Royal United Hospital BathNHS Trust

Annual Report 2002 - 2003

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Contents

Page No.

Profile and Commitment to NHS Plan 3

Chairman’s Statement 4

Chief Executive’s Overview of the Year 2002/03 5

Quarter 1: Our Position at the Beginning of the Year 8

Quarter 2: Taking Action and Making Progress 10

Quarter 3: Winter Planning and Emergency Pressures 12

Quarter 4: Our Achievements at the End of the Year 14

Key Objectives 2003/04 16

Financial Review 2002/03 17

Financial Summary 2002/03 I-XI

Directors’ Interests 18

If You Want to Know More 19

The Royal United Hospital Bath NHS Trust Annual Report is published

by the communications office, telephone 01225 825849.

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to the public. None of theseaims could be achieved withoutthe contribution of our people –the whole range of staff whoprovide care to the population.

has meant focusing on patientcare – the quality of service wegive, and performance – thequantity of care provided andthe speed it is made accessible

Profile and Commitment to NHS Plan

Bath & N.E.Somerset PCT

Kennet & NorthWiltshire PCT

West Wiltshire PCT

Mendip PCT

Wells

BATH

Glastonbury

Frome

Paulton

Keynsham

Malmesbury

Melksham

TrowbridgeDevizes

Westbury

The RUH Catchment Area

Nurses 32%

Medical staff 6%

Senior managers 3%

Maintenance 1%

Pharmacist 1%

Scientific 1%

Admin & clerical 17%

Healthcare assistants 13%

Ancillary 11%

Professional & technical 9%

Allied health professionals 6%

Chippenham

Profile of the Trust

The Royal United Hospital NHSTrust provides acute care for acatchment population of around500,000 people in Bath, and thesurrounding towns and villagesin North East Somerset, andNorth Western Wiltshire. Thetrust provides 704 beds and acomprehensive range of acuteservices including medicine andsurgery, services for women andchildren, accident andemergency services, anddiagnostic and clinical supportservices.

The trust employs 3,349 staff,some of whom also provideoutpatient, diagnostic and someday case surgery services atcommunity hospitals includingthose in Bradford-on-Avon,Chippenham, Devizes, Frome,Glastonbury, Keynsham,Malmesbury, Melksham, Paulton,Shepton Mallet, Trowbridge,Warminster, Wells and Westbury.This fulfils part of the trust’s aimto provide high quality care topeople in their localcommunities.

The trust provides health care tothe population of four primarycare trusts (PCTs), Bath andNorth East Somerset PCT,Kennet and North Wiltshire PCT,Mendip PCT and West WiltshirePCT.

Commitment to the NHS Plan

The chief executive’s objectivesreflect the trust’s commitment toworking with its partners in theBath health community to meetthe aims of the NHS Plan. This

Shepton Mallet

The Make-up of our Workforce

Bradford-on-Avon

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affirmed by the nationallypublished Sunday Times Dr FosterReport. This put the RUH amongstthe top six in the country for theclinical care provided for patients.

The key future challenge for us isvery clear – we must dramaticallyimprove our financial position. Animmediate priority is to put in placea permanent executive team tolead us through the next few years,and I am delighted to be able toannounce that a new chiefexecutive, Mark Davies, has nowbeen appointed. He will take overfrom Jenny Barker, who has beenably leading the trust as actingchief executive.There is one thing of which I amcertain - our staff and volunteerswill work hard to ensure that theexcellent standards of caredelivered in the RUH will continuein the future. My thanks toeveryone for their efforts andcommitment during the past year.

Mike RoyChairman

seconded into the organisation toreplace Richard Gleave, who hadstood aside. Jan quickly assembleda team of permanent andseconded executives who focusedon reviewing processes and hittingthe nationally set targets withexcellent results. Unfortunately,previous poor performance at thebeginning of the year meant thatwe would again receive a zero starrating in 2003.

Towards the end of 2002, the trustwas placed in further uncertaintywith the announcement that itwould be franchised; this meantthat teams from within and outsidethe NHS could bid to run theorganisation. This process waseventually stopped, but haddelayed the appointment of apermanent executive team.

There were of course many positivethings happening in the trust. TheLeague of Friends, the ForeverFriends Appeal and many othercharities continued to provideexcellent support and raise funds.A new state-of-the-art emergencydepartment was built and, perhapsmost importantly, the clinicalexcellence of the trust was re-

Chairman’s Statement

As the new Royal United Hospital(RUH) chairman, I am pleased to bepresenting this report to you.Firstly, I would like to thankProfessor Ruth Hawker, who wasinterim chairman at the RUH fromMay to October 2002 and who ablyled the board through a verydifficult time of change. The yearthat this annual report covers willsurely be remembered as one of theworst in the history of the RUH –the word turmoil, used by ourauditors, is no exaggeration.

I joined the trust as chairman inNovember 2002 and as a residentof Bath I had seen many negativenews stories about the trust in thelocal media. One of the first thingsthat I did when I was appointed,was to visit every area of thehospital and meet as many staff aspossible. I was immediately struckby the dedication and pride theydemonstrated. The message that Ipicked up very quickly was that thisis a clinically excellent hospital thatprovides the highest standards ofcare, despite a zero star rating forperformance.

In June 2002, Jan Filochowski, anexperienced chief executive, was Medical director John Waldron talks to a patient on Robin Smith ward

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● 22,516 patients were treatedusing day case electivesurgical procedures (fig.3)

During the year, theGovernment standards for in-and outpatient waiting times(access targets) were that nopatient should wait more than26 weeks for an outpatientappointment, or more than 15months for inpatient treatment(fig. 4). By the end of the year,patients were expected to waitno longer than 12 months forinpatient and day casetreatment, and 21 weeks for anoutpatient appointment (fig. 5).

Patients were waiting too longto receive planned treatment(elective rather thanemergency); however, we wereable to reassure them that onceadmitted, they would receivecare that was amongst the bestin the country.

Over the course of the year, wetreated more patients than inthe previous year:

● 53,611 patients attended theemergency department ofwhom 24,112 wereemergency admissions (fig.1)

● 249,698 new and follow-uppatients were seen in ouroutpatient departments(fig.2).

● 8,689 patients were admittedfor elective surgicalprocedures (fig.3)

Chief Executive’s Overview of the Year 2002/2003

As acting chief executive for thetrust since June 2003 andsomeone who has been adirector in the hospital for overtwo years, I have had first handexperience of the seriousfinancial and waiting listproblems that the trust hasfaced in recent years. Despitethese problems, the hospital hascontinued to provide excellentclinical care to patients asevidenced by a number ofreports including the Dr Fosterguide.

