Annual performance review and accounts 2005/06

Transcription

1 Annual performance review and accounts 2005/06

2 Contents A specialist heart and lung centre 4 - Introduction 4 - Preparing for foundation trust status 6 - Research and development 7 The year in brief 8 Our performance 12 - Clinical activity 13 - Service development 14 - Performance against Service Level Agreement targets 15 - The annual healthcheck 16 - Quality and governance 18 - Maintaining the highest standards 27 - Information and telecommunication services 32 - Estates and facilities report 33 - Harefield Hospital 34 Our services for patients 35 - Cardiology 35 - Surgery 36 - Transplant 37 - Respiratory medicine 38 - Paediatrics 39 - Anaesthesia and critical care 40 - Clinical support services 41 Director of Finance report 2005/ Summary of financial statements 47 - Remuneration report 51 Royal Brompton & Harefield Hospital Charitable Fund 54 - Annual report for the year ended 31st March Annual review: our activities 56 Board of Directors 62 Glossary of financial terms 64 If you would like a copy of this report in Arabic or Turkish please contact Victoria Gittins in the communications team: v.gittins@rbht.nhs.uk or tel:

3 Chairman s letter The Royal Brompton & Harefield NHS Trust is one of the country's leading providers of specialist health care, with immense experience in the treatment of heart and lung conditions, including transplantation. The Trust runs the world's largest centre for Cardiac Magnetic Resonance Imaging, the UK's largest cardiac nuclear medicine service and Europe's largest centre for treating cystic fibrosis. We serve the needs of patients from across the country. This report shows that by many measures - patient survey results, 3 star status, Dr Foster rating, low MRSA infection rates, research output, productivity and value for money - the Trust is a high performer. In financial terms our surplus of 3.2 million made us one of the most successful Trusts in London - enabling us to discharge within a year the liability which followed the ending of plans to re-build our hospitals in Paddington. During the year we gave much attention to work on securing foundation trust status to help us enhance our services still further. It has inevitably been a disappointment to learn more recently that a decision on our application has been deferred. We remain firmly committed, however, to taking the application forward to a successful conclusion at the earliest possible time. I am grateful to all my Board colleagues during the year, including those who have now left after many years of significant service: Isabel Boyer, whose second term as a non-executive came to an end; Professor Malcolm Green, who retired as head of the National Heart and Lung Institute; and Mary Leadbeater, Finance Director, who since the year-end has moved on to another position in the NHS. Our warm appreciation of their contribution is matched by a warm welcome to three new non-executives, Jenny Hill, Christina Croft and our former medical director and deputy chief executive Professor Tony Newman Taylor, who returns in his new capacity as Professor Green's successor at NHLI. All of us, past and present, unite in expressing our thanks to the doctors, nurses and managerial, technical and support staff of every kind whose efforts make possible the Trust's success. What is set out in these pages is their achievement. From the Chief Executive I am delighted and proud to introduce this annual performance review and accounts. In a year when the NHS has experienced substantial change, our patients have enjoyed the dividends of a first class, continuously developing service as a result of our resolute focus on addressing and meeting their needs above all else. It would not have been possible to maintain and improve our excellent performance record, to receive the ringing endorsement of our patients in the national inpatient survey, to improve productivity levels and generate a financial surplus of 3.2 million, without the full support of our dedicated and highly skilled workforce. We continue to attract the best recruits from home and abroad and I believe our strategy of fully integrating clinical staff within the management and decision-making structure of our Trust has played a major role in our success this year. The next financial year will bring its own challenges. We will respond to these by remaining clearly focussed on our specialist services to treat heart and lung disease, by continuing to work closely with our major academic partner, Imperial College and by progressing investment and improvement plans to upgrade our facilities and technology infrastructure. We are a national organisation treating patients from around the country, and the world; we will work hard to ensure that the high quality care we provide is delivered in facilities that reflect our high international standards. As we move forward in 2007, we will work closely with the many thousands of patients and their carers who have already shown their support for us by joining our foundation trust membership. We are extremely fortunate to have such a loyal following among those who matter most. Lord Newton of Braintree, Chairman 25th August 2006 Robert J Bell, Chief Executive 25th August

4 A specialist heart and lung centre Our patients say... Doctors, nurses and everyone on the wards could not have done more for the people in their care Royal Brompton & Harefield NHS Trust is the largest specialist heart and lung centre in the UK and among the largest in Europe. We work from two sites, with around 250 beds at Royal Brompton Hospital in Chelsea, west London and 150 beds at Harefield Hospital near Uxbridge. We help patients from all age groups who have heart and lung problems. As a specialist trust we serve a large national population not just a local one, with most of our patients coming from a catchment area which includes around seven million people. Smaller numbers of referrals come from consultants in other parts of the UK; we see patients from as far apart as Scotland and Cornwall. With a history stretching back over 160 years, our experts have built up an international reputation for innovation and leadership in patient care, research and education. Just over 2,500 people work at the Trust, with 1,650 based at Royal Brompton and 850 at Harefield. We have an excellent record in managing our finances, as illustrated in our annual reports and audited accounts. Our gross annual turnover is approximately 194 million (2005/06). Royal Brompton Hospital Europe s first adult Cystic Fibrosis (CF) clinic was established at Royal Brompton in 1965 and the hospital has grown into the largest treatment centre for the condition in Europe. We treat patients with around 50 different groups of respiratory diseases. The hospital is a national and international leader in the treatment of heart failure, with large research trials leading to important developments in this field. Our success rates for lung cancer surgery have been better than national benchmarks for many years. Our surgeons, both paediatric and adult, undertake some of the most complex heart surgery in the country, and our Intensive Care Units are recognised for their standards of expertise throughout Europe. Harefield Hospital The Heart and Lung Transplant Unit at Harefield is one of the largest and most experienced centres in the world. Over 2,500 operations have been carried out since Professor Sir Magdi Yacoub pioneered the programme in The surviving transplant population now numbers over 1,200 patients who need lifelong follow up, many for over 20 years. In conjunction with Imperial College s National Heart and Lung Institute, Harefield has pioneered the development of artificial Left Ventricular Assist Devices ( artificial hearts ) and is the most experienced UK centre for this treatment. Harefield is the outer north-west London centre for acute cardiology with a growing primary angioplasty service for local boroughs and the Home Counties. Primary angioplasty involves transferring heart attack patients direct from the community i.e. home or the 'street', to Harefield for cardiac catheterisation (unblocking of the arteries). Harefield is a major centre for lung, chest and oesophageal cancers and non-malignant thoracic surgery. 4

5 Our patients say... Our surgeons undertake complex surgery I wish to compliment the team at the Princess Alexandra Ward for the wonderful professional care, help, dedication and expertise I received during my recovery period. It was all very confidence boosting Our services for patients Our vision is: To be a leading international and national centre for treating heart and lung disease, developing services through research and clinical practice to improve the health of people across the world. In order to achieve this vision, the Trust: a) provides specialist and sub-specialist expertise and clinical care for our patients b) undertakes pioneering and worldclass research into heart and lung disease in order to develop new forms of treatment which can be applied across the NHS and beyond c) recruits, trains and develops tomorrow s international clinical leaders and experts d) develops and continuously improves responsive service models in partnership with our patients, carers, partner organisations and the public e) generates surpluses to invest in new technologies and services We are supported in this by active patient and community groups who enthusiastically support and challenge us to deliver our goals. 5

6 RB&H annual performance review and accounts Preparing for foundation trust status Our foundation trust consultation document was widely circulated Our patients say... I recently spent four nights in Harefield Hospital, and those four nights convinced me that Harefield Hospital is the finest hospital of its kind in the United Kingdom In September 2005, as a result of retaining our 3-star status in the annual Healthcare Commission ratings, the Trust was invited to apply to become a foundation trust. After considering the fundamental changes and opportunities of foundation status, the Board resolved in November 2005 to pursue an application. Foundation trusts are independent, public benefit corporations, firmly part of the NHS - but released from the direct control and monitoring of the Department of Health and Strategic Health Authority. As membership organisations, they are accountable to a Board of Governors made up of representatives elected from among its members - patients, carers, staff and members of the public - and appointed from among its key partners (in our case, Imperial College and our local Boroughs and primary care trusts). Foundation status will enable us to: be more responsive to the needs of our patients; create new alliances, partnerships and joint ventures to achieve our goals; retain and re-invest surpluses to provide facilities fit for 21st century medicine and research; establish governance arrangements that properly reflect our interests and ambitions. The Trust joined the third wave of applicant trusts, undergoing a development and assessment phase with the Department of Health in the run-up to submitting a formal application in June The core of the application is a detailed, 5-year business plan for our first years as a foundation trust, supported by descriptions of the new governance structures which will apply under foundation status. Consultation The Trust consulted widely on our proposals to become a foundation trust for 12 weeks between late February and late May and received overwhelming support for our plans. A consultation document was widely circulated to patients, staff and community groups; public meetings and other events were held in and around both hospitals and presentations were made to patient and voluntary groups and the scrutiny committees of the London Borough of Hillingdon and the Royal Borough of Kensington & Chelsea. Within the hospitals, staff had the opportunity to attend both open and departmental meetings to hear and ask questions about foundation status. We received well over 200 formal responses - from individuals (staff, patients and others), local MPs, councillors and both voluntary and statutory bodies. At the same time, we sought to recruit prospective foundation trust members - and almost 8,500 people had joined by the end of May We will continue to work towards foundation trust status during 2006/07. 6

7 Research and development Seamless integration Research remains central to the mission of the Royal Brompton & Harefield NHS Trust. More than 500 research studies are underway, examining new ways of improving the diagnosis and treatment of patients with heart or lung disease, be they children or adults. Many of the studies recruit our own patients, but some include patients from many other parts of the country, or even in other countries. We aim to be one of the best research hospitals in the UK, and last year the Department of Health gave all 11 of our research programmes the highest possible rating. Our main research partner is the National Heart & Lung Institute, Imperial College, but many studies are run in collaboration with other hospitals or universities in the UK or abroad. Last year more than 16.8 million of research grants were awarded from the Medical Research Council, research charities (such as the British Heart Foundation), and pharmaceutical and device manufacturers. These grants fund many research scientists, doctors and nurses and also make it easier for clinical staff to spend some of their time doing research. Our research output Between 500 and 600 research papers are published in peer-review scientific journals each year by researchers associated with the Trust. A recent analysis demonstrated that we produce the greatest number of highly-cited publications of any specialist trust in the UK. We are the top-ranked respiratory research centre in Europe. Heart and lung disease are significant causes of worldwide mortality and morbidity. Our position in the UK affords us the opportunity to make a unique contribution to global research and development. We combine formidable academic strength with our place in the NHS, a national, wholepopulation system denied to many other international centres. As such, we are proud to play a leading role in the UK s healthcare contribution to the world. Some research work is based in the laboratory, exploring the way the heart or lungs work and the changes found in various diseases; other studies test new imaging methods (such as multi-slice CT scans and cardiac magnetic resonance) or new drugs, stents or pacemakers. Some of the research studies explore why healthy people develop heart or lung disease and new ways of preventing this. The future The NHS is restructuring its research activities in 2006, and the Royal Brompton & Harefield NHS Trust has been invited to apply to become a specialist biomedical research centre for respiratory and cardiac disease and associated critical care. If successful in this bid with its main academic partner, the National Heart & Lung Institute, this will add further to the research reputation of the hospital. Some of our projects Our research projects attract international attention, often from the media. In recent months you may have seen coverage of our work on: Artificial hearts: research into the use of small battery operated artificial hearts to treat patients waiting for heart transplants. Migraine: research to investigate the relationship between migraine attacks and congenital heart disease with the aim of offering a one-off treatment for appropriate patients. Lung disease: COPD - research into one of the commonest chronic diseases, chronic obstructive pulmonary disease (COPD), the incidence of which is increasing nationally and internationally. Unlike many other lung diseases, such as most cases of asthma, COPD does not respond well to steroid treatment; the research team will investigate this. Lung disease: emphysema - research into the development of tiny umbrellalike devices which, when placed in the lungs of patients with emphysema, will improve breathing. Emphysema is a severely debilitating lung disease. Asthma: ground breaking research at the Trust discovered the role of chronic inflammation in asthma and the importance of early treatment with inhaled steroids. This has since become standard clinical practice. Asthma at work: our research into the causes of lung disease, particularly asthma in the workplace, has won a number of awards. Asthma is the commonest occupational respiratory disease in the developed world, estimated to account for one in seven new cases of asthma in adult life. Hayfever: research into immunotherapy and pollen pills for the treatment of severe hayfever. Professor Martin Cowie, Director of Research, Development and Academic Affairs, was appointed in March

