Annual report 1 October 2014 to 31 March 2015
Transcription
Annual report 1 October 2014 to 31 March 2015
A new beginning Annual Report 1 October 2014 - 31 March 2015 Contents 2Looking back Chairman Peter Worthington 6Looking to the future Chief Executive Dame Jacqueline Docherty 8Corporate objectives for 2014/15 10Research and innovation 12Recognising our dedicated staff 16What our staff said about working here 20Our performance 23 Reducing Infections 24Information governance 28Quality at the heart of what we do 34Listening to what patients tell us 37Being prepared 38Our Trust Board 44Financial Summary 2 London North West Healthcare NHS Trust brings together hospital and community services across Brent, Ealing and Harrow. Our Trust looks after: • Central Middlesex Hospital • Community services across Brent, Ealing and Harrow, including Clayponds Rehabilitation Hospital, • Meadow House Hospice, Denham Unit and Willesden Centre • Ealing Hospital • Northwick Park Hospital • St Mark’s Hospital Trust headquarters Northwick Park Hospital, Watford Road, Harrow, HA1 3UJ Telephone: 020 8869 3232 www.lnwh.nhs.uk www.facebook.com/lnwh.nhs Twitter: @lnwh_nhs Looking back Chairman Peter Worthington This has been an exciting, if challenging, six months for our new organisation with London North West Healthcare NHS Trust officially launching on 1 October 2014. Nearly four years of hard work culminated in the merger of Ealing Hospital NHS Trust and The North West London Hospitals NHS Trust, creating one of the largest integrated acute and community care trusts in the country. With our hospitals and community services now all under one umbrella we are in a privileged position to be able to make a real difference to the quality of our services and the care we can provide for our patients. The integration of clinical services will position us to move finally towards the provision of specialist services, twenty-four hours a day, seven days a week, across our hospital and community services in Brent, Ealing and Harrow. It is not just our patients that will benefit from the merger. We are also creating exciting new career opportunities for our workforce and new recruits through the integration and development of services across the acute and community setting. There is no denying that our first six months have been challenging. This was partly as a result of the increased pressure experienced by the whole of the NHS during the winter, which led to emergency departments struggling to see and treat patients within the four hour target. Closing the Central Middlesex Hospital emergency department and opening the new £21million emergency department at Northwick Park in the midst of this very busy period added additional pressure. However, I must take this opportunity to thank staff for their professionalism and dedication, ensuring that patients were cared for safely throughout the winter and during the transition into the new department. We worked extremely hard in partnership with the London Ambulance Service (LAS), local Clinical Commissioning Groups and other stakeholders to ensure that the transition was a success and the teams received commendations from the LAS, who wrote that the move was: “the most seamless they had encountered”. To address the challenges associated with reducing our waiting times in A&E, we established a dedicated emergency pathway taskforce to review clinical processes throughout the organisation. Its aim was to improve the flow of patients through the emergency department, by removing barriers that slowed down the safe discharge of medically fit patients from our services. This work has achieved real improvements in our ability to see, treat and admit or discharge patients within the four hour standard. 3 On average, 90 per cent of patients seen at Northwick Park are now treated and discharged within four hours. At Ealing this figure is above 95 per cent, following a temporary dip during the winter. However, there is still work to do and increasing our capacity remains a priority. This especially applies at Northwick Park Hospital where a new 63 bedded modular unit is being added and is scheduled to open in time for the coming winter. It is not just our emergency pathway that has seen investment, with refurbishment projects updating Denham Unit and the care of the elderly ward at Ealing Hospital, plus the addition of new state of the art surgical theatres at Northwick Park. We have also invested in a substantial upgrade to the electricity supply on the Northwick Park site to ensure we can react to increasing future demand. Our AAA rated stroke team 4 However, our finances do present an ongoing challenge as the merger and the effects of winter pressures increased our level of spending, leaving the new Trust with a deficit of £24.9 million for the six month period from 1 October. We are working closely with the Trust Development Authority and our commissioners to put the Trust in the best place going forward. The reasons for our financial challenge are varied and longstanding. They include a rise in patient activity and acuity through our emergency departments, requiring us to put in additional capacity and staffing at short notice. This incurred additional costs in advance of our planned capacity increase. In addition, as we go forward, we will be revisiting how we make best use of Central Middlesex and Ealing Hospitals to help address this issue and others specific to those acute sites. In line with other organisations, we will also be looking very closely at how we deliver good quality services within the financial envelope available and how we hold ourselves to account for this. In my round up of the last six months I must not forget to mention the LNWH staff excellence awards. This fantastic event only served to highlight what I already knew: that we have a highly talented, dedicated and driven workforce that is focused on delivering compassionate care to our patients every day and who are the key to moving this organisation forward. Trust on 1 April 2015 and brings a wealth of clinical and operational experience. She is moving rapidly to re-focus the Trust’s efforts on delivering the merger strategy and benefits, enhancing patient experience and operational effectiveness, and using the full potential of the resources now available to the Trust and our patients. Peter Worthington Chairman Another area of outstanding performance to note is the stroke team (pictured), who achieved the top AAA rating for their service, making it the busiest and best stroke service in the country. Similarly, our health visitors’ hub saw seven members of its team awarded prestigious fellowships from the Institute of Health Visiting – more than any other centre in London. The Trust’s research and development team have excelled in recruiting patients for clinical trials and St Mark’s Hospital continued to pioneer world class treatments in the year of its 180th birthday. I would like to pay tribute to all our patients, in addition to our clinical and business partners, stakeholders such as the Clinical Commissioning Groups, Health and Wellbeing Board and local councils. Also, I would like to thank our outgoing CEO, David McVittie, for his service. In 2012 he was tasked with completing the merger and starting the journey towards a more sustainable future; tasks that he can proudly count as delivered. In his place, we welcome Dame Jacqueline Docherty, who joined the 5 Looking to the future Chief Executive Dame Jacqueline Docherty I joined the organisation at a busy and exciting time and look forward to our first full year as the combined London North West Healthcare NHS Trust. There are many challenges ahead as we start to develop and integrate the organisation to be a leader in the provision of both acute and community care. In these early stages we have a real opportunity to evaluate and improve the quality of our services and patient experience for the coming months and years. In today’s NHS we do not exist in isolation and we must understand and react to challenges that face the NHS as a whole. Over the coming year, the Trust will continue to support the Shaping a Healthier Future programme, which will see the consolidation of maternity units in North West London. In supporting this change, we will see the closure of the maternity unit at Ealing Hospital, which will be difficult for staff who have developed such an effective and efficient service over the years. However, we know that only by reshaping the maternity service across the whole of the sector will we be able to continue providing the safe, high quality service that the women in our care deserve and require, both now and in the future. 6 We will also work closely with North West London Whole Systems Integrated Care, to help support patients in their own home and reduce the need for them to be admitted to hospital in the first place by delivering proactive care. As a major employer within the North West London sector we have started, and will continue to prioritise, an ambitious recruitment and retention programme. Change cannot be achieved without a wellsupported workforce and our recent staff survey demonstrates that our staff feel their roles make a real difference to patients. It is vitally important for us to invest in our staff so they can continue to make a difference. The survey also highlights the areas where staff do not feel supported and the fact that our appraisal rates are low – both of which are areas we will address. In line with the Government’s direction of travel, the Trust is positioning itself as a specialist in the provision of integrated care. We are also investing in people who will grow with the organisation, ensuring we provide training which supports staff development in their chosen career path. By retaining quality staff and increasing our recruitment we can also reduce our expenditure on costly agency staff, money which can then be reinvested in clinical services. By supporting our workforce I hope that we will be regarded as a leading employer of choice. While this is an exciting time of change and development, we must not lose sight of our finances. We ended the last financial year as a newly merged Trust with a sizeable financial deficit. As an organisation, we must look to develop efficient services that provide excellent patient care, ensuring we develop new and innovative care pathways. By delivering quality, first time, all the time, we will enhance the experience of patients whilst reducing expenditure. We can then redirect resources into areas of growth and development, bringing us back to financial stability. We must also look to make the best use of resources across all of our community and hospital sites. There is work to be done around the Trust’s strategic direction: this will involve deciding which services we provide, the contracts we bid for and the specialties we aim to develop into centres of excellence. To achieve the right balance, we will continue to work closely with our commissioners and local authorities, ensuring the right services are available