotected 214,132003393 SDH - Supplies Dept 76,943 Unprotected 76,943003411 SDH - Facilities HQ 24,814 Unprotected 24,814003412 SDH - Durnford/Personnel 40,556 Unprotected 40,556003413 SDH - Occ Health/Safety 25,538 Unprotected 25,538003415 SDH - Carpenters Store 6,669 Unprotected 6,669003422 SDH Med Physics Workshop 100,907 Unprotected 100,907003504 OMH Laundry/Compressor Rm 382,323 Unprotected 382,323003505 OMH Linen St/Sewing Room 8,041 Unprotected 8,041003506 OMH Boiler Hse/Oil T Bunk 6,647 Unprotected 6,647003507 OMH Workshps/Stores/Gas M 903 Unprotected 903003508 OMH Works/Laundry/Stores 13,753 Unprotected 13,753003509 OMH Workshop / Stores 18,003 Unprotected 18,003003540 Information services 76,322 Unprotected 76,322003801 DAY NURSERY 202,774 Unprotected 202,774004468 LAUNDRY ANNEXE 42,535 Unprotected 42,535004469 LAUNDRY ANNEXE 13,359 Unprotected 13,359004470 EXT WORKS OLD MANOR 45,513 Unprotected 45,513004472 Staff Health 367 Unprotected 367004473 Staff Health 115 Unprotected 115004475 BABY NURSERY 92,375 Unprotected 92,375003259 SDH - Avon House 189,276 Unprotected 189,276003329 OMH - The Paragon 5 & 6 202,428 Unprotected 202,428003328 OMH - The Paragon 3 & 4 227,696 Unprotected 227,696003260 SDH - Bourne House 247,336 Unprotected 247,336003327 OMH - The Paragons 1 & 2 252,996 Unprotected 252,996003287 SDH - Compton 318,163 Unprotected 318,163003286 SDH - Langley 403,276 Unprotected 403,276003288 SDH - Grovely 403,276 Unprotected 403,276004005 COURT CLOSE 7492C 453,982 Unprotected 453,982003316/637 OMH - Llangarren 480,692 Unprotected 480,692003262 SDH -Victoria Drive 2,181,029 Unprotected 2,181,029Total 70,128,952 10,610,295

Salisbury Healthcare NHS Trust Appendix AA

Protected and Unprotected Land

Asset Code Description NCRC Protected Unprotected003136 SDH - Central Corridor 34,869 Protected 34,869003137 SDH - Trust Offices 14,112 Unprotected 14,112003138 SDH -Dining/Coffee Lounge 19,255 Unprotected 19,255003139 SDH - Finance Dept 1&2 19,706 Unprotected 19,706003140 SDH - Spinal/CT/X-Ray 16,583 Protected 16,583003141 SDH - Former Main Kitchen 10,503 Unprotected 10,503003142 SDH -Engineers Dept 4,993 Unprotected 4,993003143 SDH - Main Boiler House 16,366 Unprotected 16,366003144 SDH - District Works Off 7,732 Unprotected 7,732003145 SDH - Clinical Waste Str 4,593 Unprotected 4,593003146 SDH -Mortuary 8,149 Protected 8,149003147 SDH - Generator Building 1,887 Unprotected 1,887003148 SDH -Social Block 9,302 Unprotected 9,302003149 SDH - Avon House 115,535 Unprotected 115,535003150 SDH - Bourne House 102,931 Unprotected 102,931003151 SDH - Radio Odstock 935 Unprotected 935003152 SDH - Victoria Drive 1,102,830 Unprotected 1,102,830003153 SDH - Wylye House 105,031 Unprotected 105,031003154 SDH - Midwifery School 3,424 Unprotected 3,424003155 SDH - Calorifier Room 1,670 Unprotected 1,670003156 SDH - Porters Ldg/Post RM 5,745 Unprotected 5,745003157 SDH-Hair/Comm Child Hth 11,322 Unprotected 11,322003158 SDH - Cancer Support 1,336 Unprotected 1,336003159 SDH - Housekeeping Office 14,996 Unprotected 14,996003160 SDH - Salisbury Ward 10,939 Protected 10,939003161 SDH - Woodford Ward & LI 10,337 Protected 10,337003162 SDH - Amesbury Ward 9,302 Protected 9,302003163 SDH - Sarum Ward A/B/Link 35,888 Protected 35,888003164 SDH - Childrens Unit 13,460 Protected 13,460003165 SDH - Beatrice Ward 5 8,768 Protected 8,768003166 SDH -Beatrice Ward 6 9,636 Protected 9,636003167 SDH -Beatrice Ward 3 9,652 Protected 9,652003168 SDH - Beatrice Ward 4 9,485 Protected 9,485003169 SDH - Neonatal Int Care 4,359 Protected 4,359003170 SDH - Wilton Ward A 8,768 Protected 8,768003171 SDH - Wilton Ward B 11,039 Protected 11,039003172 SDH - Day Nursery 5,244 Unprotected 5,244003173 SDH - Supplies Dept 15,047 Unprotected 15,047003174 SDH - Obstetrics & Gynae 17,903 Protected 17,903003175 SDH - Day Surgery Unit 21,627 Protected 21,627003176 SDH - Langley 203,761 Unprotected 203,761003177 SDH - Compton 161,223 Unprotected 161,223003178 SDH - Grovely 203,761 Unprotected 203,761003179 Spinal Unit 149,131 Protected 149,131003180 SDH Doctors Mess & Admin 7,832 Unprotected 7,832003181 SDH -District Gen Hosp 935,844 Protected 935,844003182 SDH - South Corridor 22,161 Protected 22,161003183 SDH - Wards 13,945 Protected 13,945

003184 SDH - Daily Living Bung 2,906 Unprotected 2,906003185 SDH - Rehab Hostel 9,686 Unprotected 9,686003186 SDH - South Boiler House 1,436 Unprotected 1,436003187 SDH - Allington Ward 12,157 Protected 12,157003188 SDH - GUM Clinic 6,479 Protected 6,479003189 SDH - Farley Ward 10,153 Unprotected 10,153003190 SDH - Burns Unit 30,327 Unprotected 30,327003191 SDH - Facililties HQ 9,219 Unprotected 9,219003192 SDH Durnfd/Personnel Off 14,829 Unprotected 14,829003193 SDH - Occ Health/Safety 8,868 Unprotected 8,868003194 SDH - Rehabilitation Ctr 35,321 Protected 35,321003195 SDH - Carpenters Store 9,352 Unprotected 9,352003196 SDH - Plastic Surgery 23,313 Protected 23,313003197 SDH - Boiler Hse/Speech 1,152 Unprotected 1,152003198 SDH - Speech Therapy 4,893 Unprotected 4,893003199 SDH - Winterslow Ward 14,396 Unprotected 14,396003200 SDH - Laser Clinic 6,246 Unprotected 6,246003201 SDH - Plastic Archive 11,573 Protected 11,573003202 SDH - Med Physics Workshp 9,603 Unprotected 9,603003203 SDH - Boiler Hse Burns 2,088 Unprotected 2,088003204 SDH - Durrington Ward 15,798 Protected 15,798003205 SDH - Portakabins 5,795 Unprotected 5,795003226 Hillcote - Hillcote House 244,700 Protected 244,700003227 OMH - Hillcote Extension 87,432 Protected 87,432003228 Hillcote - The Coach Hse 87,993 Protected 87,993003206 OMH - Llangarren 288,836 Unprotected 288,836003207 OMH Llangarren Extension 232,779 Unprotected 232,779003208 OMH Laundry Compressor Rm 564,955 Unprotected 564,955003209 OMH - Linen St/Sewing Rm 71,362 Unprotected 71,362003210 OMH-Boiler Hse/Oil T Bunk 91,540 Unprotected 91,540003211 OMH -Workshops/Stores/Gas 155,018 Unprotected 155,018003212 OMH- Works/Laundry Stores 121,551 Unprotected 121,551003213 OMH - Workshops /Stores 49,208 Unprotected 49,208003214 OMH - Kennet House 40,546 Unprotected 40,546003218 OMH - 32 Wilton Road 52,516 Unprotected 52,516003219 OMH - The Paragon 1 & 2 131,289 Unprotected 131,289003220 OMH -The Paragon 3 & 4 105,031 Unprotected 105,031003221 OMH - The Paragon 5 & 6 105,031 Unprotected 105,031003222 OMH - Garages & Stores 33,610 Unprotected 33,610003225 OMH - Non OP Land 80,464 Unprotected 80,464004474 Court Close Land 15,230 Unprotected 15,230Total 1,886,613 4,450,990