8 The year in brief The year in brief: a summary of some performance highlights For the second year running, in 2005 the Trust was awarded three stars in the Government s annual assessment of NHS performance, the only specialist cardiothoracic trust to achieve three stars in 2004 and In the recent Dr Foster Hospital Guide, which assessed the performance of all hospitals in England and Wales, there were three hospitals described as top hospitals for heart disease. They were Harefield Hospital, Royal Brompton Hospital and Wythenshawe Hospital in Manchester. According to RAND Europe s analysis of highly cited publications of health research in England, our respiratory medicine teams are among the top two most frequently cited experts and our cardiac and cardiovascular and critical care medicine teams are in the top three. We were awarded Improving Working Lives Practice Plus status in July 2005, recognising our commitment to provide the best possible working environment and opportunities for our staff. We are consistently amongst a handful of top performing hospitals with the lowest MRSA infection rates. The Trust achieved a top rating in the Healthcare Commission s 2005 adult inpatient survey. In over 80 per cent of the survey questions (43 out of 57), RB&H s performance was in the top 20 per cent of best performing trusts nationally. Our Harefield primary angioplasty service (for heart attack patients) was expanded to cover the Watford area in 2005/06 and almost 200 cases were referred. Our average arrival to procedure time is now 26 minutes: the fastest in the UK. We achieved a financial surplus of 3.24m in 2005/06. The Trust was accredited at level 2 of the NHS Litigation Authority s Clinical Negligence Scheme for Trusts (CNST). Delivering best value for money Efficiency/length of stay We improved our length of stay performance during 2005/06, finishing the year 1.2 days below the Strategic Health Authority (SHA) target. The saved bed days enabled us to undertake an additional 162 admissions. At Royal Brompton Hospital the length of stay was reduced from 13 days to 9.6 days for valve repair and replacement. Length of stay for emergency coronary artery bypass graft was reduced by 30 per cent at Harefield Hospital. Productivity benchmarks: North West London acute trusts Our nursing productivity was the best in the sector at 187 patient days per nursing whole time equivalent (lowest 92). Our medical productivity was above the sector average at 384 spells per consultant (range ). Cost and income benchmarks: North West London acute trusts We generated the greatest clinical ( 5,770) and non-clinical ( 2,000) income per activity spell in the sector. Our staff pay cost per activity spell was slightly below the sector mean at 2,400 (mean 2,500). Our agency cost per spell was the second lowest in the sector: 50 (range 0-170). 8

9 Our role in international healthcare The Trust has a clear brand, an established international market and is vertically integrated, delivering services and undertaking research for heart and lung disease across the healthcare spectrum. We are the largest provider in the country for cardiorespiratory care. We undertake 70% of the UK s total Cardiovascular Magnetic Resonance (CMR) volume. We treat patients from over 60 different countries each year. We are Europe s top-ranked respiratory research centre, between 500 and 600 research papers are published in peer-review scientific journals each year. We produce the greatest number of highly-cited publications of any specialist trust in the UK. Market analysis In terms of the overall provision of services, Papworth Hospital NHS Foundation Trust and Liverpool Cardiothoracic Centre are the most similar providers. Comparison of the activity levels between these centres reveals that we have consistently undertaken more activity than either organisation (figure 1). When considering respiratory activity, the higher levels of activity undertaken by us compared to similar organisations is clear. Furthermore, our respiratory activity continues to grow. We undertake three to four times as much activity compared to The Cardiothoracic Centre Liverpool, and up to twice as much as Papworth (figure 2). Continued overleaf figure 1 Number of spells figure 2 figure 3 Number of spells Cardiac and Respiratory Inpatient Activity Number of spells / / /04 Respiratory Activity 2001/ / / / /06 Cardiac Inpatient Activity / / / / / / /06 Royal Brompton & Harefield NHS Trust Papworth Hospital NHS FT The Cardiothoracic Centre - Liverpool NHS Trust Royal Brompton & Harefield NHS Trust Blackpool Fylde & Wyre Hospitals NHS Trust Guy's and St Thomas' NHS FT Plymouth Hospitals NHS Trust United Bristol Healthcare Trust Papworth Hospital NHS FT The Cardiothoracic Centre - Liverpool NHS Trust Royal Brompton & Harefield NHS Trust Blackpool Fylde & Wyre Hospitals NHS Trust Brighton & Sussex University Hospitals NHS Trust Guy's and St Thomas' NHS FT Papworth Hospital NHS FT Southampton University Hospitals NHS Trust St George's Healthcare NHS Trust 9

10 RB&H annual performance review and accounts The year in brief (continued) figure 4 Number of spells /02 Cardiac Catheterisation 2002/ / / /06 Royal Brompton & Harefield NHS Trust Guy's and St Thomas' NHS FT Papworth Hospital NHS FT Southampton University Hospitals NHS Trust University Hospitals of Leicester NHS Trust The Cardiothoracic Centre - Liverpool NHS Trust The total volume of cardiac inpatient activity for the Trust has reduced in recent years (figure 3), however most of this reduction is in cardiac catheterisation (figure 4). The repatriation of simple procedures, such as cardiac catheterisation, to local providers is a strategic objective to develop the wider NHS and to enable continued innovation in care at our organisation. For example, as an alternative to invasive cardiac catheterisation to assess the presence of artery blockages, we are refining the use of non-invasive, CT64 slice scans. figure 5a Number of spells /02 Congenital Heart Disease 2002/ / / /06 Royal Brompton & Harefield NHS Trust Great Ormond Street Hospital NHS Trust Guy's and St Thomas' NHS FT Royal Liverpool Children's NHS Trust Southampton University Hospitals NHS Trust United Bristol Healthcare NHS Trust At the same time as this strategic reduction in mainstream specialised care, our activity in highly specialised areas such as congenital heart disease and cystic fibrosis continues to grow (figures 5a and b). figure 5b Adult and Paediatric Cystic Fibrosis 1400 Number of spells Royal Brompton Papworth Hospital NHS FT The Cardiothoracic Centre - Liverpool NHS Trust / / / / /06 10

11 We currently play a major role in delivering electrophysiology (EP) and percutaneous cardiac procedures to adults and children (figure 6a). We are the national market leader in delivering EP to children (figure 6b). figure 6a Number of spells figure 6b Adult Electrophysiology and Percutaneous Cardiac Procedures 2001/ / / / /06 Royal Brompton & Harefield NHS Trust Guy's and St Thomas' NHS FT Papworth Hospital NHS FT St George's Healthcare NHS Trust University Hospital Birmingham NHS FT University Hospitals of Leicester NHS Trust The Cardiothoracic Centre - Liverpool NHS Trust Paediatric Electrophysiology and Percutaneous Cardiac Procedures Number of spells / / / / /06 Royal Brompton & Harefield NHS Trust Great Ormond Street Hospital NHS Trust Birmingham Children's Hospital NHS Trust Guy's & St Thomas' NHS FT Royal Liverpool Children's NHS Trust United Bristol Healthcare NHS Trust Planned service developments aim to strengthen our position in adult EP from market leader in London (figure 6c) to a national market leader. figure 6c 700 London Electrophysiology Royal Brompton & Harefield NHS Trust Barts and The London NHS Trust Number of spells Guy's and St Thomas' NHS FT Hammersmith Hospitals NHS Trust King's College Hospital NHS Trust / / / / /06 St George's Healthcare NHS Trust University College London Hospital NHS FT 11

12 Our performance Our patients say... Everything happened very quickly, very efficiently and very effectively We met all our inpatient, day case and outpatient waiting list targets for 2005/6. Inpatient The maximum wait for inpatients and day case patients requiring standard procedures was set at nine months from April to December 2005, with a requirement to reach a maximum wait of six months from 31st December We had no breaches of this standard and successfully reached and maintained a six month wait from 31st December. We are now preparing for the 2008 target maximum wait of 18 weeks from GP referral to the start of hospital treatment. Revascularisation patients The waiting time for revascularisation patients - those requiring bypass surgery or PTCA procedures (widening of blocked arteries) - has stayed at three months and the standard has been met throughout the year. Outpatients Patients referred to outpatient clinics from their GP had a target maximum wait from referral to first appointment of 17 weeks (four months) from April to December This standard reduced to 13 weeks (three months) by 31st December We successfully met the standards during the last year and are maintaining a 13 week maximum wait. Cancer waits A new standard for cancer waits began on 31st December Patients urgently referred by their GP for suspected cancer should have a maximum wait from referral to treatment of 62 days (two months). Patients who have been diagnosed with cancer should wait no more than 31 days (one month) between the decision to treat and the start of their first treatment. This waiting time includes time spent waiting or having diagnostic tests at other hospitals prior to referral to Harefield/Royal Brompton. A small number of breaches of cancer waits are accepted by the Department of Health: 5%. We had no breaches of the 31 days target between 31st December 2005 and 31st March Three patients waited longer than the 62 days target during this time, which falls outside the tolerance. A high proportion of our cases are clinically complex and their diagnosis and treatment may take longer than straightforward cases. However we are working hard with our referring hospitals to reduce cancer waiting times at every stage of the process. Diagnostic waits 2005/06 saw the introduction of measurement for diagnostic waits. This includes the monthly monitoring of radiology waiting times and activity e.g. x-ray, with a twice-yearly census of waits for all diagnostic inpatient, outpatient and imaging activity. We met our targets both in setting up processes to record and report on these waits, and in meeting the 26 weeks (six months) maximum wait for CT and MRI scans. 12

13 Clinical activity Patient admissions The Trust admitted 24,956 patients in 2005/6 compared to 24,168 in 2004/5. Year 04/05 05/06 Cancelled operations New patients 9,866 9,783 Cancelling operations at short notice is distressing for patients. Our objective is to reduce cancellations as far as possible. Where patients are cancelled on or after admission, they Outpatient clinics Outpatients are seen in clinic under the care of a consultant. Outpatient appointments account in total for 9m income per year. Outpatient clinics vary from consultations to fullday diagnostic tests. The Department of Health guidelines are currently changing to allow telephone and video-conference consultations to be recorded as outpatient appointments. Follow up appointments 75,350 74,531 Total patients seen 85,216 84,314 are offered a date for readmission within 28 days, or treatment at another NHS or private hospital of their choice. Our patients say... Having not been in hospital before overnight or for any longer period I was well impressed with the treatment I received, it was not at all how I had imagined, but much better Financial year 04/05 05/06 % cancelled of planned admissions 1.05% 1.27% Outpatient appointments account for 9 million annual income 13

14 RB&H annual performance review and accounts Service development Our patients say... Some people are amazed at the complexity of modern medical machines, while I am in awe at the high standard of teamwork, goodwill, and humanity of all involved Services at Royal Brompton and Harefield Hospitals are provided for patients locally and nationally and a programme of continuous improvement and development ensures that we meet all national requirements. A new service for children As part of our mission to develop specialist expertise for a national population, a successful bid for funding was made to the National Specialist Commissioning Advisory Group (NSCAG) to provide children from across the country with access to a system that can detect and diagnose Primary Ciliary Dyskinesia (PCD). This inherited condition causes infections in the lungs, nose, throat and ears. It is complex to diagnose and diagnosis is frequently delayed until adult life or even missed altogether. At present, one in 15,000 people in the UK has symptoms of PCD and this new service developed in association with two other centres, the University Hospitals of Leicester and Southampton means that a national service for the diagnosis and subsequent treatment of PCD is available to offer the best possible diagnostic tests and early treatment. Choose and Book progress In keeping with the spirit of patient choice and in line with the national timetable, the first phase of our Choose and Book programme has been implemented. A great deal of work has been undertaken to secure relationships across the country so that the Trust remains the first choice, both for those commissioning our services and for patients. National Cancer Peer Review Our services are regularly reviewed by national commissioning bodies and Our cancer services received a very positive peer review peer review bodies and this year in February, the National Cancer Peer Review programme assessed our lung and upper gastro intestinal cancer and palliative care services. The overall conclusion was that our teams provide services of high clinical standards and that there were no areas at all of immediate concern. Where there were suggestions for improvement, the cancer management team is preparing an action plan to take this work forward. Further developments We have consistently maintained and improved waiting times in line with national targets and have been at the forefront of expanding our primary angioplasty service The Harefield Heart Attack Centre to the Home Counties. 14

15 Performance against Service Level Agreement targets Our patients say... Activity levels increased by 4% this year I wish to personally compliment the team for their superb professionalism, efforts and dedication to my care and improvement In 2005/06, income from Service Level Agreements with primary care trusts was significantly above target. This was due to a combination of the following factors: increased activity above 2004/05 levels of approximately 4%; a more complex case mix with a shift towards more non-elective (not planned) activity, especially interhospital transfers and primary angioplasty; the impact of national changes to the funding regime Payment by Results. The Trust benefits under Payment by Results with a higher national payment made to us than our local costs. Although this gain was minimised in 2005/06 by transitional arrangements, more activity took place on procedures covered by Payment by Results, so as our costs were below the tariff paid to us, this made a significant contribution to the overall surplus generated. 15

16 RB&H annual performance review and accounts The annual health check Our patients say... After your operation, your first recollection is the first nurse you encounter in the high dependency ward. In my case it fell upon a nurse who gave me such confidence by demonstrating the dedication, professional care and understanding I was to receive not only from him, but from all nurses, ward team and doctors in the ensuing days In 2005 the Healthcare Commission launched a new system for assessing and reporting performance called the annual health check. The annual health check replaces the star ratings system and looks at a much broader range of issues. It aims to focus on what matters most to the people who use and provide healthcare services. A key part of the annual health check is the declaration of compliance against core standards. There are 24 essential standards that all NHS healthcare organisations in England should now be achieving. The standards cover seven domains of activity: safety care environment and amenities clinical and cost effectiveness governance patient focus accessible and responsive care public health In October the Healthcare Commission will publish two overall annual performance ratings for each trust - a quality rating and a finance rating. These ratings will be given a score on the scale: excellent, good, fair, weak. All trusts are required to make a self-declaration in advance of this; the Trust s declaration was accepted by the Board at its April 2006 meeting. As would be expected of a specialist, three-star trust, Royal Brompton & Harefield NHS Trust has an excellent track record of performance against financial and NHS targets. As an organisation we set ourselves high standards and work hard to maintain and exceed them. Our declaration can be read in full by visiting our website at Essential standards First domain: safety Domain outline: patient safety is enhanced by the use of healthcare processes, working practices and systemic activities that prevent or reduce the risk of harm to patients. Compliant Second domain: clinical and cost effectiveness Domain outline: patients achieve healthcare benefits that meet their individual needs through healthcare decisions and services, based on what assessed research evidence has shown provides effective clinical outcomes. Compliant Third domain: governance Domain outline: managerial and clinical leadership and accountability, as well as the organisation s culture, systems and working practices, ensure that probity, quality assurance, quality improvement and patient safety are central components of all activities of the healthcare organisation. Compliant apart from Standard C7(e) e) Healthcare organisations challenge discrimination, promote equality and respect human rights. Significant lapse start date: 1/4/05 Significant lapse end date: 25/1/06 The Trust challenges discrimination, promotes equality and diversity and respects human rights. However, due to shortcomings in the Trust's Race Equality Scheme, there was a lapse in compliance during 2005/06, now rectified by recent actions taken to develop the diversity agenda. 16

