uhcw annual report 2008-09 :layout 1 reports and... · picture courtesy of skanska facilities...

Annual Report

2008-09

Low infections, reduced mortality ratesand an increased investment in serviceshave increased quality of care for ourpatients.

The past 12 months achievementsinclude:

- The only Trust in the West Midlands to offer 24-hour primary angioplasty treatment

- £750,000 invested into our highly rated maternity services

- One of six national pilot sites conducting additional breast screening

- Reduced mortality rate for the fourth year in a row

- 50% less cases of C Diff and recorded our first ever months MRSA free.

The services we provide at the Hospital ofSt Cross are a vital part of our Trust andthese have increased with a new diabetescentre, new sexual health building andnew CT scanner.

We are proud to work closely with ourpartners from Coventry University andWarwick Medical School which is basedat the University of Warwick. The Trustworks closely with Warwick MedicalSchool to develop innovative medicaleducational programme and clinicalresearch. Students on the doctor trainingprogramme spend 30 months of thecourse on clinical attachments indepartments across the Trust. Patientsfrom Coventry, Rugby and further afieldcontinue to benefit from our medicalresearch in diabetes, lung disease andearly labour in pregnancy, an area inwhich we are already one of the worldleaders. However, while research isimportant for future care, we recognisethat our daily care is only as good as thestaff who provide it and we recognisedtheir hard work and dedication with thelaunch of our Outstanding Service andCare Awards (OSCAs).

Nationally this hard work was alsorecognised by the HealthcareCommission, which rated our quality ofservices and use of resources as ‘good’.We also met our goal to reduce waitingto a maximum of 18 weeks from referral

to treatment by the end of December2008. Although seeing and treating 98%of patients within four hours of arrivingat A&E has been challenging, measureswe introduced in January 2009 will helpus meet our targets in 2009/10 andfurther improve our service for patients.This puts us on a strong footing to moveforward as a potential Foundation Trust, aprocess which we will start to consult thepublic on soon, to give them a leadingvoice in any key decisions we make andto help us continue to Care, Achieve andInnovate to provide high quality, safe carefor those who choose our Trust fortreatment.

Philip TownshendChairman

Malcolm Stamp CBEChief Executive

Chairman’s Introduction and Chief Executive’s Report

Malcolm Stamp CBEChief Executive


Annual Report 2008-09 1

University Hospitals Coventry and Warwickshire (UHCW) NHS Trust isone of the newest and busiest NHS teaching Trusts in the country,caring for over 1,000,000 people from across Coventry,Warwickshire and beyond.

We run University Hospital, Coventry and the Hospital of St Cross,Rugby, focusing on quality patient care, stringent infection controland specialising in cardiology, neurosurgery, stroke, jointreplacements, IVF, diabetes, cancer care and kidney transplants.

We were first established as a Trust in 1992, expanded to includeRugby in 1998 and form part of West Midlands Strategic HealthAuthority (SHA).

The Trust At A Glance

Statistics for 2008/09

Number of people attending an outpatient 483,212appointment

Number of outpatient appointments 531,002

The number of people attended Accident & 150,101Emergency (A&E) including those in specialist children's A&E

The Number of Inpatients and Day Cases 128,313

Babies Delivered 5,721

Pathology Tests (including tests at the Labs at 3,961,942UHCW, George Eliot Hospital and Warwick Hospital)

Patients operated on in our theatres 44,239

Number of staff working in our hospitals Circa 6,400

Annual Report 2008-092Picture courtesy of Skanska Facilities Services

Services provided at University Hospital Services provided at Hospital of St Cross

General Acute ServicesAccident and EmergencyAcute MedicineAge Related Medicine andRehabilitationAnaestheticsAssisted ConceptionAudiologyCardiologyCritical CareDermatologyDiabetes and EndocrinolgyEar, Nose and ThroatGastroenterologyGeneral MedicineGeneral SurgeryBrest SurgeryUpper Gastrointestinal SurgeryHepatobiliary and PancreaticSurgeryColorectal SurgeryGynaecologyHaematologyMaxillo Facial SurgeryNeurology and NeurophysiologyObstetricsOphthalmologyOptometryOrthodonticsOrthopticsPaediatricsPain Management

Plastic SurgeryRenal MedicineReproductive MedicineRespiratory MedicineRheumatologyOrthopaedics TraumaUrologyVascular Surgery

Specialised ServicesBone Marrow TransplantationInvasive CardiologyCardiothoracic SurgeryClinical PhysicsHaemophiliaNeonatal Intensive Care andSpecial CareNeuro ImagingNeurosurgeryOncology and RadiotherapyRenal Dialysis andTransplantationPlastic Surgery

Diagnostic and ClinicalSupport ServicesBiochemistryDieteticsEcho CardiographyEndoscopyHaematology

HistopathologyMedical Physics/NuclearMedicineMicrobiologyOccupational TherapyPharmacyPhysiotherapyRespiratory Function TestingUltrasoundVascular Investigation

Ambulatory CareDay SurgeryOvernight Stay / 23 hour SurgeryOutpatients ServicesMagnetic Resonance Imaging(MRI)ScanningX-ray including UltrasoundScanningBone DensityLaboratory ServicesEndoscopySatellite Renal Dialysis Unit

ScreeningRetinal Screening CentreColorectal Cancer ScreeningCentreBreast Screening

Urgent Care CentreA&E DepartmentGP (Out of hours service)Walk In Centre

Acute MedicineInpatient Medical ServicesIntermediate CareInpatient Rehabilitation Service

Acute SurgeryInpatient Elective Surgery

RehabilitationServices based on the Hospitalof St Cross site, but provided byother organisationsMyton HospiceMental Health UnitSocial ServicesRecompression Chamber


UHCW patients received a good quality of service, credited by theHealthcare Commission. Each year the Healthcare Commissionundertakes an independent, patient-centred assessment, known asthe Annual Health Check, for both NHS and independent healthcareorganisations. It reviews performance and generates a rating forquality of services and the use of resources for each organisationbased on a four-point scale of ‘excellent', ‘good', ‘fair' or ‘weak'.

A Year of Achievements - 2007/08 Annual Health Check

UHCW Annual Health Check Ratings 2007/08 2006/07

Quality of Services Good GoodUse of Resources Good Weak

Use of ResourcesThis rating is based on the Audit Commission's Auditors' LocalEvaluation assessment (ALE), and incorporates performance againstfive areas which is scored on a four point scale (level 1 being thelowest and level 4 being the highest score).

Use of Resources 2007/08 2006/07

Financial Reporting Level 2 Level 2Financial Management Level 3 Level 2Financial Standing Level 3 Level 1Internal Control Level 3 Level 3Value for Money Level 3 Level 2

Quality of ServicesThe Trust’s rating for the quality of services is formed by threeindividually scored elements:

Quality of Services Core Standards Fully MetExisting National Targets Almost MetNew National Targets Good

Key Achievements

The Trust achieved 42 out of the43 core standards. One standardwas deemed as “not met”, butwith an investment of £2.5m tomeet national cleaningstandards, this was achieved byMarch 2008.

- Infection control and reducing infection rates remained a key priority for the Trust and the dedication and hard work of Trust staff ensured both a 27% reduction in MRSA and 43% reduction in Clostridium Difficile for 2007/08.

- The cancelled operations target was achieved, minimising cancelled operations and treating affected patients within 28 days.

- For the second successive year the Trust achieved andimproved performance against the three key targets for cancer patients.

Annual Report 2008-094

The Trust narrowly missed theachievement of admitting,transferring or discharging 98%of people in A&E within 4 hourswith a performance of 96.46%.In response, a robust action planwas implemented to ensureperformance against the targetimproved in 2008/09.

In 2007 a review of maternityservices was undertakenthroughout England and we wereone of the top 25% of Trustswhich achieved a rating of ‘BestPerforming’.

NHSLA Risk ManagementStandards The NHSLA Risk ManagementStandards are broken down intothree levels and for each level ofcompliance the Trust receives a10% discount in its contributionsto the scheme.

