nhs westminster annual report web
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NHS WestminsterAnnual Reportwww.westminster.nhs.uk
CONTENTS
Foreword 4
About us 7
Our performance 8
Our strategic five-year plan 14
1. Reducing health inequalities 18
2. Adding years to life 20
3. Building a choice of quality healthcare 22
4. Adding life to years 23
5. Promoting healthy lifestyles 25
Directorate Reviews 28
1. Service Development 30
2. Public Health 36
3. Nursing and Quality 38
4. Finance and Performance Management 40
5. Human Resources and Corporate Affairs 44
Our Board 46
1. Members’ interests 50
Annual Accounts 54
We changed our name from Westminster Primary Care
Trust to NHS Westminster. This reflects our key role as
commissioners, that is strategic buyers, of healthcare.
Our aim is to focus local services as much on maintaining
healthy lifestyles and preventing ill health as they do on
treating sickness.
Our community service providers (including more than 34 different types of
healthcare workers from physiotherapists to nurses) are separating from us and
forming a new organisation with their counterparts in Kensington and Chelsea
and Hammersmith and Fulham. This will be known as Central London Community
Healthcare and will have enhanced freedom to determine its own future.
This will allow us to focus on our commissioning role.
FOreWOrd Welcome to the 2008/09 NhS WeStmiNSter ANNuAl report
This report outlines how the NHS in Westminster has been
working to improve the health and healthcare of Westminster
residents during the year.
we lAuNCHeD A Five-yeAR £94M iNveStMeNt PRogRAMMe, to CReAte New HeAltH CeNtReS, PRoviDe MoRe DeNtiStS AND iNCReASe tHe NuMBeR oF NuRSeS.
A year of improvement
residents are waiting less time than ever for hospital appointments, finding their doctors’ surgeries are open longer and being better supported in leading healthier lives.
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www.westminster.nhs.ukNhS WeStmiNSter ANNuAl report 08/09
5
Health services for our community
We spent over £390 million on health services for
our residents. They are able to be treated in some
of the country’s top performing hospitals. We’ve also
reduced treatment waiting times. Mental health
services have continued to expand with investment
in community care and psychological therapies,
as well as in hospitals.
Throughout the past year we have also been
working to bring more healthcare services closer to
home, and to improve patient choice. Our investment
in community services ensures there are now more
nurses and therapists available locally. We have also
worked with local GPs to extend opening hours.
One of the highlights of the year was Health Minister
Lord darzi launching our innovative community-based
cardiovascular disease prevention programme. Healthy
Hearts and Minds identifies residents with a more
than one-in-five chance of developing cardiovascular
disease. Patients are then offered health advice from
a community team of cardiologists, nurses, dieticians
and physiotherapists to help them reduce the risk of
having a heart attack or stroke.
Our programme of polysystems, across Westminster,
aims to provide a broad range of health and wellbeing
services for local communities – they are likely to
include district nurses and physiotherapists as well as
GP services. Improvements are also planned in dental
care, with two new practices expected in 2009.
In the past year we have had great success with
a proactive stop smoking campaign, which was
targeted at areas with the highest numbers of
smokers. As a result there was a 60% increase
in the uptake of smoking cessation advice at
pharmacies where personal help is given.
We listened
We are working alongside our partners to develop
health services that meet the needs of local people,
and we encourage them to help us develop services
that are relevant, easy to access and that make
a real difference in maintaining health.
£94mwill be spent over the next
four years to create new
health centres, provide
more dentists and increase
the number of nurses
£15.5m is what we’ve saved in
2008/09 to invest in our
major health improvement
programme
£390mwas spent on healthcare
for Westminster residents
in 2008/09
50%More than 50% of
Westminster GPs now
offer appointments outside
normal working hours
we Met tHe New 18 week tARget FRoM gP ReFeRRAl to tReAtMeNt. 78% oF PAtieNtS ARe Now BeiNg SeeN witHiN 12 weekS.
MoRe tHAN HAlF oF loCAl gPS Now oFFeR APPoiNtMeNtS outSiDe NoRMAl woRkiNg HouRS.
weStMiNSteR HAS MoRe PHARMACieS tHAN ANywHeRe elSe iN tHe CouNtRy.
Looking ahead
NHS Westminster has developed a strategic plan
looking forward to 2013. This includes measures
that will tell us if we’ve achieved our goals.
Most importantly we are working to reduce health
inequalities in Westminster. Further on in this report
you will find more information on our plans and
strategic goals.
Our financial performance has been strong and we
have ended the year with a surplus of £15.5 million
– which means we can invest in a major health
improvement programme.
Our staff have again rated us as one of the top
health employers in the country. We thank them for
their commitment and hard work that makes all our
achievements possible.
We look forward to the next year when we plan to
achieve real and lasting health benefits for everyone
who uses the NHS in Westminster.
Joe hegartyChair
Dr Dennis AbadiCEC Chair
michael ScottChief Executive
we SPoke to MoRe tHAN 1,600 PeoPle ABout tHeiR FutuRe viSioN oF HeAltHCARe. tHey exPReSSeD CoNCeRN ABout HeAltHCARe ASSoCiAteD iNFeCtioNS AND CANCeR wAitiNg tiMeS. we ARe ACtiNg oN tHoSe CoNCeRNS.
Health Minister Lord Darzi with Chief Executive Michael Scott, Chair Joe Hegarty and Public Health Consultant Dr Adrian Brown.
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk
7
Where are we based?
We have been based in the heart of
Westminster for the last six years and
are responsible for funding all
the health services across
the borough.
We share our boundaries
with the City of Westminster,
extending to regent’s Park in
the north, Queens Park in the
west and Covent Garden in the
east. Our southern boundary follows
the north bank of the river Thames.
What we do
We spend over £433 million each year
making sure people in Westminster
have the best of health and the best
of healthcare.
Planned changes across the NHS
in Westminster reflect our big
three priorities:
• choice - we will provide quality
information so you can choose
how and where you receive
your healthcare
• care closer to home - we are
providing care closer to your home
and linked to other services
• health - we all need to think about
healthier lifestyles and we want to
support you to achieve yours
AbOuT uS: WhAt iS NhS WeStmiNSter?
NHS Westminster is not a new organisation; it is the new
name for Westminster Primary Care Trust. The name reflects
our new focus as buyers of healthcare services rather than
providers of healthcare.
90.07% £390m Commissioning of healthcare
£160m Maternity, general, Acute, A&e
£72m Mental health
£43m Community health services
£40m gP services
£26m Prescribing costs
£14m Dental services
£10m learning difficulties
£25m other contractual services
Who we listen to and who we
work for
We exist to improve the health and
wellbeing of our local residents. So we
listen closely to what you have to say.
We ask for your feedback through
surveys, meetings, events and so on.
Check www.westminster.nhs.uk for
upcoming events, or call freephone
0800 587 8818.
What we spend your money on:
•Familydoctors
•Dentists,opticiansandpharmacies
•Communityservices
•Hospitalcare
•Promotinghealthyliving
•Mentalhealth
9.93% £43m Property and other corporate costs
Bayswater Road
Marylebone Road
Park Road
Wellington Road
Abbey Road
Lisson Grove
Maida Vale
Oxford Street
Piccad
illy
Oxford Street
Grosvenor Street
Knightsbridge
Kensington Road
Street
Sloane
Birdcage Walk
Grosvenor Road
Vauxhall Bridge Road
Victoria Street
Buc
king
ham
Pal
ace
Roa
d
The M
all
Strand
Vict
oria
Edgware Road
Park Lane
Regent S
treet
Baker S
treetGloucester Terrace
HYDE PARK
REGENT’SPARK
our performANce
This is a snapshot of our performance over the last year.
Care Quality Commission Annual Health Check – at a glance
3 Our rating improved from “Fair” to “Good” – this means we delivered
good quality services
3 We are in the top 20% of trusts in London
3 For the second year in a row we were rated “Good” for our
use of resources – which means we spend your money wisely
3 Our substance misuse service was rated as excellent
3 An in-depth review of urgent care put Westminster in the
best Performing category
We were found to have improved services in: mental health, particularly crisis
resolution services; helping pregnant women to give up smoking; improving
access to genito-urinary clinics within 48 hours; chronic disease management;
and helping people with long term conditions remain at home longer through
support from community matrons.
(The Care Quality Commission released its findings for 2007/08 in October
2008. Findings for 2008/09 were not released in time for this report.)
Top 20%We are in the top 20%
of trusts in London, in
terms of performance
7 We met the 18 week
target seven months
ahead of schedule
Top 5We are in the top 5 for
urgent and emergency
care in London
excellentOur substance misuse
service was rated as
excellent by the Annual
Health Check
Jake Johnson with the Fit Squad
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk
9
NHS Westminster – the local leader
World Class Commissioning is a new, ground-breaking
approach to commissioning. It is designed to help
primary care trusts arrange for better services more
closely matched to local needs. This will result in
better quality care, improved health and wellbeing,
and a reduction in health inequalities across
the community.
Like every primary care trust, we were assessed
for our commissioning skills in three areas:
• Health outcomes – our priorities for health
improvements for local residents, including life
expectancy and health inequalities
• Organisational competencies – our knowledge,
skills, behaviours and characteristics that will
make our organisation world class
• Governance – our arrangements for managing
the organisation in the most effective way
possible. This includes developing areas such
as strategic, financial and organisational planning,
as well as the board’s controls and processes
NHS Westminster gained the top rating for our
strategy, vision and objectives. This included the
level of board ownership of our strategy, and the
consistency of our financial plan to deliver on it.
Getting treated faster –
exceeding the 18 week target
We not only met but exceeded the national target
for local patients to be treated within a maximum of
18 weeks. Figures from the department of Health
showed we met the target in May 2008, seven
months ahead of schedule.
by March 2009, 98% of patients who did not
require admission to hospital received treatment
within 18 weeks (ahead of the national target of
95%). 94% of patients who required a planned
admission to hospital were also treated within
18 weeks (ahead of the national target of 90%).
We are also speaking to private providers who can
meet NHS standards and prices – to provide more
choice for patients.
Urgent and emergency care
We were rated as one of the top five performers
in London for urgent and emergency care in the
Care Quality Commission report published in
September 2008.
The Care Quality Commission released a major review
covering all urgent and emergency services. For the
first time, this looked at how the whole system works.
It included all the major aspects of care, including
Accident & emergency, ambulance services, out-of-
hours GP services, NHS direct, urgent care provided
by GPs, and urgent care centres including walk-in
centres and minor injuries units.
The report gave us high scores for:
• public satisfaction with phone access
to GP surgeries
• the response time for GP out-of-hours services
to start telephone assessments of patients
• systems in place to ensure quality and safety
in GP out-of-hours services
• facilities for people with disabilities and systems
to protect vulnerable children and adults
unfortunately, we received lower scores for:
• Accident & emergency attendance for conditions
that could be treated in other settings
• patient satisfaction with GP opening times
We have already improved our GP opening times
and are working on bringing care closer to home,
which will improve the opportunities for patients to
receive care faster and more conveniently.
meetiNg our tArgetSExisting national targets
We were assessed against 17 existing national targets. We achieved 13, under achieved one and failed two.
One target was not assessed.
target rating
People with diabetes to be offered screening for the early detection of diabetic retinopathy Achieved
Maintain a maximum wait of 26 weeks for in-patients Achieved
Maintain a maximum wait of 13 weeks for an outpatient appointment Achieved
Maintain a maximum waiting time of two months from urgent referral to treatment for
all cancers
Achieved
All ambulance trusts to respond to 75% of category A calls within eight minutes Achieved
All ambulance trusts to respond to 95% of category A calls within 19 minutes after
the request has been made for transport
Achieved
All ambulance trusts to respond to 95% of category b calls within 19 minutes under achieved
Maintain delayed transfers of care at a minimal level Achieved
Maintain a maximum waiting time of one month from diagnosis to treatment for all cancers Achieved
every hospital appointment to be booked for the convenience of the patient, making it
easier for patients and their GPs to choose a hospital and consultant that best meets their
needs. Patients should be able to choose from at least four health care providers for
planned hospital care
Failed
Guaranteed access to a primary care professional within 24 hours and to a primary care
doctor within 48 hours
Failed
Improve life outcomes of adults and children with mental health problems by ensuring that
all patients who need them have access to crisis resolution services and a comprehensive
child and adolescent mental health service
Achieved
update practice-based registers so that patients with coronary heart disease and diabetes,
and the majority of patients at high risk of coronary heart disease, continue to receive
appropriate advice and treatment in line with national service framework standards
Achieved
Maintain a two week maximum wait from urgent GP referral to first outpatient appointment
for all urgent suspected cancer referrals
Achieved
Maintain the four hour maximum wait in A&e from arrival to admission, transfer or discharge Achieved
Maintain a three month maximum wait for revascularisation Achieved
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk
11
New national targets
The government’s new national targets are goals for the entire NHS. These aim to improve the health of the
population of england.