17 Fourth domain: patient focus Domain outline: healthcare is provided in partnership with patients, their carers and relatives, respecting their diverse needs, preferences and choices, and in partnership with other organisations (especially social care organisations) whose services impact on patient well-being. Compliant Fifth domain: accessible and responsive care Domain outline: patients receive services as promptly as possible, have choices in access to services and treatments, and do not experience unnecessary delay at any stage of service delivery or the care pathway. Compliant Sixth domain: care environment and amenities Domain outline: care is provided in environments that promote patient and staff well-being and respect for patients needs and preferences, in that they are designed for the effective and safe delivery of treatment, care or a specific function, provide as much privacy as possible, are well maintained and are cleaned to optimise health outcomes for patients. Compliant apart from Standard C21 Healthcare services are provided in environments which promote effective care and optimise health outcomes by being well designed and well maintained with cleanliness levels in clinical and non-clinical areas that meet the national specification for clean NHS premises. Not met The Trust achieves good cleanliness levels evidenced by high Patient Environment Action Team scores, national awards for its cleaning services and MRSA infection rates amongst the lowest in the country. Maintenance is also conducted in accordance with national directives. However, in common with many trusts, some of our buildings are not designed to modern standards. The Trust has therefore concluded that it cannot be said that Healthcare services are provided in environments which promote effective care and optimise health outcomes by being well designed (C21). However, we have a robust action plan to address the most urgent shortcomings. This meets the criteria for the relevant constituent element of the standard: the Trust has taken steps to provide care in well designed environments. Seventh domain: public health Domain outline: programmes and services are designed and delivered in collaboration with all relevant organisations and communities to promote, protect and improve the health of the population served and reduce health inequalities between different population groups and areas. Compliant Our patients say... From my very limited three day experience, it is obvious to me that, in addition, there is a genuine patient care culture throughout the establishment, not only from the excellent medical profession but including the cleaners, porters, catering and administrative staff Patients helped us develop our annual health check declaration 17

18 RB&H annual performance review and accounts Governance and quality Our patients say... Every member of staff gave us comfort during a very distressing period and gave me the confidence and inspiration to make a speedy recovery Our aim is to provide safe, effective and high quality care at all times Clinical governance Clinical Governance is the process by which we ensure that safe, effective and high-quality care is provided at all times for our patients. It covers a wide range of issues, from ensuring that staff have up-to-date professional qualifications and registration, through to reviewing any clinical error, however small, for lessons than can be learned for the future. Other important aspects include learning from patient feedback gleaned from complaints, comment cards and patient surveys, and ensuring that accurate information is entered into the clinical databases which help us review our performance. Risk management We continuously develop risk management arrangements to ensure the highest levels of patient safety. These efforts were rewarded in January when the Trust was accredited at level 2 of the NHS Litigation Authority's Clinical Negligence Scheme for Trusts (CNST), which assessed the organisation against 10 clinical risk management standards for patient safety. During the next year our systems will be strengthened further as work is undertaken to implement current best practice through the implementation of NICE guidance, National Service Frameworks, the new Risk Management Standards for Trusts and the Annual Health Check Developmental Standards. A full review of governance arrangements took place this year to develop an integrated system for the management of all risks, whether clinical or non clinical. Clinical effectiveness and audit The clinical audit and information team co-ordinates and advises directorates on clinical audit projects, clinical outcomes, databases and indicators. Its work receives widespread support across the Trust. Major Trust-wide projects this year have included auditing the quality of documentation of our clinical case notes and monitoring the care pathway for neurological events (assessing the care received by patients with neurological conditions). 18

19 Information was also provided for some key national audits this year including: adult and paediatric cardiac surgery; adult and paediatric cardiology; transplantation. There have been new database developments this year in transplant and thoracic surgery which will be rolled out for the financial year 2006/07. We also provide information for relevant audits run by the Royal Colleges on a regular basis. These provide a useful opportunity for comparison and benchmarking. Health and Safety Our site based committees continue to monitor health and safety to ensure the continued health, safety and welfare of all our patients, staff and visitors. A comprehensive set of safety inspections was undertaken across both sites with detailed reports identifying risk areas/issues. These audits included: the accessibility of buildings, facilities, car parks and roads for patients, staff, contractors and visitors; accident and incident investigation designed to prevent further occurrences; accessibility for people with disabilities and the provision of suitable facilities; physical security of the premises to minimise theft and vandalism, and to ensure appropriate levels of housekeeping. A small survey was also carried out across Harefield inpatient areas to determine staff knowledge about safe evacuation procedures. The results were encouraging and demonstrated a good level of knowledge. Safeguarding children There are a number of important ways that we protect our younger patients while they are in our care. Enhanced Criminal Record Bureau (CRB) checks are performed on all staff employed to care for them; Paediatric staff update their knowledge of child protection each year, and child protection awareness training sessions are mandatory for all staff who may come into contact with children; A paediatric social worker is employed full-time; A family liaison manager has been appointed in the last year to improve the social support provided to children and families. She also acts as a child and family advocate and also facilitates links with the Patient Advice and Liaison Service, social services, the welfare rights adviser and psychology service, as needed by individual families. Separate multidisciplinary respiratory and cardiac meetings are held once a week to discuss any psycho-social support that patients or families may need; Access to the paediatric environments is limited by a swipe card security system. Extra security has been provided by limiting access between the ward and the Paediatric Intensive Care Unit. Infection control During 2005/06, the management of the infection prevention and control nursing team was transferred to the Directorate of Governance and Quality to raise the profile of the work undertaken and to formalise the very important links between the two disciplines. The move has proved to be both successful and beneficial on both sides. Continued overleaf Our patients say... Professionalism and expertise are not always readily available market commodities. Harefield Hospital appears to have them in abundance Information was provided for key national audits this year 19

20 RB&H annual performance review and accounts Governance and quality (continued) The Trust has a very strict MRSA policy Our patients say... You have given myself and the whole family more than money could buy The appointment this year of a second Consultant Microbiologist/Infection Control Doctor based at Royal Brompton has strengthened the Trust's work in this important area. We now have dedicated consultants at both sites. MRSA The Trust has a very strict MRSA policy - which covers screening, patient management and guidelines for staff to help prevent cross infection. We have one of the lowest rates in the country for MRSA bacteraemia (the presence of MRSA in the bloodstream, as may occur during a serious wound or chest infection). For the year 2005/06, the Trust had a total of four MRSA bacteraemias; during the 24,956 procedures taking place, four of our patients became unwell due to MRSA infecting the bloodstream. The maximum target set for us by the Department of Health is five, we have therefore achieved a better rate than our target for the second year running. Clostridium difficile associated disease Clostridium difficile is a bacterium that lives in the bowel and can cause diarrhoea when antibiotics are given to patients to treat infections. It is present in a significant percentage of the population but only causes problems when antibiotic therapy is given. The Health Protection Agency started a surveillance programme in 2004 looking at the numbers of patients with C. difficile infection over the age of 65 years. In 2004 the Trust reported 25 cases in patients over 65 years old; In 2005 the Trust reported 21 cases in patients over 65 years old; Between January and March 2006, the Trust reported a total of 12 cases in patients over 65 years old. These levels are low in comparison to other centres. Surveillance of the patient population The Trust undertakes surveillance of MRSA and several other organisms. All patients admitted to the Trust have an MRSA screen. Patients in high risk areas, such as intensive care, are additionally screened once a week. All new members of staff are also screened. Winning Ways (Department of Health initiative) The Winning Ways report set out a direction for the NHS to reduce levels of certain healthcare associated infections and to curb the proliferation of antibiotic resistant organisms. In July 2005 Thames Audit undertook an audit of the Trust's compliance. The final report was received in February 2006 and the action plan is currently under review. Overall the Trust has achieved good compliance. Saving Lives update (Department of Health initiative) 'Saving lives: A delivery programme to reduce healthcare associated infection (HCAI) including MRSA', emphasises changes in the hospital environment which can help to reduce healthcare associated infection. The Saving Lives programme was launched in June 2005 and includes nine organisational challenges that identify areas of activity required and actions to be taken to achieve them. Each challenge is being led by an identified leader in the Trust who has undertaken an initial self-assessment of compliance and developed an action plan to be implemented during 2006/07. 20

21 Patient and Public Involvement (PPI) We are fortunate to have many patients, carers and members of the public from our local communities, who are willing to get involved with our activities. As a specialist trust our patients are spread throughout the country and we are especially grateful to those who travel significant distances to attend our meetings, workshops and committees. Involving our patients Our strategy Our PPI (Patient and Public Involvement) strategy was reviewed between November 2005 and March 2006 and was influenced by comments from a range of patients and representatives from voluntary organisations. Feedback was also requested from colleagues working in primary care and with a patient representative from the North West London Cardiac Network. The Trust Board has approved the new strategy. PPI core group Our PPI core group was established in Its members include representatives from patient support groups, members of the PPI Forum (which is independent of the Trust) and current and former patients. The group has contributed to the PPI Strategy review and recently took part in a tour of patient areas at Harefield to review refurbishments that are taking place to improve the care environment. The Annual Health Check - patients and the public contribute On 19th September 2005, 28 patient and public representatives attended a meeting to help us prepare for our Annual Health Check 'draft declaration'. Following a welcome from chairman, Lord Newton, our guests joined 'domain groups', each hosted by two members of staff, to discuss particular areas of our work such as safety and the care environment. The information given by guests was used in our draft declaration (see page 16), which was submitted to the Trust Board at the end of September The afternoon was well received by all and showed a real interest from patient and public representatives in getting involved with similar projects in the future. Introducing the Trust In February 2006 sessions were introduced for lay representatives called An introduction to the organisation. These give representatives an opportunity to meet staff, visit patient areas and understand more about how we work. The sessions have received some very useful feedback and improvements to the programme have been made as a result. Some examples of activity in 2005/06 Patients, carers and visitors provide feedback to the Trust using different methods such as comment cards, NHS surveys and review and focus groups. Individual interviews with patients called Patient Stories and Discovery Interviews are also a very useful tool. This year a new feedback card was developed which is given to patients as they leave hospital, asking them what they liked and what could be improved. Patient stories Six adult surgical patients were interviewed to investigate their views about medication during their stay. As a result of their responses, patient education sessions have been advertised more widely and additional supplies of the medicines' helpline cards are now available. Continued overleaf 21 We are especially grateful to those who travel significant distances to attend our meetings Our patients say... Each time I go into Lind the ward is spotless and shining with a cleaner who seems constantly in attendance. I congratulate your domestic staff for having such high standards

22 RB&H annual performance review and accounts Governance and quality (continued) Our patients say... The limitless and boundless patience and understanding I really appreciated, along with the support which did a great deal in building up my confidence Six patients from our immunotherapy clinic also shared their experiences. As a result of their comments, an information sheet about Common Variable Immune Deficiency (CVID) has been written to send to patients and their GPs. Service development A representative from the Primary Ciliary Dyskinesia Family Support Group was invited to join the team which made a successful bid to secure National Specialist Commissioning Advisory Group (NSCAG) recognition and funding for a national primary ciliary dyskinesia diagnostic service. Surveys We achieved a top rating in the Healthcare Commission's 2005 adult inpatients survey. Nationally, in 75 per cent of the survey questions (43 out of 57), our performance was in the top 20 per cent of best performing trusts. Regionally, we were the best performing trust in the North West London sector by a significant margin. Survey findings included: 96 per cent of patients felt they were treated with respect and dignity 95 per cent of patients said they were given enough privacy when being examined or treated 90 per cent felt RB&H hospital staff did everything they could to help control their pain 88 per cent of patients said they were given enough privacy when discussing their condition and treatment 87 per cent said the room or ward they were in was clean We also identified areas for development including gaining more feedback from patients about the quality of care they receive while they are with us and improving our system of providing copies of letters to patients. Essence of Care Essence of Care is a tool to help those working in healthcare to take a patient-focused and structured approach so that the quality of care is continually improving. This year patients, carers and professionals worked together to agree and describe good quality care and best practice and identify areas for improvement. Privacy and dignity As a result of a review of privacy and dignity: staff awareness of this topic was raised multilingual phrasebooks are now available in all clinical areas new bedside curtains were put up with 'do not disturb' signs attached to ensure more privacy day rooms and bathrooms were refurbished and ward bays are now single sex. 22

23 Food and nutrition As a result of a review of food and nutrition: patients were invited to meet the catering manager, nurses, modern matron and dieticians, to put forward their views on the food provided and how the service might be improved a 'nutrition action group' was set up to review key areas for improvement, such as training and nutritional support for patients unable to manage a full diet policies have been updated to incorporate national guidelines and evidence-based practice. Quality improvements: Patient Amenities Fund In 2005/06 the Charitable Funds Management Committee gave 100,000 to the patient amenity programme. The group that decides which projects to support includes staff from both hospitals plus two patient representatives. Projects included: a ceiling mural transparency with a bright relaxing picture at Royal Brompton to help patients relax as they are being treated. The mural was featured in Health Services Journal refurbishment of the patient waiting area on the adult surgical unit at Harefield a standing hoist which helps with the rehabilitation of patients by enabling them to stand after long periods in hospital, speeding the return to full mobility. Continued overleaf Our patients say... We are amazed at the dedication of you all, and the laughter that emanates around the wards. A huge thank you to every member of staff, to the doctors, nurses, office staff porters and kitchen staff for their very high standard of care A ceiling mural transparency helps patients relax at Royal Brompton Hospital 23