for our local community. I look forward to meeting and working with you all over the coming months as we develop London North West Healthcare NHS Trust together. Jacqueline Docherty, DBE Chief Executive 7 Corporate objectives for 2014/15 The legacy trusts of Ealing Hospital NHS Trust and The North West London Hospitals NHS Trust chose five key objectives to see the organisations through their merger on 1 October 2014 and beyond. They were: 1.Improving our focus on safety and quality • We will work with our patients to ensure that the Trust complies with the recommendations made by the Francis Inquiry into the events at Mid Staffordshire NHS Foundation Trust • We will continue to ensure the safety and wellbeing of all patients in our care 2.Improving patient experience, satisfaction and engagement • We will work with all our stakeholders to develop a culture of openness, caring and compassion • We will actively involve patients and carers in all aspects of care and service delivery and act on their feedback • We will complete our programme to improve our estate, including the operating theatres, emergency department and infrastructure at the Northwick Park site 3.Create a sustainable workforce that is engaged in developing and improving services • We aim to become the employer of choice for healthcare staff • We will ensure our values are understood and embedded 4.Ensure financial sustainability • We will deliver a financial strategy that supports the merged trusts but does not undermine our focus on patient safety 5.Plan for our future • We will support implementation of the Shaping a Healthier Future programme to enable better standards of care for our patients 8 9 Research and innovation The merger and launch of the new Trust has seen a significant increase in the numbers of patients participating in research studies, positioning the Trust as an important contributor to research in North West London and beyond. In March 2015, the Trust launched a new film to demonstrate the benefits of research and show patients how they can get involved. You can watch it online at www.lnwh.nhs.uk/research Success stories The patient research forum – consisting of more than 40 patients – has gone from strength to strength, supporting clinicians with research proposals and grant applications. The forum has received positive feedback from researchers and underpins the Trust’s research strategy by engaging with patients and service users. The Trust is a key player in the Government’s 100,000 Genomes Project. The aim is for the UK to become the first country in the world to sequence 100,000 whole human genomes to help diagnose and treat patients with rare/inherited diseases and common cancers. 10 The Trust has been identified as the ‘Outer London Hub’ to lead research on heart failure for the Centre for Leadership in Applied Health Research and Care (CLAHRC). It will also lead the ‘Itchy sneezy wheezy’ programme, looking at allergies in children. This year our research excellence award winners were Dr Ajay Gupta and Dr Sushen Bhattacharya, for improving care of elderly patients with hip problems by putting novel systems in place to ensure they are operated on more quickly and mobilised earlier in their recovery. A study by the Trust demonstrated the success of SMS texting in recalling to hospital patients at high risk of sexually transmitted infections. The study showed a 21 per cent increase in re-attendance amongst high risk patients, leading to earlier diagnosis and prevention of complications in HIV. October 2014 London North West Health Care NHS Trust was launched, thanks to a lot of hard work from all our staff. The new Trust is one of the largest integrated care organisations in the country, looking after hospital and community services in the boroughs of Brent, Ealing and Harrow. The Executive team spent their first day out and about meeting as many staff as possible. We have developed and tested new tools to assist patients with cognitive and communication problems, enabling them to report their own symptoms and experience despite their inability to use standard questionnaires. Many of these tools have been widely taken up in national clinical guidelines and are being integrated into routine clinical practice. Researchers at Ealing Hospital have been awarded a European Grant to investigate the prevention of diabetes in South Asian patients, both in the UK and internationally. Researchers at the Trust published data showing the impact of the London Olympics on sexual health. These data were used in preparations for the Glasgow Commonwealth Games and provide an excellent resource for the planning of any large event. 11 Recognising our dedicated staff We employ almost 8,500 staff, making us one of the largest local employers. The success of our Trust in delivering high standards of patient care can be attributed to the dedication and commitment of our staff. Here we celebrate their outstanding achievements and share what they think of our organisation. Pride in our Staff LNWH staff awards In March a special awards evening was held, with support from our sponsors, to celebrate the achievements of our staff. The prestigious awards received more than 180 nominations from patients, staff and the public. The winners were: Caring Excellence Team winners Ambulatory Emergency Care Team Ealing Hospital. “For the service they provide, which from patient feedback, has been proven to be excellent.”picture [1] Individual winner Mahadevan Thevakanthan, Nurse Practitioner, ENT. “For his unflinching, hard-working and patient-centred nursing care.” [2] Patient Safety Team winners The Endoscopy Pre-assessment Team St Mark’s Hospital. “For helping to reduce complications and increase patient safety.” [3] Individual winner Maria Yates, Community Matron. “Because of her input and passion, the district nursing team has blossomed.” [4] Stronger Together Team winners Clinical Coding Team. “For their consistent hardworking and supportive approach during times of extreme pressure to meet deadlines.” [5] Individual winner The judging panel were unable to come to a decision on one runner up and winner so there are two this year, and they are: John Hutchins, Clinical Director, Consultant Paediatrician. “For his amazing people skills, quirky style of management and strong work ethic.” (no picture) Ginder Nisar, Executive Assistant. “For being a role model to her peers and an asset to the organisation - she never takes her eye off the ball.” [6] 12 1 Pride in our Staff LNWH staff awards 2 4 3 6 5 October 2014 Brent Family Nurse Partnership was launched to support first-time teenage mums. 13 7 Unsung Hero Team winners Health visiting teams, Ealing, Brent and Harrow. “For their dedication and commitment through a period of massive change and uncertainty.” [7] Individual winner Meena Gandhi, Ward Clerk. “For working above and beyond to ensure patient safety and giving 110%.” [8] and Angie Lyon, Telephone Supervisor. “For her unfailing ability to be professional and courteous regardless of the situation.” [9] 8 Patient Experience Team winners Supervisors of Midwives, Ealing Hospital. “For being recognised for their excellent work by an external team of auditors and being used as an example of good practice for other teams in London.” [10] 10 Individual winner Debbie Bowry, Paediatric Physiotherapy Associate Practitioner. “For delivering an excellent service to her patients and commitment to her team.” [11] Innovator of the year Team winners The Microbiology Team Northwick Park Hospital. “For the introduction of the Microbiology ICE referral system, which has had more than 700 referrals since March 2014.” [12] Individual winner Andrew Lodge, Endoscopy Decontamination Manager. “For demonstrating strength of leadership and supporting his staff in learning and development.” (no picture) Volunteer of the year Winner Freda Grant. “For her dedication and commitment to the hospital over the past 24 years.” [13] 14 12 9 Pride in our Staff Student of the year From Bucks University Winner Goretti Dowdican-McAndrew “For her thesis entitled: The role of multi-professional healthcare support workers in an intermediate care team.” [14] LNWH staff 11 13 14 15 awards From University of West London Winner Paul Byrne, Student Midwife “For being an active and engaged student who is highly valued by his colleagues.” [15] Chairman’s Award The winners are the Emergency Department Teams from both Ealing and Northwick Park Hospitals. “For the dedication, hard work and professionalism they’ve shown through what has been a very busy year.” [16] 16 Congratulations to everyone shortlisted and thank you to all those who sponsored the event and those who took the time to nominate. The full list of this year’s nominations can be found at www.LNWH.nhs.uk/about-us/awards where you can also make your nominations for next year’s awards. 15 What our staff said about working here Every year, the NHS sends a survey to its staff to find out what they think about their working environment. The survey is undertaken in the autumn and 2014 was the first one for London North West Healthcare. The top five areas in which we compared favourably with other acute trusts were: staff motivation at work staff feeling satisfied with the quality of work and patient care they are able to deliver staff agreeing that their roles make a difference to patients staff agreeing that feedback from patients/service users is used to make informed decisions in their department/directorate levels of stress reported by staff Areas in which we compared less favourably with other trusts include the number of staff who have annual appraisals and the number who experience harassment or abuse. We are working through action plans to improve these areas. 16 Embracing equality and diversity The Trust is committed to ensuring that it meets and exceeds its obligations under equality legislation and is in the process of finalising equality objectives for the new organisation. Previous equality objectives from the legacy Trusts will remain in place until this process is completed. We are working to become a more inclusive Trust. Progress includes: the development of a new Equality & Inclusion Strategy engagement with local communities on how to address health inequalities the introduction of new technology to support our staff and service users in offering a more accessible service the development of a new bullying and harassment advisory service to support staff, something that was flagged up as a clear priority in the staff survey mandatory training is supported by new Trust-wide policies on bullying and harassment and equality and diversity policies. These also support staff with disabilities the Trust remains a Stonewall Diversity Champion Keeping in touch with our staff The Chief Executive and the Executive team provide visible leadership by walking-thefloor on a regular basis, visiting wards, departments and community sites across the organisation. The visits provide an opportunity for the team to interact with patients and staff, whilst also picking up on any potential issues. November 2014 Mums-to-be in Brent, Ealing and Harrow can choose to have their baby at home, following the launch of our new homebirth service. The Chief Executive holds regular open forums across our sites and regularly writes to all staff through the ‘This week’ e-bulletin. Managers are also briefed using the ‘Team talk’ cascade to encourage discussion of trust-wide issues at local team meetings. Following the merger, we launched a new Trust magazine for staff, patients and other stakeholders. Published quarterly, ‘Our Trust’ magazine shares news and showcases 17 Workforce performance Information on a range of key workforce indicators is reported to the Trust Board each month. Below are some facts and figures: 8,478 eople are employed by the p Trust (8113.21 full- time equivalents (FTE)). 