We were assessed against 13 targets. We achieved eight and under achieved five.
target rating
Achieve year on year reductions in MrSA levels, expanding to cover other healthcare
associated infections as data from mandatory surveillance becomes available
Achieved
Improve the quality of life and independence of vulnerable older people by increasing
the proportion being supported to live in their own home by 2008
Achieved
Increase the participation of problem drug users in drug treatment programmes by 2008;
and increase year on year the proportion of users successfully sustaining or completing
treatment programmes
Achieved
reduce health inequalities by 2010 Achieved
Secure sustained national improvements in NHS patient experience by 2008 Achieved
Halt the rise in obesity among children by 2010, as part of a broader strategy to tackle
obesity in the population as a whole
Achieved
ensure that by 2008 nobody waits more than 18 weeks from GP referral to
hospital treatment
Achieved
Improve health outcomes for people with long term conditions by offering a personalised
care plan for vulnerable people most at risk; and reduce emergency bed days by 2008
through improved care in primary care and community settings for people with long
term conditions
Achieved
reduce adult smoking rates by 2010 under
achieved
reduce the under-18 conception rate by 2010, as part of a broader strategy to improve
sexual health
under
achieved
Substantially reduce mortality rates from suicide and undetermined injury by 2010 under
achieved
Substantially reduce mortality rates from cancer by 2010 under
achieved
Substantially reduce mortality rates from heart disease, stroke and related diseases
by 2010
under
achieved
NHS WeSTMINSTer – iNVeStiNg iN better heAlth
A five-year investment programme of £94 million is already
changing healthcare in Westminster for the better. We spent
more than £23 million on this programme in 2008/09.
For NHS Westminster to achieve its ambitious goals and see a measurable improvement in health there must be a change in how we work and how we deliver care.
In 2008/09 our major investments included:
• £2.5 million to reduce health inequalities – including £400,000 on
transforming community nursing in Westminster
• £1.4 million to add years to life – including £700,000 on cardiovascular
disease prevention and cardiac rehabilitation
• £6.6 million to build a choice of quality healthcare – including £1 million to
ensure a maximum waiting time for patients of 12 weeks for planned care;
£1.4 million to increase the number of staff working at the Gordon and
St Charles Hospitals for Westminster residents receiving in-patient mental
health care; £1 million to ensure GP premises for Westminster residents are
of the standards required; and investments of up to half a million pounds in
individual practice-based GP commissioning clusters
• £2.7 million to add life to years – including £770,000 invested in a community
cardiac team
• £1.2 million to promote healthy lifestyles – including more than £400,000 in
addressing obesity in children and adults and more than £200,000 in our stop
smoking service
92%rated their overall experience of using
Westminster’s community health services
as excellent or good
92% said they were seen on time or within
a given time frame
ASk youR PAtieNtS week 2008 SuRvey ReSultS
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk
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Looking forward
Our investment programme for 2009/10 includes
£3.8 million in mental health services, £3.6 million in
primary care facilities and more than £6 million in
developing Westminster’s first community health
hubs or ‘polysystems’.
A new GP-led health centre will bring care closer
to home and to make it easier to see a GP
in Westminster.
The extra GP services at Queens Park will make it
easier to see a GP in Westminster. The new family
doctor drop-in services will be open for everyone
who lives, works or visits Westminster from 8am to
8pm, seven days a week. The new services will be in
addition to existing GP services and will make it
easier for everyone to see a doctor or nurse quickly,
at a convenient time. Patients can book an
appointment or simply turn up – without having
to face long, and sometimes worrying, waits.
Why polysystems?
residents said that they want to be able to see
a GP and access more health services more easily
– especially during weekends and evenings and
without having to take time off work.
What is a polysystem?
A polysystem is a health system that provides
a wide range of health and wellbeing services to
a local community, closer to home. Our polysystems
will have a central services “hub” and a network of
linked GP practices. The “hub” will be in a building
similar to a large health centre but will offer a far
wider range of services. In addition to GP services,
there will be services such as district nursing, health
visiting and physiotherapy. There will also be
specialist services such as outpatient clinics and
associated diagnostics services (like X-ray), and
health and wellbeing services such as managing
weight and how to stop smoking.
A team from NHS Westminster beat 50 others
to win in the Primary Care category, at the
Involvement to Impact Awards 2008. during
Ask Your Patients week, we used online and
paper questionnaires, and encouraged teenagers
to take part by using video booths. We spoke to
more than 2,200 people and turned their feedback
into action.
66% said they had seen the healthcare
professional’s Id
83% said they felt confident with
hygiene standards
98%had high satisfaction (‘excellent’
or ‘Good’) with a pilot community
blood-clotting prevention service
to bring care closer to home
Emily Savin and Simon Hope from NHS Westminster with Westminster residents at a polysystem consultation.
You told us… we listened
www.westminster.nhs.uk
OUR STRATEgiC FivE-YEAR plAN
Our STrATeGIC PLAN SeTS OuT our ViSioN from NoW to 2013
In partnership with our practice-based commissioning clusters,
over the next five years we will work with Westminster City
Council, a range of healthcare providers and other local
partners, to lead local healthcare improvements.
Five years – five strategic objectives
To achieve our vision, we have set five strategic goals:
1. 0 reducing health inequalities
2. 0 Adding years to life
3. 0 building a choice of quality healthcare
4. 0 Adding life to years
5. 0 Promoting healthy lifestyles
10 health outcomes
NHS Westminster has put in place 10 health outcomes that will show if our
strategy has succeeded. These are to:
1. 0 reduce overall health inequalities, including reducing the size of the gap in
life expectancy between the most affluent and those on the lowest incomes.
We intend to reduce this by 10% by 2012 measured according to the
nationally recognised Index of Multiple deprivation (IMd) score.
2. 0 Increase the overall average number of years people in Westminster are
expected to live.
3. 0 Achieve 98% coverage of children under five who complete both doses
of the mumps, measles and rubella (MMr) vaccine by 2013. Westminster
and London are below the national target of 95% (required for herd
immunity which protects those unable to be vaccinated due to medical
contraindications). The capital therefore is at risk of a measles epidemic.
4. 0 Increase the proportion of women aged 53 to 64 who are screened every
three years for breast cancer. The proportion of Westminster women who
take these regular tests is substantially below the national average.
5. 0 reduce the number of people who die from heart disease. This is the single
biggest cause of premature death in Westminster and the main reason why
people on lower incomes die younger than more affluent people.
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17
6. 0 reduce the number of people who die from
diseases related to breathing and circulation,
such as bronchitis, emphysema and other
diseases of the lungs. This is the second
biggest contributor to why people on lower
incomes die younger. The biggest cause of
these diseases is smoking and we aim to
reduce the level of smoking in young people
and adults to 10% of the population by 2013.
7. 0 Cut the rate of Clostridium difficile (known as
C-diff) in patients who go into hospital. C-diff
is a healthcare acquired infection to which older
people are particularly susceptible. Hospital
infection control is a key priority both for us and
Westminster residents.
8. 0 reduce the numbers of people who are
admitted to hospital because of harm caused
by alcohol. There is growing concern about how
many people need hospital care because of the
effects of alcohol consumption.
9.0 reduce the proportion of primary school-aged
children who are recorded as being obese. There
is growing concern about the rates of childhood
obesity, which rises sharply between starting
primary school and secondary school.
10. Increase the numbers of people with mental
health problems who receive psychological
therapies. The proportion of Westminster’s
population with mental health problems is
relatively high and not everybody is getting
the help and treatment they need.
Who we work with
Our key partners include Westminster City Council,
Imperial College Healthcare NHS Trust, Chelsea and
Westminster Hospitals NHS Foundation Trust,
university College London Hospital NHS Foundation
Trust, Central and North West London NHS Foundation
Trust, Central London Community Healthcare,
neighbouring primary care trusts, i.e. Kensington and
Chelsea, Hammersmith and Fulham, brent and
Camden, NHS London, London Ambulance Service,
Metropolitan Police, Voluntary Action Westminster,
black and Minority ethnic Health Forum, the Carers
Network, Westminster Local Involvement Network
(LINk) and other organisations in the voluntary sector.
We set these four targets after consultation and
engagement with local residents:
• reduce the proportion of our population that
smokes from around a quarter where it is now,
to one adult in ten or less.
• Measure the experience that patients and users
actually have of the NHS, so we know how
patients really feel about NHS services. We will
involve patients and their families, who will help
us make real and tangible improvements.
• reduce the level of MrSA infection in hospital.
• everyone who is diagnosed by their GP as
potentially having cancer beginning their treatment
within 31 days. by 2013 we want all patients who
have a full diagnosis of cancer to have begun their
treatment within nine days or less.
Our local targets
A Westminster resident at the Westminster Health Debate.
Our STrATeGIC FIVe-YeAr PLAN 1. reDuciNg heAlth iNequAlitieS
Overall the health of people living in Westminster is good.
However, people on different incomes and from different
backgrounds have very different levels of health. We are
working to narrow these gaps, including gaps between the
wealthiest and those on the lowest incomes, between men
and women and between different ethnic groups.
12.7 yrsThere are significant differences
in life expectancy between
Westminster’s wards with a gap
of up to 12.7 years for men and
12.6 years for women
x2 People living in the most deprived
areas of Westminster experience
twice the rate of coronary heart
disease and death from stroke,
as those living in the least
deprived areas
x6 Type 2 diabetes is up to six times
more common in people of South
Asian descent and up to three times
more common in those of African
and Caribbean descent than in the
general population
DiFFeReNCeS iN HeAltH
NHS Westminster, with City Partnership colleagues, has developed a five-year strategy to address health inequalities. It includes tackling the causes, reducing the impact, and improving the health of all Westminster residents.
Healthy Futures
This project takes an innovative approach to breaking the cycle of declining
health among residents who find it hard to access mainstream services and
opportunities. The project includes:
healthy people: Health MOTs are available at community centres.
These support residents in choosing healthy lifestyles, including stopping
smoking, increasing physical activity and healthy eating.
Above left: Lord Darzi and Dr Adrian Brown, Consultant in Public Health at the launch of Healthy Hearts and Minds
Above right: Marina, who attended our Understanding Health Improvement course, part of our Health Trainers programme.
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk
19
Local GP practices and NHS Westminster took part
in the national catch-up programme for all children
aged 13 months to 18 years. It was successful, with
the number taking the first dose of the MMr
vaccination increasing by 10% to 89%.
We are nearing the 95% recommended by the
World Health Organization (WHO) to ensure
protection for the whole community (including those
unable to have the vaccine for medical reasons).
The number of children getting the second dose of
MMr more than doubled during the programme.
67% of children have now had the vaccine.
Measles, Mumps and Rubella (MMR) catch-up campaign
healthy homes: environmental health officers
carry out home health improvement in people’s
homes. They identify people who can get help
with home adaptations, fuel poverty and winter
warmth payments.
health trainers: This is an accredited scheme that
trains local people to provide key health messages
within their community. This includes giving information
and advice on the services available locally.
Healthy Hearts and Minds
In January 2009 Health Minister Lord darzi launched
an innovative community-based cardiovascular
disease prevention programme in Westminster –
Healthy Hearts and Minds. This is designed to tackle
the biggest killers and causes of premature death,
heart disease and stroke.
Healthy Hearts and Minds identifies the residents
with a more than one in five chance of developing
cardiovascular disease. It will help them to make
lifestyle changes to reduce their chances of having
a heart attack or stroke.
Patients recruited to the programme are offered
one-to-one assessments and health advice from
a team of cardiologists, nurses, dieticians and
physiotherapists. In regular sessions at community
venues they will be able take part in supervised
exercise classes, workshops on healthy eating,
diabetes, blood pressure management and how
to stop smoking.
Improving access to psychological therapies
We have expanded our cognitive behavioural therapy
workers from 5 to 11 (funding we won through the
department of Health).
We will also support people with mental health
problems to return to work or stay in their jobs.