Salisbury Healthcare NHS Trust Appendix AB

Scenario Inflation Assumptions

Medium Case High Case Low Case2006/07 2007/08 2008/09 2009/10 2010/11 2006/07 2007/08 2008/09 2009/10 2010/11 2006/07 2007/08 2008/09 2009/10 2010/11

Volume GrowthElective -2.64% 2.15% -1.59% 0.19% 0.46% 1.11% 2.57% -0.35% 0.52% 1.19% -7.50% 2.14% -1.60% 0.18% 0.47%Day Cases 5.53% 2.29% -0.28% 0.37% 0.56% 12.49% 2.69% 0.31% 1.04% 1.54% 2.56% 2.27% -0.24% 0.39% 0.59%Non-elective -3.20% -0.68% -0.59% -0.74% -0.70% 4.43% 0.71% 0.99% 0.92% 0.98% -3.20% -0.68% -0.59% -0.74% -0.70%Outpatients -1.36% -0.65% -1.24% -0.62% -0.66% -1.61% -0.95% -0.60% -0.38% -0.42% -2.66% -0.66% -1.25% -0.63% -0.67%A&E 0.20% 0.80% 0.90% 0.80% 0.70% 3.14% 2.50% 2.50% 2.60% 2.60% -1.60% -1.60% -1.60% -1.60% -1.60%Other

Tariff inflation

Pay Awards 3.23% 3.23% 3.23% 3.23% 3.23% 3.23% 3.23% 3.23% 3.23% 3.23% 3.23% 3.23% 3.23% 3.23% 3.23%EWTDAgenda for Change * 0.45% 0.43% 0.42% 0.41% 0.40% 0.45% 0.43% 0.42% 0.41% 0.40% 0.45% 0.43% 0.42% 0.41% 0.40%Consultants Contracts

Non-Pay 2.00% 2.00% 2.00% 2.00% 2.00% 2.00% 2.00% 2.00% 2.00% 2.00% 2.00% 2.00% 2.00% 2.00% 2.00%Drug Cost Inflation 16.44% 14.40% 11.76% 10.73% 9.88% 16.44% 14.40% 11.76% 10.73% 9.88% 16.44% 14.40% 11.76% 10.73% 9.88%Establishment Cost inflationOther Cost inflation ** 4.53% 2.45% 0.98% 0.06% -0.05% 5.12% 2.99% 1.50% 0.58% 0.46% 3.73% 1.43% 0.20% -0.70% -0.78%CRESS Target 2.50% 2.00% 2.50% 2.70% 2.70% 2.50% 2.00% 2.50% 2.70% 2.70% 2.50% 2.00% 2.50% 2.70% 2.70%

Debtor days - NHS 14 14 14 14 14 14 14 14 14 14 14 14 14 14 14 - Non-NHS 100 100 100 95 92 100 100 100 95 92 100 100 100 95 92Creditor days - NHS 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 - Non-NHS 108 108 110 110 115 108 108 110 110 115 108 108 110 110 115Capex as a % of Depeciation 86.26% 94.61% 83.12% 82.17% 77.19% 86.26% 94.61% 83.12% 82.17% 77.19% 86.26% 94.61% 83.12% 82.17% 77.19%

* Agenda for change as a % of Non-Medical Pay** Excludes change in activity, only relates additional expenditure (Refer to detail behind)

abc Appendix ACMedium Scenario - Activity Projections

Specialty 2005/6 2006/7 2007/8 2008/9 2009/10 2010/11Non-Elec Daycase Elective Non-Elec Daycase Elective Non-Elec Daycase Elective Non-Elec Daycase Elective Non-Elec Daycase Elective Non-Elec Daycase Elective

General Surgery 2,140 1,832 916 2,109 2,283 786 2,100 2,304 785 2,092 2,277 770 2,081 2,292 774 2,070 2,311 779Urology 351 1,834 627 349 2,038 664 347 2,121 693 346 2,127 688 343 2,137 690 341 2,154 694Trauma & Orthopaedics 1,240 983 1,221 1,234 1,306 1,347 1,227 1,356 1,404 1,222 1,317 1,362 1,214 1,312 1,359 1,207 1,316 1,365ENT 165 334 352 165 421 253 165 436 263 165 426 259 164 424 260 163 425 262Ophthalmology 33 1,884 109 32 1,430 89 31 1,458 90 31 1,445 88 31 1,450 88 31 1,458 88Oral Surgery 125 726 165 125 879 151 125 912 157 124 892 155 123 889 154 122 891 154Spinal Injuries 72 3 41 73 3 41 74 3 41 74 3 41 75 3 42 75 3 42Plastic Surgery 1,402 1,200 1,569 1,398 1,301 1,462 1,399 1,317 1,477 1,400 1,312 1,478 1,399 1,315 1,483 1,398 1,319 1,489Burns 202 1 2 202 1 2 203 1 2 202 1 2 202 1 2 201 1 2Accident & Emergency 1,741 0 1 1,652 1 1 1,642 1 1 1,632 2 1 1,619 2 1 1,607 2 1Anaesthetics 0 119 1 0 122 1 0 125 2 0 127 1 0 128 1 0 128 1General Medicine 6,326 2,121 141 5,948 2,084 143 5,923 2,137 147 5,904 2,175 150 5,879 2,189 151 5,855 2,203 152Gastroenterology 9 29 1 9 29 1 9 30 1 8 31 1 8 31 1 8 31 1Endocrinology 6 0 0 6 0 0 6 0 0 6 0 0 6 0 0 6 0 0Clinical Haematology 100 1,643 84 100 1,673 86 99 1,719 88 98 1,749 88 98 1,763 88 98 1,775 89Rehabilitation 0 1 36 0 1 36 0 1 36 0 1 36 0 1 36 0 1 37Palliative Medicine 118 0 89 117 0 91 115 0 94 114 0 93 113 0 93 111 0 94Cardiology 5 650 28 5 662 29 5 681 30 5 693 30 5 697 30 5 702 30Dermatology 3 249 0 3 253 0 3 259 0 3 264 0 3 266 0 3 269 0Medical Oncology 51 2,105 36 50 2,145 36 50 2,203 37 50 2,238 36 50 2,251 36 50 2,263 37Neurology 2 0 0 2 0 0 2 0 0 2 0 0 2 0 0 2 0 0Rheumatology 1 175 7 1 177 8 1 182 8 1 184 8 1 185 8 1 185 8Paediatric Medicine 1,764 20 35 1,664 21 35 1,647 21 36 1,624 22 36 1,601 22 36 1,577 21 36SCBU 159 0 0 158 0 0 157 0 0 155 0 0 153 0 0 151 0 0Geriatric Medicine 284 2 48 283 2 49 281 2 51 280 2 50 278 2 50 276 2 51Obstetrics 4,470 0 0 4,408 0 0 4,347 0 0 4,303 0 0 4,250 0 0 4,204 0 0Gynaecology 620 914 398 612 943 417 604 912 409 598 831 368 591 828 368 584 830 370Learning Disability 1 0 343 1 0 350 1 0 358 1 0 367 1 0 366 1 0 365Clinical Oncology 4 194 2 4 197 2 3 202 2 3 205 2 3 206 2 3 206 2Radiology 57 209 157 57 209 160 56 214 164 56 217 164 55 219 165 54 221 166

21,451 17,228 6,411 20,764 18,180 6,242 20,622 18,597 6,376 20,499 18,545 6,274 20,348 18,613 6,286 20,205 18,717 6,315

abc Appendix ACMedium - Outpatient Activity Scenarios

2005/6 2006/7 2007/8 2008/9 2009/10 2010/11First Follow Up First Follow Up First Follow Up First Follow Up First Follow Up First Follow Up