Our position at the beginning ofthis financial year was bleak.Although, some progress hadbeen made towards reducingwaiting times, the trust had atthe end of 2001/02 again fallenshort of certain key Governmenttargets and was later given itssecond consecutive zero starrating in the Commission forHealth ImprovementPerformance Ratings. In April2002, our financial difficultieswere severe and waiting timeswere amongst the worst in thecountry.

At the end of the year work was nearing completion on a new purposebuilt emergency department

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5710015556Inpatients waitinglonger than standard

From June 2002, under theleadership of Jan Filochowskistaff quickly started to tacklewaiting time problems.Additional beds were openedwhich provided much neededcapacity to treat patients, whilststaff looked at how care wasprovided - putting patientexperience central to thisreview.

At the end of the year, workwas nearing completion on ournew purpose built emergencydepartment; it had beencarefully designed with the helpof hospital staff and primarycare colleagues. This project hadprovided an ideal opportunityto look at how we could reducewaiting times for our emergencypatients. The result was thatfrom our position of worstperformance for waiting timesin the country for admission to abed - with the exception of onepatient in January - we endedthe year by meeting theGovernment standard with nopatients waiting in theemergency department over 12hours (fig. 6). In fact, the staffwere commended for theirefforts for this improvement.We also made vastimprovements towards the newGovernment standard for theend of the year, which was that90% of patients in theemergency department shouldbe treated, and admitted ordischarged within four hours(fig.6).

Despite the gloomy outlook, theaction that the trust tookthroughout the year resulted inthe achievement of Government

Nu

mb

er o

f Pa

tien

ts

Fig. 1 Patients attending emergencydepartment

55000

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Full Year2003

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Q42002/3

Q32002/3

Q22002/3

Q12002/3

00742Outpatients waitinglonger than standard

Fig. 4 Our progress towards meeting thestandards throughout the year

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. of

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s (N

ew a

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up

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Fig. 2 Patients seen in outpatientdepartments

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Fig. 3 Patients undergoing elective surgical procedures

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Day case patients

Inpatients admitted for surgery

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access targets by the end ofMarch 2003.Recognising that our staff havebeen key to our success, greatefforts have been made toimprove the way we recruitstaff, as well as our ability toretain them. Amongst manyinitiatives was the developmentof the nursing strategy; this willhelp with the recruitment andretention of essential nursingstaff, and reduce reliance onnursing agencies. In 2003,Corinne Hall was also appointedas the permanent director ofnursing.

In summary, the trust had a verydifficult year and staff workedhard to improve things. Thecoming year will also have itsown challenges that will be evenharder. The local healthcommunity has severe financialdifficulties and all ourpartnership organisations mustbecome more efficient and makesavings. The trust has developeda transformation group to lookat how we do things now andhow we should be doing thingsin the future within theavailable resources.

I am confident that the future ofthe RUH is bright and with thededicated staff and volunteerswe will be able to continue toprovide a high quality of care tothe people we serve.

Jenny BarkerActing chief executive

Outpatients waiting longer than 21 Weeks

600

500

400

300

200

100

0April

02May02

June02

July02

Aug02

Sept02

Oct02

Nov02

Dec02

Jan03

Feb03

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Fig. 5 Our progress towards meeting the yearend targets

Inpatients waiting longer than 12 Months

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02May02

June02

July02

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Fig. 6 Our progress towards meeting A&E targets

Q42002/3

Q32002/3

Q22002/3

Q12002/3

76.5%67.8%42.4%45.4%

Time in A&E

% patients waiting less than 4hours (year end target)

10680Number of patients waiting > 12hours from decision to admit (inyear target)

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● 90% of patients waitingunder four hours in theemergency department

● Financial management.

However, the performanceratings put the RUH amongstthe top four hospitals in thecountry in terms of clinical care,and achieved four of the ninekey targets:

● 99.7% of patients readmittedwithin 28 days of operationcancelled (for non-clinicalreasons on day of surgery)

● 98% of patients seen withintwo weeks of urgent GPreferral for suspected cancer

● Improving working lives ofstaff

● Hospital cleanliness.

In 2002, a review of thecorporate governancearrangements wascommissioned following thepublication of two earlier

At the beginning of thefinancial year, our inpatient andoutpatient waiting times causedthe RUH to hit nationalheadlines and the hospital wasdescribed as the worst inEngland. There were particularproblems with trolley waits inthe emergency department andconsiderable pressurethroughout the hospitalresulting from sustained highlevels of emergency admissions.

Our performance during thefirst three months of the yearresulted in the trust receiving azero star rating for overallperformance in 2002/03, for thesecond consecutive year.

The trust significantly failed onfour of the nine key targets: ● No patients waiting over 15

months for an operation● No patients waiting over 12

hours in the emergencydepartment

Our Position at the Beginning of the Year

National Vocational Qualifications

Over the past year there hasbeen a sharp increase in thenumber of support workerswithin the RUH completingtheir NVQ level 2 & 3 Awards.The trust held an awardceremony in May 2002; over100 people attended thissuccessful event.

Q 1

Patient Advice and LiaisonService (PALS)

PALS is now firmly establishedas a resource for patients andvisitors. During 2002/03 PALSdealt with over 670 enquiriesand provided information andassistance on concerns includingmissing appointment dates,waiting times, our services, andadvice on accessing medicalrecords; enquiries are oftenmade through the PALS webpages. Plans are in place tobuild a new PALS facilitylocated near to the mainreception of the hospital. Thiswill enable patients and visitorsto access information and PALSservices more directly.

Maintaining a Safe Environment

The number of incidents ofphysical abuse towards hospitalstaff has decreased significantlyover the last three years. Tomaintain a safe environmentand to enable key staff to dealwith aggressive situations, thetrust introduced a one-daytraining course designed tohelp staff talk people throughtheir aggression, thereforediffusing the situation.

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many initiatives that wereimplemented within the trustincluded the introduction oforthopaedic physiotherapyspecialists. Thesephysiotherapists offer a servicealongside consultantorthopaedic specialists to reducethe time taken for patients toreceive an outpatientappointment.

A huge amount of hard workgot underway in the firstquarter of the year (1 April 2002– 31 July 2002) which was to besustained throughout the yearto significantly reduce the timeour patients were waiting.

Progress made at the end ofJune 2002

reports into mismanagement ofwaiting lists and poor financialmanagement, both published inMay 2002. The findings of theinvestigation were published inthe Tinston report andrecommendations were made tothe trust in order that it couldput things right.