These new services will help reduce health
inequalities and regenerate Westminster by:
• ensuring that people who need access to primary
care mental health services for anxiety and
depression receive them rapidly
• helping people to stay in work or return to work
and supporting those who have recently been
made redundant
• creating jobs for local people in both the NHS
and the voluntary sector, through investment in
the local economy
BY 2013 WE Will
• Reduceoverallhealthinequalities
• Increaseaveragenumberofyearspeoplein
Westminster are expected to live
• Increaseproportionofchildrenunderfivewho
get both doses of the MMr vaccine
Our STrATeGIC FIVe-YeAr PLAN 2. ADDiNg yeArS to life
Preventable ill health and disease is one of the major causes
of premature death in Westminster.
We will change this by working to prevent ill health, diagnosing disease much earlier and giving people more rapid access to specialist centres of excellence. This will give many more Westminster residents a better chance of living longer.
Cancer
In Westminster, cancer accounts for 33% of premature deaths in men and 41%
of those in women. The main causes of premature cancer death in men are lung
and bowel cancer. In women they are
breast, bowel and lung cancer.
We are working to ensure that people
use cancer screening programmes
(cervical, breast and bowel), promoting
healthy lifestyles, and we are improving access to cancer treatment services. This
means that people who develop cancer receive treatment as early as possible.
After talking with local residents, we have set ourselves local cancer targets:
• everyone who is diagnosed by their GP as potentially having cancer should
begin their treatment within 31 days
• by 2012 we want all patients who have cancer to have begun their treatment
within nine days or less of their diagnosis
eARly CHeCk uP iS tHe MoSt iMPoRtANt tHiNg, BeCAuSe PReveNtioN iS BetteR tHAN CuRe!Mr Kasim, Harrow Road
3 daysOne woman in Westminster
is diagnosed with cancer
every three days.
1 in 8For every eight women
diagnosed with breast
cancer, one will be spared
a mastectomy.
90%90 per cent of care
currently delivered at
hospital outpatient
departments will be
delivered by the new
community cardiac team.
170,000”NHS Westminster sets
a gold standard for the
prevention of heart attack
and stroke, which kills
170,000 people every year
in the uK.” Health Minister
Lord darzi
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk
21
MyAction
MyAction is a new and rapidly growing programme
in heart disease prevention. It integrates the care
of patients with cardiovascular disease (and their
families) and those at high risk of developing
atherosclerotic disease, within a convenient local
community setting.
In Westminster, we will provide the programme
to around 1,500 families each year, in seven
community centres.
Community Cardiac Team
This year we commissioned a new service to move
the care of patients with cardiovascular disease into
the community. We plan to integrate it with MyAction
and our new polysystems.
The services will be consultant-led with a range of
new specialist nurse posts. It will be a one-stop shop
for diagnostics and patient clinical management
plans. It will also move patients out of hospitals and
into the community. because they are run by clinical
specialists, patients will have world class expertise
closer to home.
BY 2013 WE Will
• Increasetheproportionof54-to64-year-
old women who are screened every three
years for breast cancer
• Reducethenumberofpeoplewhodie
from heart disease – the single biggest
cause of premature death in Westminster
and the main reason poorer people die
younger than wealthier people
HeARt DiSeASe AND StRoke ARe tHe BiggeSt CoNtRiButiNg FACtoRS to tHe HeAltH iNeQuAlitieS tHAt exiSt BetweeN RiCH AND PooR, Not oNly iN weStMiNSteR witH itS DiveRSe PoPulAtioN, But ACRoSS tHe uk.
Our STrATeGIC FIVe-YeAr PLAN 3. builDiNg A choice of quAlity heAlthcAre
The NHS now allows all patients to be treated at any hospital
of their choice. We’re working to ensure residents are aware
of their right to choose the care that is best for them.
Since december 2008, more than half the GP practices in Westminster offer patients longer opening times. This includes before 8.00am, after 6.30pm in the evening and on Saturday mornings. We are now planning extra GP services which will open from 8.00am to 8.00pm, seven days a week.
We’ve commissioned a GP-led health centre which should help patients see GPs and get primary care services when they need them – patients had told us that they found it difficult to see a GP at a convenient time.
The launch of our practice nursing scheme funds more nursing hours – giving
more appointment choices for patients wanting to see a practice nurse.
Local residents also told us that more dental surgeries were needed to give
them easy access to NHS dental care. We are making major improvements
to dental care with two new practices opening in 2009.
both new surgeries will be offering
longer opening hours and services for
patients with disabilities and phobias.
It is planned that the new surgeries
will cover 3,000 new patients by 2010
and that this will increase to 5,000 by
March 2011.
We have enough dentists for all
Westminster residents to register and
receive NHS dental care.
For a list of dentists accepting new patients and clear guidance on charges
visit www.westminster.nhs.uk, call freephone 0800 587 8818 or email
gp-led
heath centres
•open8amto8pm,
7 days a week
•GPappointments
•walk-inservices
•forregisteredand
non-registered
patients
we StARteD oFFeRiNg A lAte NigHt weDNeSDAy SuRgeRy uNtil 8PM AND A SAtuRDAy MoRNiNg oPeNiNg. ouR FiRSt week wAS Fully BookeD! ouR PAtieNtS HAve welCoMeD tHe New, CoNveNieNt tiMeS. Mandy Walsh, Practice Manager at Bayswater Medical Centre in Craven Road, W2
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk
23
Our STrATeGIC FIVe-YeAr PLAN 4. ADDiNg life to yeArS
Many people live with illness for a significant part of their lives.
We are working to improve the quality of their life, as well
as their lifespan, by tailoring care to their particular needs,
preferences and expectations. Where possible, we also aim
to keep patients out of hospital.
Care pathways
In 2008/09, we redesigned care pathways for clinical areas including
musculoskeletal services, dermatology, gynaecology and ear nose and throat.
The new pathways mean more services will be available in the community, as
most of these services are currently provided in hospital. We are working to have
care closer to home wherever possible.
A wide range of local clinicians have been involved in developing the new pathways,
including GPs, hospital consultants, nurses and physiotherapists. Local people were
also asked their opinions and provided ideas and feedback into the project.
The new pathways will be commissioned during 2009 and patients will be able
to have specialist care at a clinic close to their home.
Closer to home
More health services are being provided at or near the home than ever before
and people in Westminster have better access to high quality care. This particularly
helps people with long-term conditions such as asthma and diabetes to stay
healthy and independent for as long as possible.
NHS Westminster will also be funding more staff to work in the community with
increased community nursing, therapists and services to support people with
mental health problems.
Audrey Lewis, Clinical Lead for Healthy Choices/Obesity
A new team has been formed to help patients
who have suffered a stroke to leave hospital earlier.
When they return home, they are supported by an
expert team taking hospital level care into
the community.
Patients have welcomed a new community blood
clotting prevention service which gives them the
opportunity to be treated locally – or at home if they
are unable to make it to the local clinics.
Learning disabilities
NHS Westminster was praised by a national
independent inquiry for good practice in providing
health services for people with learning disabilities.
(The Independent Inquiry into Access to Healthcare
for People with Learning disabilities cited the Trust’s
work in their report released on 29 July 2008.)
NHS Westminster has developed a unique service in
conjunction with local GPs. This was developed after
listening to local people with learning disabilities and
their carers, who said that better access to health
services was needed.
People with learning disabilities now get to see
their GP at least once a year for a health check –
which includes everything from diet to sexual health
and foot care. They then develop an individual
health action plan, with their GP.
Since the new service started, blood pressure
recordings have doubled from 41% to 82.5%.
These health checks have also given us vital public
health information that we use to improve other
services such as dentistry, sexual health and weight
management for people with learning disabilities.
Since the health checks started, referrals have
increased almost tenfold.
Expert patients programme
This is a free, six week course giving you the
confidence, skills and knowledge to manage
your condition better, and reduce its impact on
your daily life. Courses are led by tutors living
with long term conditions themselves.
Call our Patient Advice and Liaison Service
(PALS) Freephone 0800 587 8818 or check
our website www.westminster.nhs.uk for
more information.
£3.6m £3.6m will be spent over three years
in community nursing services
£260,000 £260,000 in a new community-
based assessment and treatment
service for elderly patients
£540,000 £540,000 in a community-based
podiatry service which will start in
2009. More than 2,000 Westminster
residents told us what they wanted
from their local podiatry service
i HAve A HeAltH ACtioN PlAN. it’S ABout HeAltHy eAtiNg AND exeRCiSe. HeAltH ACtioN PlANS ARe veRy iMPoRtANt iF you HAve A HeAltH PRoBleM. Patricia, Learning Disability Partnership Board member
we HAve DouBleD tHe tAke-uP oF RoutiNe HeAltH teStS FoR PeoPle witH leARNiNg DiSABilitieS.
Matthew Morris and Dr Tom Mtandabar at a Health Check
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk
25
Our STrATeGIC FIVe-YeAr PLAN 5. promotiNg heAlthy lifeStyleS
London welcomes the world to its Olympic Games in three
years time, and we see our preparations for the Olympics as
a major opportunity to promote the need for us all to make
lifestyle changes that will improve our health and wellbeing.
Preventing illness is one of our major priorities. It includes raising awareness of,
as well as supporting, healthy lifestyles. There are six lifestyle areas we are
concentrating on:
1. Healthy eating
2. Physical activity
3. Smoking
4. Sexual health
5. Substance misuse
6. Mental health and wellbeing
KickStart – from strength to strength
Kickstart helps children and families in Westminster adopt a healthier
lifestyle. It’s a free 12-week after-school programme for children
above their ideal weight, who are aged 7-12, and their families.
Family-focused and hands on, the sessions are interactive and packed
with exciting activities including street dance, football and cooking.
The programme, which has been running since 2006, has helped over 60
children and their parents lead healthier lives. It uses behavioural change
strategies, healthy eating education and physical activity to help children and
families get healthier.
Drop in to Weigh In
In Westminster local schemes give support to residents to make healthy lifestyle and
food choices. Over 500 people have joined our ‘drop in to Weigh In’ scheme and lost
hundreds of kilos.
Our dieticians set up the free weight management service, to help people lose
weight and increase their knowledge and understanding of healthy eating principles
and a healthy lifestyle.
Supporting people to stop smoking
The Westminster Stop Smoking Service has helped just over
10,000 people quit smoking from 1 April 2003 – 31 March 2009.
kiCkStARt HAS BeeN gReAt Not juSt FoR My SoN, But FoR tHe wHole FAMily.Westminster Dad, Moifak Dib
kiDS ARe HeAltHieR wHeN tHeiR HoMeS ARe SMokeFRee.
This year we focussed on the areas with the heaviest
smokers: Westbourne Park, Queens Park, Church
Street, Harrow road, Warwick, Tachbrook, Churchill
and Vincent Square. Local pharmacies saw a
60% increase in referrals where one-on-one help
was available.
We have also been working to keep Westminster
homes “Smokefree”. We know second hand smoke
can cause cancer. So, we want to give families
in Westminster a reason to stop smoking around
their children. Our Smokefree project includes
a community-led programme of education, a social
marketing campaign, health promotion and a referral
to a stop smoking service if required.
Promoting Sexual Health
We aim to reduce the levels of HIV and other
sexually transmitted diseases, particularly in those
people under 25. We are adding to our sexual health
services and commissioning more community projects
to engage with young people around sexual health.
A significant element of this programme is our
chlamydia screening programme.
BY 2013 WE Will
•Havelessprimaryschool-agedchildren
recorded as being obese – obesity levels for
children rise sharply between starting primary
school and beginning secondary school
•Havelesspeopleadmittedtohospital
because of harm caused by alcohol. There
is growing concern about how many people
need hospital care because of the effects
of alcohol consumption
it iS vAluABle to See tHe DietiCiANS eACH week AND i eNjoy MeetiNg otHeR PeoPle At tHe SeSSioN FoR eNCouRAgeMeNt AND SuPPoRt AND AM FeeliNg HeAltHieR AS A ReSult. Now i Feel gooD ABout MySelF AND AM lookiNg FoRwARD to loSiNg MoRe iN 2009. David Fearn
4 Smokers are four times more likely
to quit with NHS support
24% of under-25s would not tell their
previous sexual partners that they
had chlamydia
500 More than 500 people have joined
our drop in to Weigh in scheme
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk
27
i HAve FouND it AN exCelleNt wAy oF loSiNg weigHt AS it iS RelAxiNg AND tHeRe iS No PReSSuRe. i tHiNk oF it AS HeAltHy eAtiNg, Not DietiNg. i MADe CHANgeS to My eAtiNg wHiCH HAS MADe A ReAl DiFFeReNCe AND i Now Feel BetteR, i go tHe gyM AND CAN RuN to tHe BuS. tHe FACt it’S FRee iS AN ADDeD iNCeNtive.Brenda Smith, Drop in to Weigh In participant
A Queens Park resident signing up to Smokefree Homes.
www.westminster.nhs.uk
DiRECTORATE REviEWS
dIreCTOrATe reVIeWS 1. SerVice DeVelopmeNt
Key achievements in 2008/09
Strategic and Joint Commissioning
• We invested £1 million to reduce waiting times for planned care – and since
July 2008, 95% of patients are now seen within 18 weeks
• We redesigned care pathways to move more clinical services away from
hospitals into the community to give patients care closer to home
• We helped GP Practices review the services they offer to make them more
accessible and convenient – with quicker and more proactive care.