Anaesthetics 28 5 28 5 29 5 29 5 29 5 29 5Cardiology 694 459 693 458 696 461 694 461 698 464 701 466Chemical Pathology 54 237 54 222 54 211 53 201 53 194 53 188Clinical Haematology 481 2,648 479 2,600 480 2,565 479 2,514 481 2,481 482 2,444Clinical Oncology 259 467 257 463 258 463 257 459 257 459 257 458Dermatology 3,634 7,765 3,623 7,598 3,635 7,479 3,623 7,304 3,630 7,186 3,636 7,060Endocrinology 199 860 197 853 197 852 196 845 195 844 196 844ENT 4,497 5,071 4,478 4,989 4,488 4,938 4,469 4,856 4,473 4,802 4,477 4,741Gastroenterology 0 48 0 48 0 48 0 48 0 48 0 48General Medicine 6,235 13,343 6,225 13,305 6,254 13,360 6,245 13,331 6,270 13,378 6,292 13,416General Surgery 9,240 6,461 9,198 6,444 9,219 6,473 9,181 6,458 9,193 6,480 9,203 6,497Geriatric Medicine 351 1,066 350 1,053 350 1,047 348 1,032 349 1,025 349 1,017Gynaecology 2,777 2,625 2,760 2,609 2,760 2,611 2,741 2,595 2,736 2,594 2,732 2,593Medical Oncology 159 974 159 957 159 946 159 928 159 917 160 905Neurology 510 596 507 583 508 575 506 563 507 554 507 544Obstetrics 2,089 3,363 2,065 3,321 2,055 3,301 2,036 3,270 2,028 3,255 2,021 3,244Ophthalmology 6,875 18,102 6,853 17,916 6,877 17,843 6,853 17,645 6,868 17,559 6,881 17,455Oral Surgery 2,824 5,399 2,810 5,190 2,816 5,021 2,805 4,827 2,807 4,678 2,808 4,528Orthodontics 235 1,399 233 1,389 232 1,389 230 1,375 228 1,367 227 1,360Paediatric Medicine 1,467 3,493 1,452 3,438 1,449 3,410 1,432 3,349 1,425 3,312 1,417 3,274Paediatric Surgery 110 119 109 117 109 115 108 113 107 112 107 111Plastic Surgery 4,136 9,652 4,141 9,111 4,158 8,609 4,163 8,114 4,173 7,700 4,185 7,291Rehabilitation 186 269 185 268 185 269 184 268 184 268 183 268Rheumatology 1,997 5,686 1,983 5,650 1,985 5,661 1,972 5,626 1,972 5,627 1,970 5,625Trauma & Orthopaedics 6,489 12,973 6,457 12,718 6,472 12,555 6,445 12,301 6,450 12,132 6,455 11,949Urology 2,131 2,900 2,129 2,897 2,141 2,915 2,140 2,913 2,150 2,929 2,160 2,942Neurosurgery 29 538 29 309 30 186 30 124 31 95 31 78Clinical Genetics 7 16 7 14 7 14 7 13 7 12 7 12Paediatric Neurology 0 26 0 26 0 26 0 26 0 26 0 25Midwife Episodes 368 76 364 75 361 74 357 73 355 73 354 72Child & Adolescent Psychiatr 46 256 45 252 45 251 45 248 44 247 44 245Nursing Episode 634 512 630 509 631 511 628 508 629 508 629 509Total 58,744 107,403 58,501 105,387 58,640 104,182 58,415 102,395 58,488 101,330 58,555 100,211

166,147 163,888 162,822 160,810 159,817 158,766

Salisbury Healthcare NHS Trust Appendix AD

Foundation Trust - MEDIUM

Activity assumptions: as per PCT LDP requirements (needs revision)


SLA 6.00% 6.00% 6.00% 4.70% 4.70%Non-SLA 2.00% 2.00% 2.00% 2.00% 2.00%


Hillcote monies 491Reduction in Private Patient Income (Due to cap) -600

Unregulated Bank 711 -285 -142 -142 -142Laundry 837 1,374 689 90Odstock Medical Ltd 100





Pay Senior Medical developments 400 200 -110 -100On site impact of out of hours service on A&E -60 -100Cardiology 30Savings on scientists from New Born Screening -70Non-recurring expenditure related to income 1,615NPFiT Additional Implementation Staff 300 -200Agenda for Change 300 300 300 300 300Additional Foundation Trust Staff 100

Non-Pay PFI 1,605IT service developments 150 -100 -50 0Training 250 -50 -200Information Services & Medical Records 100 -100Modernisation 100 100 -100 -100PFI savings on south side facilities -395Energy price increase above 2% 250 200Reuse of south side 100PACS 483Drugs 250 250 250 250 250Decomtamination/MRSA 200 200 200 200 200Cardiology 40Pathology 135Laundry activity 823 1,069 608 87NPFiT support 100Review of Radiology & revenue consequences of ca 50 -20 -20 -20 -20Non-recurring expenditure related to income 817 -250


11,203 5,343 4,234 3,661 3,737Net of CIP 7,250 2,215 602 -348 -369

Salisbury Healthcare NHS Trust Appendix AE

Annual Income & Expenditure Account - NHS FOUNDATION TRUST CASE




EBITDA 11,133 10,141 9,329 10,135 10,303 10,784

Depreciation (7,366) (5,623) (5,492) (5,919) (5,827) (6,396)


Net Interest 87 170 196 204 210 215


Dividends (3,372) (3,483) (3,431) (3,592) (3,606) (3,706)

Retained Surplus/(Deficit) 482 1,205 602 827 1,080 897





Annual Balance Sheet - NHS FOUNDATION TRUST CASE


Protected Fixed Assets NBVLand 1,511 511 511 553 553 577Buildings 72,873 71,448 70,698 75,803 76,626 81,364Equipment 13,059 15,097 17,456 17,989 18,355 18,026Information Technology 263 207 178 160 159 158Sub-Total 87,706 87,264 88,843 94,505 95,692 100,125

Unprotected Fixed Assets NBVLand 4,436 4,436 4,436 4,794 4,794 5,004Buildings 10,632 10,176 9,776 9,982 9,591 9,597Equipment 0 0 0 0 0 0Information Technology 0 0 0 0 0 0Sub-Total 15,068 14,612 14,212 14,777 14,385 14,600

Donated Fixed Assets NBVLand 0 0 0 0 0 0Buildings 691 682 673 706 698 720Equipment 577 435 317 215 145 75Information Technology 0 0 0 0 0 0Sub-Total 1,268 1,117 990 921 843 795


Current AssetsStock 697 760 796 833 871 910Debtors (NHS) 4,946 5,027 5,161 5,272 5,409 5,555Debtors (Other) 1,607 1,694 2,023 2,124 2,153 2,157Debtors (Brokerage) 0 0 0 0 0 0Debt Service Reserve 0 0 0 0 0 0Cash 1,870 3,230 3,234 3,449 3,499 3,767Sub-Total 9,121 10,711 11,213 11,678 11,932 12,388




Financed By

Public Dividend Capital 51,654 49,954 49,954 49,679 49,404 49,404Revaluation Reserve 44,058 44,058 44,058 49,607 49,607 53,615Donation Reserve 1,258 1,107 980 911 833 785I&E Reserves 4,489 5,694 6,296 7,123 8,203 9,100





Annual Cashflow - NHS FOUNDATION TRUST CASE



Capital Expenditure (7,051) (4,574) (6,545) (6,484) (6,545) (6,957)Debt Issuance Fees 0 0 0 0 0 0Less PDC Funding 0 0 0 0 0 0Less Donations 0 0 0 0 0 0Cash Brokerage (315) (1,700) 0 (275) (275) 0