The Trust is currently at level oneon the scheme against the acutestandards and is due to beassessed again in September2009, for the first time at leveltwo. For the maternity standards,the Trust is at level two and is dueto be assessed at this level againsta new set of standards by the endof 2009.

The Trust continues to participatein the annual national InpatientSurvey, which provides valuablefeedback on patient experienceand identifies areas forimprovement. Patients onceagain rated their experience ofcare at the Trust as among thebest in the country, with the Trustachieving the highest possiblescore for this target. The inpatientsurvey placed the Trust in the top20% of Trusts for a number ofimportant areas:

• Offering patient choice of first hospital appointments.

• Patients were not placed on mixed sex wards and did not share mixed sex facilities.

• Patients had enough help from staff to eat their meals.

• Staff informed patients of who to contact if they were worried about their condition.


The 2008/09 Annual HealthCheck Rating will be published inOctober 2009 by the newlyformed Care Quality Commission.Whilst the overall rating forquality of services and use ofresources is not yet known theTrust has improved andmaintained performance against anumber of standards and targets:

Core standardsOn 29th April 2009, the TrustBoard formally declared that theTrust was compliant against 43out of 44 Part Standards. This wason the basis that the Board wasreasonably assured there hadbeen no significant lapses, againstthose 43 standards, for the2008/2009 financial year. TheTrust will achieve a score of“Almost Met” for the CoreStandards assessment for2008/2009.

For the one remaining PartStandard, C11B (mandatorytraining), the Trust declared itselfnot to be compliant with a morelimited declaration of InsufficientAssurance. A supporting actionplan has been developed toachieve compliance by 31stOctober 2009.

Existing and New NationalTargetsYet again the Trust has maintainedits excellent record of achievingwaiting time targets and ensureda maximum wait of:

• 26 weeks for inpatient treatment

• 13 weeks for outpatient appointments

• 13 weeks for revascularisation

• 2 weeks for rapid access chest pain clinics

• 6 weeks for diagnostics.

• 18 weeks for 90% of admitted patients (achieved by December 2008)

• 18 weeks for 95% non-admitted patients (achieved by December 2008)

• 18 weeks for patients directly accessing audiology

Plus it decreased its MRSA casesby 40% and C Diff cases by 50%. The target to see 98% of patients in A&E within four hoursremains a priority for the Trust.Although performance had

improved compared to 2007/08we did not achieve this in2008/09, and in January 2009 theTrust implemented a range ofmeasures, including improving thedischarge process so patientsexperience a smooth transitionfrom hospital to home, which hasalready improved our performancein this area.

In 2008/09 the Trust narrowlymissed achievement of thecancelled operations target with aperformance of 0.89% ofcancelled operations against atarget of 0.8%. The Trust didachieve the second measure ofperformance ensuring patientswhose operation was cancelledwere rebooked within 28 days.The Trust has implementedrectification plans to ensure thetarget is achieved in 2009/10.

Quality of FinancialManagement(formerly Use of Resources)

The Trust has undertaken a self-assessment and while this work issubject to external review andvalidation, the Trust is hopefulthat an overall level 3 score will bemaintained.

Looking Ahead - 2008/09 Performance

The past year has seen an increase in staff to deal with theexpansion of renal, cancer screening and maternity services. In April2008 the Trust assumed responsibility for the local PathologyNetwork, which required the transfer of 172 posts into the Trustfrom the George Eliot and South Warwickshire hospitals

Our Staff

Staff by category

Headcount As at As at31.03.08 31.03.09

Administrative & Clerical 1,114 1,095

Allied Health Professionals 285 305

Healthcare Scientists 237 318

Medical & Dental 749 788

Nursing & Midwifery 2,125 2,240

Additional Professional Scientist 179 203& Technicians

Additional Clinical Services 1259 1,440

Students 31 28

TOTAL 5,979 6,417

The rise in staff turnover, which occurred during the move to thenew hospital site in 2006/7, dropped significantly during 2008/09and is running at 7%, which compares favourably with other Trusts.

As one of the most modern hospitals in Europe, we offer majorcareer opportunities to a wide range of professions and realise thatproviding the best patient care is critically dependent upon staffexpertise.

Of the 850 staff sent the NHS National Staff Survey 2008, 59%responded which is a higher than average response rate and thescores continue to show steady improvement year upon year.

We have also introduced asurvey for all staff to aid us infuture improvements.

The Trust’s attendance level was95.3% for 2008/09 which is justunder our target of 96.1%. Wehave implemented severalmeasures to improve attendanceincluding refresher training forline managers and introducinginitiatives to promote health andwellbeing at work.

Equality and Diversity

The Trust is fully committed toembracing diversity anddelivering equality for all itsemployees and service users.Our Single Equality Scheme,launched in 2007 covers allequality and diversity issues, andis at the heart of the drive toachieve this by acting uponvarious legal requirements,healthcare standards andequality impact assessments. The Trust Board receives reportson the Scheme’s progress whichincludes equal opportunities inemployment and ensuresinvestment where necessary. Forinstance, the Trust has recentlyappointed a very experiencedHead of Diversity to support

Annual Report 2008-096Picture courtesy of Skanska Facilities Services

Negotiating Committee, monthlyopen meetings with the ChiefExecutive are held across oursites.

The annually presented OSCAs(Outstanding Service and CareAwards), recognises exceptionalperformance by employees whoare nominated by their peers. Inaddition the Trust organisestraining awards ceremonies, anEveryone Counts celebration,staff fayres, and long serviceawards.

Clinical Development This year our staff have workedto Care, Achieve and Innovate forthe benefit of our patients withexcellent results.

• The cardiology team has established the 24/7 PrimaryCoronary Intervention service which offers rapid treatment for heart attacks resulting from blockage of coronary arteries.

• Our renal physicians and transplant team continue to improve their excellent service and established a national reputation with outstanding results for

transplantation. During the next 12 months a dedicated12 bedded Renal Transplant Unit to cope with increased demand for kidney transplants due to the Trust’s national and international reputation will be established.

• The Hospital of St Cross has seen a significant investment programme initiated in 2008/9 to provide additional services to Rugby and refurbish its buildings. This includes:

- Installation of a CT scanner

- New Genito Urinary Dept (GUM) building

- New Diabetes Centre (Joan Cox Diabetes Unit)

- New Endoscopy Unit

- Repatriation service which brings around 150 Rugby residents a month back from University Hospital to theHospital of St Cross oncetheir condition is stable, so patients can receive

care locally, enabling relatives to visit more easily.

• The delivery of planned surgical activity increased over the last year with an extra 9,200 procedures, and24,000 out patient appointments which required the opening of twoadditional wards and evening and weekend clinics.

• Capacity had expanded for the Endoscopy Unit to ensure the continued achievement of the standards required for the Trust to be a Bowel Cancer Screening Centre, with patients seen within four weeks of referral.

• The Warwickshire, Solihull &Coventry Breast Screening Service was accepted as a pilot site to screen women at two extra times between 47 and 49 and between 71 and 73.

• Investment of £1.2 million has been made in the Medicine and Emergency

division, including the Emergency Department. In order to see and treat patients quickly and safely an extra eight doctors (including one consultant), 32 extra nurses and further admin support have been employed.

• A new Department of AcuteMedicine cares for acute medical admissions which means Acute Medicine Physicians provide rapid senior review to some patients without the need of admission.

• With more patients using our highly rated maternity services, an investment of £750,000 was made, employing six more doctors (four consultants), five additional midwives and 12 other supporting staff.

managers in meeting theirresponsibilities under theScheme.

Furthermore, the Trust hasincreased investment in trainingfor staff, managers and the TrustBoard to ensure our service isaccessible and equitable for all.

We are committed to ensuringthat any person applying for ajob at the Trust who declaresthat they have a disability andwho meets the essential criteriafor a job vacancy will beguaranteed an interview. Onceemployed by the Trust, a personwith a disability will enjoy equalopportunity in terms of selectionfor promotion or transfer,training and careerdevelopment. The Trust is fullycommitted to retaining staffwho become disabled or whohave a disability which alters insome way whilst employed.