1,197 people (14.1 per cent) are employed part time. • 10.6 per cent of posts were vacant at the end of the financial year (March 2015). This was a reduction from the 13.3 per cent of posts which were vacant when the Trust was formed in October 2014. • A small proportion of our workforce left the organisation voluntarily (5.7 per cent). highlights from across the organisation. In October, the Trust launched a new intranet site which incorporated feedback from staff to make it more user-friendly. This channel is frequently used by staff to access news, information and resources. Regular health and safety bulletins and fire safety bulletins are distributed electronically to all staff and stored on the intranet. The Trust also has a number of active social media accounts, including Twitter and Facebook, which share news and encourage dialogue with staff and patients. All communication channels are widely used to keep staff informed about organisational changes. Over the last six months, staff have been updated on a range of important issues, including post-merger integration across the Trust, improvements to the performance of the organisation’s emergency department and changes to services as a result of the Shaping a Healthier Future consultation. 18 • On 9 March the Trust launched its new Education Learning Management System (ELMS). This online platform enables staff to book their training, access online learning and review their training records. It will improve the uptake and recording of training in future and will mean that new staff do not have to duplicate statutory and mandatory training where they can provide evidence that they are up to date from a previous role. • The reported sickness absence rate was 3.6 per cent. The national average is 4 per cent. It is disappointing that only 40 per cent of staff had an up-to-date appraisal recorded during this period. It has been recognised that there is an issue around completed appraisals being recorded centrally and this is being addressed. The new organisation, London North West Healthcare NHS Trust, recognises that appraisals play an important role in staff development and are crucial in attracting and retaining high quality staff. Improving appraisal rates is a key element of the Trust’s recruitment plan going forwards. Staff group shown as a percentage of our workforce Nursing and midwifery Administrative and clerical Additional clinical services Medical and dental Allied health professionals Scientific and technical Estates and ancillary Students Nursing andscientists midwifery Healthcare Administrative and clerical Additional clinical services Medical and dental Allied health professionals Scientific and technical Estates and ancillary Students Healthcare scientists 34.9% 19.6% 16.4% 14.5% 9% 3.5% 0.7% 0.7% 34.9% 0.6% 19.6% 16.4% 14.5% 9% 3.5% 0.7% 0.7% 0.6% Staff ethnicity shown as a percentage of our workforce Nursing and midwife Administrative and c Additional clinical se Working in partnership Medical and dental Allied health profess We work in partnership with our recognised Staff groups Scientific andshown technia trade unions. In line with our jointly agreed Staff group LNWH Estates change management policy, we remainand ancillary Nursing and midwife Students 0.7% committed to consultation when staff are Administrative and c Healthcare scientists affected by changes to the way services are run. Additional clinical se Our Joint Negotiating and Consultative Medical and dental Staff ethnicity shown Committee (for all staff) and the Local Allied health profess Ethnic Group LNWH Negotiating Committee (for medical Scientific and techni Whiteand 35.4% staff) work together to agree policies Estates and ancillary implement staff consultations. Asian 26.3% Students Black 16.8% 0.7% Healthcare scientists Chinese/ Other Mixed 2.4% Staff ethnicity shown Not Stated 10.9% Ethnic Group LNWH White 35.4% More than 240 community and Our district trust provides h nurses have been given a tablet Asian 26.3% computer to support their work. BlackTablet 16.8% technology is enabling community Chinese/ Other nurses in Ealing, Brent and Harrow Mixed 2.4% to review and update patient records Not This Stated while visiting patients at home. use 10.9% November 2014 of technology not only saves time spent on administration but also allows nurses Our trust provides h to spend more time supporting and caring for patients. Staff ethnicity shown as a percentage of our workforce White 35.4% Asian 26.3% Black 16.8% Chinese/Other 8.1% Mixed 2.4% Not stated 10.9% Our trust provides healthcare to a diverse White 35.4% population across north west London. The Asian 26.3% ethnic diversity of our workforce broadly reflectsBlack the composition of our local16.8% Chinese/Other 8.1% communities. Mixed Not stated 2.4% 10.9% *All figures reported in this section relate to the end of the period covered by this report, i.e. 31 March 2015. 19 Our performance organisations across North West London to deliver an action plan and resolve the issues that can sometimes lead to patients not receiving this treatment within 62 days. More than 97 out of every 100 women (97.5 per cent) Here we set out the Trust’s performance during the period, against national Department of Health standards that must be met or exceeded: Almost 95 out of every 100 patients (94.7 per cent) who were referred to the Trust by an NHS cancer screening service received their first definitive treatment within 62 days, against a national standard of at least 85 per cent. Almost 96 out of every 100 patients (95.7 per cent) who were referred with suspected cancer to the Trust by their GP or dentist were seen by a clinician within two weeks. The national standard is 93 per cent. Almost 98 out of every 100 patients (97.9 per cent) were treated for cancer within 31 days of a decision to treat being taken. This meets the national standard of at least 96 per cent. More than 8 out of 10 patients (82.2 per cent) received their treatment within 62 days following an urgent GP or dentist referral for suspected cancer. This was just below the national standard of 85 per cent. These patients are often on complex pathways, involving a number of healthcare providers. We are streamlining our internal processes and working with other 20 who were referred for a breast surgery appointment were seen within two weeks. This met the national standard of at least 93 per cent. Less than 1 out of every 100 patients (0.9 per cent) experienced a delay to their discharge once they were medically fit to go home. This was within the national standard of less than 3.5 per cent. 94 per cent of patients admitted to the Trust received an assessment for Venous Thromboembolism (VTE), narrowly missing the national standard (95 per cent). See page 33 for more information about this important indicator and what we are doing to ensure we meet the standard in future. 97 out of every 100 patients admitted with a stroke spent at least 90 per cent their stay on the stroke unit. This met the national standard of at least 80 per cent and is important because it shows that these patients were in the most appropriate place to receive specialist treatment. 86 out of every 100 patients receiving palliative care from London North West Healthcare received their care in their preferred setting in the community. This met the national target of at least 80 per cent. 21 88 per cent of patients who attended an A&E or Urgent Care Centre on one of the Trust’s sites were admitted, discharged or transferred within four hours, against a national target of at least 95 per cent. The Trust, in collaboration with its partners, is implementing a well developed action plan to improve this performance over the coming year. See page 29 for more details of the work that is taking place. Since 2013 all NHS Trusts have been required to eliminate mixed-sex accommodation, except where it is in the overall clinical interest of the patient. During the period covered in this report, the Trust had no mixed sex accommodation breaches. More than 8 out of every 10 patients (82.3 per cent) admitted for a planned procedure received their surgery within 18 weeks, against a national standard of 90 per cent. Over the last 18 months we have worked hard to ensure that all of our patients’ waiting times are counted correctly. Some patients have waited too long for their treatment and over the coming year we will be working with our commissioners to fund additional activity to rectify this. 99 out of every 100 patients using the Trust’s podiatry service reported reduced pain (or no change). This was better than the national standard of 85 per cent. The Trust reported 3.2 falls per 1,000 patient bed days within community in-patient units. This met the standard set by our local commissioners of no more than 7 falls per 1,000 bed days. 22 December 2014 Northwick Park Hospital’s new Accident and Emergency department opened its doors to patients at 4am on Wednesday 10 December 2014. The new £21m, state-of-the-art A&E department incorporates all the main elements of emergency care and brings A&E closer to the hospital’s other emergency services, such as acute assessment, intensive therapy unit, operating theatres and wards. More information about improvements to our emergency services can be found on page 29. Reducing Infections During 2014/15, our hospitals and community services remained committed to reducing all avoidable healthcare acquired infections. Every year NHS England sets each acute hospital trust a ceiling for the maximum number of patients with Clostridium difficile infections. This annual report covers the six month period immediately following the merger of Ealing Hospital NHS Trust and North West London Hospitals NHS Trust (from October 2014 to March 2015). However, for the purposes of mandatory reporting of Clostridium difficile, the two legacy organisations retained their individual targets for the whole of the 2014/15 financial year. A ceiling of no more than 26 cases was set for the combined trusts in 2014/15. This challenging target represented a reduction of 17 cases from the previous year. A total of 31 cases were recorded during the full year; a 28 per cent reduction on the previous year’s total. January 2015 St Mark’s Hospital celebrated its 180th birthday. In this anniversary year, Professor Brian Saunders presented a pioneering surgical technique which removes polyps without leaving patients with stoma bags. Since 2013/14 there has been zero tolerance to MRSA blood stream infections for all acute hospital trusts. During the period covered by this report, the Trust reported one case of MRSA at Ealing Hospital. General standards of cleanliness and hygiene are important factors in infection control. See page 26 for more information about how our patients rated the levels of cleanliness across the Trust’s sites. 