24 RB&H annual performance review and accounts Governance and quality (continued) Our patients say... You hear so many bad things about the NHS, but I have to say that the two visits that we have had to make to Harefield have been met with the best possible service Our theatres open day was a great success at Harefield Patient Advice and Liaison Service The Patient Advice and Liaison Service (PALS) works closely and confidentially with patients who value the independent point of contacts it offers. During the year PALS staff dealt with 422 patient concerns. This is a two-fold increase on last year and the breakdown is shown opposite. This increase reflects the improved visibility of PALS on both sites, a rise in the number of our volunteers making ward visits and an increase in the number of staff referring patients to us. We have started to collect data on the age and race of patients to identify whether particular groups experience any specific difficulties. We expect to reach some conclusions during 2006/07 as more data is gathered. Communication continues to be the main source of problems experienced by patients. However, our proposed training programmes in the management of complaints and dealing with difficult situations, should result in the number of such complaints decreasing. A further common concern is delayed discharge. This is now raised at clinical induction sessions and a number of initiatives are being developed to prevent significant delays. Our volunteers Volunteers from a wide range of backgrounds give the Trust over 400 hours per week. We encourage volunteers with disabilities where there is suitable support. PALS has a dedicated team of volunteers who visit patients on the wards. Their role is to talk to patients and to help resolve any issues on their behalf. They work within PALS guidelines and seek patients' consent before taking action. In the course of the year volunteers saw approximately 1,000 patients. 24

25 Complaints from patients This year we received 77 complaints about our services. At Royal Brompton the number fell from 68 to 49 and at Harefield Hospital from 30 to 28 compared to 2004/05. There were 54 complaints about clinical treatment and patient related matters, including admission arrangements, discharges, appointments and cancellations. These made up 70 per cent of all complaints. Overall, 48 per cent of complaints concerned clinical treatment. During the year 74 per cent of complaints were successfully dealt with within the 20 working days performance target. Failures in meeting this target were due to complex questions, the need to liaise with other trusts and a lack of availability of key staff who were crucial to the investigation. Of the 77 complaints received, 95 per cent were resolved locally by our staff. Four people requested an independent review by the Healthcare Commission. Of these, one was refused; one has proceeded to independent review; another is under scrutiny, and records relating to the final one have been sent to the Healthcare Commission. During the year, changes implemented as a result of complaints included: Non-emergency patient transport A review of transport was commissioned which resulted in some 30 recommendations for change. A steering group was formed with patient representation and a new ambulance service contract took effect in April Information about drug treatment following discharge (Clopidogrel) Following a complaint from a patient about incorrect advice on his drug treatment, a card has been produced for all patients on Clopidogrel, a drug which is used to prevent the formation of harmful blood clots. The neat, creditcard-size card shows patients for how long they must continue treatment. Continued overleaf Reasons for contacting PALS /06 Total concerns raised at Harefield (HH) 131 Total concerns raised at Royal Brompton (RBH) 271 The remainder were cross-site matters 20 These are broken down by type as follows: Total RBH HH Cross-site or unidentified Admissions, discharge and transfer Appointments, delays and cancellations Clinical Communications Staff attitudes Non-emergency transport Our patients say... From the cleaners and porters on the ward who treated Dad with respect and unfailing courtesy, from the bereavement officer who rang me personally when the post mortem was announced, to the security officer who was waiting at the main entrance when we were called in at 3 a.m., we have been touched and amazed by people s sensitivity, professionalism and ability to remember the individual experience at all times The remainder were for information and general enquiries (196) 25

26 RB&H annual performance review and accounts Governance and quality (continued) Our patients say... For my part I shall not miss any opportunity to praise the excellence of the catheter ablation procedure in the hope that it will become more widely known and appreciated in this country Staff are shown new bar-coded wristbands, introduced to improve patient safety Management of appointments A patient experienced difficulty in contacting one of the hospitals to try to confirm an appointment. As a result the patient did not obtain a date for the procedure he was waiting for. Following the complaint, staff have been reminded of the process for managing appointments and making sure all communication is directed to appropriate individuals. Discharge summaries The production of discharge summaries was identified as an issue within respiratory medicine last year. A patient complaint received in November reinforced the issue, and the directorate has taken a number of steps to address the problem since then. A multidisciplinary group has met and mapped the discharge summary process. A new IT programme has also been introduced which is easier for secretarial staff and doctors to use. The directorate is currently completing an audit on discharge summaries, and a case has been developed for additional resources as part of the annual business plan. 26

27 Maintaining the highest standards Nurses can now prescribe certain drugs for patients Our patients say... I am eternally grateful for the care, consideration and professionalism in looking after me during my treatment To achieve our vision and provide our patients with the care we think they deserve, we recruit, train and develop staff who we believe are leaders of the future. Specialist nurses Specialist nurses have specific skills and responsibilities and cover areas as diverse as interstitial lung disease and fetal cardiology. Patients often comment about the confidence they get from seeing the same nurse regularly. They value the expert knowledge and advice that over 70 specialist nurses provide: our clinical nurse specialist for interstitial lung disease (inflammation and scarring of lung tissues) helps patients to manage their disease and to live as independently as possible outside the hospital environment our artificial heart nurse specialist plays a vital role in helping patients with left ventricular assisted devices (LVAD) rebuild their lives with their new artificial hearts. Patients and families/carers are trained how to use the battery operated equipment. The nurse specialist is also responsible for a 24-hour on-call service our fetal cardiac nurse specialist sees mothers from the early stages of pregnancy up until the birth. She works with our leading fetal cardiologist and with the patient s local GP and maternity centre, offering support and advice. Nurse prescribing A major initiative this year was the independent/supplement prescribing course. This enables nurses to prescribe drugs for patients. Alison Pottle, nurse consultant in cardiology, describes the benefits of her ability to prescribe for patients: Drug therapy is an integral part of treatment for cardiac patients. Being able to prescribe allows me to look at all aspects of their care. It also facilitates the smooth running of the outpatient clinics as I do not need to ask the medical staff to write the prescriptions. I can therefore make sure that patients are receiving the optimum treatment and make any adjustments necessary. Nurse recruitment Recruitment and retention of nurses is an ever-increasing priority. In recent years it has become more difficult to recruit nurses with relevant cardiorespiratory experience due to the high cost of living in inner and outer London. Like most other London trusts, appointing nurses from overseas has helped to maintain the necessary staff numbers. Since September 2005, changes in practice mean that all nurses from outside the EU now complete an Overseas Nursing Programme in order to register with the Nursing and Midwifery Council. Nurses from Australia, New Zealand and North America complete 20 protected training days, while others have to complete a period of supervised practice for up to six months. Developing nursing leaders The Royal College of Nursing (RCN) Clinical Leadership Programme for nurses ran again this year. The overall aim is to enable clinical nurses to deliver high quality, patient-centred, effective and evidence-based care in day-to-day clinical practice. Twelve nurses took part and were able to demonstrate better leadership skills as a result. Continued overleaf 27

28 RB&H annual performance review and accounts Maintaining the highest standards (continued) Our patients say... At all times the anxieties of my family and I were anticipated and information was given that made the whole process easier to bear The equality and diversity team re-grouped this year During the course a number of areas where action could be taken to improve care were identified, for example to reduce the anxiety of heart attack patients admitted for emergency primary angioplasty. By ensuring a nurse and doctor meet emergency primary angioplasty patients at reception and make a room available for relatives within the cardiology department, levels of anxiety can be significantly reduced. A popular programme is also available for staff nurses that builds on the success of the staff nurse development day. This programme focuses on patient and public involvement, communication and risk management, people management (including equality and diversity) and recruitment, and clinical priorities such as data protection, confidentiality and healthcare standards. Improving Working Lives (IWL) The Trust was awarded IWL Practice Plus status in September 2005 as a recognition of our commitment to creating a working environment where everyone feels valued. Since then the IWL steering group has been working hard to put into practice the recommendations made by the external validation team. Success stories include the introduction of comprehensive diversity training, the opportunity for long-serving temporary staff to move to permanent contracts and the introduction of staff open forums hosted by the chief executive. 28

29 Equality and diversity The equality and diversity team regrouped in October 2005 with a renewed commitment to meeting the requirement of the Race Relations Act (Amended) 2000: to eliminate unlawful discrimination to promote equality of opportunity to promote good race relations between people of different racial groups. Led by the chair of the Diversity Steering Group, co-ordinators have been appointed to: Effectively promote diversity issues to staff groups: mainstreaming diversity awareness into corporate inductions and at all staff levels including the Trust Board. There has also been extensive networking with our internal and external partners who have shared good practice and helped with the consultation process. Black, Minority and Ethnic (BME) staff forums have been conducted on both sites as a first step towards setting up the BME Network. The Network will provide a voice for BME staff to share experiences. Diversity issues are covered regularly in the Trust s monthly newsletter and on the intranet. The equality and diversity area on the Trust s website is under development. Conduct Impact Assessments of Trust policies and functions: impact assessments are being conducted on Trust policies and functions with support from Trinity Development (our external partner). An Impact Assessment e-tool has been purchased which will add to the robustness of this process and improve data quality. The needs of disabled employees are monitored through the work of the equality and diversity steering group and team, risk assessments and formal environmental surveys. Our equality statement is included on all recruitment advertising. Continuously monitor required data relating to staff and service users: the quality of ethnicity data is being monitored to ensure that there is representation as required by the Race Relations Act. Rewrite the Race Equality Scheme (RES): incorporating recommendations from our partners, including the Patient and Public Forum. The changing legislative landscape and diverse needs of our patient and staff populations continue to challenge the equality and diversity agenda. Strengthening our partnerships and continuing to involve as many staff and service users as possible is integral to the progression of equality and diversity throughout the Trust. Staff survey results 2005 From October 2005 to December 2005, all our staff were asked to take part in the third annual National NHS staff survey. The results of this survey will be used by the Healthcare Commission in their Annual Health Check as part of the assessment of our compliance with core standards. The response rate was 58% which is a significant increase from the 42% in Following analysis of the survey results, discussions took place with staff groups and a comprehensive action plan to address areas for development was agreed by senior managers. A staged implementation policy was then agreed. Continued overleaf Our patients say... I hope that you can continue with your wonderful work we are forever in your debt 29

30 RB&H annual performance review and accounts Maintaining the highest standards (continued) Our patients say... I had total confidence in all the staff involved and without exception each performed his or her role most professionally The Trust is in the top 20 per cent of acute trusts for the following areas: quality of work-life balance number of staff having well-structured appraisals number of staff working in a wellstructured team environment quality of job design support from immediate managers positive feeling within the Trust staff job satisfaction We have identified harassment and bullying, long hours culture and communication as three priority areas for action. Learning and development The learning and development team was restructured this year to create a more customer-focused service. The team continues to implement a programme of development activities, which has included the launch of a new three day people management programme, the continuation of the Bullyproof training programme which aims at reducing bullying and harassment at all levels within the Trust, and the co-ordination of statutory and mandatory training. CD-Rom and e- learning opportunities are also being explored and a successful training CD- Rom for medical staff was piloted this year. All staff under the Agenda for Change pay system now have a broad Knowledge and Skills Framework (KSF) outline, with the priority for 2006/07 being to produce individual outlines for each post. Childcare The Trust s day nurseries continue to provide an important service. The nurseries offer a total of 97 subsidised childcare places (49 at Royal Brompton and 48 at Harefield) and have recently introduced the Birth to Three Matters framework (a new planning and monitoring system) to improve development and learning. Reducing sickness/absence During the last fiscal year we have made significant progress in improving the quality and accuracy of sickness and absence data, and reducing absence from work: a newly-created HR workforce analyst role has been created to deliver workshops to both managers and staff about leave benefits available to them and their responsibilities for reporting, recording and managing absence support for managers in handling sickness absence has been extended A very successful Medicines Management Week was organised by pharmacy staff 30

31 further improvements to the timeliness and accuracy of data are planned with the advent of the new payroll Electronic Staff Record (ESR) system in May 2006, and the opportunities for local ownership for departments through the self service function in those with long term sickness continue to be supported by occupational health provision. Capability As part of an overall performance management framework, two new policies have been introduced, one for medical staff and one for non-medical staff, to support managers and staff when dealing with issues of capability. This covers issues such as out-of-date practice and weaknesses in communication or working as part of a team. The policies are currently being used where a shortfall in performance has been identified and line managers are being provided with training and support from the human resources team in implementing this policy. Preparing for Emergencies We are committed to our role within the regional and national scheme for major incident planning. We have an up-to-date Major Incident Policy which is regularly tested both internally and externally. We are fully integrated with regional and national activity. The Trust has also been engaged in the extensive planning for Pandemic Flu that has taken place internally, and in conjunction with the North West London Strategic Health Authority. This process is ongoing. Emergency planning is given a high priority by all members of staff, led by senior management. Our patients say... The time I spent in your ward, although brief, was a fantastic insight into how great a nursing team can be 31