Staff Engagement

The Trust has long-standingarrangements for engaging withits employees. In addition toformal meetings of our JointConsultation and NegotiatingCommittee and the Medical Staff


Information Governance

The Information Governance(IG) team provide a vital role byidentifying and dealing withrisks to patients and keepingpatient safety at the top of theTrust agenda.

In the Trust this is co-ordinatedby the Information GovernanceBoard which in turn reports tothe Patient Confidence & SafetyCommittee.

All IG related incidents arereported in accordance with theTrust’s Incident Reporting Policyand registered on Datix, theTrust’s Incident ReportingSystem, and are investigatedand learnt from, to improvepatient care.

The IG Toolkit, against whichNHS organisations are requiredto assess themselves annually,was submitted to Connectingfor Health on 31st March 2009,following Trust Board approval.The Trust achieved an overallscore of 76% confirming astatus of GREEN. The SHA hasalso accepted assurance of theTrust’s commitment incontinuing to take forward theIG Assurance programme.

Reporting of the Trust’sPersonal Data RelatedIncidents

In accordance withcorrespondence from theDepartment of Health inSeptember 2008 the Trustresponded to a request from theStrategic Health Authority (SHA)by carrying out a review ofConfidential Information Leaksup until October 2008.

In total the Trust reported threeconfidential information leaks tothe SHA and the InformationCommissioner’s Office, all ofwhich have required no furtheraction to be taken (please seebelow).

National guidance has beenissued on Serious UntowardIncidents involving data,classifying incidents in terms ofseverity on a scale of 0 – 5 interms of risk to reputationand/or risk to individuals. Figure1 shows the risk matrix as usedby all NHS organisations.


No significantreflection onany individual orbody.

Media interestvery unlikely

Damage to anindividual’sreputation.

Possible mediainterest e.g.celebrityinvolved.

Damage to ateam’sreputation.

Some localmedia interestthat may notgo public.

Damage toservices /reputation.

Low key localmediacoverage.

Damage to anorganisation’sreputation.

Local mediacoverage.

Damage to NHSreputation.

Nationalmediacoverage.

Minor breach ofconfidentiality.Only a singleindividualaffected.

Potentiallyserious breach.Less than 5people affectedor risk assessedas low e.g. fileswere encrypted.

Seriouspotential breachand riskassessed highe.g.unencryptedclinical recordslost.Up to 20 peopleaffected.

Serious breachofconfidentialitye.g. up to 100people affected.

Serious breachwith eitherparticularsensitivity e.g.sexual healthdetails, or up to1,000 peopleaffected.

Serious breachwith potentialfor ID theft orover 1000people affected.

0 1 2 3 4 5

Figure 1

Incidents Classified at a 1-2 Severity Rating

Figure 2 shows the five categories used to break down the incidents classified as a 1-2 severity ratingwhich occurred during 2008/9.

Figure 2

SUMMARY OF OTHER PERSONAL DATA RELATED INCIDENTS IN2008-09

Category Nature of incident Total

ILoss of inadequately protected electronicequipment, devices or paper documentsfrom secured NHS premises.

0

IILoss of inadequately protected electronicequipment, devices or paper documentsfrom outside secured NHS premises.

1

IIIInsecure disposal of inadequatelyprotected equipment, devices or paperdocuments.

0

IV Unauthorised disclosure 0

V Other/near miss 7


Incidents Classified as 3-5 Severity Rating

The Trust had three incidents classified as a severity rating of 3 – 5 during 2008/9 (see figure 3 below).

Figure 3

SUMMARY OF SERIOUS UNTOWARD INCIDENTS INVOLVING PERSONAL DATA AS REPORTED TO THEINFORMATION COMMISIONER’S OFFICE IN 2008-09

Date of incident(month) Nature of incident Nature of data

involvedNumber of peoplepotentially affected

Notificationsteps

Reportedto SHA & ICO

May 2008

FOI request on in-patient and day casewaiting lists received. Patients’ hospitalnumbers and dates of birth believed to havebeen redacted had in fact been sent torequestor.

Trust received confirmation from Information Commissioner that no further actionrequired.

Further actionon informationrisk

PatientIdentifiable

+1,000


July 2008Loose filing sealed in envelopes labelled foroff site filing, inadvertently collected fromTrust Post Room by GPO.

PatientIdentifiable

+1,000



September2008

Trust patient and member of local televisionteam received from UHCW lifestyleinformation for personal use plus 3 otherpatients’ letters inadvertently attached.

PatientIdentifiable

4




The Trust takes data protectionof its staff and patients seriouslyand as a result implemented anumber of measures to preventthe deliberate or inadvertent lossof data:

- The implementation of a procedure for issuing encrypted memory sticks toemployees with a justified need to transport confidential/sensitive data off-site. To date, approximately 800 have been issued;

- All USB ports on Trust desktop computers have been barred, so that personal USB devices cannot access the Trust network;

- The active use of NHSnet email accounts for the electronic transfer of data, to ensure encryption;

- The active use of a system of self-decrypting CDs for the transport of radiology images.

As part of the ongoing IGAssurance Programme, anetwork audit will beundertaken to identify anyweaknesses in the Trust’snetwork and a programme ofaudits has been devised for allof the systems to ensure thatinformation security protocolsare being adhered to.As part of this, the Trust’s ICTSecurity Policy has been updatedto include the latest nationaldirectives and legislation oninformation security and is dueto be submitted for formalapproval, together with aTeleworking Policy to safeguardthe work that users do whilst ona remote site or at home. Arobust procedure is in place,where any user that requiresaccess to a UHCW system mustsign the ICT Security Declarationbefore access can be granted.


Learning From Our Patients

The Trust has a comprehensiveonline survey (“Impressions”)which enables patients, theirfamilies or carers to tell us abouttheir experiences and providecomments and suggestions.72% of patients reported apositive experience of ourservices and the cleanliness ofthe hospitals was ratedparticularly highly with 84%positive responses. The feedbackwe receive is used to makeimportant improvements to theservices we provide.

From 2009/10 Trusts will have toproduce a Quality Report for thefirst time, together with theannual Quality Account.However we have brought thisforward one year due to itsimportance and it will beavailable from May 2009. Thereport will show the Trust’scontinued reduction ofHealthcare Acquired Infections(MRSA and CDiff) and thereduction in hospital mortalityrate for the fourth consecutiveyear.

Community EngagementCommittee

The Trust’s CommunityEngagement Committeecomprises of Trust staff inaddition to staff from some ofthe Trust’s major stakeholderorganisations, such as NHSCoventry and Coventry AgeConcern.

During 2008 the Committee’ssub group, The Dementia CareSub Group, produced a resourcefolder which outlines bestpractice and was delivered toeach ward, compiled ActivityBoxes for the age related wardsand installed calendar clocksshowing the time, day and dateto help patients with dementiaorientate themselves.

Patients’ Council

The Patients’ Council providesvaluable input on the Trust’sservices from a lay point of viewon patient information, foodtasting and also undertakesPatient Environment ActionTeam inspections. There are 10members and most are alsomembers of various Trustcommittees giving the patients’point of view.

Annual Report 2008-09 11Picture courtesy of Skanska Facilities Services

Overview and ScrutinyCommittees

The Trust is committed toworking closely with our localauthority health Overview andScrutiny Committees, providingearly briefings on key issues suchas potential service changes. Aspart of this we attend meetingsof the committees andparticipate in public questionand answer sessions.

Principles for Remedy

In October 2007, theParliamentary and Health ServiceOmbudsman published itsdocument “Principles forRemedy” which sets out theOmbudsman’s views on thePrinciples that should guide howpublic bodies provide remediesfor injustice or hardship resultingfrom their maladministration orpoor service. It sets out how theOmbudsman thinks publicbodies should put things rightwhen they have gone wrongand confirms its approach torecommending remedies.