23 Information governance 24 Information governance is the way in which the Trust ensures it is managing information ethically and legally, and that any patient information is used following strict national guidelines to ensure confidentiality and integrity. Incidents relating to information are actively managed and monitored through the Trust’s Information Assurance Board and the Audit, Governance & Risk Committee. Becoming more sustainable The Trust is committed to improving its future sustainability. Over the past six months the Trust has: Incidents are rated according to severity used internal sustainability champions as defined by the Health and Social Care to promote cycling and cycle safety, Information Centre (HSCIC), with 0 being the lowest and 2 being the highest. All information recycling, energy and water efficiency and to help maintain local woodland incidents rated at Level 2 are notified to the Information Commissioner’s Office (the reviewed energy and waste regulator for data protection in England) via management to explore lower costs the HSCIC information governance incident and more sustainable alternatives reporting tool, and also placed on STEIS, the national incident reporting system. reduced CO2 emissions by more than During the period covered by this report, a 300 tonnes (with 270 tonnes saved by single Level 2 incident was reported. the installation of LED lighting on large sections of the Ealing Hospital site) The following table illustrates reported Level 2 incidents. built the new emergency department at Northwick Park to BREEAM 2011 Total standard. This means it is a very efficient Nature of incident reported building with boilers running on natural gas, double glazing, LED lighting and solar panels Loss of inadequately protected 1 reducing CO2 emissions by 30 tonnes a year. electronic equipment devices or paper documents from There are future plans to replace the existing secured NHS premises steam boiler system at Northwick Park with Loss of inadequately protected electronic equipment devices or paper documents from outside secured NHS premises NONE Insecure disposal of inadequately protected electronic equipment, devices or paper documents NONE Unauthorised disclosure NONE Other NONE high efficiency package boilers to ensure emissions remain below the continually decreasing target levels. We are also working with the neighbouring University of Westminster campus to produce a green travel plan. 25 What our patients say about the Trust’s environment 2014/15 was the second year that Patient Led Assessments of the Care Environment (PLACE) were carried out to assess the Trust’s environment across the hospital and community setting. This year’s assessments were held in April and May 2014, prior to the merger, but apply to the whole year. Patient assessors make up 50 per cent of our assessment teams and the valuable feedback obtained during this process is used by the Trust to make ongoing quality improvements. Our scores for the four key areas were: Cleanliness Food and hydration Privacy and dignity Condition/ appearance/ maintenance 97.25 88.79 87.73 91.97 97.03 69.58 72.64 92.14 Clayponds% 98.08 95.26 84.93 93.75 Denham Unit % 94.66 92.63 84.78 85.85 Ealing Hospital % 97.05 87.17 74.12 86.98 Meadow House Hospice % 100.00 90.32 100.00 88.96 Northwick Park & St Mark’s Hospitals% 98.35 72.02 78.05 89.20 Willesden Centre for Health & Care 99.47 97.14 81.15 96.96 National average % Central Middlesex Hospital % 26 % Following the assessments we have: implemented a new patient meal service and menu information booklet system at Central Middlesex, Northwick Park and St Mark’s Hospitals approved a curtain replacement programme for Ealing, Central Middlesex, Northwick Park and St Mark’s Hospitals improved the appearance and access route into the main entrance at Ealing Hospital reviewed the protected mealtimes policy and monitoring tools to meet the requirements of the new Trust continued to engage patients and staff in mini-assessments. The Trust has also invested in the infrastructure at Northwick Park with the completion of a new electricity supply to meet the site’s increasing demands, as well as improving the main drainage system by replacing aging infrastructure. A community estates strategy is being developed to support the infrastructure of our community sites. This will be launched later in 2015/16. February 2015 Our health visitors lead the way in tackling postnatal depression. The development of their assessment wheel will help to tackle some of the £8.1bn spent nationally on mental health problems every year. Improving our surroundings The Trust continues to improve its buildings and services and the second half of the year saw the anticipated opening of the new £21 million emergency department at Northwick Park Hospital. The enhanced facility provides a dedicated X-ray and CT scanner. The building has been built to modern standards with enhanced natural light, improved signage and increased privacy and dignity. Further refurbishments improved existing facilities: Ealing Hospital’s care of the elderly ward was redesigned to be dementia friendly, cardiology services at Northwick Park now provide enhanced facilities and additional beds, the Denham Unit saw improvements to its facilities and building commenced on a new 63 bedded unit at Northwick Park, following the approval of a £31.5m business case. 27 Quality at the heart of what we do A copy of our quality accounts can be found at www.nhs.uk In our 2013/14 Quality Accounts, pre-merger, we outlined three key priorities for quality improvement in the organisation during 2014/15. These were: PRIORITY 1 Continued development and improvement of the patient journey and experience through our accident and emergency patient pathway (see page 29) PRIORITY 2 Improved patient experience (see page 30) PRIORITY 3 Measures to reduce harm (see page 32) Throughout the last six months we worked hard to improve outcomes across these three priority areas. 28 PRIORITY 1 Continued development and improvement of the patient journey and experience through our emergency patient pathway The winter was particularly difficult for the whole of the NHS with significant pressures created by an increase in the number of patients who were acutely unwell and in need of 1:1 care. This created a challenge for the Trust in attempting to meet the national emergency department standard to see, treat and admit or discharge 95 per cent of patients within four hours. Since the winter we have taken some innovative steps to improve clinical processes across the Trust. We have seen real progress in reducing the number of patients who wait more than four hours before being admitted or discharged from A&E and we remain committed to meeting the national standard in future. We have made a number of changes across the organisation to improve the experience of patients who require emergency care at our hospitals and, in particular, at Northwick Park Hospital. Improvements to support our emergency pathway include: Capacity Capacity within the organisation, and especially at Northwick Park Hospital, played a part in the failure to meet the emergency target this winter. Throughout the winter 56 beds were opened across the organisation and a new modular build is currently under construction which will provide 63 new beds to Northwick Park by the winter of 2015/16. Increasing beds is not the only issue that needed to be addressed to improve our performance and give patients attending our emergency departments the very best care. In order to make our processes as efficient as possible across the organisation, we established a dedicated ‘emergency pathway taskforce’, led by our Director of Operations with key lead nurses and clinicians. Emergency pathway taskforce To help improve the flow of patients from the emergency department into the hospital, a dedicated taskforce was set up to look at all procedures across the hospital and community settings. A major success of the taskforce was the launch of a new rapid assessment process and care pathway allowing the emergency department team to treat stable emergency patients quickly, without taking up additional beds. The taskforce is now looking to improve access to community beds and care services so that patients who are ready for discharge can leave hospital at the appropriate time. 29 Opening the new emergency department at Northwick Park Hospital December 2014 saw the opening of the new £21million A&E and Urgent Care Centre at Northwick Park Hospital. The state-of-the-art department provides a dedicated treatment area for children and includes 40 individual bays, giving patients a greater level of privacy. Following the closure of the A&E at Central Middlesex Hospital, staff moved to Northwick Park Hospital to support the new department. This resulted in the introduction of more senior clinical staff and consultant cover. Community beds To help reduce the pressure on our A&E departments, our community rehabilitation hospitals received additional patients over the course of the winter. These patients still required care but could be safely looked after outside our acute hospitals. STARRS and ICE admissions avoidance The Intermediate Care Ealing service (ICE) and the Short Term Assessment and Rehabilitation and Reablement Service (STARRS) both worked to support patients in their own homes throughout the winter. These services helped to increase the number of patients that received their care without being admitted to hospital. 