The trust board approved anaction plan that focused on:

● Leadership and management● Monitoring performance● Financial management and

administration● Quality and maintaining

standards● Staff● External relations ● Corporate governance

controls.

It was clear that radical changeswould need to be put in placeto reduce the amount of timepatients had to wait fortreatment. The trust instigated anew waiting list policy andstarted looking at alternativemeans by which patients couldbe treated. One example of the

The Arts Programme

An arts programme waslaunched to commissionartworks to display on many ofthe vast blank wall spaces thatthe new central buildingprovides. The artworkcommissioned has contributedenormously to our hospitalenvironment providing patientsand staff with some pleasantdistraction from some of theday to day stresses. Amongstsome of the art commissioned isa stained glass window that willacknowledge the names ofmany of the donors to theForever Friends Appeal.

League of Friends

In May, thehospital’s League ofFriends celebrated45 years’ service andthe donation of nearly £5million to the hospital duringthat time. As one of the mostactive League of Friends in thecountry, the Friends of the RUHhave 350 working volunteerswho support patients and staffin all departments, generouslygiving a total of 40,000 hourseach year and managing threethriving shops.

The Friends celebrated a goodyear with a very successfulChristmas fair in late autumnand a wonderful garden partyin the summer. In between, anIndian supper and a live jazzevening were held in theconservatory coffee shop.

Key Targets Q1 Q2 Q3 Q402/03 02/03 02/03 02/03

Inpatients waiting 556longer than thestandard

Outpatients 42waiting longer than the standard

A&E emergency 80admission waits (12 hours)

Total Time in A&E

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nurses from Spain significantlyhelped to reduce our nursingvacancies and boost ourrecruitment figures. Job-sharinginternational recruitmentcoordinators support the overalltrust overseas recruitmentstrategy, as well as clinicalpractice and pastoral care of theoverseas nurses.

An outline human resources(HR) strategy was developedand reflected the nationalstrategy - ‘HR in the NHS Plan:More Staff Working Differently.’It aims to set the direction forhuman resources developmentat the RUH and to ensure thatas part of our overall aim toimprove patient care we areable to provide a more stableworkforce with the right peoplein the right places - and thatthey will remain there.

A new nursing strategy wasplanned and later approvedwith the help of 100 of ournursing staff. The strategyoutlines the overall direction,objectives and actions the trustwould like to see for nursingover the next three years. It willnot only benefit patients butwill support the recruitment andretention of nursing staff.

Plans for new managementarrangements were being put inplace during this quarter of theyear. Medical and surgicalboards were set up to includedoctors, nurses and managers -each with a chair, boardmanager, and head of nursing(who would provide leadershipand development in nursingpractice). In addition, leadclinicians and nurses were

Our Workforce

Our staff are the key to oursuccess – and if we can improvetheir working life, we willimprove the care they are ableto give our patients. A lot ofwork focused on improving theworking lives of our staff andensuring that the hospital is agood place to work.

The staff turnover rate for Junewas down compared to previousmonths; the annual figure wasbelow 20%. However, the truststill had some way to go toachieve the national average of16.2% and we had high levels ofnursing vacancies. A number ofinitiatives were implemented toimprove the position, includinga series of recruitment opendays. The registration of 48international nurses and therecruitment of a further nine

Taking Action and Making Progress

Patient’s Survey

In June 2002, we had some verypositive feedback from theCommunity Health Council(CHC) in its Acute InpatientSurvey. The outcome of thesurvey was published on thefront page of the BathChronicle, reporting that nineout of ten patients are happywith the way they are treatedat the RUH. Credit must go toour front line staff for their partin achieving such excellentresults and also to catering andfacilities staff for the goodfeedback we received on ourfood and cleanliness.

Q 2

Improving Working Lives

Following a successful visit by ateam of external assessors thetrust was awarded practicestage in the Improving WorkingLives Standard. This was due tothe hard work of the HRdepartment and other staffinvolved in various improvingworking lives sub-groups.

Clinical Governance

Solutions to some of the highrisks of injury to patients andstaff in the trust were put inplace. These includedupgrading the main theatreanaesthetic machines,purchasing new laparoscopicequipment, new beds,mattresses and trolleys.

Improvements in Radiotherapy

In September, a new high-energyx-ray machine was installedproviding radiotherapy treatmentfor patients with cancer. Thelinear accelerator (LINAC) nowoperates alongside the existingLINAC. The new LINAC includes anumber of features which willhelp more targeted and effectiveradiotherapy to be provided. Ithas already significantly helped inreducing waiting times forradiotherapy treatment. Health care assistant Philippa

Bourne

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In August, the trust began dailymonitoring of the amount oftime our patients were waitingfor treatment. Thanks to thehuge efforts made by our staffby the end of September therewere no patients waiting over26 weeks for an outpatientappointment in the RUH.

Great improvements for patientswere also achieved, when nopatients were waiting on atrolley in our emergencydepartment prior to admissionfor more than 12 hours and thishad been the case since midJuly. Although a large numberof operations were still beingcancelled and having to be re-scheduled, there was areduction in the number ofoperations cancelled on the dayof surgery.

By the end of September 2002we were making really goodprogress at cutting access timesfor patients; all but 27 of ouroutpatients and inpatients werewaiting within the Governmentstandard waiting times and onlyone person had waited on atrolley in our emergencydepartment for more than 12hours.

Progress made at the end ofSeptember 2002

identified for each specialty.Changes were also taking placewithin the executive team.

In August, a theatre projectmanager was appointed to workwith managers, and clinical andadministration staff with theaim of reducing the number ofcancelled operations andtherefore reducing waiting timefor patients.

Our Progress

In some areas of the hospitalthere were huge improvementsin reducing waiting times forour patients. In August, theamount of time our patientshad to wait for routine CT scanswas reduced from one year inJanuary to just eight weeks. Thework patterns of radiology staffwere revised so that CT scanscould be carried out seven daysa week, including week dayevenings. The attention wasthen turned to reducing theamount of time our patientswere waiting for routine MRIscans; there still remains asignificant amount of work tobe done in this area.

In order to enable us to copewith emergency pressures moreeffectively, work was in progressto look at options for providingadditional beds at the hospital.This would also help us toreduce the extent to which wehad to send patients - waitingfor routine operations - to theprivate sector. In 2002/03, thenumbers of patients requiringemergency admission to thehospital were around 10%higher than the previous year.