Sub-Total 0 0 0 0 0 0


Funded ByDividends (3,372) (3,483) (3,431) (3,592) (3,606) (3,706)Change In Cash (1,531) (1,360) (4) (215) (50) (267)Interest 87 170 196 204 210 215Total (4,815) (4,673) (3,239) (3,603) (3,446) (3,759)





abc Appendix AFLow Scenario - Activity Projections by Year

Non-Elec Daycase Elective Non-Elec Daycase Elective Non-Elec Daycase Elective Non-Elec Daycase Elective Non-Elec Daycase Elective Non-Elec Daycase ElectiveGeneral Surgery 2,140 1,832 916 2,109 2,567 747 2,100 2,593 746 2,092 2,573 732 2,081 2,594 736 2,070 2,619 740Urology 351 1,834 627 349 1,936 631 347 2,015 658 346 2,021 654 343 2,030 656 341 2,046 660Trauma & Orthopaedics 1,240 983 1,221 1,234 1,241 1,280 1,227 1,289 1,334 1,222 1,251 1,294 1,214 1,246 1,291 1,207 1,251 1,297ENT 165 334 352 165 400 241 165 414 250 165 405 246 164 403 247 163 404 248Ophthalmology 33 1,884 109 32 1,358 84 31 1,385 86 31 1,373 83 31 1,378 83 31 1,385 84Oral Surgery 125 726 165 125 835 144 125 866 149 124 848 147 123 844 146 122 846 147Spinal Injuries 72 3 41 73 3 39 74 3 39 74 3 39 75 3 40 75 3 40Plastic Surgery 1,402 1,200 1,569 1,398 1,236 1,389 1,399 1,251 1,403 1,400 1,247 1,404 1,399 1,249 1,409 1,398 1,253 1,414Burns 202 1 2 202 1 2 203 1 2 202 1 2 202 1 2 201 1 2Accident & Emergency 1,741 0 1 1,652 1 1 1,642 1 1 1,632 2 1 1,619 2 1 1,607 2 1Anaesthetics 0 119 1 0 115 1 0 118 1 0 120 1 0 121 1 0 122 1General Medicine 6,326 2,121 141 5,948 1,980 136 5,923 2,030 140 5,904 2,066 142 5,879 2,080 143 5,855 2,093 144Gastroenterology 9 29 1 9 28 1 9 29 1 8 30 1 8 30 1 8 30 1Endocrinology 6 0 0 6 0 0 6 0 0 6 0 0 6 0 0 6 0 0Clinical Haematology 100 1,643 84 100 1,590 81 99 1,633 83 98 1,661 83 98 1,675 84 98 1,686 85Rehabilitation 0 1 36 0 1 35 0 1 35 0 1 34 0 1 35 0 1 35Palliative Medicine 118 0 89 117 0 87 115 0 89 114 0 88 113 0 89 111 0 89Cardiology 5 650 28 5 629 28 5 647 29 5 658 28 5 662 29 5 666 29Dermatology 3 249 0 3 240 0 3 246 0 3 251 0 3 253 0 3 255 0Medical Oncology 51 2,105 36 50 2,037 34 50 2,093 35 50 2,126 34 50 2,139 35 50 2,149 35Neurology 2 0 0 2 0 0 2 0 0 2 0 0 2 0 0 2 0 0Rheumatology 1 175 7 1 169 7 1 173 7 1 175 7 1 176 7 1 176 7Paediatric Medicine 1,764 20 35 1,664 20 34 1,647 20 34 1,624 20 34 1,601 20 34 1,577 20 34SCBU 159 0 0 158 0 0 157 0 0 155 0 0 153 0 0 151 0 0Geriatric Medicine 284 2 48 283 2 47 281 2 48 280 2 48 278 2 48 276 2 48Obstetrics 4,470 0 0 4,408 0 0 4,347 0 0 4,303 0 0 4,250 0 0 4,204 0 0Gynaecology 620 914 398 612 896 396 604 866 388 598 790 350 591 786 350 584 789 352Learning Disability 1 0 343 1 0 332 1 0 340 1 0 348 1 0 347 1 0 347Clinical Oncology 4 194 2 4 187 2 3 192 2 3 195 2 3 195 2 3 195 2Radiology 57 209 157 57 198 152 56 203 156 56 207 155 55 208 157 54 210 158

21,451 17,228 6,411 20,764 17,669 5,930 20,622 18,071 6,057 20,499 18,027 5,960 20,348 18,099 5,971 20,205 18,205 5,999

2009/10 2010/112005/6 2006/7 2007/8 2008/9

abc Appendix AFLow - Outpatient Activity Scenario


Anaesthetics 28 5 28 5 29 5 29 5 29 5 29 5Cardiology 694 459 693 458 696 461 694 461 698 464 701 466Chemical Pathology 54 237 54 222 54 211 53 201 53 194 53 188Clinical Haematology 481 2,648 479 2,600 480 2,565 479 2,514 481 2,481 482 2,444Clinical Oncology 259 467 257 463 258 463 257 459 257 459 257 458Dermatology 3,634 7,765 3,623 7,598 3,635 7,479 3,623 7,304 3,630 7,186 3,636 7,060Endocrinology 199 860 187 853 187 852 186 845 186 844 186 844ENT 4,497 5,071 4,255 4,989 4,264 4,938 4,246 4,856 4,249 4,802 4,253 4,741Gastroenterology 0 48 0 48 0 48 0 48 0 48 0 48General Medicine 6,235 13,343 5,914 13,305 5,941 13,360 5,933 13,331 5,957 13,378 5,977 13,416General Surgery 9,240 6,461 8,738 6,444 8,758 6,473 8,722 6,458 8,733 6,480 8,743 6,497Geriatric Medicine 351 1,066 332 1,053 333 1,047 331 1,032 332 1,025 332 1,017Gynaecology 2,777 2,625 2,760 2,609 2,760 2,611 2,741 2,595 2,736 2,594 2,732 2,593Medical Oncology 159 974 159 957 159 946 159 928 159 917 160 905Neurology 510 596 482 583 483 575 481 563 481 554 482 544Obstetrics 2,089 3,363 1,962 3,321 1,952 3,301 1,935 3,270 1,927 3,255 1,920 3,244Ophthalmology 6,875 18,102 6,853 17,916 6,877 17,843 6,853 17,645 6,868 17,559 6,881 17,455Oral Surgery 2,824 5,399 2,670 5,190 2,675 5,021 2,665 4,827 2,666 4,678 2,668 4,528Orthodontics 235 1,399 233 1,389 232 1,389 230 1,375 228 1,367 227 1,360Paediatric Medicine 1,467 3,493 1,380 3,438 1,377 3,410 1,361 3,349 1,354 3,312 1,346 3,274Paediatric Surgery 110 119 109 117 109 115 108 113 107 112 107 111Plastic Surgery 4,136 9,652 3,934 9,111 3,950 8,609 3,955 8,114 3,965 7,700 3,975 7,291Rehabilitation 186 269 176 268 176 269 174 268 174 268 174 268Rheumatology 1,997 5,686 1,884 5,650 1,886 5,661 1,873 5,626 1,873 5,627 1,872 5,625Trauma & Orthopaedics 6,489 12,973 6,134 12,718 6,148 12,555 6,123 12,301 6,128 12,132 6,132 11,949Urology 2,131 2,900 2,022 2,897 2,034 2,915 2,033 2,913 2,043 2,929 2,052 2,942Neurosurgery 29 538 28 309 28 186 29 124 29 95 29 78Clinical Genetics 7 16 7 14 7 14 6 13 6 12 6 12Paediatric Neurology 0 26 0 26 0 26 0 26 0 26 0 25Midwife Episodes 368 76 346 75 343 74 340 73 338 73 336 72Child & Adolescent Psych 46 256 43 252 43 251 42 248 42 247 42 245Nursing Episode 634 512 599 509 600 511 597 508 597 508 598 509Total 58,744 107,403 56,338 105,387 56,473 104,182 56,256 102,395 56,325 101,330 56,390 100,211

166,147 161,725 160,654 158,651 157,655 156,602

Salisbury Healthcare NHS Trust Appendix AG

Foundation Trust - LOW



SLA 6.00% 6.00% 6.00% 4.70% 4.70%Non-SLA 2.00% 2.00% 2.00% 2.00% 2.00%









Non-Pay PFI 1,605IT service developments 100 100 -100 -100 0Training 0 0 0Information Services & Medical Records 0 0Modernisation 0 0 0 0PFI savings on south side facilities -395Energy price increase above 2% 250 200Reuse of south side 100PACS 483Drugs 250 250 250 250 250Decomtamination/MRSA 200 200 200 200 200Cardiology 40Pathology 135Laundry activity 823 1,069 608 87NPFiT support 100Review of Radiology & revenue consequences of capital 50 -20 -20 -20 -20Non-recurring expenditure related to income 817 -250


10,703 5,343 4,234 3,861 4,037Net of CIP 6,510 2,151 552 -178 -119

Salisbury Healthcare NHS Trust Appendix AH

Manpower Plan Low Scenario



Medical & Dental 261.13 22,220 261.13 22,220 261.13 22,220 261.13 22,220 261.13 22,220 261.13 22,220

Nursing 1105.78 30,274 -33.00 -782 1072.78 29,492 -11.00 -260 1061.78 29,232 -17.00 -403 1044.78 28,829 -10.00 -237 1034.78 28,592 -17.00 -403 1017.78 28,189