The document gives six keyprinciples:

1. Getting it right

2. Being customer focused

3. Being open and accountable

4. Acting fairly and proportionately

5. Putting things right

6. Seeking continuous improvement

The Trust fully supports these,and they are supported in itsmission statement, corporateobjectives and policies andprocedures for dealing withcomplaints.

The Trust aims are to: “Deliversafe, clinically effective servicesthat minimise all avoidable harmto patients and reduce hospitalacquired infection. Ensurecompliance with nationalhealthcare standards anddelivery of all performancetargets.” This underpins all ofthe work undertaken by theTrust.

In addition, the Trust activelyseeks patient feedback which ituses to improve its services (seebelow). When complaints doarise, they are handled in linewith the Trust’s complaintspolicy, which is compliant withthe NHS Complaints Regulations2004 (and amended 2006). Thekey principle underpinning this isthat: “all complaints are dealtwith quickly, fairly, impartiallyand that the subsequentinvestigation will be honest andthorough with the prime aimbeing to satisfy thecomplainant.”

This year, the Trust received 456complaints (a reduction of 63over the previous year), 100%of which were resolved withinour target of 25 working days.13 requests for independentreview were received this yearfrom the HealthcareCommission.

The Trust will be viewing andrevising its Complaints Policy inthe light of the new nationalcomplaints guidance to beintroduced in 2009.

Political and CharitableDonations

The Companies Act requiresdisclosure of political andcharitable donations. The Trusthas not made any suchdonations during 2008/09. Itshould be noted that theDepartment of Health hasreceived legal advice that takesthe view that NHS bodies do nothave the power to make suchdonations.


This year has seen animprovement in theunderstanding of environmentalissues and its profile hasincreased. However there ismuch to do to buildenvironmental management andsustainability into the dailyoperational activities of theTrust.

The Trust has:

• Participated in the development of the NHS Carbon Reduction Strategy

• Improved training on environmental issues

• Improved the segregation of hazardous waste.

The Trust is part of the regionalGood Corporate Citizen groupset up by the SHA andSustainable DevelopmentCommission for Acute Hospitalsand PCTs to develop and accessto resources. It came 4th out of17 Trusts regionally using theGood Corporate Citizen tooldeveloped by the Group.

Emergency Preparedness

The Trust has a Major IncidentPlan which guides themanagement of any significantincident which may affect theTrust and provides guidance andaction cards for individualsresponding to such an incident.It is available on the intranet forall staff to access and is fullycompliant with the requirementsof the NHS Emergency PlanningGuidance 2005.

The Trust was also required tosubmit a self assessment of it’spreparedness for an InfluenzaPandemic in December 2008.Feedback from the SHA inMarch 2009 placed the Trust asthe most prepared in the region.

Environmental Impact and Sustainability

Annual Report 2008-09 13Picture courtesy of Skanska Facilities Services

Our Organisational StructureExecutive Directors

Malcolm Stamp CBE Chief Executive

Appointed December 2008,Malcolm is responsible formeeting all the statutoryrequirements of the Trust and isthe Trust’s Accountable Officerto Parliament.

He joined the NHS in 1974 andhas held numerous ChiefExecutive posts including atCambridge University Hospital,Norfolk & Norwich UniversityHospitals and Royal LiverpoolUniversity Hospital.

Andrew HardyDeputy Chief Executive /Chief Finance Officer

Appointed Chief Finance Officerin June 2004, and Deputy ChiefExecutive in July 2008, Andrewis responsible for financialreporting, financial control,payroll and financialperformance management.

Tim AtackChief Operating Officer

Appointed November 2008, Timis responsible for the operationalrunning of the Trust, includingall clinical and non-clinicalservices. Previously he was ChiefOperating Officer at Sandwelland West Birmingham Hospitalsand has held various roles in theNHS going back to 1986.

Richard KennedyChief Medical Officer

Appointed August 2008,Richard is responsible forclinical governance andconsultant appraisal and joinedthe Trust in 1988 as ConsultantObstetrician and Gynaecologist.He is also Director of the Centrefor Reproductive Medicine(CRM) and a Specialist Advisorto the Human Fertilisation andEmbryology Authority.

Dr Ann-Marie CannabyChief Nursing Officer

Appointed February 2005 andresponsible for infection control,safeguarding children, nursingand midwifery. Ann-Mariejoined the NHS in 1989 and waspreviously Head of Nursing forMedicine and A&E Services forUniversity Hospitals of LeicesterNHS Trust.


Our Organisational StructureNon - Executive Directors


Appointed 2001 until February2011. He is chairman of theTrust Board, Charitable FundsCommittee, Patient Confidence& Safety Committee andRemuneration Committee.

He is also a practising solicitorwho is an elected councillor onCoventry City Council.

Professor Yvonne Carter OBEVice Chair

Appointed March 2004 untilFebruary 2012. Yvonne is Deanof Warwick Medical School, anacademic GP and HonoraryConsultant in Primary Care atCoventry Teaching PCT andchair of Comprehensive LocalResearch Network (WestMidlands South).

Brendan ConnorNon-Executive Director

Appointed June 2007 until June2011. He is chair of the financecommittee. His experienceincludes being a board memberof Advantage West Midlandsand he is an independentmember of West MidlandsPolice Authority and a Justice ofthe Peace.

Jack Harrison MBE JPNon-Executive Director

Appointed October 2007 untilSeptember 2011. Jack is chair ofthe HR & CommunicationsCommittee. He was also electedto Coventry City Council in1996 and is a Justice of thePeace.

Tim SawdonNon-Executive Director

Appointed from June 2003 toMay 2011, Tim was chair of theAudit Committee until March2009 . He is also an electedmember of Coventry CityCouncil, a member of the WestMidlands Policy Authority and apractising optometrist.


Nicholas Stokes Non-Executive Director

Appointed April 2004 to March2012, Nicholas is chair of theDevelopment & PFI Committee.He is also Director of Marketingand Communications atCoventry University and waspreviously Marketing Director ofLloyds Pharmacy Ltd.

Trevor Robinson Non-Executive Director

Appointed December 2008 toDecember 2012, Trevor tookover as chair of the auditcommittee from April 2009. Hehas a strong background inpublic sector finance includingthe Finance Director of Centroand Financial Advisor to theAssociation of LondonGovernment.

Trust Board

Led by the Chairman and ChiefExecutive, the Trust Board is theprincipal decision making bodyfor the Trust. It is made up ofExecutive Directors, who arepaid by the Trust for particularroles within the organisation,and Non-Executive Directorswho are members of thecommunity appointed by theindependent NHS AppointmentsCommission. Biographical detailsof our Board members, aresummarised on page 14 - 16.The Trust Board manages theTrust by:

• Setting the overall strategicdirection of the Trust withinthe context of NHS priorities

• Regularly monitoring Trust performance against objectives

• Providing financial stewardship through value for money, financial controland financial planning

• Ensuring that the Trust provides high quality, effective and patient

focused services through clinical governance

• Promoting effective dialogue between the Trustand local communities we serve

Board Meetings

Monthly Board meetings areopen to the public, withagendas, papers and minutes onour websitehttp://www.uhcw.nhs.uk/about/board along with dates of futuremeetings.

Further information about publicmeetings is available from:

Jenny Cole, Board SecretaryUniversity Hospitals Coventry &Warwickshire NHS Trust Clifford Bridge Road, Coventry, CV2 2DXTel: 024 7696 7621email: [email protected]

Sub Committees

The Trust Board has establisheda number of Sub Committees tosupport the Trust Board insetting and monitoring theoverall strategic direction.

Principal Board SubCommittees:

Audit Committee: isresponsible for reviewing theTrust’s governance, riskmanagement and internalcontrol systems. It also receivesreports from the Trust’s internaland external auditors.

Remuneration Committee: isresponsible for determining theremuneration and terms ofservice of the Trust’s ExecutiveDirectors.

Patient Confidence andSafety Committee: providesthe Board with assurance aboutthe effectiveness ofarrangements for clinicalgovernance and riskmanagement.