Communication and Openness

The trust demonstrated itscommitment to extending andimproving communicationswithin the trust with its firstissue of the Bath Board Bulletinand the introduction of regularstaff open meetings. Both weredesigned to provide staff withan update of items discussed atmonthly board meetings.

Key Targets Q1 Q2 Q3 Q402/03 02/03 02/03 02/03

Inpatients waiting 556 15longer than thestandard

Outpatients 42 7waiting longer than the standard

A&E emergency 80 6admission waits (12 hours)

Total Time in A&E

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appropriate arrangements weremade for the patient at home.

During November, an outbreakof the Norwalk-like virus forcedbed closures and exacerbatedemergency pressures that wewould normally expect for thattime of year. To ensure patientsreceived appropriate treatmentand care in a safe environmentthe decision was made to cancelmany routine operations forinpatients – urgent and day casesurgery continued. The outbreakremained with us throughoutmost of the winter months and

Before the onset of winter andthe beginning of pressuresassociated with it, the RUH andlocal primary care trusts (PCTs)worked together to produce ajoint winter plan.

During the winter months, wetraditionally see a rise in thenumber of emergency patientsadmitted to the RUH. To ensurethat only those patientsrequiring admission to an acutehospital are admitted, the trustset up a rapid assessment teammade up of nursing andtherapies staff, and socialworkers who could quicklyassess whether a patientrequired admission to the RUHor could be treated elsewhere.

A lot of work went into thedischarge planning for thosepatients who were admitted toensure that when patients nolonger required acute hospitalcare, they were discharged ortransferred appropriately. ThePCTs helped to ensure that bedswere made available incommunity hospitals or

Winter Planning and Emergency Pressures

Patient Complaints

During 2002/03 the trustreceived 610 complaints – asmall reduction from theprevious year - acknowledging98% promptly within the targetof two working days. Lessonslearned from complaints haveled directly to changes inservice provision andimprovements in patient care.

The trust responded fully to57% of complaints within the20 working day target – adeterioration from the previousyear reflecting the complexityof many of the complaintsreceived.

There were eight requests forindependent review during theyear, one of which proceededto panel. The ombudsmancalled for papers in four casesduring this year and hasdecided to further investigateone case.

Modern Matron Appointments

In September, we appointedour first modern matron forsurgery; this followed twosimilar appointments inmedicine. We are delightedthat our modern matrons arealready having an impact onpatient care and improvingstandards in the wards andwithin our emergencydepartment.

Q 3

New Emergency GynaecologicalClinic

Last August, a gynaecologyemergency assessment clinicwas set up to reduce theamount of time patients werewaiting to see specialistgynaecology doctors and nursesand to receive ultrasoundscans.

Theatre project manager Caerrie Barber with theatre sister Clare Fowler

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A new medical short stay unitreplaced the medical admissionsunit and included an additionaltwelve-bed area. Clinically stablepatients being referred by GPswere now admitted directly intoa new acute medical assessmentarea rather than attending theemergency department. Inaddition, the rapid assessmentteam reduced the inappropriateadmission of patients to thehospital and assisted in the earlyand safe discharge of patients.The benefits of the changeswere recognised within weeks.In November, 56% of ourpatients spent under four hoursin our emergency department.By the end of December, thisfigure had risen to 68%.

Progress made at the end ofDecember

increased our use of agencynurses, which had previouslybeen on a decline. There werealso reports in the local pressabout the delays thatambulance trusts wereexperiencing in handing overthe care of their patients tostaff in the emergencydepartment.

To reduce pressure on ouremergency services, the trustintroduced major changes to theway emergency admissions wereorganised. The newarrangements were designed toensure that emergency patientswere assessed and treated morequickly.

Essence of Care

The trust has gained nationalrecognition for some of itswork on the Government’sinitiative called Essence of Care- this provides a patient focusedstructured approach toimproving essential patientcare. The trust continues tomake good progress in theareas of continence, oral care,improved nutrition, privacy anddignity, and safety of patientswith mental health needs in anacute hospital.

Key Targets Q1 Q2 Q3 Q402/03 02/03 02/03 02/03

Inpatients waiting 556 15 0longer than thestandard

Outpatients 42 7 0waiting longer than the standard

A&E emergency 80 6 0admission waits (12 hours)

Total Time in A&E

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to be built. The temporary wardis a surgical short-stay unit forpatients recovering from routineoperations. It increased thenumber of beds at the hospitalby 12 and helped us to achievethe end of year targets. Wewere successful in attracting areally good team of nursingstaff to work on this newsurgical ward.

At the end of 2002/03, wesucceeded in achieving all themain national waiting targets.There were no patients waitingmore than 12 months for anoperation, or more than 21weeks for an outpatientappointment. Only one patienthad waited longer than 12 hourson a trolley since July and thishad been due to clinical need.

Our Achievements at the End of the Year

The Press

Each week, letters of support andgratitude appeared and continueto appear in the ‘Letter’s’ page ofthe Bath Chronicle – the localdaily newspaper – and manymore are received in patient areasthroughout the trust.

In March, the Saturday TelegraphMagazine published a feature onthe RUH. The feature reflected onpast issues and highlighted theenormity of the pressures facedby the trust. In addition, itrepresented our staff in anextremely professional and caringlight.

Data Accreditation

In March 2003, the trust wasawarded Stage Two for dataaccreditation. The informationservices department and servicerenewal team helped to resolveproblems we were experiencingin data quality and successfullybuilt foundations for reallyrobust data quality.

Major Incident Planning

A lot of work and involvement ofstaff throughout the trust wasput into updating our majorincident plan with a first draftapproved by the board. A majorincident simulation exercise wasplanned for May; this proved tobe a very successful learningopportunity.

Q 4

Children’s Rights Charter

The pre-school assessment andtherapy centre received its firstChildren’s Rights Charter - anaward recognising children’sviews and ideas in developingservices that are important tothem.

In February, the trust welcomedits first patients onto Widcombeward just seven weeks after theorder was placed for the ward

Work commenced in February toextend day care facilities forcancer and haematologypatients. The trust is extremelygrateful to the Bath Cancer UnitSupport Group for raising morethan £310,000 towards the newenlarged treatment room, whichnow completed enables agreater percentage of patientsto receive their treatments asoutpatients.

Children enjoying activities in the pre-school assessment and therapy centre

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Key Targets Q1 Q2 Q3 Q402/03 02/03 02/03 02/03

Inpatients waiting 556 15 0 0longer than thestandard

Outpatients 42 7 0 0waiting longer than the standard

A&E emergency 80 6 0 1admission waits (12 hours)

Total Time in A&E

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the trust’s objectives andachieve a strategic vision forthe Bath health community

● Ensure that the trust hasstrong corporate, clinical andrisk managementarrangements

● Communicate effectivelywith the public and staff toensure a realistic view of thechallenges that face the trust

● Develop an organisationalstrategy for the trust andappoint a permanentexecutive team.