32 RB&H annual performance review and accounts Information and telecommunications services We have an ongoing programme to constantly improve our IT services The Trust has an ever-increasing commitment to investment in IT and telecommunications, with an ongoing programme to constantly review and update equipment and services. Our IT strategy is designed to integrate services between the two sites by ensuring we use common systems, and our aim is to be paperless by To achieve this there are many projects underway. Our Electronic Patient Record system (EPR), which displays all patient details, consultant details, diagnostic imaging reports and pathology reports, continues to be developed. This vital system will consolidate all patient information into one computer system which can be accessed anywhere within the hospitals. In the next financial year, all PACS images (x-rays, MRI scans, CT scans etc.) and clinical audit details will be displayed within the EPR. The digitisation of x-rays (PACS) remains a very successful service. Last year imaging teams on both sites were given access to the service (nuclear medicine at Royal Brompton will get access during the next financial year). Connecting for Health (CfH) Introducing new improved systems to the NHS NHS Connecting for Health is a national government initiative to bring modern computer systems into the NHS to improve patient care and services. Over the next ten years, the National Programme for IT will connect over 30,000 GPs in England to almost 300 hospitals and give patients access to their personal health and care information. We continue to carry out the necessary preparation work for the introduction of this programme. A project board, chaired by Caroline Shuldham, Director of Nursing & Quality, oversees the various streams of work. A number of clinical staff, including consultants, have been involved in the programme and have been very supportive. The IT Helpdesk has achieved the Investors in People Quality Standard (ITIL) which shows that the team has the necessary technical expertise to provide the new services on the telephone and on site. Delivery and connection to the new NHS data network this year will enable staff more easily to connect to various NHS systems (securely) within NHS organisations. Choose and Book 'Choose and Book', the electronic patient appointment system, is an important part of Connecting for Health (CfH). Under this scheme appointments can be made direct via a GP or patient's computer. We are continuing to make steady progress with Choose and Book, which will be gradually introduced for the 30 per cent of outpatient appointments booked via GPs during 2006/07. New theatre systems An initiative to upgrade our theatre systems under CfH is also underway. There will be many benefits of investing in new systems, such as more speedy and accurate booking of theatre slots and the availability of far better financial and clinical information on theatre activity. A related system will also allow staff to order diagnostic tests electronically; this is currently done manually throughout the Trust. 32

33 Estates and facilities report The need for a comprehensive new estates strategy became evident following the withdrawal of the outline business case for the Paddington Health Campus Project by the Strategic Health Authority in summer Work was undertaken on the strategy during 2005/06 and the final document will set out the vision for the next eight to 10 year period, reflecting the Trust s and its partners longer term clinical and research objectives. Capital projects A wide range of capital investment projects was delivered across both hospital sites during 2005/06. The majority of estates capital investment was targeted at supporting and improving the hospitals existing building infrastructure. Our catering services The catering departments at both hospitals continue to improve services for both patients and staff. At Royal Brompton there is an increased focus on the use of organic and locally produced goods wherever possible. Catering manager Mike Duckett has been a guest speaker at several conferences on the subject and the hospital has been featured in a variety of trade magazines. At Harefield, new improved patient menus have been introduced and significant improvements have been made to our menu cards and service information ward folders. PEAT The Patient Environment Action Team (PEAT) programme for 2006 was revised by the Healthcare Commission to place greater emphasis on cleaning standards, infection control issues and food quality. As in the past two years, our hospitals were self-assessed and a PPI representative was included on the assessment team. Particular improvements have been made at Harefield with an increased overall score of 93 per cent, from 88 per cent in 2004/05. Royal Brompton also achieved a high score of 92 per cent (93 per cent in 2004/05). Our cleaning services Cleaning (Domestic Services) is carried out throughout the Trust by ISS Mediclean Ltd. The company was awarded a new contract for up to five years from 1st April The first year of this new contract, tendered against a specification based on the requirements of the National Standards of Cleanliness, has been a great success. The highlight of the year was the Kimberly-Clark Golden Service Awards. Sheila Duffy, who has worked at Royal Brompton for over 24 years, was a finalist in the Supervisor of the Year category and ISS Mediclean won the Best Cleaned Premises by a Contract Cleaning Company in the Healthcare Section and was judged the overall winner of the awards due to their outstanding performance at Royal Brompton. Patient transport The patient transport department has completed its first full year as part of the estates and facilities directorate. Emphasis has been placed on increasing flexibility and customer service. Policies and manuals have been re-written and an up-to-date patient leaflet about the service has been produced. As a consequence patient satisfaction in relation to this service has increased. An extensive market-testing exercise was carried out and an exclusive contract was finally offered to Caring For You Limited. The company is providing improved standards with a significant reduction in cost to the Trust. Harefield achieved a PEAT score of 93% this year 33

34 RB&H annual performance review and accounts Harefield Hospital All residents in the Harrow area can now benefit from Harefield s life-saving primary angioplasty service A great deal of work has been undertaken this year to secure a more certain future for services currently provided at Harefield. An independent project panel undertook a review of the future of the hospital's services, following publication of a North West London Strategic Health Authority (NWLSHA) clinical governance review of surgical services at Harefield (in November 2005). Sir Michael Partridge presented the panel's findings at the Trust's June Board meeting and outlined five options that had emerged as a result of a comprehensive stakeholder consultation. The Trust agreed to commission an options appraisal of these possible solutions, conducted by an external consultancy, before the end of the calendar year (2006). Meanwhile, remedial work to undertake much needed improvements to the infrastructure of Harefield supported by 2.3 million awarded by the NWLSHA, begins in Autumn Harefield remains one of the country's leading cardiothoracic centres and is the designated outer north west London centre for acute cardiology (with a growing primary angioplasty service for local boroughs and the homes counties). Our commitment to enhance and improve our patient care environments and to develop our high performing specialised services remains strong; we believe our patients deserve the very best that we can offer them. Chelsea striker Joe Cole joined our transplant anniversary celebrations at Harefield, to the delight of our younger guests 34

35 Our services for patients Cardiology ROYAL BROMPTON & HAREFIELD NHS TRUST IS ONE OF THE LARGEST CENTRES FOR THE TREATMENT AND DIAGNOSIS OF CARDIAC DISEASE IN EUROPE AND A LEADING CENTRE IN INNOVATIVE DEVELOPMENTS IN CARDIOLOGY. The Trust is one of the largest centres for the diagnosis and treatment of heart disease in Europe Our patients say... From the moment that I had my angiogram your team gave me such confidence that everything seemed so normal and routine like having a haircut! This year s highlights All 250,000 residents in the Harrow area can now benefit from life-saving primary angioplasty, courtesy of Harefield s specialist cardiology teams. The average door-to-procedure time is under 30 minutes, which is significantly better than the international average. The primary angioplasty service provided to Hillingdon continues to flourish. Royal Brompton Hospital is one of the largest and busiest of 12 centres performing cardiac electrophysiology procedures in the UK. This year the team has expanded with the appointment of Dr Vias Markides to the new position of clinical lead for electrophysiology and pacing. Dr Markides will work closely with consultant cardiologists Dr Jonathan Clague, Dr Jan Till (children) and Dr Tom Wong. The new specialist angina clinic set up in 2005 continues to provide a muchneeded service. Christine Wright, clinical nurse specialist, now treats over 70 patients and works alongside a multi-disciplinary team including cardiologists, surgeons, a pain management consultant, consultant radiologist and psychologists. Dr Lorna Swan was appointed consultant cardiologist attached to Royal Brompton s Adult Congenital Heart Disease Unit. Dr Miles Dalby and Dr Rajesh Kharbanda were appointed as interventional consultants at Harefield. Lottery grants supported the refurbishment and improvement of two catheter laboratories this year one at Royal Brompton and one at Harefield. 35

36 RB&H annual performance review and accounts Surgery THE ROYAL BROMPTON & HAREFIELD NHS TRUST IS INTERNATIONALLY RENOWNED FOR OFFERING A WIDE SPECTRUM OF CARDIAC SURGICAL TREATMENTS, SPANNING NEONATES TO ADULTS. THORACIC SURGEONS WITHIN THE TRUST TREAT MORE THAN 1,400 INPATIENTS A YEAR, PROVIDING ONE OF THE BIGGEST CHEST SURGERY SERVICES IN THE UK. Our patients say... I was impressed from the beginning with the scale and depth of all the information and treatment received during the period leading up to the operation, including the registrar briefing, the surgical information seminar and the advice and liaison services on offer This year s highlights Government targets of three months waiting time for coronary bypass surgery (revascularisation) and six months waiting time for all other surgery were met. Targets for clinical activity were exceeded with 1.6 per cent more cardiac surgery being undertaken than originally forecast and 5.5 per cent more thoracic surgery. In February 2006 the National Cancer Peer Review Programme assessed our lung and upper gastrointestinal cancer and palliative care services. The assessment team concluded that our teams provide services of high clinical standards. Professor Peter Goldstraw, consultant in thoracic surgery since 1979, received a lifetime achievement award from the British Thoracic Oncology Group (BTOG). Professor Goldstraw also received the Price Thomas Gold Medal from the Royal College of Surgeons of England. Welcome improvements to the patient areas took place at Harefield with the complete refurbishment of C East Ward, creating two separate female and male wards with bathrooms, offering greater space between beds and much more privacy. Targets for clinical activity were exceeded this year This year has seen the significant development of surgical radiofrequency ablation services - the use of high frequency radiowaves to treat atrial fibrillation (when part of the heart is not beating in the correct rhythm). In response to the national Modernising Medical Careers initiative, a team of advanced nurse practitioners in the Trust now takes on some of the duties traditionally done by junior medical staff. A team of four specialist surgical practitioners (SSPs) and three perioperative specialist practitioners (PSPs) have been appointed and are undertaking formal training with Imperial College. 36

37 Transplant THE TRANSPLANT UNIT AT HAREFIELD HOSPITAL REMAINS THE LARGEST AND MOST EXPERIENCED CENTRE IN THE WORLD FOR HEART AND LUNG TRANSPLANTS. THE SURVIVING TRANSPLANT POPULATION NOW NUMBERS OVER 1,200 PATIENTS WHO NEED LIFE- LONG FOLLOW UP. ALONG WITH IMPERIAL COLLEGE S NATIONAL HEART AND LUNG INSTITUTE, OUR EXPERTS HAVE PIONEERED THE DEVELOPMENT OF LEFT VENTRICULAR ASSIST DEVICES (LVADS - ARTIFICIAL HEARTS). Over 1,000 guests joined us to celebrate the 25th anniversary of the first adult heart transplant at Harefield hospital This year s highlights Over 1,000 transplant patients and their families attended a day of celebration in June 2005 to mark the 25th anniversary of Harefield s first heart transplant. Each patient was presented with a commemorative medal by Professor Sir Magdi Yacoub, Mr Asghar Khaghani and Dr Rosemary Radley- Smith, whose retirement was also marked at an evening reception. The Transplant Unit contributed significantly to the completion of a three-year LVAD study into the use of artificial hearts as a 'bridge to transplant'. When a patient's own heart becomes too weak to survive on its own, LVAD can be used as a bridge while patients wait for an appropriate donor heart. The Unit published several new protocols for heart patients. These are detailed clinical documents explaining all aspects of care for heart transplant patients. Dr Emma Birks was appointed consultant cardiologist with a special interest in mechanical circulatory support, in October Following an external review of the Transplant Unit by NSCAG, a comprehensive review of services took place. As a result, significant changes to working practices were introduced to improve the quality of patient care. These included: a two-day clinical workshop to undertake a multidisciplinary review of current practice the implementation of a 52-point action plan Dr Emma Birks has a special interest in mechanical circulatory support the introduction of a series of clinical protocols the development of a rolling programme of clinical audit the allocation of additional resources to support organ retrieval the decision to appoint two additional consultant surgeons. NSCAG produced a report containing recommendations for implementation within three and six months. Evidence of progress on the three-month recommendations was presented to NSCAG in March 2006 and on progress towards achieving the six-month recommendations in June NSCAG was satisfied with the progress made. The Unit was peer reviewed against the National Standards for Heart and Lung Transplantation and VADs in March The peer review team did not identify any significant non-compliance with the standards and commended the Harefield team on the quality and quantity of evidence provided to the review. 37

38 RB&H annual performance review and accounts Respiratory medicine PATIENTS WITH AROUND 50 DIFFERENT GROUPS OF RESPIRATORY DISEASES ARE TREATED AT ROYAL BROMPTON HOSPITAL. WE HAVE AN INTERNATIONAL REPUTATION FOR THE DIAGNOSIS AND MANAGEMENT OF LUNG DISEASE AND FOR OUR RESEARCH PROGRAMMES, THE RESULT OF OVER 160 YEARS OF EXPERIENCE. This year s highlights Government targets for waiting times six months for inpatients and 13 weeks for outpatients were met. Activity levels have increased with no additional bed resources being required. This has been achieved through continuing work on bed management, administrative support and a flexible attitude towards staffing across the unit, and by having consultants more visibly involved in patient services. We have developed a clear Patient and Public Involvement programme in line with the government strategy. As a way of gathering information from patients, we conducted patient interviews to help us review how we provide drug therapy information to patients. We conducted a similar approach in the immunotherapy clinic outpatients unit. Valuable feedback about the clinic was received. Dr John Janssen, a part time consultant neurologist, joined us this year. Vijay Lutchmere was appointed in the newly created nurse educator post, leading on critical care support for nursing staff. The capacity of our High Dependency Unit has been increased from two to four beds. A Sleep / Ventilation drop-in clinic has been introduced, which is convenient for patients and will hopefully relieve the current pressure on outpatient services. A pilot scheme is currently underway providing outpatients with cystic fibrosis with telephone consultations for routine follow-ups rather than having to travel a long distance to the Trust. Initial signs are that the pilot is receiving positive feedback. Specialist nurses were recently introduced in five different diseasefocused groups. The introduction of specialist nurses has been greatly valued in respiratory medicine and further investment in this role is planned for the future. Activity levels have increased without the need for extra bed resources 38