Finance and PerformanceCommittee: is responsible forreviewing financial andperformance managementarrangements and advising onthe adequacy of thosearrangements.

To view the register of interests for our Trust Board members pleasecontact the Trust Board Secretary.

Our Organisational Structure


Development and PrivateFinance Initiative (PFI)Performance Committee: isresponsible for overseeing allmajor construction,development and capitalprojects within the Trust.

Human Resources andCommunications Committee:oversees the productivity andefficiency agenda, monitors keyHR performance indicators andreviews key HR policies andprocedures.

Charitable Funds Committee:oversees the management,investment and disbursement ofcharitable and other funds heldon trust.

Remuneration ReportChairs and Non-ExecutiveDirectorsChairs and Non-ExecutiveDirectors of NHS Trusts holdstatutory office under the NHSand Community Care Act 1990.The appointment and tenure ofoffice is governed by the NHSTrusts (Membership andProcedure) Regulations 1990.The appointments are made by

the Appointment Commissionon behalf of the Secretary ofState, and are usually for aperiod of up to four years.Under the terms of the Act,Chairs and Non-ExecutiveDirectors are entitled to beremunerated by the NHS Trust,based on national pay rates setby the Secretary of State forHealth, for as long as theycontinue to hold office.

For 2008/09 these rates were setas:

a. Current rates for Chairs -Remuneration is payable to NHS Trust Chairs in one of three bands according to the turnover of the Trust. UHCW is classified in Band 1, which is remunerated as £23,020 per annum. The time commitment of Chairs is 3 – 3.5 days per week.

b. Current rate for Non-Executive Directors - The current rate of remuneration payable to non-executive directors is £6,005 pa. The time commitment for is normally 2.5 days a month.

Remuneration is taxable andsubject to National Insurancecontributions. Chairs and Non-Executive Directors are alsoeligible to claim allowances, atrates set centrally, for travel andsubsistence costs incurred onNHS Trust business.

Executive DirectorsThe Trust RemunerationCommittee, comprising of theChairman and Non-ExecutiveDirectors, determines localremuneration policies andpractices for the Trust’s mostsenior managers (defined by theChief Executive as ExecutiveDirectors who are votingmembers of the Trust Board).

Executive Director pay levels areset locally by the RemunerationCommittee, with the aim ofattracting and retaining highcalibre directors who will deliverhigh standards of patient careand customer service. Whereappropriate, terms andconditions are consistent withthe NHS Agenda for Changeframework.

All Executive Directors are

employed on contracts of serviceand are substantive employeesof the Trust. Their contracts canbe terminated by either partywith six months notice. TheTrust’s normal disciplinarypolicies apply to ExecutiveDirectors, including the sanctionof instant dismissal for grossmisconduct. The Trust’sredundancy policy is consistentwith NHS redundancy terms forall staff.

The only non-cash element ofthe Executive Directors’remuneration packages ispension related benefits accruedunder the NHS Pension Schemeand in some cases a leasedvehicle. Contributions to theNHS Pension Scheme are madeby the employer and employeein accordance with the rules ofthe national scheme.

Individual objectives forExecutive and Non-ExecutiveDirectors are set from the keybusiness objectives of the Trust’sstrategy. However the keyobjective of the Trust Board isalways to provide high quality ofcare to our patients in a safe

environment.

Performance related pay is inplace for some ExecutiveDirectors based on achievementof personal objectives.Arrangements for individualsmay differ and include baselinesalary increases or one-offpayments. No performancerelated bonuses were payableduring the financial year2008/09.

Details of remuneration andallowances, including salary andpension entitlements arepublished in the annual reporton page 18 for all votingDirectors who have served theTrust throughout the year. ForExecutive Directors whocontinue to perform clinicalduties (for example the ChiefMedical Officer), pay isapportioned based on thenumber of programmedactivities (clinical PAs accordingto their consultant contract),national Clinical ExcellenceAwards and managementresponsibilities. The informationcontained in these tables hasbeen subject to audit review.


Remuneration List of Senior Managers for 2008/09 - Salaries relating to time as voting member of the Trust Board

Malcolm Stamp Chief Executive 01.12.2008 70-75 0 70-75 0 0 0 0 0 0 0

Martin Lee Interim Chief Executive 30.11.2008 65-70 105-110 175-180 0 0 130-135 75-80 205-210 0 400

Andrew Hardy Deputy Chief Executive and 140-145 0 140-145 0 3,600 130-135 0 130-135 0 3,400Chief Finance Officer

Tim Atack Chief Operating Officer 24.11.2008 45-50 0 45-50 0 0 0 0 0 0 0

Nicholas Elliott Interim Chief Operating Officer 19.06.2008 23.11.2008 50-55 0 50-55 0 0 105-110 0 105-110 0 0

Ann-Marie Cannaby Chief Nursing Officer 100-105 0 100-105 0 0 85-90 0 85-90 0 0

Richard Kennedy Chief Medical Officer 85-90 90-95 180-185 0 0 50-55 40-45 95-100 0 0

Jackie Daniel Interim Transitional Director 29.07.2008 30-35 0 30-35 0 0 125-130 0 125-130 0 0

Chairman and Non Executives

Philip Townshend Chairman 20-25 0 20-25 0 0 20-25 0 20-25 0 0

Tim Sawdon Non Executive Director 5-10 0 5-10 0 0 5-10 0 5-10 0 0

Yvonne Carter Non Executive Director 5-10 0 5-10 0 0 5-10 0 5-10 0 0

Nick Stokes Non Executive Director 5-10 0 5-10 0 0 5-10 0 5-10 0 0

Brendan Connor Non Executive Director 5-10 0 5-10 0 0 0-5 0 0-5 0 0

Roman McAlindon Non Executive Director 30.09.2008 0-5 0 0-5 0 0 0-5 0 0-5 0 0

Jack Harrison Non Executive Director 5-10 0 5-10 0 0 0-5 0 0-5 0 0

Trevor Robinson Non Executive Director 15.12.2008 0-5 0 0-5 0 0 0 0 0 0 0

Directors' salaries and emoluments are given for both director roles and where directors retain clinical responsibilities. Where such clinical salaries are given they include both basic salaries andpayments in respect of Clinical Excellence Awards. However, the salary given relates to the director's time as a voting executive during the year.

Name

Executives

TitleDate in Post

From (State ifnew in post

from 01/04/08)

To (If no longerin post

31/03/09)

2008-09 2007-08

Salary asDirector

(Bands of£5000)

£000

Salary forClinicalDuties

(Bands of£5000)

£000

TotalSalary

(Bands of£5000)

£000

OtherRemuneration

(Bands of£5000)

£000

Benefits inKind

Rounded tothe nearest

£100

Salary asDirector

(Bands of£5000)

£000

Salary forClinicalDuties

(Bands of£5000)

£000

TotalSalary

(Bands of£5000)

£000

OtherRemuneration

(Bands of£5000)

£000

Benefits inKind

Rounded tothe nearest

£100


Remuneration Senior Managers pension information

Malcolm Stamp Chief Executive 01.12.2008 0-25 2.5-5.0 90-95 270-275 2,086 1,344 164 0

Martin Lee Interim Chief Executive 30.11.2008 10-12.5 35.0-37.5 95-100 295-300 2,495 1,442 476 0

Andrew Hardy Deputy Chief Executive and 2.5-5.0 5.0-7.5 25-30 80-85 366 264 67 0Chief Operating Officer

Tim Atack Chief Operating Officer 24.11.2008 0-2.5 5.0-7.5 25-30 80-85 443 287 43 0

Nicholas Elliott Interim Chief Operating Officer 19.06.2008 23.11.2008 0-2.5 25-50 20-25 65-70 355 245 31 0

Ann-Marie Cannaby Chief Nursing Officer 5.0-7.5 17.5-20.0 25-30 75-80 394 242 102 0

Richard Kennedy Chief Medical Officer 5.0-7.5 17.25-17.5 70-75 210-215 1,694 1,124 380 0

As Ms J Daniel was not directly employed by the Trust and seconded from NHS West Midlands, her pension figures are not available. 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 themember'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 anotherpension 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 theindividual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which the disclosure applies. The CETV figures and the otherpension 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 additionalpension 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 frameworkprescribed by the Institute and Faculty of Actuaries.