● Achieve savings/incometargets

● Continue with the commitment to achieve NHS Plan targets and other star rating criteria for 2003/04

● Finalise local delivery plans with our local primary care trusts to provide care to the local health community

● Improve internalorganisational efficiencies

● Work in partnership with ourlocal primary care trusts andsocial services to help achieve

Key Objectives 2003/2004

Review of 2002/03 Objectives

The trust worked hard to meetthe objectives set for 2002/03.Although the hospital had a verydifficult year we continued toprovide a high quality service,we reduced waiting times forpatients, we passed ourimproving working livesassessment, and we workedmore closely than ever beforewith our partners and the public.

Details on how we met ourobjectives and targets, andexamples of our compliance withclinical governance standards areincluded within the main bodyof the report.

The challenge for the year2003/04 will be to continue withthe progress made but to tryand bring the organisation backinto financial balance. Nextyear’s objectives will focus uponthat task.

Key Objectives in 2003/04

The trust has set challengingobjectives in 2003/04 that buildupon the success of work in2002/03. The trust must nowwork towards achieving financialbalance whilst still maintaininghigh standards of clinical care.The objectives agreed by thetrust board are as follows:

● Develop a credible plan(called the transformationplan) that will bring the trustinto financial balance over athree year period ensuringachievement of access andother NHS Plan targetswithout reducing quality ofcare

A team including information analyst Glyn Young helped the trust achievestage two for data accreditation, improving data quality

Summary Financial Statements 2002/2003

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I

Summary Financial Statements

Introduction

The audited accounts show the Trust recorded a deficit of £24.784m for the financial year.

The financial targets set for Capital Cost Absorption Rate and Capital Resource Limit were achievedwithin the permitted parameters.

In achieving these targets the Trust received cash assistance of £19m from BANES Primary Care Trust inthe form of short term loans. As a result the Trust exceeded the external financing limit (EFL) notified bythe Department of Health (DoH) by £11,604k. Had this been received as income or by way of PublicDividend Capital (PDC) the Trust would have delivered its core external financing limit of £1,699k towithin £25k.

The Trust’s Public Sector Payment Policy achievement for 2002/03 was 68% by number and 64% by valueof bills paid within 30 days.

Further details of the key financial targets are shown on page VIII.

Looking ahead, 2003/04 will be another difficult year as the Trust strives to deliver high quality patientcare and improved waiting times against a background of substantial financial pressures.

The year started with a planned financial deficit of £8.7m for the Bath Health Community. The Trust, asan NHS body, has a fundamental duty to set a break even budget. Plans to fully understand and managefinancial risks and to deliver the financial targets continue to develop with local primary care trusts(PCTs) and Avon, Gloucester and Wiltshire Strategic Health Authority (AGW SHA).

I would like to thank staff throughout the Trust and related agencies for their hard work and support instriving to deliver the financial targets and provide value for money services for our patients andcommunity.

Margaret PrattActing Director of FinanceSeptember 2003

The accounts for the year ended 31 March 2003 have been prepared by the Royal United Hospital, BathNHS Trust 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 theSecretary of State has, with the approval of the Treasury, directed.

The Audit Committee receive the draft accounts prior to Trust Board approval, and the current nonexecutive members are: Maura Poole, Thomas Sheppard and Richard Weatherhead.

The summary financial statements that follow are a summary of the information in the full accountswhich are available from the Trust’s Finance Department. Please write to Richard Hogger, Head ofFinancial Services, Royal United Hospital, Bath NHS Trust, Combe Park, Bath BA1 3NG.

II

Directors' Statements

Statement of the Chief Executive's responsibilitiesas the Accountable Officer of the Trust

The Secretary of State has directed that the Chief Executive should be the Accountable Officer to theTrust. The relevant responsibilities of Accountable Officers, including their responsibility for the proprietyand regularity of the public finances for which they are answerable, and for the keeping of properrecords, are set out in the Accountable Officers’ Memorandum issued by the Department of Health.

To the best of my knowledge and belief, I have properly discharged the responsibilities set out in myletter of appointment as an Accountable Officer.

Jenny Barker, Acting Chief ExecutiveSeptember 2003

Statement of Directors' responsibilities in respect of the accounts

The Directors are required under the National Health Services Act 1977 to prepare accounts for eachfinancial year.

The Secretary of State, with the approval of the Treasury, directs that these accounts give a true and fairview of the state of affairs of the Trust and of the income and expenditure of the Trust for that period.In preparing those accounts, the Directors are required to:

- apply on a consistent basis accounting policies laid down by the Secretary of State with the approval ofthe Treasury- make judgements and estimates which are reasonable and prudent- state whether applicable accounting standards have been followed, subject to any material departuresdisclosed and explained in the accounts.

The Directors confirm they have complied with the above requirements in preparing the accounts. TheDirectors are responsible for keeping proper accounting records which disclose with reasonable accuracyat any time the financial position of the Trust and to enable them to ensure that the accounts complywith requirements outlined in the above mentioned direction of the Secretary of State. They are alsoresponsible for safeguarding the assets of the Trust and hence for taking reasonable steps for theprevention and detection of fraud and other irregularities.

By order of the Board

Jenny Barker, Acting Chief ExecutiveSeptember 2003

Margaret Pratt, Acting Director of FinanceSeptember 2003

III

Directors' Statements

Statement of Directors' responsibility in respect of internal control

The Board is accountable for internal control. As Accountable Officer, and Chief Executive Officer of thisBoard, I have responsibility for maintaining a sound system of internal control that supports theachievement of the organisation’s objectives, and for reviewing its effectiveness. The system of internalcontrol is designed to manage rather than eliminate the risk of failure to achieve these objectives; it cantherefore only provide reasonable and not absolute assurance of effectiveness.

The system of internal control is based on an ongoing risk management process designed to identify theprincipal risks to the achievement of the organisation’s objectives; to evaluate the nature and extent ofthose risks; and to manage them efficiently, effectively and economically. The system of internal controlis underpinned by compliance with the requirements of the core Controls Assurance standards:

- Governance- Financial Management- Risk Management.

The assurance framework is still being finalised and will be fully embedded during 2003/04 to providethe necessary evidence of an effective system of internal control.