39 Paediatrics OUR PAEDIATRIC WORK CAN BE DIVIDED INTO THE SUBSPECIALITIES: RESPIRATORY MEDICINE; CARDIOLOGY; FETAL CARDIOLOGY AND CARDIOTHORACIC SURGERY. AN EXTENSIVE PAEDIATRIC MULTIDISCIPLINARY TEAM SUPPORTS THE MEDICAL AND NURSING STAFF. Our patients say... The whole team have been so fantastic, helpful and supportive and given huge encouragement to us as parents This year s highlights The government s six month waiting list target was met comfortably this year from 141 children on the waiting list in April 2003, there were 44 in December Primary Ciliary Dyskinesia (PCD) was recognised as a new national specialist service this year, bringing new funding to the Trust and supporting the appointment of a new consultant to lead the service, Dr Claire Hogg. This new national service should radically reduce the numbers of children wrongly diagnosed with chronic infection and inflammation of the ears and lungs. Our unique multi-hospital paediatric intensive care retrieval service for North Thames and East Anglia won the emergency care section of the London Region 2005 NHS Health and Social Care Awards. The specialised rapid response team assists local hospitals to stabilise and transfer critically ill children who require intensive care and is a joint venture with Great Ormond Street and St Mary s Hospitals. In February 2006, two new children's cardiac nurse specialists joined our current team of four. The British Heart Foundation will fund these positions for the first two years. The fetal cardiology programme was expanded during 2005/06. The creation of a joint post between Hammersmith/Queen Charlotte s and Royal Brompton means that five cardiologists specialise in this field - this equals the largest fetal cardiology service in the UK. The paediatric cardiology team has also been instrumental in launching a major new international multi-centre research project over three countries: the UK, Ireland and Sweden. Dr Piers Daubeney is the lead clinician. The fetal cardiology programme was expanded during 2005/06 European training programmes in fetal cardiology have continued with a three day course in Effective Prenatal Screening of Congenital Heart Disease. Dr Julene Carvalho and Dr Yen Ho also visited Pravia in Italy in April 2006 to run a similar two day course and will visit Nice, Switzerland and Hong Kong later in the year. Dr Helena Gardiner, fetal cardiologist, co-ordinated a multi-centre collaborative project between Glasgow, Southampton and Royal Brompton, screening 100,000 women for fetal heart defects at 20 weeks, on behalf of the Echo UK charity. Dr Joan La Rovere, consultant paediatric intensivist, and Mr Richard Connett, general manager for paediatrics, undertook a project as part of a programme run by the Royal College of Physicians and the NHS Institute for Innovation and Improvement. The results were presented at a national conference and work is currently underway to assess the potential for introducing new ways of working as a result of their research. 39

40 RB&H annual performance review and accounts Anaesthesia and critical care THE DEPARTMENT OF ANAESTHESIA AND CRITICAL CARE PROVIDES WORLD-CLASS ANAESTHETIC AND CRITICAL CARE SERVICES TO PATIENTS. THE LEVEL OF EXPERTISE AVAILABLE WITHIN THE TRUST ENABLES SURGERY TO BE CARRIED OUT ON PATIENTS WHO WOULD BE DEEMED INOPERABLE AT OTHER CENTRES. Our patients say... I cannot find the right words that can express my sincere gratitude to you both and all the MCU staff for the care and support you not only gave me but also my family and friends This year s highlights Two new consultant appointments have strengthened the team this year: Dr Susanna Price has been appointed to the newly created post of consultant in critical care medicine and cardiology/echocardiography. Dr John Wort has been appointed as consultant in pulmonary hypertension and critical care medicine. RAND Europe s analysis for the Department of Health of highly cited publications of health research in England, showed that research papers from our critical care experts are among the most frequently cited in medical literature. CLINICIP Royal Brompton Hospital is one of several European Centres taking part in this EU funded project to use advanced computer technology to automate the control of glucose metabolism in critically ill patients. The automation improves safety and reduces the workload of the ICU nursing staff compared to traditional methods. With the appointment of Dr Wort, the Critical Care Unit will now be responsible for the investigation ad management of patients with severe pulmonary hypertension referred from all over the south east of England. Royal Brompton Hospital is a national centre for the treatment of a very rare lung disease called Pulmonary Alveolar Proteinosis (PAP). There has been a significant increase in the number of patients referred for assessment and treatment of PAP over the past two years and considerable advances have been made in the understanding of its root causes. Dr Cliff Morgan, lead clinician - critical care medicine, has joined the Rare Lung Disease Consortium of the National Institutes of Health in the USA, a group set up to redress the problems of rare disease management. Four of our anaesthetic consultants now have USA Board Certification in Trans Oesophageal Echocardiography and together with the new appointment of Susanna Price, provide a seamless diagnostic and perioperative monitoring service. Our acute pain service has been extended to paediatric for the first time, improving the pain management now available to our younger patients. Dr Andrea Kelleher is the Chair of the Cross Trust Transfusion Committee and has overseen the implementation of a number of blood safety initiatives and audits. Dr Cliff Morgan is a member of the Chief Medical Officer s National Transfusion Committee and the Executive Working Group of the committee. Dr David Hunter, consultant anaesthetist, has been appointed clinical lead for sedation by nonanaesthetists. This initiative was introduced to ensure safe and effective use of sedative drugs for patients undergoing a range of investigations and procedures. 40

41 Clinical support services CLINICIANS AT ROYAL BROMPTON & HAREFIELD NHS TRUST ARE SUPPORTED BY SOME OF THE MOST ADVANCED TECHNOLOGY CURRENTLY AVAILABLE. The Directorate of Laboratory Medicine provides an expert service to the Trust Imaging: this year s highlights Government targets for waiting times of 20 weeks for a CT (Computerised Tomography) or MRI (Magnetic Resonance Imaging) scan were met. A state-of-the-art 64-channel cardiac CT scanner, which has the capacity to diagnose early coronary heart disease, has been installed at Royal Brompton Hospital (a similar scanner is planned for Harefield in 2006/07). Over 4,000 patients from around the UK will benefit every year, dramatically reducing waiting list times for heart disease diagnosis and treatment. Doctors will now be able to diagnose patients coronary disease by looking at extraordinarily precise images of the inside of the body. Substantial preparation work has been carried out for the installation of a new Radiology Information System (RIS) and Picture Archiving and Communication System (PACS). These new computerised systems will greatly improve the flow of medical images and diagnostic reports around the hospital and provide the opportunity to access other hospitals PACS systems for the cross-referral of patients. Two radiographers, a nurse and a cardiac physiologist completed the first course for generic catheter laboratory workers. The objective of the course was to improve integrated working in the labs; this should reduce cancellations and make better use of the existing facilities. The Royal Brompton nuclear medicine department replaced its two Sopha gamma cameras with more sophisticated, higher quality machines. One of these is the first of its kind in the world to be used for cardiac nuclear medicine. Newer, more reliable machines will mean shorter examination times. A new Cardiac Magnetic Resonance scanner, donated by Siemens, was installed. This uses a new method of imaging the heart using MRI. A total of 60 peer reviewed research papers using the scanner were published. Laboratory medicine: this year s highlights To comply with the Human Tissue Act, Item Tracker software has been introduced. This tracks and provides a complete audit trail of any samples used in research. The Clinisys WinPath laboratory information system has been rolled out at Harefield to replace its older Telepath system. Results of all tests carried out on patients, such as blood tests, can now be made available immediately on computer, giving clinicians instant access which speeds up diagnosis. Laboratory medicine has been instrumental in the introduction of the Electronic Patient Record (EPR). This means that all patient information relating to laboratory medicine disciplines, such as blood test results and x-rays, can be accessed on computer. Haematology / blood transfusion clinical biochemistry / phlebotomy New technology has been introduced at Harefield, Diamed Gel Station, for automated blood transfusions and tests. The Olympus Blood Track system has been installed at both sites. We can now track blood samples; where the blood came from and where it goes. This enables us to provide a complete audit trail so the traceability of blood samples can be easily tracked. To minimise the risk of needlestick injuries, safer equipment such as retractable needles have been introduced to replace normal syringes for staff taking blood from patients. Continued overleaf 41

42 RB&H annual performance review and accounts Our patients say... Thanks to your efforts and those of the doctors I am making an excellent recovery, free from pain Rehabilitation classes are available for cardiac and respiratory patients Microbiology We have maintained our low MRSA bacteraemia rate with four bacteraemias for the year, which met the Department of Health s target. One of the ways we have achieved this is by screening patients on admission, especially if they have been transferred from other hospitals. In keeping with the national Cleanyourhands Campaign, alcohol hand rubs have been placed beside each patient bed and in all clinical and laboratory medicine areas. Audits of hand washing facilities and hand hygiene practices have been undertaken, with participating areas producing their action plans for improvement. Histopathology (study of the tissues of the body) Cross-site histopathology service review findings were implemented, with an agreement for closer working and for Royal Brompton staff to provide support for the Harefield department when necessary. Pharmacy department: this year s highlights Our specialist pharmacists for transplantation and respiratory medicine have both successfully completed courses in supplementary prescribing. This means they are qualified to prescribe medicines. The Patients Own Drugs (PODs) scheme was introduced in all areas of adult care. Under the scheme medicines which patients bring with them on admission are assessed and patients continue to use them provided they are the correct quality. Plans are well underway for the installation of pharmacy robots that will select and dispense drugs for patients. A significant amount of preparation work has been carried out and the machines are expected to be installed in They will save money, speed up pharmacy services and free up pharmacists. The pharmacy department organised a medicines management induction programme for all clinical staff. Any staff member unable to attend accessed the programme online, through a computer-aided learning module. The programme covered how to manage medication prescribing risks. In November 2005 we held our first Medicines Management Week to raise understanding and awareness of safety when using medicines. Our awareness week coincided with Ask About Medicines Week, a national initiative to encourage patients to ask healthcare professionals questions about their medicines and how to use them safely and effectively. As part of this campaign, a Medicines Management intranet website for staff was launched. Rehabilitation and therapies: this year s highlights The Rehabilitation and Therapies directorate has attracted more research grants this year and has raised its profile significantly through a greater presence at international conferences. Significant grants were awarded for two research projects - a study of probiotic nutritional supplements for intensive care patients and a study of post surgery physiotherapy care for children. 42

43 A study investigating the diagnosis of food allergies is currently underway Isabel Skypala, director of rehabilitation and dietetics, was presented with a prestigious award from the Health Foundation to fund a study looking at the diagnosis of food allergies associated with hayfever. Isabel is chair of the Food Allergy and Intolerance Specialist Group of the British Dietetic Association and represents this organisation on a Department of Health allergy advisory group. The health psychology team has developed policies and training on psychological well-being, such as suicide risk. In line with national requirements, a new database has been set up to prevent the delayed discharge of patients to other organisations. This prevents costly delays in the system. A new oxygen assessment service has been introduced by the occupational therapy oxygen technician and therapy colleagues. This is in keeping with the national re-organisation of oxygen provision in the UK. Physiotherapy and health psychology therapists have introduced rehabilitation classes for both cardiac and respiratory patients and at Royal Brompton they are now involved in the rehabilitation of heart failure patients. They are also working with patients in critical care and intensive care, as well as providing resources and training for nurses running rehab classes. At Royal Brompton, physiotherapists are becoming more involved in the care of long-term ventilation patients. A new Anglican chaplain, the Reverend Tony Rablen, has joined the team at Harefield. He was licensed by the Bishop of Willesden in the hospital chapel. Father Cedric Stanley, Roman Catholic chaplain at Harefield, was made an MBE in the Queen s Birthday Honours list. This was awarded for his work counselling patients and comforting the bereaved. Father Stanley has worked at Harefield for 18 years and has been involved in hospital chaplaincy for almost 50 years. Our patients say... You all deserve a medal for the hard work you do 43