30 PRIORITY 2 Improved patient experience Ensuring that our patients have the best possible experience is a key priority and at the centre of everything we do. However, in the last year, the two predecessor Trusts received feedback from surveys stating that there were areas of the patient experience they were not getting right. So, in 2014/15, the new merged Trust looked at how we could do better and we have been working hard to improve training, our culture, communication and care. New ward rounds New ward round standards have been introduced across the whole Trust by the Chief Nurse and Medical Director. Under these new standards, members of the multidisciplinary team take part in daily ward rounds, contributing to patient reviews and receiving important clinical information. Posters with the new standard are being displayed across all ward areas. Tablets in the community More than 240 community and district nurses have been provided with a tablet computer to support their work. Tablet technology is enabling community nurses in Ealing, Brent and Harrow to review and update patient records while visiting patients at home. This use of technology not only saves time spent on administration, it also allows nurses to spend more time supporting and caring for patients. The ‘Hello my name is…’ campaign One of the main issues picked up in feedback from patients was that they didn’t always know who was treating them. Acting on this feedback, the ‘hello my name is…’ campaign was piloted in our emergency departments and will be rolled out across our wards in 2015/16. The campaign raises awareness of the importance of introductions and encourages staff to build them in to their routine. Name boards New name boards have been placed above all patient beds to identify each patient’s lead consultant. Information boards New quality boards have been displayed on all wards to ensure that patients and visitors can see, at a glance, how the ward is performing against a range of measures. Staff use the boards to ensure that necessary actions are taken to address any trends before they pose a problem. Measures displayed on the boards include items from the NHS Safety Thermometer (see page 32), staffing levels and patient experiences, such as responses to the Friends and Family Test (see page 36). Foundations of Safety The Trust signed up to the Foundations of Safety campaign in conjunction with Imperial College Health Partners. The 31 PRIORITY 3 Measures to reduce harm The Trust uses the NHS Safety Thermometer to measure harm and the proportion of patients that are ‘harm free’ in four key areas (see below). campaign is designed to help change staff behaviours and clinical practice, based on evidence. Patient champions have also joined the campaign and surveys have been sent to staff and patient groups to help identify areas of improvement. Capturing patient feedback The Trust introduced an electronic, real-time patient survey system which facilitates a responsive approach to patient feedback. There are a number of electronic kiosks situated in outpatient areas to ensure patient views are captured. The ‘100 voices’ programme was held Trust-wide in February 2015 in order to find out what patients and staff thought of their experience with our services. Responses were received from 705 staff members and 360 patients. Their feedback will help to shape and improve the outpatient service. Diabetes Integrated Care Ealing (DICE) To support patients with diabetes in the community, the DICE team held a patient conference in November. The conference was designed to support and help people with diabetes to manage their own condition. 32 To record this data, every third Wednesday of the month inpatients are surveyed to capture a snapshot of the situation across the Trust. During the period covered by this report, on average the Trust met the national target to provide ‘all harm free care’ to at least 95 out of every 100 patients. Reducing harm from hospital and community acquired pressure ulcers The Trust scored well against the NHS England benchmark of less than 1% of patients surveyed acquiring a new pressure ulcer. Just 0.69 per cent of new patients surveyed acquired a new pressure ulcer while in our care. This measure has been added to the wards’ key performance indicators which are discussed at the monthly meeting of Matrons and Heads of Nursing. This will help to reduce the incidence of pressure ulcers by sharing learning and implementing best practice across the organisation. Reducing harm from falls The Trust performed well against this target during the period covered by this report. Just 1 out of every 400 (0.25 per cent) patients reported harm from falls, meeting the national standard of less than 0.6 per cent. The Trust uses a falls care bundle (checklist) to identify patients at risk of falling in our hospital and community settings. We work hard to reduce the risk of patients coming to harm in this way by employing a range of methods, such as ensuring side rails on beds are used appropriately and low-rise beds are provided to those patients who find it difficult to get in and out of bed. Falls are routinely recorded as part of the wards’ key performance indicators and the Trust has a Falls Committee which examines data and the reasons for patients falling. It ensures corrective measures are put in place to reduce the incidence of falls in future. Ealing Hospital’s care of the elderly ward has been upgraded with new non-slip floors to improve safety and colour coded bays to make it easier to navigate for patients. Reducing harm from catheter-associated urinary tract infections (UTIs) Fewer than 1 in 500 (0.19 per cent) patients acquired a catheter-associated UTI, against a target of less than 0.7 per cent. The Trust continues to use the catheter insertion care bundle (checklist) to monitor and support the care of patients with a new catheter. A new patient ‘passport’ was developed to help reduce urinary catheter infections. The passport joins up patients’ care across the hospital and community settings, supporting them when they are out of hospital. It enables all clinicians to see when and why the catheter was inserted, ensuring that it is changed regularly and ultimately leading to a reduction in infections. Reducing the incidence of venous thromboembolism (VTE) VTE is a condition where a blood clot forms in a vein and may travel in the blood, with potentially fatal consequences. By assessing those at risk of acquiring VTE, we are able to take preventative measures. On average, the Trust reviewed more than 94 per cent of patients for being at risk of VTE, narrowly missing the 95 per cent standard. The Trust closely monitors the completion of assessments. We will continue to support and educate staff to ensure appropriate and timely assessment and reviews take place for all patients. To help improve our compliance, the VTE assessment has been added on to the clinicians’ electronic white board. This means that new patients who have not been reviewed for VTE within six hours of admission will be clearly flagged up. Similarly, the system will highlight any patients who remain in hospital and require a seven day review. Data about VTE assessments have also been added to the wards’ key performance indicators which are reviewed monthly for compliance. Where the standard is not met, wards are set an action plan to improve compliance. Staff training New e-learning training modules have been introduced, enabling staff to develop their awareness and skills when caring for patients with dementia and diabetes. 33 Listening to what patients tell us The Trust welcomes feedback about our services from patients and their families. We learn from comments received, using them to improve patient services and care. For the period covered by this report, 97 per cent of complaints were responded to within the date at the Ealing Hospital NHS Trust legacy organisation. 73 per cent of complaints were responded to within the date for the legacy organisation The North West London Hospitals NHS Trust. Themes of complaints Across the Trust the top four themes of complaints were: • Clinical treatment • Verbal communication and information PALS Our patient advice and liaison service (PALs) received 1,995 comments and queries from patients and visitors between October 2014 and March 2015. • Staff attitude • Appointments in the outpatient department These reflect the themes identified by the NHS Information Centre. Compliments During this period we received 381 formal compliments across our hospital and community sites. These were in addition to the many cards, letters and tokens of appreciation received directly by wards and departments. Complaints During the period covered by this report, the Trust received 494 formal complaints. More than 98 per cent of complaints were acknowledged within three days of receipt. The complaint regulations, which were published in 2009, gave NHS trusts the ability to negotiate a timeframe for responding to a complaint with each complainant, and for a second date to be agreed with the complainant if the first response date is not met. These regulations also gave guidance that all complaints should be responded to within six months. 34 Principles for remedy In handling complaints, the Trust adheres to the Parliamentary and Health Service Ombudsman’s (PHSO) six principles for remedy. These highlight best practice for organisations to ensure complainants are treated in a fair, open and accountable manner and that appropriate and proportionate remedies are offered. Complainants can ask the PHSO to review the way in which their complaints have been handled if they remain dissatisfied with the investigation and action taken by the Trust in response to their complaint. During this period the trust had ten complaints referred to the PHSO. Of these, one has not been upheld and the remainder are still open. Acting on feedback As a result of the feedback we received, a number of improvements and changes to services have been made: communication between multidisciplinary teams, patients and their families has been improved by scheduling formal ‘family meetings’ to discuss care for patients with complex conditions mobile devices (tablets) have been given to 240 community and district nurses, increasing their access to patient information and ensuring they are better equipped to meet patient needs a new Patient Discharge Coordinator is in place to improve discharge processes and communication. 