The actions taken so far include:

- The organisation has undertaken a self-assessment exercise against the core Controls Assurancestandards (Governance, Financial Management and Risk Management). An action plan has beendeveloped and is being implemented to meet any gaps.- The organisation has put in place arrangements to monitor, as part of its risk identification andmanagement processes, compliance with other key standards, including relevant Controls Assurancestandards covering areas of potentially significant organisational risk.- Establishing a revised sub committee structure with improved lines of accountability and developing anAssurance framework

The main priorities of the Trust will be to :

- Develop an established executive and senior management team- Develop and implement a new robust performance management framework including accountability for activities.

In addition to the actions outlined above, in the coming year it is planned to continue to:

- Further develop the Board’s awareness of their responsibilities towards the coreControls Assurance standards, support risk awareness training for key staff and develop anassurance framework.

Qtr 3/4

Qtr 3

Qtr 3

IV

Directors' Statements

Statement of Directors' responsibility in respect of internal control (cont.)

- Further develop the Trust’s risk register to capture all significant risks identified through financial, clinical and non clinical risk assessment processes.- Introduce a real time risk register with a prioritisation process which will report to the Trust Board.- Further develop the financial controls framework and corporate governance of the organisation ensuring transparencies of accountabilities and process.- Further strengthen the management culture and structure and develop a robust corporate risk management culture.- Participate in and contribute to benchmarking across the local health community and nationally.

As Accountable Officer, I also have responsibility for reviewing the effectiveness of the system of internalcontrol. My review of the effectiveness of the system of internal control has taken account of the workof the executive management team within the organisation who have responsibility for thedevelopment and maintenance of the internal control framework, and of the internal auditors. I havealso taken account of comments made by external auditors and other review bodies in their reports.

Signed Acting Chief Executive Officer

Date 18 September 2003(on behalf of the Board)

In 2002/03 for the first time, the Head of Internal Audit for the Trust has been required to give a formalopinion on the internal controls in operation in the Trust. The statement signed by the Chief ExecutiveOfficer incorporates the key statements of assurance within that opinion.

In this opinion, the Head of Internal Audit stated:

“It is my opinion that for the identified principal risks covered by Internal Audit work the Board hassignificant assurance that there is a generally sound system of control designed to meet theorganisation’s objectives. However some weaknesses in the design or inconsistent application of controlsmay have put the achievement of particular objectives at risk.”

Qtr 3

Qtr 3

Qtr 2/3

Qtr 3

Qtr 3

V

Independent Auditors' Report to the Directors of Royal United Hospital, Bath NHS Trust on the Summary Financial Statements

We have examined the summary financial statements set out on pages VI to Xl.

This report is made solely to the Board of Royal United Hospital Bath NHS Trust in accordance with Part IIof the Audit Commission Act 1998 and for no other purpose, as set out in paragraph 54 of theStatement of Responsibilities of Auditors and of Audited Bodies, prepared by the Audit Commission

Respective responsibilities of directors and auditors

The directors are responsible for preparing the Annual Report. Our responsibility is to report to you ouropinion on the consistency of the summary financial statements with the statutory financial statements.We also read the other information contained in the Annual Report and consider the implications forour report if we become aware of any misstatements or material inconsistencies with the summaryfinancial statements.

Basis of opinion

We conducted our work in accordance with Bulletin 1999/6 ‘The auditor’s statement on the summaryfinancial statements’ issued by the Auditing Practices Board for use in the United Kingdom.

Opinion

In our opinion the summary financial statements are consistent with the statutory financial statementsof the Trust for the year ended 31 March 2003 on which we have issued an unqualified opinion.

PricewaterhouseCoopers31 Great George StreetBristolBS1 5QDDate - September 2003

VI

Summary Financial Statements

Income and Expenditure for the Year Ended 31 March 2003

2002/03 2001/02Restated

£000 £000

Income from activities 108,982 119,466Other operating income 12,025 10,422Operating expenses (139,684) (121,817)

Operating Surplus/(deficit) (18,677) 8,071

Exceptional loss: charitable funds provision (464) 0Exceptional gain: write-out of clinical negligence provisions 0 3,761Exceptional loss: write-out of clinical negligence debtors 0 (3,761)Loss on disposal of fixed assets 10 (6)

Surplus/(deficit) before Interest (19,131) 8,065

Interest receivable 98 96Interest payable (1) 0Other finance costs - unwinding of discount (18) (24)

Surplus/(deficit) for the financial year (19,052) 8,137

Public Dividend Capital - dividends payable (5,732) (5,984)

Retained Surplus/(deficit) for the year (24,784) 2,153

Balance Sheet as at 31 March 2003

2002/03 2001/02Restated

£000 £000Fixed Assets

Tangible Fixed Assets 130,938 116,578Current Assets

Stocks 2,602 2,324Debtors 7,206 16,061Cash at bank and in hand 30 2,072

Current LiabilitiesCreditors (33,595) (19,293)Net Current Assets (23,757) 1,164

Total Assets less Current Liabilities 107,181 117,742

Provision for liabilities and charges (1,000) (299)Total Assets Employed 106,181 117,443

Financed byPublic dividend capital 126,035 124,485Revaluation reserve 8,121 (2,412)Donation reserve 4,954 4,240Income and expenditure reserve (32,929) (8,870)

Total Capital and Reserves 106,181 117,443

VII

Summary Financial Statements

Cash Flow Statement

2002/03 2001/02Restated

£000 £000Operating Activities

Net cash inflow/(outflow) from activities (58) 8,768Returns on investments and servicing of finance

Interest received 98 96Interest paid (1) 0

Net cash inflow from returns on investments and servicing of finance 97 96

Capital ExpenditurePayments to acquire tangible fixed assets (7,620) (12,184)Receipts from sale of tangible fixed assets 10 24

Net cash outflow from capital expenditure (7,610) (12,160)

Dividends paid (5,732) (5,984)Net cash outflow before management of liquid resources and financing (13,303) (9,280)Management of liquid resources 0 0Net cash outflow before financing (13,303) (9,280)

FinancingPublic dividend capital received 17,796 15,315Public dividend capital repaid - not previously accrued (16,097) (13,127)Public dividend capital repaid - accrued in prior period 0 (276)Loans Received 19,000 7,371Loans repaid (7,371) 0Net cash inflow from financing 13,328 9,283

Increase in Cash 25 3

Statement of Recognised Gains and Losses

2002/03 2001/02Restated

£000 £000

Surplus / (Deficit) for the financial year before dividend payments (19,052) 8,137

Fixed asset impairment losses (5,096) (450)