• We developed an electrocardiogram reporting service, a falls prevention clinic
and an anticoagulation service
• based on an assessment of health needs in Westminster,
we developed new, three year commissioning strategies, that
bear in mind the needs of users, carers and the wider community
• We received “beacon” status for our joint strategic
commissioning, which means we have been recognised as
delivering best practice, from the IdeA programme on behalf
of the department for Communities and Local Government.
We plan to share our experiences in 2009/10
• We developed a procurement policy and a procurement competition dispute
resolution procedure for dealing with issues raised around individual tenders
• Major re-commissioning programmes have been implemented or are in
progress and include: the integration of drug and alcohol services; access to
psychological therapies; new supported housing for people with learning
disabilities; improved access to wheelchair services; and an overhaul of the
chlamydia screening programme
we ARe CReAtiNg joBS FoR loCAl PeoPle By eNCouRAgiNg ouR ReSiDeNtS to tRAiN AS PSyCHologiCAl tHeRAPy woRkeRS.
sectionthree
www.westminster.nhs.ukNhS WeStmiNSter ANNuAl report 08/09
31
• We are reviewing our contract portfolio to make
services more personalised and to give new
guidance on community health service and mental
health contracting
Mental Health
• We invested an extra £1.4 million to improve the
quality of care at the mental health in-patient
wards at Gordon Hospital and the St Charles’
Mental Health unit, including putting more staff
on the wards
• We secured additional investment to improve
access to psychological therapies by employing
14 low and high intensity, locally based, cognitive
behavioural therapy workers. This means that
more people get help for depression and anxiety
when they need it
• We commissioned a user-led website,
Go4mentalhealth.com which was conceived,
implemented, led and maintained by service users,
employs a website manager and a trained
volunteer team. More than 200 people have
visited the site each month since April 2008
• Westminster Forum, our local mental health user
group, organised three Open Forum events and
a user-led conference
Learning Disabilities
• We increased investment in learning disability
services to support young people moving from
children’s to adult’s services, and the resettlement
of people from NHS campuses
tHe Big PlAN outliNeS tHe joiNt CoMMiSSioNiNg StRAtegy FoR PeoPle witH leARNiNg DiSABilitieS oveR tHe Next tHRee yeARS. it CAN Be DowNloADeD FRoM tHe weStMiNSteR City CouNCil weBSite At: www.weStMiNSteR.gov.uk/wlDP/tHeBigPlAN
• As part of the local housing strategy for people
with learning disabilities, seven new flats with on
site support have been opened. We are working
with Westminster City Council to develop more
• Our locally enhanced service, to ensure people
with learning disabilities receive an annual health
assessment and health action plan, has been
acknowledged by the department of Health
as an example of best practice
• We have invested in oral hygiene, healthy living,
health and fitness projects – and a liaison post
at St Mary’s Hospital
• The Learning disability Partnership board
had elections for positions that included video
campaign addresses on the website. Over 100
people voted
Older People and Physical Disabilities
• A pilot scheme to support early discharge of
stroke patients from hospital has been set up.
This involves providing specialist multidisciplinary
stroke rehabilitation and care in the home setting.
The team includes home support, physiotherapy
and voluntary sector services, providing return to
work support, re-training, vocational rehabilitation
and so on
• Two hub projects, strategically attached to older
peoples’ housing units, provide drop-in centres for
patients over 50 years of age – allowing them
access to a range of services that help them stay
well and independent at home
• A new memory assessment service has been
commissioned as part of the development of
Chelsea and Westminster Hospital NHS
Foundation Trust opened a new state-of-the-art
HIV and sexual health centre in the heart of Soho
in March 2009. 56 dean Street, which replaced
the Trust’s Victoria Clinic at the South Westminster
Centre, has been designed to be welcoming and
friendly, with a social, rather than clinical, feel. It
provides a full range of HIV and sexual health
services and is even open during the evenings and
on Saturdays. It has proved popular with patients
- 23% more people used services at 56 dean
Street in the 4 months from 2 March - 31 July
compared with the same period last year at the
Victoria Clinic.
New sexual health centre at 56 Dean Street
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk
33
a dementia strategy. This service will ensure good
quality diagnosis and intervention for all, with easy,
direct access to services
• A survey was introduced to obtain patient
feedback on their experience of using major
home adaptations and community equipment. It is
influencing the way local services are developed
• At the Physical disabilities and Sensory Needs
Strategy stakeholder event, the aims and priorities
of the strategy for the next three years were agreed
by service users, carers and group members
HIV and Sexual Health
• We commissioned a range of services to screen
15-24 year olds in Westminster for chlamydia
which included screening in sexual health centres,
GP and pharmacy services, outreach in community
and social services, the www.check-kit.org.uk
website and marketing campaigns
• We currently have the third largest HIV positive
population in London. So, in partnership with
Westminster City Council, we carried out an HIV
needs assessment to ensure we have the right
services in place by April 2010. We’re aiming to
make HIV testing more accessible – in primary
care, out-patient services, and community and
social venues; provide support to people at times
of need, such as when they are first diagnosed,
start treatment, are entering a new relationship
or have children; and continue to have services in
place to meet people’s needs around housing,
welfare benefits and debt advice
Substance Misuse
• We are on target to increase by 3% the numbers
of drug users receiving treatment
• An additional three hostels offering services were
established in 2008/09
• We have commissioned two new services to
improve the general health and well being of
substance misusers
• A joint pilot project to develop a comprehensive
package of testing and support in Westminster to
offer dry blood spot testing was successful. It will
be mainstreamed in 2009/2010 and focus on
improving pathways into secondary care for
substance mis-users who test positive for
hepatitis C and HIV
• We increased the provision and availability of
alcohol services in Accident and emergency
(A&e), which increased the number of referrals
from 848 in 2007/08 to 956 in 2008/09
Blood Borne Viruses
• From just two testing sessions in 2007/08 the
service has expanded to coverage across the city
five days a week in 2008/09. Over 500 patients
have been tested for blood borne viruses
• The project has been endorsed by the National
Treatment Agency as an example of best practice
in terms of harm reduction
16 to 24-yeAR-olDS iN weSt loNDoN CAN get A FRee CHlAMyDiA teSt FRoM www.CHeCk-kit.oRg.uk
Alcohol and Accident & Emergency
• We commission two posts based in Accident
& emergency who offer brief interventions and
referrals into specialist alcohol services in their
borough of residence. The service is embedded as
part of the core staff team which is part of the
reason it has been successful
Dentistry
• We have designed a new, quality focused, service
specification to procure two new dental practices
• Working with our current practices, we’ve
increased provision and improved access to
already established practices
• We have implemented a communication strategy
to give local people information about good oral
health and where to find services
• We’ve also funded digital signage in 11 local
practices to inform patients about their
entitlement to care, costs and to promote oral
health. The digital screens will also display other
healthcare messages and we aim to install the
same equipment in further practices
Community Pharmacy
With the Community Pharmacy Advisor, we have
commissioned a range of new services to be
delivered through local pharmacies. These include:
• stop smoking services
• flu vaccinations
• chlamydia screenings
• medicine usage reviews
• emergency hormonal contraception
• minor ailments
• supervised consumption and needle exchange
Following the 2007/08 pilot, this year we
implemented the flu vaccination service in pharmacies
and increased the numbers of patients vaccinated
there from 412 to 946 – an increase of over 100%.
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35
Eye Care
On 1 August, we rolled out the national contract
across 70 NHS practices. As part of this, 19 opticians
now provide home-based services. We are developing
a needs assessment to inform future commissioning
decisions for eye care services for local people.
General Practice
We have been working with GPs to improve access
to services, both in primary care and for specialist
referrals. We recently awarded a contract for a new
GP-led health centres. Our aim is to increase the
range of services that patients can receive from their
GPs. So we have funded practices to:
• implement Choose and book, which allows
patients real choice in where they obtain
secondary care (most practices have now
implemented this system)
• open longer – over 50% now have more sessions
at the weekend or open later for at least some
evenings during the week
• offer chlamydia screening
• increase coverage of flu vaccination
• provide a greater range of minor surgery
• develop anticoagulation services
NHS Westminster has introduced a system to measure
practice performance, including the range of services
available at each GP surgery. The results will be shared
with the public through NHS Westminster’s website.
This will give patients information on practices in their
area, and to help them choose where they would like to
register. A similar scheme will be introduced for dentists.
91 We have 91 pharmacists working
in Westminster
2,283,360 In 2008/09 we filled over
2.2 million prescriptions
50% More than 50% of
Westminster GPs now
offer appointments outside
normal working hours
2. public heAlth
We aim to lead the development and implementation of
programmes to improve the health and wellbeing of the
local population and to reduce health inequalities.
Key achievements in 2008/09
• The Westminster Health debate, where 1,600 local people contributed to the
development of our strategic plan
• The 2006/07 Public Health report, which identified the health inequalities
that exist in Westminster, and the development on behalf of the Westminster
City Partnership of a joint strategy to tackle these health inequalities
• Our joint strategic needs assessment, developed in partnership with Westminster
City Council, which aims to build a shared view of Westminster and ensure that
our services meet the needs of our population, now and in the future
• The Westminster Smoke Free Homes Project, which encourages local people
to keep their homes smoke free, reduces exposure of children to second hand
smoke, and supports people to quit smoking
• The launch of the Healthy Hearts and Minds Programme, a community-based
cardiovascular disease prevention and treatment programme
• The implementation of our new diabetes service,
which has enabled more people to receive high
quality care closer to where they live (our model is
now recommended by Healthcare for London for
how to improve diabetes services across the capital)
• Our Health Trainer Programme, which supports
people living in Westminster’s most deprived
areas to choose healthier lifestyles and to access
health and social care services
• The black, Minority and ethnic (bMe) Health
Forum’s Good Practices for Access and Wellbeing
programme for GPs and dental practices
• National recognition for our Ask Your Patients Week
Programme, which won the Primary Care Category
of the Involvement to Impact Awards 2008
• Safer management of controlled drugs in
Westminster resulting from the sharing of
intelligence with external agencies
Key findings from the Westminster
Health Debate
Health care services in Westminster generally
have a good quality but there was felt to be
“room for improvement”. A need for increased
dental and mental health services was identified
as well as more flexibility from GP surgeries.
There is also a call to reduce waiting times.
Westminster residents are aware of core health
services. but, there is much less known about
specialist services.
General lifestyle was seen to be the main
barrier to healthy living.
There was broad agreement that people need
to take responsibility for their own actions,
however NHS Westminster can help by
promoting healthy lifestyle services.
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37
Stephen, who attended our Understanding Health Improvement course.
Health training
“I work for a charity that deals with the older Asian
community. Health is something that we deal with and
health and nutrition is of particular importance. I will
use what I have learnt of this course to inform people
of the impact of food on health.” Adbul Kalum
“I am interested in anything that is designed to keep
you fit and well. I will use this information to talk to the
children that I work with and hopefully take the next
level of this course.” Mary Amayo
3. NurSiNg AND quAlity
We aim to provide nursing advice to the Board, ensure that
vulnerable adults and children are protected, and that our
nurses are fit to practice.