Name TitleDate in Post

From (State ifnew in post

from 01/04/08)

To (If no longerin post

31/03/09)

Real Increase in pension at

age 60 (Bands of£2,500)

£000

Real Increase in pension

lump sum at aged 60 (Bands of£2,500)

£000

Total accuredpension at age

60 at 31 March 2009

(Bands of£2,500)

£000

Lump sum atage 60 related

to accuredpension at 31March 2009

(Bands of£5,000)

£000

Cash Equivalent

Transfer Value at 31 March

2009

£000

Cash Equivalent

Transfer Value at 31 March

2008

£000

Real increase in

Cash Equivalent

Transfer Value

£000

EmployersContribution

to Stakeholder

Pension

To nearest£100


Financial Performance Overview 2008/09Statement from Andrew Hardy, Chief Finance Officer

I am extremely pleased to be able toreport that the year ended 31st March2009 has been a successful year for theTrust in financial terms and it has met itskey financial duty to break-even on itsincome and expenditure account,delivering a surplus of £4.8 million. Thisperformance is particularly commendablein view of the fact that only two yearsago, the Trust was designated as“financially challenged” by theDepartment of Health (along with 16other NHS trusts).

Furthermore, I am delighted to reportthat this position has been achievedwithout external income support and thatthe recurrent effect of savings achievedfully meets the 2008/09 target of £15.8million. This means that the Trust hasdelivered recurrent efficiency savings ofaround £45 million over the last twoyears and is no longer designated asfinancially challenged.

The Trust’s continued success in meetingthe financial challenges provides a firmbasis for year on year improvements inthe delivery of patient care and itsFoundation Trust application.

Clearly this position could not have beenachieved without the efforts of all staffgroups throughout the organisation andon behalf of the Trust Board, I should liketo place on record our thanks andappreciation for their hard work.

Key financial challenges

The Trust commenced 2008/09 with twomajor financial challenges. Firstly the Trustneeded to identify £15.8 million ofsavings in order to achieve a breakevenposition on its income and expenditureaccount in year. Secondly, followingdesignation as one of 17 financiallychallenged trusts by the Department ofHealth in 2007/08, the Trust needed torepay half of its £16 million workingcapital loan by the end of the financialyear.

£15.8 million savings target

Each year, NHS organisations are requiredto make efficiency improvements asoutlined in the NHS OperatingFramework; in addition, any shortfallsagainst planned levels of income need tobe covered. A savings programme wasput into place and successfully deliveredacross the Trust including plans toimprove productivity and reduce the costsof procurement.

Repayment of Working Capital Loan

Following the Trust’s designation as afinancially challenged trust (FCT), a cashsolution was agreed with the Departmentof Health, the Trust, NHS West Midlandsand both Coventry and WarwickshirePrimary Care Trusts. Part of that solutionwas for the Trust to take a £16 million

working capital loan repayable over a fiveyear period; £8 million was repayable inyear one (2008/09) through plannedasset sales.

However, the impact of the economicdownturn resulted in the stalling of thesale of the city centre Coventry &Warwickshire Hospital site by the summerof 2008 which was intended to havecontributed significantly to the year oneprinciple loan repayment. Consequently, agreater income and expenditure surplushas been delivered to generate sufficientcash to ensure that the Trust could meetthe required repayment.

Andrew HardyChief Finance Officer


Financial Performance Overview 2008/09

Performance against financial duties

The table below summarises the Trust’s performance against its key financial duties and shows that theTrust met all of the four key targets.

Duty Target Performance

Breakeven on its Income andExpenditure Account - this requires the Trust to ensurethat total expenditure does notexceed the total income it receives

Breakeven £4,825,000 Surplus

Target achieved(the Trust is permitted to generate a surplus)

Remain within its approved ExternalFinancing Limit- this requires the Trust to remain

within the borrowing limits set by the Department of Health

- £7,166,000

- this requires the Trust to repay Public Dividend Capital and/or increase cash balances amounting to at least this sum

- £7,180,000

£14,000 undershoot

Target achieved (the Trust is permitted toundershoot its EFL)

Achieve a capital cost absorptionrate of 3.5% ± 0.5% - this requires the Trust to pay a

dividend to the Department of Health equal to 3.5% of the average value of its net relevant assets

3.5% ± 0.5% 3.7%

Target achieved

Breakeven on its Income andExpenditure Account - this requires the Trust to ensure

that total expenditure does not exceed the total income it receives

Breakeven £11,055,000

£391,000 underspend

Target achieved(the Trust is permitted tounderspend against its CRL)

In addition to the duties, the Trust is also required to comply withthe Better Payment Practice Code. This requires the Trust to aim topay all undisputed invoices by the due date or within 30 days ofreceipt of goods or a valid invoice, whichever is later. The Trust’sperformance against this target is summarised below:

63,856 266,334 56,635 225,754Total non-NHS tradeinvoices paid in year

50,181 242,402 50,036 214,105Total non-NHS tradeinvoices paid within target

79% 91% 88% 95%% of non-NHS trade invoices paid within target

1,955 52,140 2,636 55,452Total NHS tradeinvoices paid in year

1,409 44,810 1,642 47,744Total NHS tradeinvoices paid within target

72% 86% 62% 86%% of NHS trade invoices paid within target

2008/09

Number £’000

2007/08

Number £’000


Revenue incomeDuring 2008/09 the Trust recorded totalincome (including interest receivable) of£427 million. This represents a significantincrease when compared with the grossincome of £380 million in 2007/08.

This rise in income reflects a number offactors including inflation uplifts, changesto the national Payment by Results (PbR)tariff, increased levels of clinical activity(e.g. 18 week referral to treatmenttarget), increased income for clinicaltraining, education and research andincreased charges for services provided toother NHS bodies.

The chart compares income by categoryfor 2008/09 with 2007/08 and 2006/07.This clearly demonstrates that themajority of the Trust’s income (almost80% in 2008/09) is received from PrimaryCare Trusts for the purchase ofhealthcare.

Revenue expenditureThe Trust’s total expenditure (includinginterest payable and dividend payable) for2008/09 amounted to £423 million. Thelargest cost element relates to salaries andwages with the average number of people employed during the year being 5,730whole time equivalents with a total cost of £237 million which equates to 56% oftotal costs. This compares with 5,308whole time equivalents and £215 million

in 2007/08. The increase in staff numbersis as a result of a combination of factorsincluding hosting of the newly createdCoventry and Warwickshire PathologyNetwork and the opening of additionalbeds to meet access targets and thedevelopment of new services.

The second largest cost continues to bepremises expenses which include theunitary payment for the UniversityHospital. These expenses amounted to£72 million and represent almost 17% oftotal costs. Clinical supplies and services(including drugs and other medical /surgical consumables) are also asignificant cost element and amounted to£63 million which equates toapproximately 15% of total costs.

The chart compares expenditure bycategory for 2008/09 with 2007/08 and2006/07. This clearly shows that for themajority of expenses headings, costincreases for 2008/09 were generallysmall and reflect the impact of the Trust’ssavings programme.

Capital expenditureIn addition to the day to day operatingexpenses of the Trust, the Trust also spentapproximately £11.3 million (including adonated sum of £150,000) on purchasingnew or replacement capital assets. Thesingle largest item within this sum relates

0 50,000 100,000 150,000 200,000 250,000 300,000 350,000

Interestreceivable

MiscellaneousIncome

Education trainingand research

Other operatingIncome

Department ofHealth

PFI/ImpairmentSupport

Primary Care Trust

£’000

2008 - 09

2007 - 08

2006 - 07

0 50,000 100,000 150,000 200,000 250,000

£’000

2008 - 09

2007 - 08

2006 - 07

Interest/dividendspayable

Other expenses

Fixed asset costs

Premises

Clinical suppliesand services

Staff

Financial Highlights


Analysis of Income

Analysis of Expenditure

to the capitalisation of £3.5 million of thepayment made to the Trust’s PFI partner.The capitalisation of part of the unitarypayment each year over the life of the PFIcontract under current accounting policies(see the section on “Financial Outlook”below) will eventually create an asset onthe Trust’s balance sheet equating to theexpected residual value of the UniversityHospital in 2042.