Unrealised surplus on fixed asset revaluations/indexation 16,707 3,920

Increase in the donation reserve due to receipt of donated assets 786 450

Reduction in the donation reserve due to depreciation, impairment(loss of economic benefits), and/or disposal of donated assets (425) (350)

Total Recognised Gains and Losses for the financial year (7,080) 11,707

Prior period adjustment* (299) 0

Total Gains and Losses Recognised in the financial year (7,379) 11,707

In 2002/03 the accounting for pre 6 March 1995 early retirements has been brought into line with that for post 6 March earlyretirements (see note 1.11 in the full Financial Statements). As a result a prior period adjustment has been made to the accounts. Theeffects of the adjustment on the 2001/02 figures are to:- reduce the income and expenditure reserve by £299K- increase the reported surplus by £74K- reduce the staff costs (in note 5.1 in the full Financial Statements) by £50K- reduce government funds by £299K- increase the interest payable by £24KThe effect of the change in accounting treatment on the results for 2002/03 is to reduce the deficit by £12K compared to that whichwould have been recorded had there been no change in accounting policy.

VIII

Summary Financial Statements

Key Financial Targets

Breakeven PerformanceA substantial deficit was recorded in the local health economy in 2002/03. The Trust has incurred a deficitof £24,784k. The Trust has a legal responsibility to breakeven taking one year with another. This isnormally taken as a period of 3 years but can be extended to 5 years under exceptional circumstances.The Trust's deficit is £24,784k and this has to be recovered by the end of 2004/05. Discussions betweenAGW and the DoH are taking place to secure additional one-off income in 2003/04 to eliminate thisaccumulated deficit. If this income is secured then the Trust will show a significant surplus in 2003/04.

External Financing Limit (EFL)Spending on the acquisition of land and buildings is financed by borrowing from the Government. TheEFL is a limit on the amount of cash that may be borrowed in any one financial year and, at nationallevel, is an important component in the control of public expenditure. Managing the EFL is a keyfinancial duty of the Trust. In achieving these targets the Trust received cash assistance of £19m fromBANES PCT in the form of short term loans. As a result the Trust exceeded the external financing limitnotified by the DoH by £11,604k. Had this been received as income or by way of PDC the Trust wouldhave delivered its core EFL of £1,699k to within £25k.

Capital Resource Limit (CRL)The Capital Resource Limit is set by the Department of Health. This limits the funding available to theTrust for capital expenditure. The Trust is required to stay within it's CRL but is permitted to undershoot(underspend). The undershoot for the year was £90k

2002/03£000

Gross capital expenditure 8,729Less book value of assets disposed of 0Less donations (786)Charge against CRL 7,943Capital Resource Limit 8,033

Public Sector Payment Policy Trusts are required to pay their non-NHS trade creditors in accordance with the Confederation of BritishIndustries (CBI) prompt payment code and Government Accounting Rules. Government Accounting Rulesstate that 'the timing of payment should normally be stated in the contract .... where there is nocontractual provision the Trust should pay within 30 days of receipt of goods and services or thepresentation of a valid invoice, whichever is the later'The Trust's payment policy is consistent with both of these and its measurement of compliance is:

2002/03Total number of bills paid 47,539Total number of bills paid within target 32,185Percentage of bills paid within target 68%

Total value of bills paid (£'000) 43,648Total value of bills paid within target (£'000) 27,912Percentage of bills paid within target 64%

Under the Late Payment of Commercial Debts (interest) Act 1998 companies can charge interest onoverdue accounts. During the year 2002/03 the Trust paid £1k interest from claims made under thislegislation.

Management Costs 2002/03£000

Income (excluding FRS11 income) 114,066Management costs in year 6,810Management costs expressed as a percentage of income 6.0%

Capital Cost Absorption RateThe Trust is required to absorb the cost of capital at a rate of 6% of average relevant net assets. In 2002/03the Trust achieved a rate of 5.8% which is within the NHS Executive's materiality range of 5.5% to 6.5%.

IX

Summary Financial Statements

Financial Health

The following disclosures on the financial health of the organisation are taken from the annualaccounts:

The Trust has a legal responsibility to break even taking one year with another. This is normallytaken as a period of 3 years but can be extended to 5 years under exceptional circumstances.The Trust’s deficit is £24,784k and this has to be recovered by the end of 2004/05. Discussionsbetween AGW SHA and the DoH are taking place to secure additional one-off income in2003/04 to eliminate this accumulated deficit. If this income is secured then the Trust will showa significant surplus in 2003/04.

2003/04 Financial Position

The Trust is planning to achieve financial balance in 2003/04, before accounting for theadditional one-off income referred to above. To do so it has to close a gap between knownincome and planned expenditure. AGW SHA has confirmed that £7m will be made availablefrom the NHS Bank special assistance funding and other non-recurring sources in 2003/04.

In order to achieve financial balance in 2003/04 the Trust must achieve the following:

- Deliver a savings programme of no less than £3.4m- Manage other known risks amounting to £10.9m, including unfunded ward costs.

The Trust, in conjunction with AGW SHA, is developing further plans to manage the risksoutstanding. By the 31st October 2003 the Trust will have prepared a plan on how theseremaining risks will be managed and submitted it to local partners and AGW SHA.

Financial Recovery

The Trust is developing a financial recovery plan working with others locally to achieveunderlying financial balance (i.e. without the need for external special financial assistance) bythe 31st March 2007. The Plan will be submitted to AGW SHA by the 19th September 2003 andagreed by the 31st October 2003.

In developing the Plan the Trust expects to receive further financial assistance in 2004/05 of£3.5m and in 2005/06 of £NIL. These amounts are subject to confirmation by AGW SHA.

X

Summary Financial StatementsBoard Directors' Remuneration

This note reflects the Greenbury requirements for senior employees. Senior employees are those persons in senior positions havingauthority or responsibility for directing or controlling the major activities of the trust. The Chief Executive has confirmed that thisdefinition relates to the Executive and Non-Executive Directors of the Trust. The disclosures in this note have only been made withthe prior consent of the individuals concerned.The Remuneration Committee consists of Non-Executive Directors who set the salary of Executive Directors and the Chief ExecutiveOfficer using national benchmarking information.Non-Executive Directors remuneration is set nationally by the NHS appointments office.