35 NHS Choices Feedback placed on the NHS Choices website (www.nhs.uk), much of which is anonymous, is accessed by our patient relations team and passed on to managers for action as necessary. Some of this feedback raises concerns, but an increased number of postings are positive comments. Friends and Family Test NHS hospitals are required to carry out the ‘Friends and Family Test’, an important opportunity for patients to provide feedback on the services that provide their treatment and care. The test asks people if they would recommend the healthcare services used to their family and friends if they needed similar care. It was launched in April 2013 and since then the question has been asked in all 36 NHS inpatient and A&E departments across England and, since October 2013, in NHS maternity services. The Friends and Family Test was offered to all our patients following their care and was made available through our website. The average response rate was 29.7 per cent (against a target of 30 per cent), with almost nine out of ten (88.3 per cent) people who responded saying they would recommend our inpatient care to their friends and family. In our A&E department, the average response rate was 14.9 per cent (against a target of 20 per cent), with almost 8 out of every ten (77 per cent) people who responded saying they would recommend our emergency services. The Trust has an extensive action plan in place to improve the performance of its emergency pathway (including A&E), see page 29. Being prepared It is essential for the Trust to prepare for an emergency and to ensure it would respond appropriately if a major incident did occur. Major incident planning To ensure the Trust is prepared in case of a major incident we take part in coordinated exercises. Multi-agency table top exercises took place with health and social care partner organisations in North West London to test multi-agency support and mutual aid. This included Exercise Fadden, a Harrow Borough resilience forum exercise which simulated a live command and control environment. The Trust participated in an exercise at Wembley stadium which was designed to test and validate Brent Council’s procedures for the opening of public buildings as shelters in an emergency. Working with our partners The Trust works in partnership with individuals, groups and other organisations to achieve its aims and objectives and improve services for patients. We work closely with our local clinical commissioning groups (CCGs), local councils and Healthwatch Brent, Ealing and Harrow. Our local Healthwatches are made up of individuals, community groups and social care services. We regularly meet with them to discuss potential changes to services and Healthwatch representatives are welcome to attend our monthly Trust Board meetings which are held in public. We work closely with our partners across the NHS, including our neighbouring acute trusts in North West London, the Trust Development Authority, North West London Commissioning Support Unit, the Shaping a Healthier Future programme and NHS England. March 2015 ‘Pride in our Staff’- the LNWH staff excellence awards. The awards ceremony was held on 12 March and all the winners can be found on page 12. The Trust also took part in a regional Public Health England Ebola based exercise which reviewed local preparedness and response arrangements to a suspected Ebola case. 37 Our Trust Board Members of the Trust Board during 1 October 2014 to 31 March 2015 were as follows: Chairman Chief Executive Peter Worthington David McVittie Non-Executive Directors: Patricia Williamson, Professor (Deputy Chairman) David Taube Caroline Corby Stella Dutton Jeanne Spinks Medical Director Dr Charles Cayley (interim) (from December 2014 ongoing) Chief Financial Officer Simon Crawford (interim) Chief Operating Officer Christopher Pocklington (interim) Martin West Executive Directors: Chief Nurse Carole Flowers (interim) Medical Director Dr Alfa Sa’adu (Oct 2014 to December 2014) (interim) In attendance Director of Human Resources & Organisational Development Paul Stanton (interim) 38 Director of Operations Tina Benson Director of Community Services Yvonne Leese (Appointed October 2014) Director of Commercial Development Christopher Blake (interim) Director of Governance Catherine Thorne (Resigned January 2015) Director of Estates and Facilities Paul Kingsmore Chief Information Officer Kevin Connolly (interim) Board Sub-Committee Membership Charitable Funds Committee Chair: Stella Dutton Caroline Corby, NED Jeanne Spinks, NED Chief Financial Officer Chief Nurse Remuneration and Senior Appointments Committee Chair: Patricia Williamson Caroline Corby, NED Stella Dutton, NED Professor David Taube, NED Other members co-opted as required Audit Governance and Risk Committee Chair: Martin West Caroline Corby, NED Jeanne Spinks, NED Chief Executive (twice a year) Chief Operating Officer Chief Financial Officer Finance, Investment and Estates Committee Chair: Caroline Corby Stella Dutton, NED Martin West, NED Chief Financial Officer Chief Operating Officer Director of Estates and Facilities Clinical Performance and Patient Experience Committee Chair: Professor David Taube Stella Dutton, NED Caroline Corby, NED Jeanne Spinks, NED Chief Operating Officer Medical Director Chief Nurse Strategy, Organisational Development, HR and Communications Committee Chair: Jeanne Spinks Professor David Taube, NED Stella Dutton, NED Chief Executive Officer Chief Operating Officer Director of HR & OD Director of Commercial Development Integration Board Chair: Peter Worthington Deputy Chair: Patricia Williamson, NED Martin West, NED Caroline Corby, NED Chief Executive Officer Chief Operating Officer Medical Director Chief Nurse Chief Financial Officer Director of HR and OD Director of Estates and Facilities Chief Information Officer Director of Operations Director of Community Services 39 Non-Executive and Executive leads (mandatory requirements) Role Executive lead Accountable Officer David McVittie Caldicott Guardian Delegated by C Cayley to Simon Gabe Safeguarding Adults Carole Flowers Stella Dutton Safeguarding Children Carole Flowers Stella Dutton Security Paul Kingsmore Counter fraud Simon Crawford Martin West Whistleblowing Carole Flowers (Clinical) / Paul Stanton (non-Clinical) Jeanne Spinks Health and Safety Paul Kingsmore David Taube SIRO Kevin Connolly Responsible Officer Charles Cayley Controlled Drugs Charles Cayley Patient Safety Charles Cayley Allegations against professional Carole Flowers Infection Control David McVittie/ Fiona Coogan Fire Safety Paul Kingsmore Emergency planning Tina Benson CQC Carole Flowers Doctors in Difficulty 40 Non-Executive lead David Taube David Taube Declaration of interests Name Title Declaration Peter Worthington Chairman Director: LP orgination Chesilton Consultancy Limited MRIMC Management Company LLP Midway Resources International Patricia Williamson Deputy Chairman Director PMW HR Consulting Ltd David McVittie Chief Executive Director of Imperial College Health Partners Simon Crawford Interim Chief Financial Officer No Interests declared Chris Pocklington Chief Operating Officer Director of Imperial College Health Partners Charles Cayley Medical Director No interests declared Carole Flowers Chief Nurse No interests declared Paul Stanton Interim HR Director No interests declared Paul Kingsmore Director of Estates & Facilities Patron of the Association of Healthcare Cleaning Professionals 2009 – current Director of Institute of Healthcare Engineering and Estate Management Ltd February 2015 - current Christopher Blake Commercial Director No interests declared David Taube Non-Executive Director Director Imperial College Academic Healthy Science Centre Advisor National Kidney Federation Trustee St Mary’s Kidney Patients Association 41 Name Title Declaration Stella Dutton Non-Executive Director No interests declared Caroline Corby Non-Executive Director Director of the Probation Association until July 2014 Chair of the London Probation Trust (until July 2014) Board member of JML since January 2014 Non-Executive Director Criminal Cases Review Commission (July 2014). Non-Executive Director of Children and Family Court Advisory Service (CAFCASS) (December 2014). Member; Management Committee of the Parole Board (January 2015) Martin West Non-Executive Director Non-Executive Director of NHS Property Services Ltd (NHSPS) Non-Executive Director of Kent Surrey and Sussex Academic Health Science Network Jeanne Spinks Non-Executive Director Member of the Advisory Panel to the Welsh Ministers about the Public Policy Institute for Wales Kevin Connolly Director of ICT No interests declared Catherine Thorne Director of Governance No interests declared Tina Benson Director of Operations No interests declared Yvonne Leese Director of Community Services 42 No interests declared Each director states that, as far as they are aware, there is no relevant audit information of which the Trust’s auditors are unaware, and that they have taken all steps to ensure they and the auditors are aware of any relevant audit information. Service changes to directors Catherine Thorne’s last day of service: 18 January 2015 (NWLHT/LNWHT) Yvonne Leese from October 2014 (in her new role LNWHT) Professor Rory Shaw Medical Director (NWLHT) to 10 December 2014, seconded to Medical Director Health in the UK with UKTI from 1 November 2013 Dr Alfa Sa’adu Medical Director (LNWHT) from 30 October 2014 to 10 December 2014 Dr Charles Cayley Interim Medical Director from 10 December 2014 to present (LNWHT) Dr William Lynn until 31 October 2014 (as Deputy CEO EHT) Don Fairley Director of Human Resources (NWLHT) seconded to Bedford Hospital NHS Trust from 5 May 2014 Christopher Blake Turnaround Director from November 2013 to 31 October 2014 (EHT) 43 Financial Summary London North West Healthcare NHS Trust was established on 1 October 2014 as a result of the merger between Ealing Hospital NHS Trust and North West London Hospitals NHS Trust. The initial six month period following the merger presented increased financial demands for the new organisation. These demands were also combined with the continuingly increasing pressure on NHS resources and the drive for continued efficiencies across the NHS, together they created a series of complex challenges. Despite this, the Trust delivered a retained deficit of £24.9m for the six months to 31 March 2015, which was in line with the final plan agreed with the Trust Development Authority (TDA). (See ‘statement of comprehensive income’ of the financial statements). From 2009/10 onwards, NHS Trusts have been required to account and report financial information in accordance with International Financial Reporting Standards (IFRS). This requires Trusts to revalue their assets periodically and the impact of this was a charge for impairment and reversal of impairment of £6m in the six months to March 2015. Additionally, an International Financial Reporting Interpretations Committee Standard, IFRIC 12 (technical reporting relating to PFI assets) required an adjustment of £0.3m and a change of accounting 44 treatment for donated and government grant reserve adjustment of £0.187m. As a result of the merger between North West London Hospitals NHS Trust and Ealing Hospital NHS Trust, a final adjustment of £294.8m was included within the six month accounts to reflect the net value of assets that were transferred into the new organisation. These four adjustments have been applied to the reported £263.3m income and expenditure account surplus, resulting in an adjusted retained deficit of £24.9m which is used to measure the Trust’s financial performance. The table below shows the financial performance of the Trust over the last six months: Summary of results Income Expenditure Operating surplus/(deficit) Finance costs and dividends payable Period ended 31st March 2015 £000s 346,730 (370,220) (23,490) (7,947) Net gain on transfer by absorption 294,802 Surplus/(deficit) for the year 263,365 IFRIC 12, Donated / Government Grant Reserve and Impairments 6,502 Adjustment for absorption accounting (294,802) Adjusted (deficit)/ surplus re statutory break even duty (24,935) The Trust’s deficit in the current year was achieved after delivering £15.8m of savings (4.6% of turnover) for the six month period from October to March 2015. This included an additional income contribution of £1.8m relating to over-performance in delivering patient activity. Income The Trust income was £346.7m for the six months to 31 March 2015. Where the money comes from The graph below shows 61% of the Trusts income is derived from three main commissioners - Ealing CCG (22%), Brent CCG (21%) and Harrow CCG (18%). The Trust continues to provide services to Hillingdon and Barnet patients, who provide 4% of our income. NHS England accounts for 14% of the Trust’s income and is largely related to specialist patient healthcare. Research and education makes up 5% of our income. The Trust continues to be principally a public sector NHS provider of services, with just 1% of income derived from private patient activity. Expenditure The Trust’s total operating expenditure for the six month period was £370.2m. The Trust spent a total of £241.4m on pay in the period, as shown below, with 69% spent directly on doctors and nursing staff. NHS Ealing CCG 22% NHS Brent CCG 21% NHS Harrow CCG 18% NHS England 14% Other 8% Other CCG 5% Education and research 5% NHS Hillingdon CCG 3% Local authorities 2% NHS Barnet CCG 1% Private patients 1% How much we spend on staff - £millions Staff group Other staff Administrative and clerical Professions allied to medicine Scientific, technical and professional Medical staff Nursing staff 0 20 40 60 80 100 120 £million October - March 2015 45 Our non-pay expenditure The chart below illustrates our non-pay expenditure for the period. The largest category of nonpay spend was clinical supplies which supports direct patient care on our wards and within our services. Impairments in the period were £6m as a result of the revaluation of the Trust’s estate assets. This is excluded from the Trust’s reported deficit, against which we are performance managed. Non-pay expenditure - £millions Non pay type Other Impairments Depreciation Premises Establishment and transport Research, development, education and training Non-clinical supplies Clinical supplies 20 40 60 80 October - March 2015 Capital investment The Trust invested £18.9m in its capital programme in the period October – March 2015. This significant investment has allowed us to continue with our substantial programme to improve facilities and equipment for patient care. The capital programme was financed by £6.9m of internally generated funds and £12.0m public dividend capital (PDC) from the Department of Health. The Trust has maintained capital expenditure within its agreed Capital Resource Limit from the Trust Development Authority (TDA). 46 The chart opposite shows how our capital was spent. Total spend on key projects amounted to £12.3m, or 65%, and comprised of: • A new emergency department opened at Northwick Park in December 2014 • A new picture archiving and communication system (PACS) – A common medical imaging technology solution that underpins seamless information exchange across large geographic areas enabling the Trust to tailor, deliver and manage in a more integrated fashion. • IT costs included spend on projects such as Community Information Systems. • Medical equipment programme included purchases of a MRI scanner, ultrasound machines and neonatal equipment. The balance of capital spending, £6.5m, related to smaller schemes – development programme Infrastructure, health and safety and private finance initiative (PFI) (lifecycle replacement cost). Capital spent October - March 2015 Cash and liquidity The Trust received revenue Public Dividend Capital (PDC) of £21.4m cash in the six months to March 2015 from the Department of Health, this supported the financing of the Trust’s planned deficit as a result of income not covering the Trust’s in year expenditure. The Trust retained £1m cash in the bank at period end. The Trust has managed its cash within its external financing limit with a small undershoot of £0.01m. The better payment practice code requires the Trust to aim to pay 95% of undisputed invoices by the due date or within 30 days of the receipt of goods and services or a valid invoice, whichever is later. The Trust paid 58.1% by value of its Non-NHS suppliers within 30 days. The under achievement of the target was due to cash management resulting from the deficit. Medical equipment £4.2m PACS £3.4m Development programme £3.1m A&E £2.5m IT equipment £2.2m Infrastructure £1.9m Health and safety programme £1m PFI lifecycle £0.5m Challenging financial environment The major financial concern for the Trust was to deliver a challenging savings programme and maintain financial stability while also meeting the demands of increased activity and National operational performance targets. The Trust has a Project Management Office (PMO) in place, which monitors and manages the savings programme. The Trust has managed to achieve its savings target of £15.8m for the period October to March 2015 through cost reductions and efficiency savings as well as a £1.8m efficiency contribution from the additional income gained by the Trust from the additional activity. In spite of the significant progress made in reducing our costs this year it is expected that the coming year will be a very challenging one in terms 47 of our finances. The Trust has set a target of £23.3m of further cost improvements in 2015/16, but this will still not balance the books and the Trust is forecasting a deficit of £88.3m against its statutory break-even duty. The Trust is seeking agreement with the Department of Health for the necessary funding to mitigate the cash impact of its expected deficit position, to be provided through either PDC support or a working capital loan. The continuing annual deficit position is expected to be resolved through structural change, from realising the service transformational benefits now that the Trusts have merged. In spite of the on-going challenges the Trust has clear plans to achieve financial stability through realising the merger transformational savings and synergies as well as a fundamental review of its cost base for delivering services. The Trust has had confirmation of TDA support to the level of cash support needed in the next 12 months to maintain its trading position. The Directors, therefore, have a reasonable expectation that the Trust has adequate resources to continue in operational existence for the foreseeable future and, consequently, continues to adopt the ‘going concern’ basis in preparing the annual accounts. Financial accountability Grant Thornton UK LLP is the appointed external auditor to the Trust. During the six months to March 2015, the fees payable to Grant Thornton for its statutory external audit were £140k. A further payment of £10k was made in relation to the audit of the Trust’s Quality Accounts. 48 Counter fraud and corruption The Trust is committed to promoting and maintaining an absolute standard of honesty and integrity, and to eliminating fraud and illegal acts committed within the Trust. We undertake rigorous investigation and disciplinary action where appropriate and seek recovery of any losses where possible. The Trust has adopted best practice, as recommended by the NHS Counter Fraud and Security Management Service (CFSMS), and is also involved in the National Fraud Initiative, which is led by the Audit Commission. We have widely publicised our procedure for staff to report any concerns about potential fraud and corruption. Any concerns raised are investigated by our local counter-fraud specialists or the CFSMS as appropriate and all investigations are reported to the Audit Committee. Simon Crawford Interim Chief Financial Officer 3 June 2015 Independent auditor’s report to the directors of London North West Healthcare NHS Trust We have audited the financial statements of London North West Healthcare NHS Trust for the period ended 31 March 2015 under the Audit Commission Act 1998. The financial statements comprise the Statement of Comprehensive Income, the Statement of Financial Position, the Statement of Changes in Taxpayers’ Equity, the Statement of Cash Flows and the related notes. The financial reporting framework that has been applied in their preparation is applicable law and the accounting policies directed by the Secretary of State with the consent of the Treasury as relevant to the National Health Service in England. We have also audited the information in the Remuneration Report that is subject to audit, being: • the table of salaries and allowances of senior managers and related narrative notes marked subject to audit • the table of pension benefits of senior managers and related narrative notes marked subject to audit • the table of pay multiples and related narrative notes marked subject to audit. This report is made solely to the Board of Directors of London North West Healthcare NHS Trust in accordance with Part II of the Audit Commission Act 1998 and for no other purpose, as set out in paragraph 44 of the Statement of Responsibilities of Auditors and Audited Bodies published by the Audit Commission in March 2014. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Trust’s directors and the Trust as a body, for our audit work, for this report, or for the opinions we have formed. Respective responsibilities of Directors and auditor As explained more fully in the Statement of Directors’ Responsibilities in respect of the accounts, the Directors are responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view. Our responsibility is to audit and express an opinion on the financial statements in accordance with applicable law and International Standards on Auditing (UK and Ireland). Those standards also require us to comply with the Auditing Practices Board’s Ethical Standards for Auditors. Scope of the audit of the financial statements An audit involves obtaining evidence about the amounts and disclosures in the financial statements sufficient to give reasonable assurance that the financial statements are free from material misstatement, whether caused by fraud or error. This includes an assessment of: whether the accounting policies are appropriate to the Trust’s circumstances and have been consistently applied and adequately disclosed; the reasonableness of significant accounting estimates made by the directors; and the overall presentation of the financial statements. In addition, we read all the financial and non-financial information in the annual report to identify material 49 inconsistencies with the audited financial statements and to identify any information that is apparently materially incorrect based on, or materially inconsistent with, the knowledge acquired by us in the course of performing the audit. If we become aware of any apparent material misstatements or inconsistencies we consider the implications for our report. Opinion on financial statements In our opinion the financial statements: • give a true and fair view of the financial position of London North West Healthcare NHS Trust as at 31 March 2015 and of its expenditure and income for the period then ended; and • have been prepared properly in accordance with the accounting policies directed by the Secretary of State with the consent of the Treasury as relevant to the National Health Service in England. Opinion on other matters In our opinion: • the part of the Remuneration Report subject to audit has been prepared properly in accordance with the requirements directed by the Secretary of State with the