Professional & Technical (Scientists) 67.46 2,808 67.46 2,808 67.46 2,808 67.46 2,808 67.46 2,808 67.46 2,808

Pharmacists 15.53 679 15.53 679 15.53 679 15.53 679 15.53 679 15.53 679


Professional & Technical (other) 226.17 5,745 -1.00 -33 225.17 5,712 -0.57 -19 224.60 5,693 224.60 5,693 -0.57 -19 224.03 5,674 224.03 5,674

Administrative & Clerical 446.82 8,051 -1.00 -14 445.82 8,037 -0.50 -7 445.32 8,030 -0.50 -7 444.82 8,023 -0.50 -7 444.32 8,016 -0.50 -7 443.82 8,009

Ancillary 274.20 4,329 -1.25 -16 272.95 4,313 -0.50 -6.5 272.45 4,307 -1.50 -19.5 270.95 4,287 -0.50 -6.5 270.45 4,281 -1.50 -19.5 268.95 4,261

Maintenance 32.55 656 32.55 656 32.55 656 32.55 656 32.55 656 32.55 656

Ambulance 14.00 235 14.00 235 14.00 235 14.00 235 14.00 235 14.00 235

Other 776 0.00 776 0.00 776 0.00 776 0.00 776 0.00 776

TOTAL PAY 2637.54 83,250 -36.25 -845 2601.29 82,405 -12.57 -293 2588.72 82,113 -19.00 -430 2569.72 81,683 -11.57 -270 2558.15 81,414 -19.00 -430 2539.15 80,984

Non Pay 33,069 -240 32,829 24 32,853 -67 32,786 -35 32,751 -33 32,718

Total Inpatient - Ward 2637.54 116,319 -36.25 -1,085 2601.29 115,234 -12.57 -269 2588.72 114,966 -19.00 -497 2569.72 114,469 -11.57 -305 2558.15 114,165 -19.00 -463 2539.15 113,702

Out PatientsMedical -1.25 -125 -0.86 -88 -1.05 -108 -0.86 -80 0.78 -85

Nursing -1.75 -60 -1.46 -39 -1.85 -52 -2.00 -35 -2.25 -45

Non Pay -150 5 -50 -20 -10

Total Out Patients -3.00 -335 -2.32 -122 -2.90 -210 -2.86 -135 -1.47 -140


Medical & Dental 4.00 400 2.00 200 -1.00 -110 -1.00 -100



Salisbury Healthcare NHS Trust Appendix AI

Annual Income & Expenditure Account - NHS FOUNDATION TRUST CASE LOW




EBITDA 11,133 9,729 8,930 9,794 9,988 10,516

Depreciation (7,366) (5,623) (5,492) (5,919) (5,827) (6,396)


Net Interest 87 160 165 158 151 143


Dividends (3,372) (3,483) (3,431) (3,592) (3,606) (3,706)

Retained Surplus/(Deficit) 482 784 173 441 706 557





Annual Balance Sheet - NHS FOUNDATION TRUST CASE LOW










Financed By






Annual Cashflow - NHS FOUNDATION TRUST CASE LOW









Sub-Total 0 0 0 0 0 0


Funded ByDividends (3,372) (3,483) (3,431) (3,592) (3,606) (3,706)Change In Cash (1,531) (692) 433 180 298 15Interest 87 160 165 158 151 143Total (4,815) (4,015) (2,833) (3,254) (3,157) (3,548)





abc Appendix AJHigh Scenario - Activity Projections

Specialty 2005/6 2006/7 2007/8 2008/9 2009/10 2010/11Non-Elec Daycase Elective Non-Elec Daycase Elective Non-Elec Daycase Elective Non-Elec Daycase Elective Non-Elec Daycase Elective Non-Elec Daycase Elective

General Surgery 2,204 1,887 964 2,210 2,662 710 2,216 2,749 726 2,228 2,750 725 2,238 2,773 733 2,250 2,812 745Urology 384 2,103 754 390 2,382 685 394 2,494 722 399 2,491 717 405 2,516 723 411 2,560 735Trauma & Orthopaed 1,284 1,279 1,507 1,287 1,539 1,254 1,293 1,578 1,291 1,298 1,527 1,255 1,302 1,513 1,250 1,305 1,527 1,267ENT 170 335 339 173 522 188 175 543 196 177 534 194 179 530 194 181 532 196Ophthalmology 36 1,190 98 35 1,274 74 36 1,322 76 37 1,343 75 38 1,382 76 39 1,429 77Oral Surgery 129 929 152 131 1,018 141 132 1,056 147 133 1,032 144 134 1,020 143 134 1,021 144Spinal Injuries 86 2 50 87 2 50 88 2 51 89 2 51 90 2 51 90 2 51Plastic Surgery 1,504 1,187 1,557 1,524 1,337 1,434 1,548 1,344 1,451 1,574 1,352 1,469 1,599 1,360 1,486 1,625 1,369 1,504Burns 262 1 5 263 2 5 264 2 5 265 2 5 265 2 5 266 2 5Accident & Emergen 1,814 0 1 1,841 1 1 1,866 1 1 1,890 2 1 1,915 2 1 1,939 2 1Anaesthetics 0 132 1 0 134 1 0 136 1 0 138 1 0 140 1 0 142 1General Medicine 6,484 2,001 130 6,606 2,029 132 6,715 2,056 134 6,831 2,086 136 6,960 2,119 139 7,081 2,151 141Gastroenterology 8 23 1 8 23 1 8 23 1 8 23 1 9 23 1 9 23 1Endocrinology 6 0 0 6 0 0 6 0 0 6 0 0 6 0 0 7 0 0Clinical Haematology 108 1,761 109 109 1,784 110 111 1,812 111 113 1,841 113 116 1,874 115 118 1,903 118Rehabilitation 0 1 41 0 1 41 0 1 41 0 1 41 0 1 42 0 1 42Palliative Medicine 123 0 86 125 0 87 126 0 87 127 0 88 130 0 90 132 0 91Cardiology 5 599 40 5 636 41 5 675 43 5 704 44 6 734 45 6 767 46Dermatology 3 272 1 3 278 1 3 281 1 3 286 1 3 292 1 3 298 1Medical Oncology 53 2,021 44 54 2,049 45 55 2,078 45 56 2,114 45 58 2,151 46 59 2,185 47Neurology 2 0 0 2 0 0 2 0 0 2 0 0 2 0 0 2 0 0Rheumatology 1 170 8 1 171 8 1 172 8 1 174 8 1 176 8 1 178 8Paediatric Medicine 1,832 23 47 1,822 24 47 1,819 24 47 1,811 24 46 1,803 24 46 1,794 24 46SCBU 163 0 0 162 1 0 162 1 0 162 1 0 161 1 0 161 1 0Geriatric Medicine 287 2 60 295 2 61 302 2 62 308 2 64 316 2 65 322 2 66Obstetrics 2 0 0 2 0 0 2 0 0 2 0 0 2 0 0 2 0 0Obstetrics 4,585 1 3 4,565 1 3 4,535 1 3 4,557 1 3 4,555 1 3 4,581 1 3Gynaecology 626 1,042 468 626 1,141 466 625 1,178 493 628 1,159 488 628 1,152 488 631 1,161 493Obstetrics 1 0 0 1 0 0 1 0 0 1 0 0 1 0 0 1 0 0General Practice - Ot 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Learning Disability 1 0 603 1 0 603 1 0 606 1 0 608 1 0 602 1 0 600Clinical Oncology 3 173 2 3 175 2 3 176 2 3 178 2 3 181 2 3 184 2Radiology 63 190 146 64 193 148 65 195 151 65 198 154 67 201 157 67 204 160