2002/03Name and Title Age Salary Other Golden Hellos/ Benefits in Real increase Total accrued

remuneration Compensation kind in pension pensionfor loss of at at age 60

office age 60 at 31.3.02£000 £000 £000 £000 £000 £000

Executive DirectorsMs. Jenny Barker - Dr of Partnerships & Service Support 43 72 0 0 0 1 14Mrs. Jane Cummings - Director of Nursing * 67 0 0 3 * *Mr. Martin Dove - Director of Finance * * * * * * *Ms. Sally Fox - (consent to disclose withheld) * 70 0 0 0 * *Mr. Richard Gleave - Chief Executive 39 108 0 0 0 4 21Ms. Barbara Harris - Chief Executive * * * * * * *Mr. Stephen Holt - Director of Facilities 45 61 0 0 0 * *Dr. James Playfair - Director of Primary Care 49 24 0 9 0 0 2Dr. Graham Smith - Medical Director 50 5 75 0 0 1 19Mr. John Stephenson - Director of Corporate Affairs * * * * * * *Dr. John Waldron - Medical Director 48 21 85 0 0 1 21Mr. Gerald Chown - Chairman * 3 0 0 0 ** **Mr. Mike Roy - Chairman 63 8 0 0 0 ** **Rev. Jonathan LLoyd - Non-Executive Director 46 5 0 0 0 ** **Mr. Jeff Manning - Non-Executive Director 58 5 0 0 0 ** **Mrs. Maura Poole - Non-Executive Director 43 1 0 0 0 ** **Mr. Thomas Sheppard - Non-Executive Director 50 5 0 0 0 ** **Mrs. Prudence Skene - Non-Executive Director 59 5 0 0 0 ** **Mr. Barry Stevenson - Non-Executive Director 64 5 0 0 0 ** **

*Consent to disclose withheld.

**This is a non-pensionable employment

The following directors provided their services to the Trust during the year by means of interim, short-term contracts;

Name Title Cost to Trust £000Mr. Kevin Hodgkinson Interim Director of Finance 3Mr. David Gilburt Interim Director of Finance 32Mr. Stan Griffiths Interim Director of Finance 26

The following directors were seconded to the Trust by other NHS Bodies during the year to fill vacant directorial posts.Their remuneration details can be found in the accounts of the organisation which holds their contract of employment.

Name Title Period of Secondment Employing OrganisationMr. Stephen Cass Interim Director of Finance 17-Sept-02 to 7-Mar-03 Worthing and Southlands NHS TrustMr. Jan Filochowski Chief Executive 27-Jun-02 to 31-Jul-03 Medway NHS TrustMs. Paula Friend Director of Service Renewal 22-Jul-02 to I-Jun-03 Medway NHS TrustMs. Corinne Hall Director of Nursing 1-Aug-02 to 2-Jun-03 The Hillingdon Hospital NHS TrustProf Ruth Hawker Chairman 17-May-02 to 01-Nov-02 Royal Devon and Exeter NHS Trust

Following the end of Ms Hall's secondment she was appointed as the substantive Director of Nursing for the Trust.

During the year the following executive and non executive directors started or left their post.

Name Title Start Date Leaving DateMrs. Jane Cummings Director of Nursing N/A 01-Aug-02Mr. Martin Dove Director of Finance N/A 24-Jan-03Ms. Sally Fox Consent to disclose withheld N/A 31-Mar-03Ms. Barbara Harris Chief Executive N/A 22-Aug-02Dr. James Playfair Director of Primary Care, N/A 22-Nov-02Dr. Graham Smith Medical Director N/A 17-Jan-03Mr. John Stephenson Director of Corporate Affairs N/A 05-Dec-02Dr. John Waldron Medical Director 31-May-02 N/AMr. Gerald Chown Chairman N/A 17-May-02Mr. Mike Roy Chairman 01-Nov-02 N/ARev. Jonathan LLoyd Non Executive Director 01-Apr-02 N/AMrs. Maura Poole Non Executive Director 01-Jan-03 N/AMrs. Prudence Skene Non Executive Director N/A 30-Apr-03Mr. Barry Stevenson Non Executive Director N/A 30-Jun-02

XI

Summary Financial Statements

Charitable Funds

Charitable Funds arise from donations, subscriptions and bequests and must be accounted forindependently of monies received from purchasers for the provision of health care. Charitable Funds arevery important to the Trust and provide additional benefits to patients and staff which could nototherwise be provided.

The Royal United Hospital, Bath NHS Trust is the Trustee for the Charitable Fund, registered charitynumber 1058323. The Trust Board is therefore fully accountable for the funds but has delegated someresponsibilities to the Charitable Funds Committee. The Charitable Funds Committee is supported by theAudit Committee and a finance department representative. The main duties of the Charitable FundsCommittee are to ensure that the funds are collected, spent and managed legally, ethically and inaccordance with all relevant legislation. The Committee also recommends policy and procedural changesto the Trust Board in relation to Charitable Funds to ensure compliance with statutory changes. Thisincludes fundraising, investment, expenditure and operational policies.

The Trust wishes to thank all those who have generously donated funds during the year.

The accounts for the Charitable Funds have not yet been finalised and subsequently the Trust is unableto publish any summary financial information. Anyone wishing to review these accounts should write tothe address on the page I of the summary financial statements within this annual report; copies will besent when they become available.

18

Directors’ Interests

The trust is required to maintain a register of directorships and other significant interests of all boardmembers and to publish them in the annual report. Below are listed those directors to whom thisapplies:

Gerald Chown - (Resigned from the trust in May 2002)

Member of the Council of the University of Bath

Mike Roy

Chairman of City of Bath College

Jeff Manning

Member of Bath & North East Somerset Council (Stood down in May 2003 election)

Prudence Skene - (Completed term of office on 30 April 2002)

Director of the Ballet Rambert Limited and Rambert Trust

Director of The Arvon Foundation Limited

Director of the Theatre Royal Bath Limited

Trustee of Stephen Spender Memorial Trust

Graham Smith - (Resigned from the trust 17 January 2003)

Director of the Prior Walk Management Company

Barry Stevenson - (Completed term of office on 30 June 2002)

Director of Brunel Holdings plc.

19

If You Want to Know More

If you would like to know more, or to comment on our plans, please write to the chairman Mike Roy orour chief executive Mark Davies at:

Royal United Hospital NHS TrustCombe ParkBATHBA1 3NG

Telephone: 01225 824033

Fax: 01225 824304

E-mail: info@ruh-bath.swest.nhs.uk

Website: www.ruh-bath.swest.nhs.uk

20

Royal United Hospital, Combe Park, Bath BA1 3NGTelephone: 01225 428331

email: info@ruh-bath.swest.nhs.ukwebsite: www.ruh-bath.swest.nhs.uk

Royal United Hospital BathNHS Trust