Key achievements in 2008/09
• Continued to implement the community nursing programme with an
investment of £3.6 million over the next two years
• Strengthened clinical practice by employing nurses with teaching skills
• Created clinical leads for end of life care, long term conditions, urgent care,
access and medical technology, self care and health inequalities
• Took part in the productive ward scheme in Garside Nursing Home and the
rehabilitation unit at Athlone House with real improvements for patients and staff
• Worked with children’s services on the integration agenda including the family
recovery project
• delivered the national cervical cancer immunisation programme for young girls
• recruited two GPs to provide four sessions a week on safeguarding children
to support General Practices in Westminster
• Continued to raise the safeguarding agenda, making it everyone’s responsibility
• Achieved compliance for all 24 core standards for better Health, as both
a commissioner and provider of healthcare services
• delivered a research governance audit and we now submit all projects for
monitoring and onto national research registers
• data quality send from NHS Westminster to the National Patient Safety
Agency met 100% accuracy
• Actions to prevent incidents occurring and minimising actions had greater
data quality
• Greater number of incidents with ‘no harm’ outcomes reported
• 13% increase in numbers of incidents reported on 2005/06
• All incidents involving patients reported effectively via the National Patient
Safety Agency reporting and learning mechanism
• Improvement in staff skills to de-escalate conflict situations
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39
Our investment in community nursing
We are recruiting over 80 extra staff, ranging
from health care support workers, assistant
administrators to district nurses. This will
increase the quality of patient care and the
ability to look after more patients in the
community to deliver care closer to people’s
homes within Westminster.
“community nursing will be transformed under this programme to bring the most specialised hospital level care out to patients in their own homes. We will aim to recruit a number of the new staff from the Westminster area to build up community links and knowledge. this investment supports the theme of bringing care out of hospital and closer to people’s home which is a major aim of NhS Westminster and healthcare for london” Chief executive Michael Scott
4. fiNANce AND performANce mANAgemeNt
This year, we spent over £390 million on services for
our residents.
We also had a revenue surplus of £15.5m for 2008/09, achieving financial
balance for the seventh consecutive year. The surplus is £3.0m above the
planned £12.5m and remains within the local surplus target range of £14.7m
to £15.9m set by NHS London.
Funding our goals
during 2008/09 NHS Westminster has invested an extra £10m in support of
the five strategic goals which best reflect the health needs of our population.
This includes:
• funding 115 individual schemes ranging in value from £0.02m to £1.42m
• a further £20m has been set aside for strategic goals in 2009/10
• an action plan is being developed to prioritise investment schemes and ensure
they deliver the intended health and quality improvements whilst achieving
value for money
Key achievements in 2008/09
• Supporting provider services to separate from NHS Westminster
• Continuing to support and develop our practice-based commissioning clusters
• Preparing the organisation and systems to operate under International
Financial reporting Standards (IFrS) from 2009/10
• Providing significant financial and informatics support to the world class
commissioning submission and associated strategic plan
• delivering annual accounts within the national faster closure timetable
• developing a new information strategy for 2009-14
• Significant progress on information governance agenda
• Implementing GP referrals information service
• Continuing to roll out IT network improvements across NHS Westminster
and primary care services in Westminster
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41
Looking to the future
The financial prospects for NHS Westminster show
a continuing surplus. This allows us to support both
our five-year Commissioning Strategy Plan and the
Healthcare for London programme. We have reported
to our board that the biggest risk to our plans during
this period is our capacity to deliver on our ambitious
investment programme. The final two years are likely
to be much more financially challenging and a savings
programme of at least £5m is being developed to
ensure NHS Westminster has the funds required to
invest in the future.
Annual Health Check
The Care Quality Commission’s (previously the
Healthcare Commission) Annual Health Check seeks
to establish whether an organisation is getting the
basics right and is making and sustaining progress.
Trusts are assessed in five areas and an overall
rating determined for:
• use of resources (focussing on how well finances
are managed)
• quality of services (which includes whether we are
meeting standards and targets set by Government)
ratings are excellent, Good, Fair or Weak.
The Care Quality Commission released its findings for
2007/08 in October 2008. Findings for 2008/09
were not released in time for inclusion in this report.
For 2007/08, NHS Westminster again scored
“Good” for use of resources, and we also scored
“Good” for quality of services – an improvement
on “Fair” in previous years.
Use of Resources
The Annual Health Check looked for evidence of
positive outcomes from our use of resources and
processes in terms of economy, efficiency and
effectiveness. It covered the following themes:
• Managing finances – How effectively does NHS
Westminster manage its finances to deliver value
for money?
• Governing the business – How well does NHS
Westminster govern itself; ensure value for money
in the services it delivers and commissions; and
delivers better outcomes for local people?
• Managing resources – How well does NHS
Westminster achieve value for money in relation
to a wider definition of resources, including
natural resources, people and assets
The Annual Health Check interim review for use of
resources in 2008/9 classed us as good. The final
rating will be confirmed in October 2009.
Declaration of Core Standards
One of the five components of the Care Quality
Commission’s, Annual Health Check is the
“Core Standards for better Health”.
This sets out 24 standards as a minimum level of
service NHS Westminster should provide to ensure
our services are safe and of an acceptable quality.
We assessed and rated our performance against the
core standards and declared compliance as both
a buyer and provider of healthcare.
Meeting our targets
NHS Westminster is required to meet five financial and administrative duties to ensure that public funds are
used appropriately.
Duties our performance in 2008/09 Duty met?
1 Meet revenue resources limit NHS Westminster has a surplus of £15.53 million against a revenue resource limit of £428.51 million
Yes
2 Meet capital resource limit We underspent by £0.04 million on a capital resource limit of £1.43 million
Yes
3 Meet cash limit (revenue and capital) with no unplanned borrowing at year end
No variance against the cash limit Yes
4 Full cost recovery of directly provided services £0.91 million underspend Yes
5 To meet the better Practice Code by paying 95% of non-NHS creditors within 30 days of the invoice date
NHS Westminster achieved 91.7% (on volume) and 93.1% (on value) which are lower than 2007/08 due to the impact of operating two financial systems for commissioning/provider split. An action plan is in place to improve performance in 2009/10
No
Information Governance
Information governance risks are management actions and are included in the corporate objectives
document that incorporates the board Assurance Framework, and our risk register.
There were no breaches of information governance which met the criteria outlined for serious untoward
incidents. All incidents are shown below.
Summary of other personal data incidents 2008-09
Dh category Nature of incident total
I Loss of inadequately protected electronic equipment devices
or paper documents from secured NHS premises
0
II Loss of inadequately protected electronic equipment devices
or paper documents from outside secured NHS premises
5
III Insecure disposal of inadequately protected electronic equipment,
devices or paper documents
0
IV unauthorised disclosure 7
V Other – Patient notes not available for consultation 13
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43
5. humAN reSourceS AND corporAte AffAirS
Key achievements in 2008/09
• Supporting and preparing our provider services and commissioning services
to be fit for their future including the Strengthening Commissioning
programme and World Class Commissioning audit process
• engaging and supporting staff through the processes of significant
organisational change
• Keeping our sickness absence rate at 3.26% which is well below our
target of 5%
• Keeping our staff turnover rate at a reasonable level of 19.65% full time
employed at a time of significant organisational change
• Assisting in the recruitment of a significant number of key new nursing
positions – an example of our extra investment in district nursing
• relocating the Occupational Health Service to a new site with a view to
providing increased services for the wellbeing of staff
• Supporting staff through sickness to improve their health and wellbeing
through our Occupational Health department
• Increasing the number of cases handled by our Patient Advice and Liaison
Service (PALS) by 21%
StAFF RAteD uS iN tHe toP 20% oF PRiMARy CARe tRuStS iN 15 AReAS oF woRk iN tHe 2008 NAtioNAl NHS StAFF SuRvey.
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45
Annual Staff Survey
For the fifth year running, our staff told us that NHS
Westminster is well-run, well-managed and a good
place to work.
We were particularly pleased to be rated second
of all trusts in the country for having a high majority
of staff who would recommend the organisation as
a great place to work.
Key areas in which NHS Westminster is in the top
20% of primary care trusts nationally;
• staff feeling satisfied with the quality of care they
are able to deliver
• staff agreeing that their role makes a difference
to patients
• quality of job design
• perceptions of effective action from employer
towards violence and harassment
• fairness and effectiveness of procedures for
reporting errors, near misses or incidents
NHS Westminster also scored a higher than our
average percentage for staff receiving job relevant
training, learning or development. This maintains our
strong performance from last year’s survey.
Challenges and opportunities of the year ahead
To support our staff in facing the challenges
of working in a new and more market-oriented
environment, we are developing:
• a board development programme
• a Talent Management Strategy to develop NHS
Westminster’s ability to identify and manage
talented staff rising through the ranks
• project management and leadership skills
• a range of commissioning capabilities including
database management and monitoring skills,
procurement, risk analysis, predictive modelling
and contract management
• effective induction and appraisal systems
We are also developing a range of skills such as
management, leadership, IT and business planning,
as well as looking at new approaches of working
with patients to improve their experience of using
our services.
Staff group Total
Administration and estates 392
Healthcare assistants and other support staff 106
Medical and dental 43
Nursing, midwifery and health visiting learners 5
Nursing, midwifery and health visiting staff 343
Other 7
Scientific, therapeutic and technical staff (including allied health professionals) 220
grand Total 1116
OUR BOARD
our boArD
Nicholas Woolf Non-Executive Director
Marian Harrington* Co-Opted Board Member
Marek Stepniak Non-Executive Director
Brigitta lock** Co-Opted Board Member
David Hawker* Co-Opted Board Member
Joe Hegarty Chair
Catherine longworth Vice Chair
Michael Scott Chief Executive
Dr Dennis Abadi PEC/CEC Chair
Jeff Deane Executive Director
Dr Margaret guy Executive Director
Ann Duncan Executive Director
Dr Sheila D’Souza Non-Executive Director
Andrew Whitley Non-Executive Director
Councillor Ed Argar* Co-Opted Board Member
* Co-opted member (Westminster City Council)** Co-opted member (Patient Public Involvement Forum)
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49
Board membership 2008/09
NHS Westminster non-executive directors Catherine
Longworth, Sheila d’Souza and Andrew Whitley have
been re-appointed in the past year.
Catherine Longworth is Vice-Chair of the board
and has been a non-executive director at NHS
Westminster since 2002, Sheila d’Souza since
2005 and Andrew Whitley since 2002.
In the last year david Hawker and brigitta Lock left
the board and we thank them for all their hard work
and commitment.
We have been joined by Councillor ed Argar and
Marian Harrington (Co-Opted Members, Westminster
City Council). Councillor Argar is the Cabinet Member
for Health and Adult Social Care. Marian is currently
responsible for the care management service and
commissioning and developing services for older
and disabled people in Westminster.
Throughout the year our board members have taken
part in a wide range of seminars and training.
Changes in our Commissioning
Executive Committee
The Professional executive Committee (PeC)
was dissolved on 31 december 2008 and the
Commissioning executive Committee (CeC) began
on 1 January 2009.
The change in membership of the Commissioning
executive Committee reflects the need for a more
formal commissioning relationship between NHS
Westminster and the practice-based commissioning
consortia.
The chairs of each practice-based commissioning
cluster/consortium will be full members of the
Commissioning executive Committee. They will be
tasked with leading, or at least contributing to, the
strategic commissioning decisions of NHS Westminster.
They will also bring their local commissioning plans
to the Commissioning executive Committee for
discussion and endorsement.
The practice-based commissioning chairs will be
making healthcare commissioning decisions on
behalf of their clusters/consortia, as well as the
populations they serve. They will therefore be
mandated to disseminate these decisions back
to their constituent practices. Practice-based
commissioning cluster chairs will also be mandated
to make decisions on behalf of their practice-based
commissioning clusters/consortia.
Professional Executive
Committee Members
dr Maher Shakarchi***
Sangita Patel
Meredith Gamble
dr derek Chase ***
dr Mike Cornell ***
dr Nazeer Ahmed ***
Tera Younger
Paul Jenkins
Marian Harrington*
dr dennis Abadi (Chair)
Jeff deane
Margaret Guy
Ann duncan
Michael Scott
Commissioning Executive
Committee Members
dr derek Chase ***
dr Nazeer Ahmed ***
dr Matthew Johnson***
dr Jonathan Fluxman***
dr Jonathan Munday***
Tera Younger
Paul Jenkins
Marian Harrington*
dr dennis Abadi (Chair)
Karen broughton
Jeff deane
Margaret Guy
Ann duncan
Michael Scott
* Co-opted member (Westminster City Council)*** Practice-based commissioning cluster representative
memberS’ iNtereStS
All board, Professional executive Committee and Commissioning executive
Committee members of NHS Westminster are required, on appointment,
to subscribe to a Code of Conduct. As part of this, they should declare any
conflict of interest that arises in the course of conducting NHS business.