22,229 17,325 7,218 22,401 19,380 6,340 22,559 19,903 6,503 22,783 19,965 6,480 22,993 20,172 6,514 23,218 20,482 6,592

abc Appendix AJHigh - Outpatient Activity Scenarios


Anaesthetics 28 5 29 5 29 5 30 5 30 5 31 5Cardiology 697 460 706 465 714 472 725 480 737 489 749 498Chemical Pathology 54 196 54 154 54 119 54 92 54 73 55 56Clinical Haematology 483 2,574 488 2,497 493 2,411 500 2,336 507 2,274 514 2,205Clinical Oncology 262 469 266 473 270 479 275 486 280 494 285 503Dermatology 3,629 7,629 3,648 7,475 3,669 7,313 3,691 7,186 3,714 7,088 3,738 6,970Endocrinology 199 858 199 861 199 862 201 868 202 873 203 881ENT 4,513 4,990 4,551 4,894 4,582 4,783 4,623 4,685 4,666 4,597 4,710 4,501Gastroenterology 0 49 0 49 0 50 0 50 0 51 0 52General Medicine 6,264 13,366 6,338 13,531 6,410 13,699 6,499 13,906 6,596 14,138 6,689 14,353General Surgery 9,280 6,474 9,361 6,552 9,428 6,630 9,525 6,728 9,621 6,829 9,721 6,925Geriatric Medicine 355 1,043 363 1,031 371 1,016 378 1,002 386 993 393 978Gynaecology 2,786 2,627 2,802 2,646 2,810 2,661 2,833 2,689 2,846 2,710 2,867 2,736Medical Oncology 160 952 162 926 164 897 167 873 169 850 172 827Neurology 513 580 517 561 520 541 525 522 530 505 535 487Obstetrics 2,083 3,337 2,071 3,311 2,056 3,280 2,062 3,286 2,059 3,276 2,068 3,289Ophthalmology 6,897 17,882 6,965 17,741 7,035 17,568 7,115 17,431 7,205 17,353 7,292 17,232Oral Surgery 2,833 5,156 2,851 4,797 2,864 4,437 2,886 4,110 2,906 3,824 2,926 3,539Orthodontics 235 1,405 234 1,417 234 1,428 233 1,426 231 1,424 230 1,416Paediatric Medicine 1,461 3,426 1,456 3,357 1,451 3,285 1,444 3,210 1,437 3,138 1,432 3,068Paediatric Surgery 110 117 109 114 109 111 108 108 107 105 107 103Plastic Surgery 4,197 9,521 4,202 8,749 4,206 7,998 4,211 7,311 4,216 6,719 4,221 6,143Rehabilitation 188 269 189 272 191 275 192 279 194 281 195 284Rheumatology 2,009 5,695 2,026 5,746 2,041 5,797 2,066 5,875 2,089 5,949 2,113 6,024Trauma & Orthopaedic 6,520 12,677 6,569 12,311 6,623 11,942 6,690 11,598 6,752 11,290 6,812 10,950Urology 2,142 2,906 2,172 2,954 2,200 2,997 2,230 3,049 2,269 3,116 2,306 3,177Neurosurgery 29 505 29 262 30 130 30 65 31 34 31 17Clinical Genetics 7 14 7 11 7 9 7 7 7 6 7 5Paediatric Neurology 0 26 0 26 0 26 0 26 0 26 0 26Midwife Episodes 367 75 365 75 362 74 362 74 362 74 364 75Child & Adolescent Psy 46 256 46 256 46 257 46 256 45 254 45 252Nursing Episode 639 515 648 523 656 532 667 542 679 553 690 563Total 58,986 106,051 59,424 104,043 59,824 102,084 60,373 100,561 60,927 99,393 61,502 98,138

165,037 163,467 161,908 160,934 160,321 159,641

Salisbury Healthcare NHS Trust Appendix AK

Foundation Trust - HIGH



SLA 6.00% 6.00% 6.00% 4.70% 4.70%Non-SLA 2.00% 2.00% 2.00% 2.00% 2.00%






Other £'000 £'000 £'000 £'000 £'000Activity Reduction in Costs (due to activity and efficiency) 972 -490 -76 -53 -19



Non-Pay PFI 1,605IT service developments 150 -100 -50 0Training 250 -50 0Information Services & Medical Records 100 -100Modernisation 100 100 -100 0PFI savings on south side facilities -395Energy price increase above 2% 250 200Reuse of south side 100PACS 483Drugs 250 250 250 250 250Decomtamination/MRSA 200 200 200 200 200Cardiology 40Pathology 135Laundry activity 823 1,069 608 87NPFiT support 100Review of Radiology & revenue consequences of capital 50 -20 -20 -20 -20Non-recurring expenditure related to income 817 -250

Generic CP Medical consumables 250 250 200 200 200Drugs 250 250 200 200 200Change in clinical practice 300 300 300 300Loss of non-SLA agreements 200PbR contingency & tariff deflation 600 200Additional high costs contingency 700 700 700 700 700Other tariff uplift costs (awaiting DH guidance) 1,930 2,344 2,956 2,544 2,607

11,903 6,043 4,934 4,361 4,737Net of CIP 10,602 3,252 1,883 704 1,165

Salisbury Healthcare NHS Trust Appendix AL

Manpower Plan High Scenario



Medical & Dental 261.13 22,220 1.50 150 262.63 22,370 262.63 22,370 262.63 22,370 262.63 22,370 262.63 22,370

Nursing 1105.78 30,274 33.00 745 1138.78 31,019 -3.00 -93 1135.78 30,926 -7.00 -220 1128.78 30,706 -6.70 -190 1122.08 30,516 -5.80 -175 1116.28 30,341


Professional & Technical (Scientists) 67.46 2,808 1.00 30 68.46 2,838 68.46 2,838 68.46 2,838 68.46 2,838 68.46 2,838

Pharmacists 15.53 679 1.00 40 16.53 719 16.53 719 16.53 719 16.53 719 16.53 719


Professional & Technical (other) 226.17 5,745 2.50 79 228.67 5,824 -0.25 -8 228.42 5,816 -0.44 -16 227.98 5,800 -0.25 -8 227.73 5,792 -0.25 -9 227.48 5,783

Administrative & Clerical 446.82 8,051 2.00 28 448.82 8,079 -0.25 -6 448.57 8,073 -0.35 -8 448.22 8,065 -0.25 -3.5 447.97 8,062 -0.25 -3.5 447.72 8,058

Ancillary 274.20 4,329 2.00 26 276.20 4,355 0.25 5 276.45 4,360 -0.35 -5 276.10 4,355 -0.25 -3.25 275.85 4,352 -0.25 -3.25 275.60 4,349

Maintenance 32.55 656 1.00 25 33.55 681 33.55 681 33.55 681 33.55 681 33.55 681

Ambulance 14.00 235 14.00 235 14.00 235 14.00 235 14.00 235 14.00 235

Other 776 0.00 776 0.00 776 0.00 776 0.00 776 0.00 776

TOTAL PAY 2637.54 83,250 44.00 1,123 2681.54 84,373 -3.25 -102 2678.29 84,271 -8.14 -249 2670.15 84,022 -7.45 -205 2662.70 83,817 -6.55 -191 2656.15 83,627

Non Pay 33,069 156 33,225 63 33,288 61 33,349 82 33,431 85 33,516

Total Inpatient - Ward 2637.54 116,319 44.00 1,279 2681.54 117,598 -3.25 -39 2678.29 117,559 -8.14 -188 2670.15 117,371 -7.45 -123 2662.70 117,248 -6.55 -106 2656.15 117,143

Out PatientsMedical 1.00 95 -0.25 -24 0.84 69 0.35 33 0.45 42

Nursing 1.00 25 0.35 39 0.55 23 0.35 15 0.35 15

Non Pay 73 34 20 22 30

Total Out Patients 2.00 193 0.10 49 1.39 112 0.70 70 0.80 87


Medical & Dental 4.00 400 2.00 200 -1.00 -110 -1.00 -100



Salisbury Healthcare NHS Trust Appendix AM

Annual Income & Expenditure Account - NHS FOUNDATION TRUST CASE HIGH SCENARIO




EBITDA 11,133 11,587 10,818 11,603 11,880 12,394

Depreciation (7,366) (5,623) (5,492) (5,919) (5,827) (6,396)


Net Interest 87 193 281 356 432 513


Dividends (3,372) (3,483) (3,431) (3,592) (3,606) (3,706)

Retained Surplus/(Deficit) 482 2,673 2,177 2,447 2,880 2,805





Annual Balance Sheet - NHS FOUNDATION TRUST CASE HIGH SCENARIO








Net Current Assets (2,368) (497) 500 1,995 3,804 5,969Long Term LiabilitiesLong Term Debtors 1,249 1,249 1,249 1,249 1,249 1,249Provisions (1,465) (1,465) (1,465) (1,465) (1,465) (1,465)Commercial Loan Account 0 0 0 0 0 0NHS Bank Loan Account 0 0 0 0 0 0Finance Lease Account 0 0 0 0 0 0Sub-Total (216) (216) (216) (216) (216) (216)