Whilst the Trust’s PFI contract includes theinitial provision and replacement of themajority of medical and other equipmentin the University Hospital, the Trustcontinues to have responsibility forinformation technology assets and certaincategories of medical equipment. During2008/09 the Trust invested £3.1 million onnew medical and other equipment and£1.9 million on IT infrastructure. Inaddition to this, the Trust also spentapproximately £2.8 million on upgradingparts of its non-PFI estate.

Financial outlookThe Trust plans to achieve a surplus at theend of the coming financial year of £3.2million. This equates to approximately 1%of turnover and is in line with the nationalaverage for both NHS and FoundationTrusts.

There are three key financial challenges forthe Trust, affecting both the short andlonger term financial health of theorganisation: the introduction of the

International Financial Reporting Standards(IFRS) from 1st April 2009; the NHSFinancial Framework for 2009/10 and therequirement to improve itsliquidity/working capital position.

International Financial ReportingStandardsThis change in accounting standards i.e.the way in which an organisation preparesits accounts, is effective across allGovernment Departments (including theNHS) from 1st April 2009. As such, it isnecessary to both restate the accounts for2008/09 in the new format as well asfundamentally change the basis on whichthey are prepared. For UHCW NHS Trustthe key impact results from the financingof the new hospital through the PrivateFinance Initiative. Under existing UnitedKingdom General Accepted AccountingPrinciples (UK GAAP) the Trust built up thevalue of the new asset each year over thelife of the PFI contract until, at the end ofthat contract in 2042, the asset was statedat its full value on the Trust balance sheet.

However, under IFRS, the full value of thePFI asset is brought onto the Trust’sbalance sheet with immediate effect alongwith an equal and opposite liability. Whilstthe implementation of this change inaccounting practice does not change thepayments made under the PFI contract, itwill result in approximately £9 million ofadditional depreciation and interest

charges to the Trust. In order to mitigatethis impact, the Trust has reachedagreement with the West Midlands SHA tore-profile previously approved non-recurrent funding. This funding is now tobe accounted for in two equal tranches of£3.7 million in 2009/10 and 2010/11. Thebalance of the additional costs will be metthrough an increased savings programme.

NHS Financial FrameworkAll NHS organisations are expected toidentify and deliver cash releasingefficiency savings for each year until2010/11 of 3%. In addition, further riskshave arisen from the implementation ofrevised policies for coding clinical activityand changes to the national tariff.

Improvement of the Trust’s liquiditypositionAt the end 2008/09 the Trust estimatedthat it needed to increase its net workingcapital by approximately £8 million inorder to achieve a level 3 rating in theMonitor financial risk ratios which wouldallow it to apply for Foundation Truststatus. In addition, it is required to repayits outstanding working capital loan of £8million at a rate of £2 million per annumover the next four years.

Key elements of the Trust’s plan to improveits liquidity ratio include the generation ofa £3.2 million surplus and the retention ofcirca £4.5 million of internally generatedcash (through depreciation charges) which

is not required for capital investment. Inaddition, the Trust expects to generateadditional cash through property sales,although the timing of these remainsuncertain.

ConclusionAs a result of the combined impact of thefactors outlined above and the Trust’sintention to generate a surplus of £3.2million, the Trust plans to achieve a savingstarget of £15 million in 2009/10 on arecurrent basis.

Delivering against these key challenges isessential in supporting the Trust’sapplication to become a Foundation Trustin 2010. Foundation Trust status bringswith it a number of key financial freedomsnot available to a NHS Trust, such as theability to retain any surpluses generatedand to enter into joint ventures with non-NHS organisations. However, a successfulapplication is predicated upon long termfinancial health and viability, including astrong liquidity or cash position and theorganisation’s response to these keychallenges will underpin this.


Andrew HardyDeputy Chief Executive /Chief Finance Officer

INCOME AND EXPENDITURE ACCOUNT FOR THE YEAR ENDED31st March 2009

Restated2008-09 2007-08

£000 £000

Income from activities* 363,514 335,761

Other operating income* 63,159 43,106

Operating expenses** (415,461) (376,025)

OPERATING SURPLUS** 11,212 2,842

Loss on disposal of fixed assets (83) (21)

SURPLUS BEFORE INTEREST** 11,129 2,821

Interest receivable 773 1,367

Interest payable (543) 0

Other finance costs - unwinding of discount (52) (43)

SURPLUS FOR THE FINANCIAL YEAR** 11,307 4,145

Public dividend capital dividends payable (6,482) (5,850)

RETAINED SURPLUS/(DEFICIT) FOR THE YEAR** 4,825 (1,705)

All income and expenditure is derived from continuing operations.

INCOME AND EXPENDITURE* The prior year comparators have been restated following re-analysis of income.

** The prior year comparators have been restated following a change in accounting policy in relation to the Trust now accruing for untaken annual leave at the end of the year

BALANCE SHEETAs at 31st March 2009

Restated2008-09 2007-08

£000 £000

FIXED ASSETSIntangible assets 264 375Tangible assets 147,021 179,034Financial assets 0 0

TOTAL FIXED ASSETS 147,285 179,409

DEBTORS: Amounts falling due after one year 42,809 42,954

CURRENT ASSETSStocks and work in progress 7,327 6,216Debtors 13,159 12,682Investments 0 0Cash at bank and in hand 1,306 925

TOTAL CURRENT ASSETS 21,792 19,823

CREDITORS: Amounts falling due within one year* (46,468) (38,008)Financial liabilities 0 0

NET CURRENT LIABILITIES (24,676) (18,185)

TOTAL ASSETS LESS CURRENT LIABILITIES 165,418 204,178

CREDITORS: Amounts falling due after more than one year (6,000) 0Financial liablilities 0 0

PROVISIONS FOR LIABILITIES AND CHARGES (3,406) (3,168)

TOTAL ASSETS EMPLOYED 156,012 201,010

FINANCED BY:

TAXPAYERS’ EQUITYPublic dividend capital 28,631 43,797Revaluation reserve** 88,018 123,585Donated asset reserve 2,195 2,350Government grant reserve 0 0Other reserves 0 0Income and expenditure reserve* ** 37,168 31,278

TOTAL TAXPAYERS’ EQUITY 156,012 201,010

BALANCE SHEET* The prior year comparators have been restated following a change in accounting policy in relation to the Trust now

making an accrual for staff untaken annual leave at the end of the financial year.

** The prior year comparators have been restated following a change in accounting policy where by the Trust no longer carries negative reserve balances.


Summarised Financial StatementsThis summary financial statement on pages 24-25 does not contain sufficient information to allow as fullan understanding of the results and state of affairs of the Trust and its policies and arrangementsconcerning directors’ remuneration as provided by the full annual accounts, a copy of which is availablefree of charge by contacting the Chief Finance Officer as follows:write to: The Chief Finance Officer

University HospitalClifford Bridge RoadCoventry. CV2 2DX

or telephone: 024 7696 7606.

STATEMENT OF TOTAL RECOGNISED GAINS AND LOSSES For the year ended 31st March 2009

2008-09 2007-08£000 £000

Surplus for the financial year before 11,307 4,145divdend payments **

Fixed asset impairment losses * (35,268) 0

Unrealised surplus/(deficit) on fixed asset 842 9,210revaluations/indexation

Increases in the donated asset and government 150 84grant reserve due to receipt of donated andgovernment grant financed assets

Defined benefit scheme actuarial gains/(losses) 0 0

Additions/(reductions) in “other reserves” 0 0

TOTAL RECOGNISED GAINS AND LOSSES (22,969) 13,439FOR THE FINANCIAL YEAR

Prior period adjustment ** (1,906) (818)

TOTAL RECOGNISED GAINS AND LOSSES (24,875) 12,621FOR THE FINANCIAL YEAR

* The fixed assets impairment losses reflect the estimated impact of the fall in land and building indices due to the current global economic crisis.