They are required to declare:
• directorships
• Ownerships or part ownerships of private businesses or consultancies likely
to or seeking to do business with the NHS
• Significant shareholdings in organisations likely or possibly seeking to do
business with the NHS
• details of any position of authority in any body, including a charity or voluntary
body, in the field of health and social care
• details of any connection with a voluntary or other body contracting
for NHS services
• details of fees received from public bodies or other organisations
Westminster LINk is your chance to have a say
on how health and social care services are
provided in Westminster. The LINk is independent,
run by local volunteers and open to everyone:
you can take part whether you’re an individual
or part of a group.
[email protected] 020 7535 0492
Westminster LINk, c/o VAW, 37 Chapel St,
London, NW1 5dP
www.westminsterlink.org.uk
Westminster local involvement Network (liNk)
Catherine Longworth at The Rainbow Centre
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk
51
during 2008-09 the following interests were declared:
dr dennis
AbadiChair PEC*, CEC** GP Principal St John’s Wood Medical Practice under
contract with NHS Westminster. director/Shareholder
General Healthcare provision, a company set up in 2006
to provide health services in the community. Fees from
GMS GP Contract, additional enhanced services, rent and
rates reimbursement from NHS Westminster
dr Nazeer
AhmedMember PEC*, CEC** No outside interests declared
Councillor
edward ArgarCo-opted Board Member Cabinet Member, Health and Adult Social Care,
Westminster City Council. Vice-Chair London Councils
Health and Social Care Forum. employed by Mouchel
Contracting with various NHS bodies. Allowance paid by
Westminster City Council and also by London Councils
Karen
broughtonDirector of Human Resources and Corporate Affairs, Senior Management Team
No outside interests declared
dr derek
ChaseMember PEC*, Member CEC**
director, Central London Healthcare Ltd. director/
part-owner/shareholder, Central Healthcare Provider Ltd.
Chairman, Central London Healthcare Ltd. Fees from
Central London Healthcare Ltd and Central Healthcare
Provider Limited
Jeff deane Director of Finance and Performance, Senior Management Team, Member PEC*, CEC**
director Allington Healthcare Ltd. A company providing
residential care to elderly people
dr Sheila
d’SouzaNon-Executive No outside interests declared
Ann duncan Director of Nursing and Quality, Senior Management Team, Member PEC*, CEC**
No outside interests declared
dr Jonathan
FluxmanMember CEC** delegated representative on CeC to dr Nazeer Ahmed
Meredith
GambleMember PEC* No outside interests declared
dr Margaret Guy Director of Public Health /Medical Director, Senior Management Team, Member PEC*, CEC**
General board Member, Faculty of Public Health. Member
of Healthcare delivery Working Group, diabetes uK
Marian
HarringtonMember PEC*, CEC**, Co-opted Board Member
Strategic director, Adult & Community Services
Westminster City Council. Salary Westminster
City Council
Joe Hegarty Chair, Non-Executive director Manor House (Marylebone) Ltd, a company
established to purchase the freehold of Mr Hegarty’s
home. Chair of Governors, St Vincent’s Catholic
Primary School
Paul Jenkins Director of Service Development, Senior Management Team, Member PEC*, CEC**
Chair, rugby House
dr Matthew
JohnsonMember CEC** Owner, small private medical practice providing treatment
and testing for persons with drug related problems.
No NHS work planned
brigitta Lock Co-opted Board Member Co-owner and Trustee of a family charity trust,
Member of LINk
Catherine
LongworthVice Chair, Non-Executive Trustee, dolphin Square Charitable Foundation,
Francis Holland School Trust
dr Jonathan
MundayMember CEC** Chairman Victoria GPs LLP. President, Hammersmith
division St John’s Ambulance. GMS Locum Fees PCT
Sangita Patel Member PEC* No outside interests declared
Michael Scott* Chief Executive, Senior Management Team, Member PEC*, CEC**
Governor, Quintin Kynaston School
dr Maher
SharkachiMember PEC* PeC Practice-based commissioning Cluster representative,
board Member, Victoria Commissioning Consortium
Marek Stepniak Non-Executive director, Stepniak & Partners, Governor North West
London NHS Foundation Trust, Non executive director
CWL Community Services. Advisor and consultant to
Perot Systems Corporation
Andrew Whitley Non-Executive Interim Chair, City West Homes (paid role). retainer,
richmond Fellowship
Nicholas Woolf Non-Executive director, derby Homes Limited, Concilian Group. Trustee,
Princess Alice Hospice, beating bowel Cancer and barts
& The London Charity
Tera Younger Member PEC*, CEC** Owner, TY Consultancy
* The PeC was dissolved on 31 december 2008.**The Commissioning executive Committee superseded PeC on 1 January 2009.
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53
ANNUAl ACCOUNTS
FINANCIAL STATeMeNTS 2008/09
Foreword to the Accounts
These accounts for the year ended 31 March 2009 have been prepared by Westminster PCT under section 98 (2) of the National Health Service Act 1977 (as amended by section 24 (2), schedule 2 of the National Health Service and Community Care Act 1990) in the form which the Secretary of State has, with the approval of the Treasury, directed.
Westminster PCT was established with effect from 1 April 2002.
dIreCTOr’S STATeMeNT
Statement of the Chief Executive’s responsibilities as the Accountable Officer of the Primary Care Trust
The Secretary of State has directed that the Chief executive should be the Accountable Officer to the Primary Care Trust. The relevant responsibilities of Accountable Officers are set out in the Accountable Officers Memorandum issued by the department of Health. These include ensuring that:
• there are effective management systems in place to safeguard public funds and assets and assist in the implementation of corporate governance;
• value for money is achieved from the resources available to the authority;
• the expenditure and income of the authority has been applied to the purpose intended by Parliament and conform to the authorities which govern them;
• effective and sound financial management systems are in place; and
• annual statutory accounts are prepared in a format directed by the Secretary of State, with the approval of the Treasury, to give a true and fair view of the state of affairs as at the end of the financial year and the net operating cost, recognised gains and losses and cash flows for the year.
To the best of my knowledge and belief, I have properly discharged the responsibilities set out in my letter of appointment as an Accountable Officer.
Chief executive
date 09.06.09
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STATeMeNT OF dIreCTOrS’ reSPONSIbILITIeS IN reSPeCT OF THe ACCOuNTS
The directors are required under the National Health Service Act 2006 to prepare accounts for each financial year. The Secretary of State, with the approval of the Treasury, directs that these accounts give a true and fair view of the state of affairs of the organisation and the net operating cost, recognised gains and losses and cash flows for the year. In preparing these accounts, directors are required to:
• apply on a consistent basis accounting policies laid down by the Secretary of State with the
approval of the Treasury;
• make judgements and estimates which are reasonable and prudent;
• state whether applicable accounting standards have been followed, subject to any material
departures disclosed and explained in the accounts.
The directors are responsible for keeping proper accounting records which disclose with
reasonable accuracy at any time the financial position of the organisation and to enable them
to ensure that the accounts comply with requirements outlined in the above mentioned direction
of the Secretary of State. They are also responsible for safeguarding the assets of the health
authority and hence for taking reasonable steps for the prevention of fraud and other irregularities.
The directors confirm to the best of their knowledge and belief they have complied with the
above requirements in preparing the financial statements.
by order of the board.
Chief executive
date 09.06.09
director of Finance
date 09.06.09
STATeMeNT OF INTerNAL CONTrOL
Scope of Responsibility
The board is accountable for internal control. As Accountable Officer, and Chief executive of
this board, I have responsibility for maintaining a sound system of internal control that supports
the achievement of the organisation’s policies, aims and objectives. I also have responsibility
for safeguarding the public funds and the organisation’s assets for which I am personally
responsible as set out in the Accountable Officer Memorandum.
I am accountable to the Chair of the Trust and to the Chief executive of the Strategic Health
Authority. The Chief executive is regularly performance managed through twice yearly
performance appraisals undertaken by the Trust Chair and, at the year end, the Chief executive
of the Strategic Health Authority formally records his/her comments on NHS Westminster
Chief executive’s performance. Westminster Primary Care Trust also undergoes a quarterly
performance review process with the Strategic Health Authority, involving NHS Westminster
Chief executive and other PCT executive directors.
I have constructed systems and processes to ensure effective working with partner organisations.
The Purpose of the System of Internal Control
The system of internal control is designed to manage risk to a reasonable level rather than to
eliminate all risk of failure to achieve policies, aims and objectives; it can therefore only provide
reasonable and not absolute assurance of effectiveness. The system of internal control is
based on an ongoing process designed to:
i. identify and prioritise the risks to the achievement of the organisation’s policies,
aims and objectives
ii. evaluate the likelihood of those risks being realised and the impact should they be realised
and to manage them efficiently, effectively and economically.
The system of internal control has been in place in Westminster Primary Care Trust for the year
ended 31 March 2009 and up to the date of approval of the annual report and accounts.
Capacity to Handle Risk
NHS Westminster has in place a risk management strategy that is reviewed annually.
The director of Nursing and Quality has delegated responsibility for managing the strategic
development and implementation of organisational risk management and controls assurance.
The director of Nursing and Quality has overall responsibility for clinical risk management and
this includes being the Lead director, in 2008/09, for the work on risk Assessment.
The risk management agenda is led at directorate level by clinical governance facilitators who
are provided with training. The Trust learns from good practice through clinical supervision and
reflective practice, individual and peer reviews, performance management, continuing professional
development programmes, clinical audit and application of evidence-based practice.
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The Risk and Control Framework
The system of internal control is based on an ongoing risk management process which combines the following elements:
• the identification and treatment of principal risks to the achievement of the
organisation’s objectives;
• the identification of risks through the comparison of Trust practice against external
standards such as Standards for better Health, Clinical Negligence Scheme for Trusts,
risk Pooling Scheme for Trusts and National Frameworks; and
• the analysis, recording and learning from untoward occurrences or near misses.
The Trust’s risk Assessment Tool ensures a consistent approach is taken to the evaluation and monitoring of risk, in terms of the assessment of likelihood and consequence. The board, Audit Committee and the Clinical Governance Assurance Committee are responsible for reviewing action plans, providing scrutiny and monitoring their implementation for risks with a significant and high rating.
The risk Management Strategy clearly states that risk management is the responsibility of all employees. All staff are provided with risk management training at induction. Clinical governance facilitators act as local risk management leads. All staff are able to identify risks through incident reports and risk assessments.
The board Assurance Framework is based on the four corporate and 37 principal objectives underpinning them for 2008/09 as identified in the Westminster Primary Care Trust’s business Plan. The risks to achieving these objectives have been identified and there are action plans and improvements underway accordingly.
The Framework identifies the effectiveness of the operation of the key controls to manage the risks identified and the assurance provider for those controls. Gaps in control and gaps in assurance have been identified and prioritised and include major incident and flu pandemic planning, the achievement of breast cancer screening targets, chlamydia screening, targets to reduce healthcare-associated infections in acute hospital activity, meeting the 18 week referral to treatment target (including the robust scrutiny of patient data), the monitoring of independent contractor performance and meeting the decontamination standard requirements. The board requires the development and implementation of action plans for gaps identified but not presently being addressed, and monitors the development of these action plans.
The partnership mechanisms described previously are used to explore potential risks which may impact upon other organisations and public stakeholders. Additionally, there are also many cross organisation fora which exist to support this approach.
As an employer with staff entitled to membership of the NHS Pension Scheme, control measures are in place to ensure all employer obligations contained within the Scheme regulations are complied with. This includes ensuring that deductions from salary, employer’s contributions and payments in to the Scheme are in accordance with the Scheme rules, and that member Pension Scheme records are accurately updated in accordance with the timescales detailed in the regulations.
Control measures are in place to ensure that all the organisation’s obligations under equality,
diversity and human rights legislation are complied with.
Review of Effectiveness
As Accountable Officer, I have responsibility for reviewing the effectiveness of the system of internal control.
My review is informed in a number of ways. The Head of Internal Audit provides me with an opinion on the overall arrangements for gaining assurance through the board Assurance Framework and on the controls reviewed as part of the internal audit work. executive managers within the organisation who have responsibility for the development and maintenance of the system of internal control provide me with assurance.
The Assurance Framework itself provides me with evidence that the effectiveness of controls that manage the risks to the organisation achieving its principal objectives have been reviewed.
My review is also informed by a regular performance reporting on targets and objectives to the Trust board, internal and external audits including the use of resources, Healthcare Commission Annual Healthcheck and other reviews, the Commissioning Strategy Plan, Operating Plan and Local delivery Plans, Health and Safety executive inspections, and Patient and Staff Surveys. The performance improvement plan is driven by both the Healthcare Commission Annual Healthcheck and NHS London’s quality and outcome framework.
The Trust is fully compliant with the core standards for better health.