Financed By






Annual Cashflow - NHS FOUNDATION TRUST CASE HIGH SCENARIO









Sub-Total 0 0 0 0 0 0


Funded ByDividends (3,372) (3,483) (3,431) (3,592) (3,606) (3,706)Change In Cash (1,531) (3,036) (1,770) (2,068) (2,085) (2,414)Interest 87 193 281 356 432 513Total (4,815) (6,326) (4,919) (5,305) (5,259) (5,607)





Salisbury Healthcare NHS Trust Appendix AN

Normalised Earnings

Normalised Earnings Schedule, £mActual Plan2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11

Net Surplus/(Deficit) 0.00 0.00 0.00 0.48 1.21 0.60 0.83 1.08 0.90LessCapital to revenue transfersWDC Income -1.00I&E Brokerage Returned -0.75PFI Unitary Payment (Full year effect) -2.20Exceptional income - PFI Bank Support -0.57 -0.71 -0.43 -0.28 -0.14 0.00Exceptional income - Foundation Trust -0.14Exceptional income - Agenda for Change -0.02Exceptional income - Non-recurring income (Appendix H) -4.16

AddRevenue to capital transfersI&E Brokerage Given 0.75 1.00PCT Financial recovery planTapering support for tariff transition 2.20 1.80 1.40 0.00 0.00 0.00Exceptional costs - Foundation Trust 0.14Exceptional costs - Agenda for Change 0.02Exceptional costs - PFI comissioning 0.30Exceptional income - Non-recurring income (Appendix H) 4.16Exceptional costs - Provision for PbR Tariff deflation 0.60 0.80 0.80 0.80 0.80

Normalised Net Surplus/(Deficit) 0.00 0.00 0.75 0.46 1.90 2.37 1.35 1.74 1.70AddDepreciation 4.84 5.66 5.74 5.53 5.22 5.49 5.92 5.83 6.40Exceptional cost - Accelerated depreciation 1.84 0.40PDC Dividend 5.09 3.29 3.44 3.37 3.48 3.43 3.59 3.61 3.71Other costs below operating surplus 0.03 0.04 0.01LessOther income below operating surplus -0.14 -0.14 -0.23 -0.09 -0.17 -0.19 -0.20 -0.21 -0.22

Normalised EBITDA 9.82 8.84 9.70 11.11 10.83 11.10 10.66 10.97 11.59

Normalised EBITDA Margin % 9.20% 7.53% 7.65% 8.16% 7.74% 7.64% 7.08% 7.11% 7.33%

Turnover 106.70 117.51 126.80 136.23 139.96 145.18 150.47 154.23 158.16

Abc Appendix AO

Appendix AO Finance Committee of the Board

Terms of Reference

Purpose The overall purpose of the committee is to provide assurance to the Board that key financial issues have had adequate scrutiny. The Committee will examine all financial issues as requested by the Board and in particular will routinely:

• Scrutinise detailed financial plans, budgets, efficiency and income generation programmes and financial monitoring reports on behalf of the Board

• Review reports to the appropriate Regulatory or Statutory authority, quarterly/annually

• Ensure financial reporting consistent with the NHS Foundation Trust financial regime including key ratio reporting

• Monitor the development and implementation of the financial information systems strategy

• Approve financial policies of strategic significance, eg Treasury Management Policy, Investment Policy

Membership Chair Chairman Other members Chief Executive Director of Finance Director of Operations 2 Non-Executives Quorum 2 Non-Executives, 2 Executives Frequency At least bimonthly, initially monthly.

Abc Appendix AP

July 2005 1

Appendix AP – Risk Management Strategy Risk Level Detail Management

FINANCE Costs of providing services rise in excess of tariff

Medium The rise in tariff will reflect the overall funding available to the NHS. However, long-term funding commitments from the Government should mean that tariffs rise at a rate that properly reflect cost increases. Though the rate of tariff increase is beyond the control of the Trust.

Focus will continue on efficiency and cost-effectiveness. Our strong track record of financial performance provides a sounds foundation upon which to build.

Reduction of value of tariff in real terms

Medium DOH has recognised that in 2005/6 the introduction of the tariff has led to a funding gap nationally. There is the likelihood of a topslicing of the tariff to resolve the funding gap.

A contingency for this eventuality has been included across all scenarios. However if the level of reduction in the value of the tariff were in excess of the contingency the Trust would need to add to its CIP.

Activity levels rise above forecast, exceeding local PCT’s ability to afford services delivered.

High The local community has struggled in the past few years, which has led to an unstable local health economy. Negotiations have taken place and overperformance for 2004/05 was paid for at 50%. Though, it is recognised that this cannot continue and overperformance should be paid at full tariff.

Close liaison with our PCTs. The activity assumptions within our financial model have been agreed. We are also actively engaged in work to develop models of care which reduce the necessity for patients to come to the hospital.

Activity levels fall below forecast, as patients choose to travel elsewhere or turn to alternative providers.

Low It is anticipated that there will be no major shifts as a result of Patient Choice. The factors that influence Patient Choice are performing well in the Trust. A possible risk would be from the private sector.

Our aim is to ensure careful scenario planning is completed ensuring that our strategies are robust and sensitive to demand. These scenarios will continue to be modelled.

The costs for individual services exceed the tariff income

Medium We have analysed all our services to understand their individual position and on the publication of reference costs we have also benchmarked our costs against the national average. We have recognised high cost areas and are working to understand the reasons behind these high costs.

On completion of our cost analysis we shall initiate changes to reduce our costs and become more cost-effective. We shall continue to monitor costs against benchmarked costs.

Abc Appendix AP

July 2005 2

Risk Level Detail Management Changes to PbR and MFF adversely affect the Trust

Medium

The Trust received a much lower MFF than expected for 2005/06, which has been taken account of within the financial modelling. Changes to this in the future will affect our cost and income tariff.

The MFF issue is being pursued with ministers at the DoH.

Failure to achieve Cost Improvement Programme

Low The Trust has a good record of achieving historic CIP’s however given low reference cost, the ability to reduce costs further each year becomes increasingly challenging.

The Trust will continue to adopt robust performance management systems through reporting at the Trust Board and the 3:3 meetings to ensure Directorates are complying with plans.

Restricted capital borrowing capacity

Low The Trust does not have a capital dependent strategy.

The Trust does not currently plan to borrow funds for capital expenditure and is therefore not reliant on the borrowing facility.

Private Patient Income High The Trust had a low level of private patient income in 02/03 and therefore the level of PP activity it can undertake on becoming an FT will need to be reduced by the equivalent of £600k.

The Trust will need to work closely with medical staff to manage the number of PP admissions and to manage the financial implications.

Laundry Medium New initiative, failure to secure through put which will result in loss making situation

The Trust is actively tendering and marketing to other Health Service Providers. Commercial Manager now in place to develop and grow business.

Cash Management Medium Risk that the Trust has insufficient cash funds to pay creditors at any point in the financial year.

The Trust will negotiate a working capital facility of approximately £11m to cover 30 days operating costs. This includes a safety net of £500k to allow for unforeseen events. Cash management processes will be strengthened within the Trust.

Capacity & capability of Finance Staff

Medium This risk acknowledges the fundamental differences in financial management of a FT compared to an NHS Trust.

The Trust has commissioned Robson Rhodes to undertake a gap analysis and skills assessment of the existing Finance Department. The Trust will develop an action plan and development plans for the department as required.

Abc Appendix AP

July 2005 3

HUMAN RESOURCES Risk Level Detail Management Staff Recruitment and Retention

Low

High cost area to live, rural location, competition from other NHS providers and maintaining competitive salaries. Static workforce limits career development.

Recruitment and Retention Strategy, a number of projects developed to address specific issues i.e. housing initiative, marketing career opportunities to school leavers, workforce redesign initiatives.

Workforce reconfiguration to meet changing service needs and responding to European Working Time Directive (EWTD)& Modernising careers.

Medium/ High

The Trust’s traditional professional boundaries present problems in responding to service changes and demands.

Workforce development projects in Nursing & Midwifery. Development of new roles i.e. Surgical Nurse Practitioner. Further development of the Hospital at Night Team.