44 Director of Finance report 2005/06 The Trust has achieved all its operational financial targets and reported a surplus above plan of 3.24m at the end of 2005/06. This surplus was earned from additional private practice income, as well as from extra NHS income for items either excluded from Service Level Agreements or chargeable as supplementary items. The Trust was also able to release some prior year income provisions following the resolution of outstanding debts, as well as releasing a variety of unused non-pay provisions. The SHA had set the Trust an original surplus target of 1.6m but as the year moved on, by Q4 both NW London SHA and DOH requirements led to the Trust being asked to meet a 3.1m surplus. Other statutory duties The Capital Resource Limit was fully used in the delivery of the planned capital expenditure programme. The Trust also met the capital cost absorption rate of 3.5% and the planned Public Dividend Capital payment of 6.023m was paid on time to the Department of Health. However, the Trust was unable to maintain its previous Better Payment Practice code position, and paid 56% in number and 60% in value of non-nhs trade invoices. The details of compliance with the code are given on page 49. Income and expenditure Patient spell activity of 24,949 was 6.7% above plan. The resulting financial surplus has eliminated the effect of the deficit reported in the statutory accounts in 2004/05. The rise in private practice income was a key contributor, generating 2.24m (11.7%) above plan, and 3.49m more income than in 2004/05. The Trust earned 46% of NHS clinical income under PbR (Payment by Results) and this included gains from pricing due to the over performance of non-elective activity of 0.9m. The income and expenditure plan was supported by the development and implementation of a Financial Stability Plan (FSP) of 11.8m. This included the review of individual income streams, and a range of expenditure efficiency projects. The Trust delivered 11.25m from this process of which income contributed 8.0m, and close control of cost pressure and expenditure budgets delivered 3.25m, all of which contributed recurrent savings. Pay costs rose by 8.1% and the pay budget overspent by 1.35m (1.2% of budget) due to the additional costs of 4.4m incurred in implementing the Agenda for Change (AfC) pay scheme. Whilst temporary staff costs rose this year to 7.6m, ( 0.5m above previous year s) agency costs reduced to 2.4m and the bank agency ratio improved to 68:32. Establishment levels grew by 2%. Trust Management cost rose to 9.6m (4.96%). Non-pay budgets were reported to be in balance at year-end. This was an unusual year in that the customary rise in pacing costs from increased activity was offset by the release of two new non pay reserves for new projects as actual costs became clear. Concerted efforts to reduce cardiology stock levels on both sites were reflected in the final stock count position. Balance sheet The successful management of the balance sheet position was made more difficult by the need to support the DOH/SHA surplus requirements of 3.1m with cash. In addition, the majority of PCTs commissioned below outturn levels leading to a marked reduction in regular mid monthly income receipts and leading to a delay of some months before the quarterly agreement of NHS balances released the overperformance income. This approach by Primary Care Trusts (PCT) to setting activity levels impacted on Trust cashflow, but benefited the Trust income plan under PbR rules for the payment of overperformance. The old debtors balances were still affected by difficulties in recovering income related to Drug Eluting Stent usage in 2004/05, 1.5m was billed that year and 0.7 remains unpaid. The Trust continued to implement the materials management service and system from outsource agency Exel. This led to greater clarity on the volume, type, age, location and necessary top up levels for stocks. Stock values reduced by 7% to 4.7m after the inclusion of the value of items counted in-house which had risen by 0.4m. Capital expenditure of 5.5m included NHS operational capital of 4.2m and New Opportunities catheter laboratory and Charitable funding for schemes of 1.3m. The accounting treatment of pension liabilities is laid out in the accounting policy note 1.14 in the statutory accounts. The pension entitlements of the senior managers are shown in the Remuneration Report on page 53. National but unaudited NHS financial results published on 7th June 2006 showed that the Trust surplus of 1.7% of turnover was the highest achieved by an acute trust. This was the most successful result in NW London and was delivered despite the Trust s host and other major local PCT commissioners reporting significant deficits. 44

45 The Trust has submitted its application as a Wave 3 candidate for foundation trust status in June The application includes an integrated business plan for the period to This plan shows that the Trust expects to benefit significantly from the ability to retain PbR gains, and to deliver surpluses of between 2.6m and 3m in all but one year, when costs rise to reflect the impairment costs related to the redevelopment plan at Harefield Hospital. The Trust has no long or short term debt to encumber its progress in the early years as a foundation trust and its plan includes the ability to fund major asset renewal and infrastructure developments to support planned service developments on both sites. Code of conduct, accountability and openness The Trust has an obligation under the Codes of conduct and Accountability for NHS Boards to compile and maintain a register of the interests of Directors, which might influence their role. The register is available to the public, in accordance with the Freedom of Information Act, through written application to the Trust s Chief Executive. The Trust is also required to publish in the Annual Report the Directorships of any member of the Board in companies that are likely to, or seek to, conduct business with the NHS. In this context it is noted that: Mrs Isabel Boyer (left on 30th November 2005) was a Director of Prime Estates Ltd, a property investment company and a member of the UK Advisory Panel on Healthcare Workers with blood-borne viruses and of the Expert Group on Healthcare Infections of the Health Protection Agency. Professor Malcolm Green (retired on 31st March 2006) was a Trustee of the National Heart & Lung Institute Foundation. Professor Anthony Newman Taylor is Chairman of the Industrial Injuries Advisory Council (an expert advisory body to the Department of Works and Pensions), Chairman of CORDA, the heart charity, a member of Health Honours Committee, a Trustee of the National Heart and Lung Institute Foundation and a Trustee of Colt Foundation and Non Executive Director of Royal Brompton & Harefield NHS Trust (from 1st April 2006). Mrs Suzanne McCarthy is the United Kingdom s Immigration Services Commissioner, a Member of the Council and of the Audit Committee, University of London, a member of the Pensions Regulators Determinations Panel and a Board Member of the Royal Institute of British Architects. Lord Newton of Braintree, Trust Chairman, is a Council member of the Institute of Directors, Council Member of Essex University, Chairman of Help The Hospices; Chairman of Council on Tribunals; Chairman of Honours Committee for Community, Voluntary and Local Services, Governor of Writtle College and of Felsted School, President of a number of national and local voluntary organisations including Drugscope, Friends of Carers UK, Neighbourhood Energy Action, Essex Disabled Peoples Association, Essex Lupus Group, Braintree Multiple Sclerosis Society, Braintree Parkinson s Disease Society, Braintree and Bocking Abbeyfield Society, Tabor Centre for Disabled People Braintree, Corporate Friends of Farleigh Hospice and Phoenix Group Homes Colchester, a Trustee (former Chairman) of East Anglia s Children s Hospices, Trustee of National Heart and Lung Institute Foundation and Trustee of National Benevolent Fund Association. Mr Charles Perrin is Chairman of MRC Pension Trust Ltd and Chairman of Retroscreen Virology Ltd. (a virologybased research company); a member of the Investment Review Board of Kinetique Biomedical Seed Fund; a Lay Member of the Finance and General Purposes Board and Trustee of Pension Fund, Royal College of Physicians; a Member of Council and Chair of Finance Committee, University of London; Hon Treasurer and a Member of Council, Queen Mary & Westfield College; a Member of the Council, Central School of Speech and Drama; a Member of the Investment Committee of SAUL Trustee Co (University of London Pension Fund); a Director of the Griffin Community Trust Ltd (Royal London Hospital Charity for Housing the elderly and medical students), a Trustee of the Foundation of Grey Coat Hospital and a Trustee of the Medical Research Foundation. Professor Tim Evans is Academic Registrar, Royal College of Physicians (from 1st September 2005), Council Member of the British Lung Foundation and an adviser, grant reviewer and Advisory Board member for multiple organisations including the Medical Research Council, Wellcome Trust, Dunhill Medical Trust, British Lung Foundation and the British Heart Foundation. Mrs Sonya Bhatt (appointed on 1st July 2005 and resigned on 31st January 2006) was a member of British Red Cross. Mrs Jenny Hill is Deputy Chair of Chelsea and Westminster health charity and consulting director of Echelon Ltd. 45

46 RB&H annual performance review and accounts Summary accounts The summary financial statements are a summary of the information contained in the full accounts, which provide a fuller understanding of the results and state of affairs of the Trust. A copy of the full accounts can be obtained, free of charge by writing to: The Director of Finance, Royal Brompton & Harefield NHS Trust, Sydney Street, London, SW3 6NP. Independent auditors report to the Directors of Royal Brompton & Harefield NHS Trust on the summary financial statements We have examined the summary financial statements, which comprise the Income & Expenditure Account, Balance Sheet, Cash Flow Statement, Statement of Total Recognised Gains and Losses, and the related notes 1 to 9. This report is made solely to the Board of Royal Brompton & Harefield NHS Trust in accordance with Part II of the Audit Commission Act 1998 and for no other purpose, as set out in paragraph 36 of the Statement of Responsibilities of Auditors and of Audited Bodies, prepared by the Audit Commission. To the fullest extent permitted by law, we do not, in giving our opinion, accept or assume responsibility to anyone other than the Board of Directors for our audit work, for this report, or for the opinions we have formed. Respective responsibilities of directors and auditors The directors are responsible for preparing the Annual Report. Our responsibility is to report to you our opinion on the consistency of the summary financial statements with the statutory financial statements. We also read the other information contained in the Annual Report and consider the implications for our report if we become aware of any misstatements or material inconsistencies with the summary financial statements. Basis of opinion We conducted our work in accordance with Bulletin 1999/6 The auditor s statement on the summary financial statements issued by the Auditing Practices Board for use in the United Kingdom. Opinion In our opinion the summary financial statements are consistent with the statutory financial statements of the Trust for the year ended 31st March 2006 on which we have issued an unqualified opinion. We have not considered the effects of any events between the date on which we signed our report on the annual accounts (10th July 2006) and the date of this statement. 30th August 2006 Deloitte & Touche LLP 3 Victoria Square Victoria Street St Albans Hertfordshire AL1 3TF 46

47 1. Summary financial statements Income and expenditure for the year ended 31st March Income from activities 144, ,834 Other operating income 49,369 48,629 Total income 193, ,463 Operating expenses 184, ,525 Operating Surplus before interest 8,912 2,938 Interest receivable Interest payable 0 0 Surplus for the financial year 9,263 3,157 Dividends paid (6,023) (6,374) Retained surplus / (deficit) for the year 3,240 (3,217) Balance sheet as at 31st March Fixed Assets 184, ,673 Current assets Stocks 4,667 5,018 Debtors 17,539 19,338 Cash at Bank and in hand Creditors: amounts falling due within one year (25,883) (20,831) Net current (liabilities) / assets (3,155) 4,047 Total assets less current liabilities 180, ,720 Provisions for liabilities and charges (496) (5,523) Total assets employed 180, ,197 Financed by: Public dividend capital 96, ,621 Revaluation Reserve 71,007 67,333 Donation reserve 8,510 8,220 Income and Expenditure reserve 4, Total capital and reserves 180, ,197 Signed on behalf of the Board Chief Executive Date: 30th June 2006 Director of Finance Date: 30th June

48 RB&H annual performance review and accounts Cash flow statement for the year ended 31st March Operating activities Net cash inflow from operating activities 17,227 10,784 Returns from investments and servicing of finance: Interest received Net cash inflow from returns on investment and servicing of finance Capital expenditure Payments to acquire tangible fixed assets (4,249) (4,884) Net cash outflow from capital expenditure (4,249) (4,884) Dividends paid (6,023) (6,374) Net cash inflow/ (outflow) before financing 7,306 (255) Financing Public Dividend Capital received 2, Public Dividend Capital repaid (not previously accrued) (10,258) 0 Public Dividend Capital repaid (accrued in previous period) 0 0 Net cash inflow/ (outflow) from financing (7,306) 0 Increase in cash 0 36 Statement of total recognised gains and losses for the year ended 31st March Surplus for the financial year before dividend payments 9,263 3,157 Fixed assets impairment losses 0 0 Unrealised surplus (deficit) on fixed asset revaluations/indexations 5,139 (4,345) Increase in the donation reserve due to receipt of donated assets 1,256 1,748 Total gains and losses recognised in the financial year 15,

49 2. Management costs 4. Tangible fixed assets 2005/ / Management costs 9,614 8,361 Income 193, , Better payment practice Number Value ( 000) Total non-nhs bills paid 51,200 74,536 Total non-nhs bills paid within target 28,716 44,593 Percentage of non-nhs bills paid within target 56% 60% Total 000 Cost or valuation at 1st April ,274 Additions purchased 4,249 Additions donated/government granted 1,256 Indexation 5,139 Other in year revaluation (294) At 31st March ,624 Accumulated depreciation at 1st April ,601 Charged during the year 7,268 Other in year revaluation (294) Accumulated depreciation at 31st March ,575 Net book value Purchased at 31st March ,453 Donated at 31st March ,220 Total at 31st March ,673 Number Value ( 000) Total NHS bills paid 2,456 25,722 Total NHS bills paid within target ,075 Net book value Purchased at 31st March ,539 Donated at 31st March ,510 Total at 31st March ,049 Percentage of NHS bills paid within target 38% 66% The Better Payment Practice Code requires the Trust to aim to pay all valid invoices by the due date or within 30 days of receipt of goods or a valid invoice, whichever is later. 5. External financing The Trust is given an external financing limit which it is permitted to undershoot. 2005/ / External financing limit (7,306) 255 set by the Department of Health Cash flow financing (7,306) 255 External financing requirement (7,306) 255 Undershoot (overshoot)