The Head of Internal Audit Opinion’s review awarded overall significant assurance for the sound system of internal control, with 3 out of 10 objectives achieving limited assurances. These relate to occupational health, dental contracts and practice-based commissioning. It must be noted that action plans are in place to improve these risks identified in the review.
I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the board, the Professional executive Committee, the Audit Committee and the Clinical Governance Assurance Committee. A plan to address weaknesses and ensure continuous improvement of the system is in place and includes:
• the implementation of action plans arising from Corporate Objectives/board Assurance Framework;
• increasing the number of significant principal risks monitored by the Audit and Clinical
Governance Assurance Committees.
The Audit Committee provides the board with an independent and objective view of arrangements for internal financial control within the PCT, ensuring the Internal Audit service complies with mandatory auditing standards including the review of all fundamental financial systems.
executive directors have managed and reviewed their principal risks through the business
Planning process, the Performance Improvement Plan and their contribution to development
of the board Assurance Framework.
Signed on behalf of the board
Chief executive
date: 09.06.09
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INdePeNdeNT AudITOr’S rePOrT to the Director’S of the boArD of WeStmiNSter primAry cAre truSt
Opinion on the financial statements
I have audited the financial statements of Westminster PCT for the year ended 31 March 2009
under the Audit Commission Act 1998. The financial statements comprise the Operating Cost
Statement, the balance Sheet, the Cashflow Statement, the Statement of Total recognised
Gains and Losses and the related notes. These financial statements have been prepared in
accordance with the accounting policies directed by the Secretary of State with the consent of
the Treasury as relevant to the National Health Service set out within them. I have also audited
the information in the remuneration report that is described as having been audited.
This report is made solely to the board of directors of Westminster PCT 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.
Respective responsibilities of Directors and auditor
The directors’ responsibilities for preparing the financial statements in accordance with
directions made by the Secretary of State are set out in the Statement of directors’ responsibilities.
The Chief executive’s responsibility, as Accountable Officer, for ensuring the regularity of financial
transactions is set out in the Statement of the Chief executive’s responsibilities.
My responsibility is to audit the financial statements in accordance with relevant legal and
regulatory requirements and International Standards on Auditing (uK and Ireland).
I report to you my opinion as to whether the financial statements give a true and fair view in
accordance with the accounting policies directed by the Secretary of State as being relevant to
the National Health Service in england. I report whether the financial statements and the part
of the remuneration report to be audited have been properly prepared in accordance with the
accounting policies directed by the Secretary of State as being relevant to the National Health
Service in england. I report to you whether, in my opinion, the information which comprises the
‘General Introduction’, ‘Annual Health Check’, ‘use of resources’ and ‘Meeting our Targets’ sections in the commentary on ‘Financial and Performance Management’ in the Annual report
is consistent with the financial statements. I also report whether in all material respects the
expenditure and income have been applied to the purposes intended by Parliament and the
financial transactions conform to the authorities which govern them.
I review whether the directors’ Statement on Internal Control reflects compliance with the
department of Health’s requirements, set out in ‘Guidance on Completing the Statement
on Internal Control 2008/09’, issued on 25 February 2009. I report if it does not meet the
requirements specified by the department of Health or if the statement is misleading or
inconsistent with other information I am aware of from my audit of the financial statements.
I am not required to consider, nor have I considered, whether the directors’ Statement on
Internal Control covers all risks and controls. Neither am I required to form an opinion on the
effectiveness of the PCT’s corporate governance procedures or its risk and control procedures.
I read the other information contained in the Annual report and consider whether it is consistent
with the audited financial statements. This other information comprises the Annual report,
except for the ‘General Introduction’, ‘Annual Health Check’, ‘use of resources’ and ‘Meeting
our Targets’ sections of the commentary on ‘Financial and Performance Management’, and the
unaudited part of the remuneration report. I consider the implications for my report if I become
aware of any apparent misstatements or material inconsistencies with the financial statements.
My responsibilities do not extend to any other information.
Basis of audit opinion
I conducted my audit in accordance with the Audit Commission Act 1998, the Code of Audit
Practice issued by the Audit Commission and International Standards on Auditing (uK and
Ireland) issued by the Auditing Practices board. An audit includes examination, on a test basis,
of evidence relevant to the amounts and disclosures in the financial statements and the part
of the remuneration report to be audited. It also includes an assessment of the significant
estimates and judgments made by the directors in the preparation of the financial statements,
and of whether the accounting policies are appropriate to the PCT’s circumstances,
consistently applied and adequately disclosed.
I planned and performed my audit so as to obtain all the information and explanations which
I considered necessary in order to provide me with sufficient evidence to give reasonable
assurance that:
• the financial statements are free from material misstatement, whether caused by fraud
or other irregularity or error;
• the financial statements and the part of the remuneration report to be audited have been
properly prepared; and
• in all material respects the expenditure and income have been applied to the purposes
intended by Parliament and the financial transactions conform to the authorities which
govern them.
In forming my opinion I also evaluated the overall adequacy of the presentation of information
in the financial statements and the part of the remuneration report to be audited.
Opinion
In my opinion:
• the financial statements give a true and fair view, in accordance with the accounting policies
directed by the Secretary of State as being relevant to the National Health Service in england,
of the state of the Westminster PCT’s affairs as at 31 March 2009 and of its net operating
costs for the year then ended;
• the part of the remuneration report to be audited has been properly prepared in accordance
with the accounting policies directed by the Secretary of State as being relevant to the
National Health Service in england;
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• in all material respects the expenditure and income have been applied to the purposes
intended by Parliament and the financial transactions conform to the authorities which
govern them; and
• information which comprises the ‘General Introduction’, ‘Annual Health Check’,
‘use of resources’ and ‘Meeting our Targets’ sections of the commentary on ‘Financial and
Performance Management’ in the Annual report is consistent with the financial statements.
Conclusion on arrangements for securing economy, efficiency and effectiveness
in the use of resources
Directors’ responsibilities
The directors are responsible for putting in place proper arrangements to secure economy,
efficiency and effectiveness in the PCT’s use of resources, to ensure proper stewardship and
governance and regularly to review the adequacy and effectiveness of these arrangements.
Auditor’s responsibilities
I am required by the Audit Commission Act 1998 to be satisfied that proper arrangements
have been made by the PCT for securing economy, efficiency and effectiveness in its use of
resources. The Code of Audit Practice issued by the Audit Commission requires me to report
to you my conclusion in relation to proper arrangements, having regard to the use of resources
Guidance issued by the Audit Commission. I report if significant matters have come to my
attention which prevent me from concluding that the PCT has made such proper arrangements.
I am not required to consider, nor have I considered, whether all aspects of the PCT’s arrangements
for securing economy, efficiency and effectiveness in its use of resources are operating effectively.
Conclusion
I have undertaken my audit in accordance with the Code of Audit Practice and having regard
to the use of resources Guidance published by the Audit Commission in May 2008 and
updated in February 2009, I am satisfied that, in all significant respects, Westminster PCT
made proper arrangements to secure economy, efficiency and effectiveness in its use of
resources for the year ended 31 March 2009.
Certificate
I certify that I have completed the audit of the accounts in accordance with the requirements of
the Audit Commission Act 1998 and the Code of Audit Practice issued by the Audit Commission.
Michael Haworth-Maden
district Auditor
Audit Commission
1st Floor, Millbank Tower
Millbank , London SW1P 4HQ
June 2009
operAtiNg coSt StAtemeNt FOr THe YeAr eNded 31 MArCH 2009commissioning
2008/09 £000
2007/08
£000
Gross operating costs 397,632 374,306
Less: Miscellaneous income (10,284) (7,712)
Commissioning net operating costs 387,348 366,594
provider
Gross operating costs 36,320 30,326
Less: Miscellaneous income (9,352) (5,910)
Provider Net operating costs 26,968 24,416
Net operating costs before interest 414,316 391,010
Interest receivable 0 0
Interest payable 147 23
Net operating cost for the financial year 414,463 391,033
StAtemeNt of recogNiSeD gAiNS AND loSSeS FOr THe YeAr eNded 31 MArCH 2009
2008/09 £000
2007/08
£000
Fixed asset impairment losses 0 0
unrealised surplus / (deficit) on fixed asset
revaluations/indexation (7,740) 3,991
Increase in the donated asset reserve and government
grant reserve due to receipt of donated and government
granted assets 0 0
Additions / (reductions) in the General Fund due to the
transfer of assets from/(to) NHS bodies and the
department of Health 0 0
Additions / (reductions) in “other reserves” 0 0
recognised gains and losses for the financial year (7,740) 3,991
Prior period adjustment – other 0 0
gains and losses recognised in the financial year (7,740) 3,991
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65
bAlANce Sheet AS At 31 MArCH 200931 march 2009
£000
31 March 2008
£000
fixed assets
Intangible assets 150 81
Tangible assets 54,095 61,278
Investments 0 0
Financial assets 0 –
54,245 61,359
current assets
Stocks and work in progress 0 75
debtors 6,790 5,582
Other financial assets 0 –
Cash at bank and in hand 10 38
total current assets 6,800 5,695
Creditors: Amounts falling due within one year (26,049) (26,784)
Other financial liabilities falling due within one year 0 –
Net current assets / (liabilities) (19,249) (21,089)
total assets less current liabilities 34,996 40,270
Creditors: Amounts falling due after more than one year (2,570) (255)
Other financial liabilities falling due after more than one year 0 –
Provisions for liabilities and charges (14,979) (16,225)
total assets employed 17,447 23,790
financed by: taxpayers equity
General fund 0 0
revaluation reserve 2,961 1,485
Other reserves 0 0
total taxpayers equity 17,447 23,790
The financial statements were approved by the board
on 9th June 2009 and signed on its behalf by:
Chief executive
cASh floW StAtemeNt FOr THe YeAr eNded 31 MArCH 2009
2008/09 £000
2007/08
£000
operating activities Net cash outflow from operating activities (415,092) (391,566)
Servicing of finance and returns on investment:
Interest paid 0 0
Interest received 0 0
Interest element of finance leases (147) 0
Net cash inflow/(outflow) from servicing of finance and returns on investment (147) 0
capital expenditure
Payments to acquire intangible assets (90) (24)
receipts from sale of intangible assets 0 0
Payments to acquire tangible fixed assets (2,071) (1,150)
receipts from sale of tangible fixed assets 0 0
Payments to acquire fixed asset investments – 0
receipts from sale of fixed asset investments – 0
Payments to acquire financial instruments 0 0
receipts from sale of financial instruments 0 0
Net cash inflow/(outflow) from capital expenditure (2,161) (1,174)
Net cash inflow/(outflow) before financing and management of liquid resources (417,400) (392,740)
management of liquid resources
(Purchase) of other current asset investments – 0
Sale of other current asset investments – 0
Net cash inflow/(outflow) from management of liquid resources 0 0
Net cash inflow/(outflow) before financing (417,400) (392,740)
financing
Net Parliamentary Funding 417,372 392,795
Other capital receipts surrendered 0 0
Capital grants received 0 0
Capital element of finance lease rental payments 0 (23)
Cash transfers (to)/from other NHS bodies 0 0
Net cash inflow/(outflow) from financing 417,372 392,772
increase/(decrease) in cash (28) 32
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67
Note 2. financial performance targets Note 2.1 revenue resource limit
The PCTs’ performance for 2008/09 is as follows:
2008/09 £000
2007/08
£000
Total net operating cost for the financial year 414,463 391,033
Less: Non-discretionary expenditure 1,488 1,107
operating costs less non-discretionary expenditure 412,975 389,926
Final revenue resource Limit for year 428,509 401,801
under/(over) spend against revenue resource limit 15,534 11,875
Note 2.2. capital resource limitThe PCT is required to keep within its Capital resource Limit
Gross Capital expenditure 1,389 1,960
Add: Loss in respect of disposals of donated assets 0 0
Less: Net book value of assets disposed of 0 0
Less: Capital grants 0 0
Less: donations 0 0
charge Against the capital resource limit 1,389 1,960
capital resource limit 1,429 3,151
(over) / under spend against capital resource limit 40 1,191
Note 2.3. provider full cost recovery dutyThe PCT is required to recover full costs in relation to its provider functions.
The performance for 2008/09 is as follows:
Provider gross operating cost* 36,320 30,326
Less: Miscellaneous income relating to provider functions (9,352) (5,910)
Net operating cost 26,968 24,416
Less: Costs met from PCT’s own allocation (27,879) (24,802)
under / (over) recovery of costs (911) (386)
*Costs do not include an allocation for corporate overheads.