** The prior adjustment in 2008/09 has arisen following a change in accounting policy in relation to the Trust now making an accrual for staff untaken annual leave at the end of the financial year. The prior period adjustment in 2007/08 relates to a change in accounting policy regarding the capitalisation of hearing aids.

CASH FLOW STATEMENT For the year ended 31st March 2009

2008-09 2007-08£000 £000

OPERATING ACTIVITIESNet cash inflow from operating activities 26,601 52,588

RETURNS ON INVESTMENTS AND SERVICING OF FINANCE:Interest received 773 1,367Interest paid (524) 0Interest element of finance leases 0 0

Net cash inflow from returns on investments 249 1,367and servicing of finance

CAPITAL EXPENDITUREPayment to acquire tangible fixed assets (13,188) (12,266)Receipts from sale of tangible fixed assets 0 566(Payments) to acquire intangible assets 0 0Receipts from sale of intangible assets 0 0(Payments to acquire)/receipts from sale of fixed asset investments - 0(Payments to acquire)/receipts from sale of financial instruments 0 -

Net cash outflow from capital expenditure (13,188) (11,700)

DIVIDENDS PAID (6,482) (5,850)

Net cash inflow before management of 7,180 36,405liquid resources and financing

MANAGEMENT OF LIQUID RESOURCES(Purchase) of financial assets with the Department of Health 0 0(Purchase) of other current financial assets 0 0Sale of financial assets with Department of Health 0 0Sale of other current financial assets 0 0

Net cash inflow/(outflow) from management of liquid resources 0 0

Net cash inflow before financing 7,180 36,405

FINANCINGPublic dividend capital received 834 10,000Public dividend capital repaid (16,000) (46,805)Loans received from Department of Health 16,000 0Other loans received 0 0Loans repaid to the Department of Health (8,000) 0Other loans repaid 0 0Other capital receipts 0 0Capital element of finance lease rental payments 0 0

Net cash outflow from financing (7,166) (36,805)

Increase/(Decrease) in cash 14 (400)

MANAGEMENT COSTS2008-09 2007-08

£000 £000

Manage costs 16,184 14,861Income 426,673 378,867Management costs as % of income 3.8 3.9

Management costs are defined as those on the management costs website at:www.dh.gov/PolicyAndGuidance/OrganisationPolicy/FinanceAndPlanning/NHSManagementCosts/fs/en


Accounting Policies

Accounting Policies

The Trust’s accounting policies are inaccordance with directions provided bythe Secretary of State for Health andfollow UK generally accepted accountingpractice and HM Treasury’s GovernmentFinancial Reporting Manual to the extentthat they are meaningful and appropriateto the NHS. There have been two keychanges to accounting policies during thelast year as follows:

1. Annual leave which remains untaken at the end of the financialyear (and approved to be carried forward to the following year) is now reflected in the accounts as accrued expenditure; and

2. Negative revaluation reserve balances for individual assets (mainly arising from impairments upon bringing a new asset into use) are no longer allowed – such impairments are now charged directly to the income and expenditure account.

Both these changes have resulted in priorperiod adjustments to the accounts.

Statement of the Chief Executive’sResponsibility as the AccountableOfficer

The Statement of the Chief Executive’sresponsibility as the Accountable officerof the Trust is printed in full in the Trust’s2008/09 Annual Accounts.

Statement of Directors’ Responsibility

The Statement of Directors’ Responsibilityis printed in full in the Trust’s 2008/09Annual Accounts.

Statement on Internal Control

The Statement on Internal Control is alsoprinted in full in the Trust’s 2008/09Annual Accounts.

Disclosure of Information to Auditors

The directors confirm that as far as theyare aware there is no relevant auditinformation of which the NHS body’sauditors are unaware and they havetaken all the steps that they ought tohave taken as a director in order to makethemselves aware of any relevant auditinformation and to establish that the NHSbody's auditors are aware of thatinformation.

External Auditor

The Audit Commission has appointedPricewaterhouseCoopers LLP as the

external auditor to the Trust. The auditors perform their work inaccordance with the Audit Commission’sCode of Practice and there are two keyelements to their work:

• The audit of the annual accounts including a review of the Statement on Internal Control; and

• A review of the Trust’s financial management arrangements which informs the Quality of Financial Management element of the Annual Health Check.

However, for 2008/09, the AuditCommission also required the auditors toundertake a review of the Trust’sarrangements to restate its balance sheetas at 1st April 2008 under InternationalFinancial Reporting Standards. This workis clearly closely related to the statutorywork undertaken by the auditors but isreported separately.

In addition to the statutory workundertaken by the auditors, the Trustengaged PricewaterhouseCoopers toundertake a review of the governancearrangements for the HealthcarePurchasing Consortium (HPC) which is aprocurement function providing servicesto over 40 NHS bodies and has been

hosted by the Trust since October 2006.In order to maintain independence, thiswork has been overseen by a director ofPricewaterhouseCoopers who is nolonger involved in the statutory audit.

The total external audit fees /remuneration recorded in the accountsfor 2008/09 is £255,000 – of which£205,000 relates to the statutory auditwork and £50,000 relates to the HPCreview.


Auditors’ Opinion


We have examined the summary financialstatement for the year ended 31 March 2009which comprises the Income and ExpenditureAccount, the Balance Sheet, the Statement ofTotal Recognised Gains and Losses, the CashflowStatement, the related notes and the informationin the Directors’ Remuneration Report.

This statement, including the opinion, has beenprepared for and only for the Board of UniversityHospitals Coventry & Warwickshire NHS Trust inaccordance with Part II of the Audit CommissionAct 1998 and for no other purpose, as set out inparagraph 36 of the Statement of Responsibilitiesof Auditors and of Audited Bodies prepared bythe Audit Commission. We do not, in giving thisopinion, accept or assume responsibility for anyother purpose or to any other person to whomthis statement is shown or into whose hands itmay come save where expressly agreed by ourprior consent in writing.

Respective Responsibilities of Directors andAuditorsThe directors are responsible for preparing theAnnual Report and summary financial statement,in accordance with directions issued by theSecretary of State.

Our responsibility is to report to you our opinionon the consistency of the summary financialstatement within the Annual Report with thestatutory financial statements and the Directors’Remuneration Report and its compliance with therelevant requirements of the directions issued bythe Secretary of State.

We also read the other information contained inthe Annual Report and consider the implicationsfor our statement if we become aware of anyapparent misstatements or materialinconsistencies with the summary financialstatements.

Basis of OpinionWe conducted our work in accordance withBulletin 1999/6 ‘The auditors’ statement on thesummary financial statement’ issued by theAuditing Practices Board. Our report on thestatutory financial statements describes the basisof our audit opinion on those financialstatements and the Directors’ RemunerationReport.

OpinionIn our opinion the summary financial statement isconsistent with the statutory financial statements

and the Directors’ Remuneration Report of theTrust for the year ended 31 March 2009 andcomplies with the relevant requirements of thedirections issued by the Secretary of State.

We have not considered the effects of any eventsbetween the date on which we signed our reporton the statutory financial statements and thedate of this statement

PricewaterhouseCoopers LLPCornwall Court19 Cornwall StreetBirminghamB3 2DT

Independent auditors’ statement to the Directors of the Board of University Hospitals Coventry & Warwickshire NHS Trust

Stained glass recovered from Walsgrave Hospital and now in placein the Faith Centre of University Hospital, Coventry.


University Hospitals Coventry and Warwickshire NHS TrustClifford Bridge Road, Coventry CV2 2DX

Tel: 024 7696 4000 Fax: 024 7696 6056www.uhcw.nhs.uk

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uhcw annual report 2008-09 :layout 1 reports and... · picture courtesy of skanska facilities...

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