50 RB&H annual performance review and accounts 6. Capital resource limit The Trust is given a Capital Resource Limit which it is not permitted to overspend 7. Trust formation The Trust was established on 1st April 1998 under Statutory Instrument 1998 no. 784 (Royal Brompton and Harefield NHS Trust (Establishment) Order 1998). 8. Related party transactions 2005/ / Gross capital expenditure (5,505) 4,884 Less: donations (1,256) 0 Charge against the CRL 4,249 4,884 Capital resource limit 4,249 4,884 (Over)underspend against 0 0 the CRL The Royal Brompton and Harefield NHS Trust is a body corporate established by order of the Secretary of State for Health. During the year none of the Board Members or key management staff or parties related to them has undertaken any material transactions with the Royal Brompton & Harefield NHS Trust. The Department of Health is regarded as a related party. During the year the Trust has had a significant number of material transactions with the Department, and with other entities for which the Department is regarded as the parent Department via UK Strategic Health Authorities, Primary Care Trusts, other NHS Trusts, the NHS Litigation Authority and NHS Logistics. In addition, the Trust has had a number of material transactions with other Government Departments and other central and local Government bodies. Most of these transactions have been with the Imperial College of Science, Technology and Medicine, the University of London (relating to research projects), the London Borough of Hillingdon and the Royal Borough of Kensington and Chelsea (relating to non-domestic rates). The Trust operates in close collaboration with the National Heart & Lung Institute of the Imperial College of Science, Technology and Medicine to deliver education, research and medical care. The Trust has also received from the Royal Brompton and Harefield Charitable Fund, funding for benefits ( 598,000), Research activity ( 2,260,000), and contributions towards fixed assets ( 553,000). The Trust acts as its Corporate Trustee. The audited accounts of the Charitable Fund are available separately. Sir Michael Partridge, who is a member of the Charitable Funds Management Committee, was paid 15,000 for chairing a panel for the Trust during the last quarter of the 2005/06 financial year. 9. Audit costs Auditor's remuneration includes 168,000 for audit services provided by Deloitte & Touche LLP. As per the code of audit practice, the cost of audit services includes the auditing of the financial statements and the use of resources. The auditing of the use of resources involves reviewing the arrangements for securing economy, efficiency and effectiveness. This is assessed through a combination of national audits which are determined by the Healthcare Commission and locally agreed risk based audits. Finance Committee (as at 31st March 2006) Mr. Charles Perrin (Chairman) Mr. Robert Bell Mrs. Mary Leadbeater Professor Duncan Geddes Professor Anthony Newman Taylor Professor Malcolm Green Dr. Charles Ilsley Mr. Nicholas Hunt Mr. Patrick Mitchell Dr. Caroline Shuldham Mr. Anthony Vickers Remuneration Committee (as at 31st March 2006) Lord Newton of Braintree (Chairman) Vacancy Non Executive Director (previously Mrs. Isabel Boyer until 30/11/05) Mr. Charles Perrin Charitable Funds Management Committee (as at 31st March 2006) Mr. Charles Perrin (Chairman) Mrs. Isabel Boyer (until 30/11/05) Mr. Robert Bell Ms. Maria Cabrelli Mrs. Mary Leadbeater Mr. Patrick Mitchell Professor Anthony Newman Taylor Dr. Rosemary Radley-Smith Sir Michael Partridge Risk Strategy Committee (as at 31st March 2006) Mrs. Suzanne McCarthy (Chair) Mr. Roger Brealey Mr. Robert Craig Professor Timothy Evans Mr. Robert Bell Dr. Libby Haxby Mrs. Lyn Jenkins Mrs. Mary Leadbeater Mr. Patrick Mitchell Dr. Caroline Shuldham Mr. Steve Syer Ms. Josephine Ocloo Mr. Anthony Vickers Audit Committee (at 31st March 2006) Mr. Charles Perrin (Chairman)* Professor Malcolm Green Mrs. Jennifer Hill Mrs Suzanne McCarthy * In October 2004, at the request of the Trust Board Chairman, Mr. Charles Perrin agreed to take on the chairmanship of the Audit Committee on a temporary basis until another appointment could be made. 50

51 Remuneration Report Membership of Remuneration and Terms of Service Committee Chairman - Lord Newton of Braintree (Trust Chairman) Mr Charles Perrin - (Non Executive Director and Trust Vice -Chairman) Mrs Christina Croft - (Non Executive Director) Mrs Jennifer Hill - (Non Executive Director) Mrs Suzanne McCarthy - (Non Executive Director) Professor Tony Newman Taylor - (Non Executive Director and Head of National Heart & Lung Institute) In attendance: Mr Robert J Bell - Chief Executive Mr Tony Vickers - HR Director From June 2006 the membership of the Remuneration and Terms of Service Committee has included all non-executive directors. Mrs Christina Croft was appointed non-executive director of the Trust in May Statement of policy in current and future years The Remuneration and Terms of Service Committee advises the Trust Board on appropriate remuneration and terms of service for the Chief Executive, other executive directors and other senior managers reporting directly to the Chief Executive as specified by the Board. The Committee ensures that these very senior managers are fairly rewarded for their individual contribution to the Trust, having proper regard to the Trust s circumstances and performance and to the provisions of any national arrangements for such staff where appropriate. The Committee monitors and evaluates the performance of individual executive directors and also advises on appropriate contractual arrangements for such staff. The Committee will be advised by two external HR consultancies, Jackie Reeves Associates, and Hays HR Consulting, in respect of its deliberations during 2006/07. This will include a detailed comparison with the executive salary arrangements of other relevant NHS and non-nhs employers. Assessing performance The Committee has previously received recommendations from the Chief Executive concerning proposed performance related bonus payments for direct reports to the Chief Executive. These payments were paid against individual and Trust business targets as a result of the Trust being awarded a three star rating by the Healthcare Commission in respect of 2003/04 and 2004/05. Individual annual performance bonus payments of between 4,000 and 7,000 were paid in respect of performance during this period. Such sums were not consolidated into basic salaries, and were not pensionable. Any prior performance bonus arrangements are currently in abeyance pending the review of remuneration arrangements for very senior managers. Policy on duration of contracts, notice periods and termination payments The policy on duration of contracts, notice periods and termination payments for each executive director is determined by the Remuneration and Terms of Service Committee on the appointment of each postholder. Arrangements for those serving in 2005/06 are detailed below: Chief Executive (appointed 28th March 2005) - 12 months from employer and six months from employee. Director of Nursing & Quality (appointed 5th May 1998), Finance Director (appointed 1st July 1999), and Operations Director (appointed 12th June 2000) - six months by either party. Medical Director (appointed 5th May 2005); Deputy Chief Executive and Director of Research and Academic Affairs (appointed 1st April 2005 until 31st March 2006) - three months by either party. All the above appointments are permanent with the exception of the Medical Director, whose appointment from within the Trust consultant body is subject to periodic review. Please note that the Deputy Chief Executive and the Director of Research and Academic Affairs roles were reallocated to other senior staff following the appointment of Professor A. Newman Taylor as Head of the National Heart and Lung Institute and Non Executive Director on 1st April The duration of contracts, notice periods and termination payments for the Trust Chairman and non executive directors are determined by the Department of Health. Below are listed the details of those serving in 2005/06: Lord Newton of Braintree (Chairman) - appointed 1st April 2001, term of office until 30th November 2008; Charles Perrin (Vice Chairman) - appointed 1st April 1994, term of office until 30th November 2007; Suzanne McCarthy - appointed 1st April 1998, term of office until 30th November 2006; Jenny Hill - appointed 1st December 2005 term of office until 30th November 2009; Professor Malcolm Green - appointed 1st February 2002, ceased in office on 31st March 2006; Isabel Boyer - appointed 20th July 1998, ceased in office on 30th November 2005; Sonya Bhatt - appointed 1st July 2005, ceased in office on 31st January Robert J Bell, Chief Executive 51

52 RB&H annual performance review and accounts Salary and pension entitlements of senior managers Remuneration (Restated) Name and title Salary Performance pay Other remuneration Benefits in kind Salary Performance pay Other remuneration Benefits in kind Robert J. Bell, Chief Executive (appointed March 2005) I. Boyer, Non Executive Director Prof. T Evans, Medical Director Dr. G. Goodier, Chief Executive (left 31/8/04) R. Gorlin, Associate Non Executive Director (deceased) Prof. M. Green, Non-Executive Director (retired 31/3/06) M. Leadbeater, Director of Finance S. McCarthy, Non-Executive Director P. Mitchell, Director of Operations Prof.A. Newman Taylor, Deputy Chief Executive and Director of Research & Academic Affairs Lord Newton of Braintree, Chairman C. Shuldham, Director of Nursing & Quality J. Hill, Non-Executive Director (from 1/12/05) S. Bhatt, Non-Executive Director (from 1/7/05 to 31/1/06) (bands of 5,000) (bands of 5,000) (bands of 5,000) Rounded to the nearest 100 (bands of 5,000) (bands of 5,000) (bands of 5,000) Rounded to the nearest 100 Prof. A. Newman Taylor was Deputy Chief Executive and Director of Research & Academic Affairs between 1st April 2005 and 31st March He was appointed Non Executive Director on 1st April 2006 and replaced Prof. M. Green as Head of the National Heart and Lung Institute from 1st April Mrs. S. Bhatt resigned on 31st January 2006 and was replaced by Mrs C. Croft as Non Executive Director from 1st April Mrs I. Boyer ceased to be a Non Executive Director on 30th November 2005 when her term of appointment ended. She was replaced by Mrs J. Hill on 1st December Dr. G. Goodier left the Trust to join another NHS organisation on 31st August Mr. Gorlin passed away during 2004/05 Mr. C. Perrin (Vice Chairman) waived his entitlement to remuneration during both years. 52

53 Pension entitlements of senior managers Pension benefits* Name and title Real increase in pension and related lump sum at age 60 at 31st March 2006 Total accrued pension and related lump sum at age 60 at 31st March 2006 Cash equivalent transfer value at 31st March 2006 Cash equivalent transfer value at 31st March 2005 Real increase in cash equivalent transfer value Employers contribution to Stakeholder Pension (bands of 2,500) 000 (bands of 5,000) To nearest 100 Robert J. Bell, Chief Executive Prof. T Evans, Medical Director Dr. G. Goodier, Chief Executive (left 31/8/04) M. Leadbeater, Director of Finance P. Mitchell, Director of Operations Prof.A. Newman Taylor, Deputy Chief Executive and Director of Research & Academic Affairs C. Shuldham, Director of Nursing & Quality , * From 2005/06 all pension calculations will be provided by NHS Pensions Agency. In 2004/05 some pension calculations were calculated internally and may have been underestimated, resulting in two cases showing higher real increase in pension and related lump sum at age 60 at 31st March As Non Executive members do not receive pensionable remuneration, there will be no entries in respect of pensions for Non Executive members. A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member's accrued benefits and any contingent spouse's pension payable from the scheme. A CETV is a payment made by a pension scheme, or arrangement to secure pension benefits in another pension scheme of arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which the disclosure applies. The CETV figures, and from the other pension details, include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETV are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries. Real increase in CETV - This reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another pension scheme or arrangement) and uses common market valuation factors for the started and end of the period. 53

54 Royal Brompton & Harefield Hospital Charitable Fund Annual report for the year ended 31st March 2006 The Royal Brompton & Harefield Hospital Charitable Fund was created in 1998, following the merger of the Royal Brompton and Harefield Hospitals, to generate income for projects which are outside the scope of NHS funding. The Charity receives grants, donations and holds funds that finance research, medical equipment and amenities for patients and staff at Harefield and Royal Brompton Hospitals. During the year the Charity incurred 6.4m of Charitable Expenditure of which 2.4m was for restricted purposes and 4m for unrestricted purposes. The Charity also generated income of 5.8m of which 2.6m was restricted, 3m unrestricted and 0.2m was endowment. At 31st March 2006 the Charity had 66.4m of funds of which 57m was unrestricted, 9.1m was restricted, with 0.3m of endowment funds. Approximately half of the Charity s income during the past year came from donations and legacies. Sincere thanks go to all donors and volunteers who have contributed to this effort. This generous support provides vital research, equipment, and enhanced facilities to improve the quality of life for patients and staff. Examples of some projects funded are listed in this report. All donations are welcome and make a difference. Continued support will ensure the Trust remains innovative in the diagnosis, treatment and care of patients with heart and lung disease. The Charity s annual report and accounts for the year ended 31st March 2006 have been prepared by the Corporate Trustee which is the Royal Brompton & Harefield NHS Trust, in accordance with Part VI of the Charities Act 1993 and the Charities (Accounts & Reports) Regulations The Charity s report and accounts include all the separately established funds for which the Royal Brompton & Harefield NHS Trust is the main beneficiary. This report provides a summary of the accounts; the full audited annual accounts of the Charity are available as a separate booklet from the address on page 61. Objectives and activities The objectives of the Charity as stated in its governing document, the Charity Commission scheme dated 19th April 1999, are to further such Charitable purpose or purposes as the Trustees think fit, relating; a) To hospital services of the Royal Brompton & Harefield NHS Trust, including research, or b) To any other part of the service associated with any hospital. In meeting these objectives the Charity aims to maximise the income generated through fundraising and investment management and to use as much of the income as possible to provide grants for the benefit of the NHS Trust. Therefore the Charity aims to break-even or operate at a deficit each year, maximising the grants provided without having a materially adverse effect on the long-term income from investments. Grants distribution policy Unrestricted funds The Charity has both restricted and unrestricted funds. Restricted funds are given to the Charity for purposes specified by the donor and used in accordance with the donor s wishes. These restricted funds are spent mainly on research and medical equipment. Unrestricted funds may be used for general purposes for the benefit of the hospitals. The Charity has adopted the following guidelines for the annual allocation of unrestricted funds in accordance with the needs of the Royal Brompton and Harefield Hospitals: 15% 15% 15% 25% Research Medical equipment Staff amenities 30% Patient amenities Strategic initiative These percentages are applied after taking into account depreciation, administration and fundraising costs and costs incurred in maintaining and upgrading charitable property. Using these criteria the actual percentages achieved in 2005/6 were: 54

55 Research (18.5%), Medical Equipment (36%), Staff Amenities (21%), Patient Amenities (14%), and Strategic Initiatives (10.5%). During 2005/06, the percentage allocated for Medical Equipment and Staff Amenities was higher than the guidelines due to an additional grant made of 348,000 for the purchase of Medical Equipment for the Imaging Department of the Trust and two additional grants totalling 75,000 related to Staff Amenities. In some cases where the grants are payable over a period of more than one year, as in this instance, under the Statement of Recommended Practice (SORP), grants that are over more than one year are fully recognised in the year the grant is made. However over a period of years, the expenditure over various categories evens out and is close to the percentage guidelines shown above. The NHS Trust requests applications for funding as part of its annual business process. From the applications, the Trust chooses a list of items that it feels are suitable to be considered eligible for funding from Charitable Funds. The list is put forward to the Charitable Funds Management Committee, which chooses the most appropriate projects that the Charity should fund by considering the merits of each project and taking into account the percentage allocation above as a guide. Incoming resources 2005/06 Resources expended 2005/06 10% 50% 8% 1% 40% 40% 21% 9% 7% 14% 2005/ / Donations and legacies 2,879 2,848 Investment income 2,337 2,414 Rent from accommodation properties Total 5,822 5, / / Research 2,573 3,498 Medical equipment Patient amenities Staff amenities Accommodation properties 1,373 1,245 Commercial properties & fundraising Governance costs Total resources expended 6,391 6,416 55