Flexible staff to cover peak demands

High

Inadequate staff numbers for peak activity periods will lead to high agency costs.

Closer management of in house bank for temporary staff, Nursing & Midwifery and Admin & Clerical, will address. Annualised contracts and greater job share opportunities to be introduced. Performance management to feature.

Management Capability

High

Management does not respond to increased accountability in a Foundation trust environment, with need to become more responsive to performance management and financial data.

Provide training to all managers to ensure they are developed to respond to these Foundation Trust changes i.e. GO MAD management sessions and Band 7 development. A structured appraisal process is in place with performance management of each directorate at monthly 3:3’s. KSF outline will reflect competence required to carry out their individual roles.

Abc Appendix AP

July 2005 4

OPERATIONAL Risk Level Detail Management Systems to manage Choice

Medium

Ability to respond to changes in demand with systems in place to flag up increasing and decreasing activity.

Head of Modernisation working with partners to introduce effective choice system at the end of the year.

Clinical issues effecting Choice.

Medium

Loss of reputation and lack of patient confidence due to poor standards of hygiene (Infection Control Issues) or lack of statistical information could result in reduced actively levels. This in turn would reduce potential income.

Infection Prevention & Control Team effectively manage a planned programme of work focused around minimising the Infection control risk. The Trust Board regularly monitors performance. Information systems developed which provide data of clinical outcomes and link to consultant appraisal.

Performance management systems

Medium

Accuracy of clinical coding, inability to have accurate information to inform and assist decision making, which can lead to a financial impact for the Trust.

Percentage of clinical coding accuracy monitored by the Trust Board. A revised coding process is being developed, which identifies who and within what times scales coding should be undertaken. Greater clinician involvement in clinical coding. Review of reporting arrangements of key data to senior managers both clinical and non clinical.

Improvements in performance not achieved

Medium

The Trust has set itself robust targets for improvements in performance for length of stay, outpatient new to follow up ratios and reductions in DNA’s. Failure to achieve these will affect the Trust's efficiency and could result in reduced income levels and could impact on achievement and maintenance of waiting time targets.

The purchase of the Dr Foster system will give the Trust access for the first time to robust, contemporaneous benchmarking information allowing it to address outliers in terms of performance and to develop action plans. Routine reporting to Trust Board on performance will be regularised so that top level focus on these issues is maintained.

Abc Appendix AP

July 2005 5

Risk Level Detail Management Capacity Planning

Do not have appropriate bed availability to match commissioning need and emergency patients. Could result in delayed elective surgery leading to rearranging operation dates, which will be difficult given expectations of low waiting times, and consequence effect on cashflow. In due course the Trust may not need as much capacity as at present and must plan according to ensure unnecessary expense does not occur. Possible effect of local Independent Treatment Centres may have an impact.

High levels of partnership work with PCT’s. – formal monthly reviews of activity planned against action plan. Trend data to be analysed post 2008.

Capacity linked to income budgets and staff.

High

Commissioned activity drives capacity which forms the basis of the Trusts income, budget setting and staff numbers. Failure to link will result in the trust encountering financial difficulties.

More work will be done to effectively understand the relationship between these three components and to test the assumptions on which the Service Development Strategy has been prepared.

EXTERNAL RISKS Risk Level Detail Management NHS Reconfiguration

Medium

Changes within the structure and personnel of partnership organisations could cause short and medium term interruptions in contract management and/ or agreements. Contested market place could impact on patient flow.

Continue working relations with partnership organisations and involve at Governor level. The Trust to be alert and respond to any change in activity levels. Maintain active dialogue with key commissioners and ensure the hospital remains first choice for local people.

Specialist Services

Medium

Loss or gain in specialist services such as cancer, oncology, cardiology, plastics, burns spinal and paediatrics.

Ensure continued dialogue with commissioners and specialist network to ensure commissioning is clear. The Trust meets cancer national standards and other NSFs.

Abc Appendix AP

July 2005 6

GOVERNANCE Risk Level Detail Management Trust Board

High

Need for Trust Board to recognise culture and accountability changes. Each Director must be capable of making an informed decision and contribute positively to the new commercially orientated environment.

Change culture with new accountability arrangements, already discussed in detail. Trust Board members have been individually performance reviewed and assessed by the Chairman or Chief Executive. Professional Development Plans agreed where appropriate.

Membership Recruitment

Low

Insufficient members recruited to demonstrate public support for Foundation Trust status

A comprehensive Membership Strategy developed. An active recruitment campaign and a Membership Manager in place.

Governor involvement

Medium/ High

This role in new style of NHS organisation requires Governors to quickly understand responsibilities and where they are expected to contribute to the strategic directions or the Trust.

Forge relationships with members and provide strategic direction for the Trust. Effective induction programme, clearly defined roles and responsibilities and code of conduct prepared.

Appendix AQ ASSESSING THE LEVEL OF RISK Risk = Consequence X Likelihood

Measures of Likelihood – choose one of the descriptors below. Consider how likely it is that under similar circumstances the event will happen again.

Level Descriptor Description 1 Rare Do not believe this event will happen again except only in exceptional circumstances e.g. once a

decade 2 Unlikely Do not expect the event to happen again but it is a possibility e.g. once a year 3 Possible The event may re occur occasionally e.g. once a month 4 Likely The event will probably re occur e.g. once a week 5 Certain The event is likely to re occur on may occasions e.g. once a day

Measures of Consequence – choose one of the descriptors below, consider each section what the most realistic scenario would be if the event occurred again. The most serious consequence identified determines the future consequence rating of the event.

Level Descriptor Description 1 Insignificant No apparent injuries. Low financial loss/cost <£1 000. No risk to organisation. Insignificant

slippage 2 Minor Short term injury or damage. First Aid Treatment. Moderate financial loss up to £5 000.

Complaint possible. Remote litigation risk. Staff sickness < 3 days. Schedule slippage. Minimal risk to organisation.

3 Moderate Medical Treatment required. Temporary incapacity/injury/harm. Short-term monitoring or additional treatment required. Potential for adverse publicity. Moderate environmental implications. Financial loss £5000 - £10 000. Staff sickness > 3 days. RIDDOR. MDA reportable. Moderate loss of reputation. Moderate business interruption. Moderate risk to Trust. Complaint likely, litigation possible.

4 Major Permanent injury/harm. Injury requiring major clinical intervention or unplanned admission to ITU. Long-term staff sickness >4 weeks. Serious complaint anticipated. Litigation expected. High environmental implications. Major financial loss up to £250 000. Major loss of reputation. Major business interruption – service restriction or closure. Schedule slippage:doesn’t meet secondary objectives. Probable media interest. High risk to Trust.

5 Catastrophic Death/Suicide/Homicide. Incident involving multiple people e.g. screening errors. National media interest and adverse publicity. High financial loss over £250 000. Litigation expected. Schedule slippage – doesn’t meet primary objectives. Extreme risk to Trust.

Risk Assessment Matrix – Level of Risk (Consequence x Likelihood) This provides the overall risk score for this event. Take your answers from the assessment of likelihood and consequence tables and plot them on the graph below.

RISK ASSESSMENT MATRIX – LEVEL OF RISK Likelihood Consequence Negligible 1 Minor 2 Moderate 3 Major 4 Catastrophic 5 Rare 1 1 2 3 4 5 Unlikely 2 2 4 6 8 10 Possible 3 3 6 9 12 15 Likely 4 4 8 12 16 20 Certain 5 5 10 15 20 25

Key: Low Risk 1-3 Moderate Risk 4-6 High Risk 8-12 Extreme Risk 15-25

Risk Level and Action Required. Use this table for guidance about the preventative measures that should be taken to manage the incident and prevent it happening again.

Score Risk Preventative Measures to be Taken or Planned 1-3 Low Risk – manage by routine procedure. Implement any action that will eliminate the risk of the incident /risk

occurring 4-6 Moderate Risk – Management action must be specified. The departmental manager must investigate the incident

and devise and implement an action plan to reduce or eliminate the risk 8-12 High Risk – Senior Management action needed. Managers must devise and implement an action plan to reduce,

control, or eliminate the risk. 15-25 Extreme Risk – Immediate action required. An investigation and action plan to be started immediately to reduce,

control, or eliminate the risk. Must be reported immediately following Major Incident Reporting procedure.

Appendix AR PCT Letters of Support

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