2008/09 £000
2007/08
£000
employee benefits 0 0
0 0
retirements due to ill-health during 2008/09 there was one early retirement from the PCT agreed on the grounds of
ill-health (2007/08: 2). The estimated additional pension liabilities of this ill-health retirement
(calculated on an average basis and borne by the NHS Pension Scheme) will be £2k
(2007/08: £32k).
management costs
Management costs (£000s) 9,081 8,206
Weighted population (Number) 256,602 256,602
management cost per head of weighted population (£) 35.39 31.98
the pct measures its management costs according to the definitions provided by the Department of health
better payment practice codebetter Payment Practice Code – measure of compliance
2008/09 number
2008/09 £000
2007/08
number
2007/08
£000
Non-NhS creditors
Total bills paid in the year 24,284 77,407 21,152 47,494
Total bills paid within target 22,273 72,089 19,973 45,936
Percentage of bills paid within target 91.72% 93.13% 94.43% 96.72%
NhS creditors
Total bills paid in the year 3,019 294,419 2,808 247,406
Total bills paid within target 2,776 287,206 2,680 246,161
Percentage of bills paid within target 91.95% 97.55% 95.44% 99.50%
The better Payment Practice Code requires the PCT to aim to pay all valid invoices by the due
date or within 30 days of receipt of a valid invoice, whichever is later.
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69
Note 20. Related Party Transactions
Westminster Primary Care Trust is a body corporate established by order of the Secretary of
State for Health.
related party transactions between the PCT and board Members and members of key
management were:
payments to related party 08/09 £
payments to related party 07/08 £
dr Chase (Cavendish Health Centre
and Kings College*)
1,871,658 1,801,911
dr N Ahmed (Queens Park Health Centre) 249,367 216,402
dr Abadi (dr S Charkin & Partners –
St John’s Wood Medical Centre)
1,267,873 1,065,121
dr M Cornell (dr M Cornell & Partners) 192,836 918,534
dr M Shakarchi (dr V Muir & Partner –
belgrave Medical Centre)
444,478 785,336
Other senior manager related party interests are:
*£924,848 relates to Kings College and £946,810 relates to Cavendish Health Centre.
London Central & West unscheduled Care Collaborative (dr M Cornell is a director)
£1,790,763 - Payment for unscheduled GP cover for Westminster practices and accident
& emergency. dr. Cornell also received £16,302 for the completion of GP appraisals.
Westminster City Council (d Hawker – deputy Chief executive & director of Children Services
(to July 2008), M Harrington Head of Care Management Service) £41,865k for the provision
of social services and payments in respect of joint working in 2008/09 (2007/08 £24,839k).
The department of Health is regarded as a related party. during the year Westminster Primary
Care 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. The entities
with transactions greater than 1% of Westminster Primary Care Trust’s net operating cost for
the financial year are listed below:
• Imperial College Healthcare NHS Trust, provision of acute healthcare services, £98,704k,
formerly St Mary’s NHS Trust, provision of acute healthcare services (2006/07 £107,857k)
• Hammersmith Hospitals NHS Trust, provision of acute healthcare services (2006/07 £9,752k)
• Central & North West London Mental Health NHS Foundation Trust, provision of mental
healthcare services £53,389k (2007/08 £49,166k)
• Chelsea & Westminster NHS Foundation Trust, provision of acute healthcare services
£16,284k (2007/08 £15,068k)
• university College London Hospital NHS Foundation Trust, provision of acute healthcare
services £16,102k (2007/08 £12,508K)
• Hillingdon PCT, provision of acute and community healthcare services through shared
commissioning £12,080k (2007/08 £12,055k)
• London Ambulance Service NHS Trust, provision of acute healthcare services £10,415k
(2007/08 £7,271k)
• royal Free Hampstead NHS Trust, provision of acute healthcare services £5,089k
(07/08 £3,935k)
• Guy’s and St Thomas’ NHS Foundation Trust, provision of acute healthcare services
£8,775k (2007/08 £7,260k)
The PCT has not received revenue or capital payments from any charitable funds, apart from
the charitable funds hosted by North West London Hospitals Trust. Net receipts for 2008/09
were £32k. (In 2007/08 there were net receipts of £3k).
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71
remuNerAtioN report 2008/09
This report has been prepared in accordance with the directors’ remuneration regulations 2002.
Membership of the remuneration and Terms of Services Committee:
Nicholas Woolf Non executive director (Chair)
marek Stepniak Non executive director
Sheila D’Souza Non executive director
catherine longworth Non executive director
Joe hegarty (in an advisory capacity)
Andrew Whitley (receives papers)
Karen broughton director of Human resources – Secretary
Role of the Remuneration and Terms of Services Committee and Statement of Policy on the
Remuneration of Senior Managers
The Committee advises the board on appropriate remuneration and terms of service for the Chief executive
and Trust directors. The Committee monitors and evaluates the performance of the Chief executive,
directors and individual officer members of the Professional executive Committee – having proper regard
to the PCT’s circumstances and performance and to the provisions of any national arrangements for such
members and staff where appropriate.
The Committee reports the basis for its recommendations to the board which uses the Committee’s report
as the basis for its decisions on remuneration. However, the board remains accountable for taking final
decisions on the remuneration and terms of service for the Chief executive and Trust directors.
For directors’ pay increases, the following factors are considered:
• current national market rates of comparable director posts;
• the individual performance of directors;
• internal comparators;
• changes to director portfolios;
• NHS pay awards for other staff groups;
• any national guidance relating to maximum pay bill increases;
• significant recruitment and/or retention issues; and
• financial position of the PCT.
Performance measurement
directors’ performance is appraised on an annual basis by the Chief executive. The Chief executive’s
performance is appraised on an annual basis by the Chief executive of the Strategic Health Authority,
now called NHS London.
Summary and explanation of policy on duration of contracts, and notice periods and
termination payments
Senior managers are permanent employees of the PCT, and in the event of redundancy, they are subject
to standard NHS severance packages.
CEC and Non-Executive unexpired contract dates
contract end date
Non-executive
Joe Hegarty – (Chair) 31 January 2011
Catherine Longworth –
(Vice Chair)
31 March 2013
Sheila d’Souza 31 March 2013
Marek Stepniak 31 March 2010
Andrew Whitley 31 March 2013
Nicholas Woolf 31 March 2010
pec members (the pec was dissolved on 31 Dec 08)
dr dennis Abadi –
(PeC Chair)
31 december 2008
dr Nazeer Ahmed 31 december 2008
dr derek Chase 31 december 2008
dr Mike Cornell 30 September 2008
Jeff deane*
Ann duncan *
Meredith Gamble 31 december 2008
Margaret Guy*
Marian Harrington *
Paul Jenkins *
Sangita Patel 31 december 2008
Michael Scott*
dr Maher Sharkachi 31 december 2008
Tera Younger 31 december 2008
* These people retain tenure in the PeC as long as
they remain in post.
contract end date
cec (commissioning executive committee, superseded pec on 1/01/2009)
dr dennis Abadi –
(CeC Chair)
01 January 2011
Karen broughton*
dr derek Chase 31 March 2009
Jeff deane*
Ann duncan *
Margaret Guy*
Marian Harrington *
dr Nazeer Ahmed
Paul Jenkins *
dr Matthew Johnson 01 January 2011
dr Jonathan Fluxman 31 March 2009
dr Jonathan Munday 01 January 2011
Michael Scott* 01 January 2011
Tera Younger 13 January 2011
* These people retain tenure in the CeC as long as
they remain in post.
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73
Senior Managers’ remuneration
2008-09 2007-08
Name and title Salary (bands of
£5,000)
other remuneration
(bands of £5,000)
benefits in kind
(bands of £100)
Salary (bands of £5,000)
Other remuneration
(bands of £5,000)
benefits in kind
(bands of £100)
£000 £000 £00 £000 £000 £00
d Abadi –
PeC/CeC Chair
35-40 0 0 30-35 0 0
K broughton – director
of Human resources
70-75 0 0 65-70 0 0
J deane –
director of Finance
& Performance Mgmt
95-100 0 0 95-100 0 0
A duncan – director
of Nursing and Quality
70-75 0 0 60-65 0 0
M Gamble – Clinical
PeC Member1
5-10 60-65 0 5-10 60-65 0
J Gannon – director
of Primary Care2
0 50-55 0 85-90 0 0
M Guy – director of
Public Health/
Medical director
155-160 0 0 160-165 0 0
L Hamlyn –
Chief executive3
0 0 0 105-110 0 0
J Hegarty –
Chair – Non executive
30-35 0 0 30-35 0 0
P Jenkins – director of
Service development
100-105 0 0 95-100 0 0
C Longworth –
Non executive
5-10 0 0 5-10 0 0
T Mali – Clinical
PeC Member4
0 0 0 5-10 40-45 0
S Patel –
Clinical PeC Member5
0-5 35-40 0 0-5 20-25 0
M Scott –
Chief executive6
130-135 0 0 0 0 0
S d’Souza –
Non executive
5-10 0 0 5-10 0 0
1. up to 31/12/20082. left 1/09/20083. left 11/01/20084. left 30/03/085. from 31/12/20086. from 28/03/2008
2008-09 2007-08
Name and title Salary (bands of
£5,000)
other remuneration
(bands of £5,000)
benefits in kind
(bands of £100)
Salary (bands of £5,000)
Other remuneration
(bands of £5,000)
benefits in kind
(bands of £100)
£000 £000 £00 £000 £000 £00
M Stepniak –
Non executive
5-10 0 0 5-10 0 0
A Whitley –
Non executive
5-10 0 0 5-10 0 0
N Woolf – Audit
Committee Chair
& Non-executive
10-15 0 0 10-15 0 0
T Younger –
Lay CeC Member
0-5 0 0 0 0 0
• Marian Harrington – CeC Member for Westminster City Council – her remuneration is a recharge
therefore excluded
• Tera Younger – Lay CeC Member – received a nominal amount of £16.05 per meeting up to
december 2008
• dr N Ahmed, dr derek Chase, dr Michael Cornell and dr Maher Sharkachi are practice-based
commissioning cluster representatives who receive locum cover only
• Councillor ed Argar, Marian Harrington and brigitta Lock are co-opted board members who are unpaid
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75
Pension entitlements
Name and title real increase
in pension at age 60 (bands of
£2,500)
lump sum at age 60 related to
real increase in
pension (bands of
£2,500)
total accrued
pension at age 60 at 31 march
2009 (bands of
£5,000)
cash equivalent
transfer Value at
31 march 2009
Cash
equivalent
Transfer
Value at
31 March
2008
real
increase in
in Cash
equivalent
Transfer
Value
2007/08 £000 £000 £000 £000 £000
d Abadi – CeC Chair 0-2.5 5-7.5 40-45 686 506 168
K broughton – director
of Human resources
5-7.5 17.5-20 15-20 221 130 88
J deane –
director of Finance
& Performance Mgmt
0-2.5 5-7.5 40-45 860 637 207
A duncan –
Chief Nurse
2.5-5 12.5-15 20-25 421 284 130
J Gannon – director
of Primary Care
2.5-5 7.5-10 20-25 344 231 36
L Hamlyn –
Chief executive
0 0 0 0 963 215
M Gamble –
Clinical PeC Member
0-2.5 0-2.5 5-10 113 83 28
M Guy – director
of Public Health/
Medical director
10-12.5 32.5-35 50-55 1,173 1,085 61
P Jenkins – director of
Service development
0-2.5 0-2.5 20-25 395 312 76
T Mali –
Clinical PeC Member
0 0 0 0 103 n/a
S Patel – Clinical
PeC Member
0-2.5 0-2.5 10-15 216 163 49
M Scott –
Chief executive
0-2.5 2.5-5 0-5 33 0 33
real increase in Cash equivalent Transfer Value is the comparison of the inflated values at 31 March 2008 with the actual values at 31 March 2009.
As Non-executive members have elected not to receive pensionable remuneration, there are no entries in respect of pensions
for Non-executive members.
What do you think?
NHS Westminster wants to hear from you.
If you have any questions, ideas or feedback about health or healthcare in Westminster, get in touch.
Call freephone 0800 587 8818email [email protected]
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Photography by:
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Cash Equivalent Transfer Values
A Cash equivalent Transfer Value (CeTV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a 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 or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme.
The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies.
The CeTV figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme.
They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost.
CeTVs are calculated within the guidelines and framework prescribed by the Institute of 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 scheme or arrangement) and uses common market valuation factors for the start and end of period.
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