consent of the Treasury as relevant to the National Health Service in England; and • the information given in the annual report for the financial period for which the financial statements are prepared is consistent with the financial statements. Matters on which we report by exception We report to you if: • in our opinion the governance statement does not reflect compliance with the NHS Trust Development Authority’s Guidance 50 • we refer the matter to the Secretary of State under section 19 of the Audit Commission Act 1998 because we have reason to believe that the Trust, or an officer of the Trust, is about to make, or has made, a decision involving unlawful expenditure, or is about to take, or has taken, unlawful action likely to cause a loss or deficiency; or • we issue a report in the public interest under section 8 of the Audit Commission Act 1998. We have nothing to report in these respects. Conclusion on the Trust’s arrangements for securing economy, efficiency and effectiveness in the use of resources Respective responsibilities of the Trust and auditor The Trust is responsible for putting in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources, to ensure proper stewardship and governance, and to review regularly the adequacy and effectiveness of these arrangements. We are required under Section 5 of the Audit Commission Act 1998 to satisfy ourselves that the Trust has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources. The Code of Audit Practice issued by the Audit Commission requires us to report to you our conclusion relating to proper arrangements, having regard to relevant criteria specified by the Audit Commission in October 2014. We report if significant matters have come to our attention which prevent us from concluding that the Trust has put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources. We are not required to consider, nor have we considered, whether all aspects of the Trust’s arrangements for securing economy, efficiency and effectiveness in its use of resources are operating effectively. Scope of the review of arrangements for securing economy, efficiency and effectiveness in the use of resources We have undertaken our review in accordance with the Code of Audit Practice, having regard to the guidance on the specified criteria, published by the Audit Commission in October 2014, as to whether the Trust has proper arrangements for: • securing financial resilience • challenging how it secures economy, efficiency and effectiveness. The Audit Commission has determined these two criteria as those necessary for us to consider under the Code of Audit Practice in satisfying ourselves whether the Trust put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the period ended 31 March 2015. We planned our work in accordance with the Code of Audit Practice. Based on our risk assessment, we undertook such work as we considered necessary to form a view on whether, in all significant respects, the Trust had put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources. Basis for qualified conclusion In considering the Trust’s arrangements for securing financial resilience, we identified the following matter: • The Trust delivered a deficit of £24.9 million for the six month period ended 31 March 2015.The Trust is currently projecting a full year deficit of £88.3 million in 2015/16, compared to the planned deficit of £19.1 million which was included within the approved merger business case. Due to this divergence from the merger business case, the Trust needs to complete a significant refresh of its medium term financial plan. The actual and planned deficits and lack of a realistic medium term financial plan are evidence of weaknesses in arrangements in respect of the Trust’s strategic financial planning. Adverse conclusion On the basis of our work, having regard to the guidance on the specified criteria published by the Audit Commission in October 2014, the matters reported in the basis for adverse conclusion paragraph above prevent us from being satisfied that in all significant respects London North West Healthcare NHS Trust put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources for the period ending 31 March 2015. Certificate We certify that we have completed the audit of the accounts of London North West Healthcare NHS Trust in accordance with the requirements of the Audit Commission Act 1998 and the Code of Audit Practice issued by the Audit Commission. Emily Hill for and on behalf of Grant Thornton UK LLP, Appointed Auditor Grant Thornton House Melton Street London NW1 2EP 3 June 2015 51 London North West Healthcare NHS Trust - Six Month Accounts Six month accounts for the period ended 31st March 2015 These accounts are for London North West Healthcare NHS Trust for the six month ended 31st March 2015. Directors The following have been Directors of the Trust during the Six Month: Chairman - Mr Peter Worthington Executive Directors: Chief Executive - Interim Chief Operating Officer - Interim Medical Director (until December 2014) - Interim Medical Director (from December 2014) Interim Chief Financial Officer - Interim Chief Nurse - Interim Director of Human Resources and Organisational Development - Director of Governance (left January 2015) - Director of Estates and Facilities - Interim Chief Information Officer - Non-Executive Directors Non-Executive Director and Vice Chairman - - - - - - Mr David McVittie Mr Chris Pocklington Dr Alfa Sa’adu Dr Charles Cayley Mr Simon Crawford Mrs Carole Flowers Mr Paul Stanton Ms Catherine Thorne Mr Paul Kingsmore Mr Kevin Connolly Mr Martin West Professor David Taube Mrs Stella Dutton Mrs Caroline Corby Mrs Jeanne Spinks Ms Patricia Williamson BankersAuditors Lloyds TSB Bank Plc Grant Thornton UK LLP 286/288 Station Road Chartered Accountants Harrow Grant Thornton House Middlesex Melton Street HA1 2EB London NW1 2EP National Wetminster Bank PLC 162 Uxbridge Road London W13 8JL Government Banking Services West Wing Somerset House Strand London WC2R 1LB 52 Foreword to the accounts London North West Healthcare NHS Trust These accounts for the six month ended 31st March 2015 have been prepared by London North West Healthcare NHS 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 the Secretary of State has, with the approval of the Treasury, directed. London North West Healthcare NHS Trust - six month accounts ended 31 March 2015 53 Statement of comprehensive income for period ended 31 March 2015 NOTE 31 March 2015 £000s Gross employee benefits 9 (241,463) Other operating costs 7 (128,757) Revenue from patient care activities 4 309,522 Other operating revenue 5 37,208 Operating (deficit) (23,490) Investment revenue 11 33 Other losses 12 (78) Finance costs 13 (3,277) (Deficit) for the financial period Public dividend capital dividends payable Transfers by absorption - gains Transfers by absorption - (losses) (26,812) (4,626) 473,443 (178,641) Net Gain on transfers by absorption 294,802 Retained surplus for the period 263,364 Other Comprehensive Income Net gain on revaluation of property, plant & equipment Total comprehensive income for the period 814 264,178 Financial performance for the period Retained surplus for the year 263,364 IFRIC 12 adjustment (including IFRIC 12 impairments) 3,324 Impairments (excluding IFRIC 12 impairments) 2,992 Adjustments in respect of donated gov’t grant asset reserve elimination Adjustment re absorption accounting Adjusted retained (deficit) PDC dividend balance (payable) at 31 March 2015 54 187 (294,802) (24,935) (216) The Trusts reported NHS financial performance position is derived from its Retained Surplus (Deficit), but adjusted for the following:a) London North West Healthcare NHS Trust was established with originating Public Dividend Capital totalling £294,802,000, equal to the net assets and liabilities of Ealing Hospital NHS Trust and North West London Hospitals NHS Trust transferring over to the newly formed organisation. Under Absorption accounting, this gain is taken through the Statement of Comprehensive Income to arrive at the adjusted retained deficit. It is the adjusted retained deficit of £24.935m which is measured against the Department of Health performance target. b) The revenue cost of bringing PFI assets onto the balance sheet (due to the introduction of International Financial Reporting Standards (IFRS) accounting in 2009/10) - NHS Trusts’ financial performance measurement needs to be aligned with the guidance issued by HM Treasury measuring Departmental expenditure. Therefore, the incremental revenue expenditure resulting from the application of IFRS to PFI, which has no cash impact and is not chargeable for overall budgeting purposes, should be reported as technical. This additional cost £0.29m is not considered part of the organisation’s operating position. c) The Trust is required to revalue its Land and Building on a regular basis as a result of the IFRS implementation and this has resulted in an impairment of its Building by £6.027m, of which zero was available to absorbed by the revaluation reserve. Therefore, an impairment of £6.027m has been recognised in the I&E account. The impairment for Trust owned buildings is £2.992m and £3.035m for PFI buildings. Impairments are specifically excluded from measurement of the Trust’s financial performance. d) Due to change in accounting requirement, elimination of donated and government grant reserve has resulted in net income of £0.187m.Therefore, the reduction of income resulting from the application of change to donated and government grant account treatment, which has no cash impact and is not chargeable for overall budgeting purposes, should be reported as technical. This is not considered part of the organisation’s operating position. The notes on pages 60 to 100 form part of this account. London North West Healthcare NHS Trust - six month accounts ended 31 March 2015 55 Statement of financial position as at 31 March 2015 NOTE 31 March 2015 £000s 1 October 2014 £000s 14 419,094 412,160 Intangible assets 15 2,179 2,328 Trade and other receivables 20 0 72 421,273 414,560 Non-current assets: Property, plant and equipment Total non-current assets Current assets: Inventories 19 8,034 7,910 Trade and other receivables 20 49,154 47,444 Cash and cash equivalents 21 1,043 2,877 Sub-total current assets 58,231 58,231 Total current assets 58,231 58,231 479,504 472,791 Total assets Current liabilities Trade and other payables 22 (110,608) (107,372) Other liabilities 23 0 (2,128) Provisions 27 (3,528) (925) Borrowings 24 (2,070) (1,741) DH capital loan 24 (136) (136) Total current liabilities (116,342) (112,302) Net current liabilities (58,111) (54,071) Total assets less current liabilities 363,162 360,489 0 (1,692) Non-current liabilities Trade and other payables 22 Provisions 27 (4,116) (3,919) Borrowings 24 (57,520) (58,735) DH capital loan 24 (1,273) (1,341) Total non-current liabilities (62,909) (65,687) Total assets employed: 300,253 294,802 330,877 294,802 31,438 0 FINANCED BY: Public dividend capital Retained earnings Revaluation reserve Other reserves Total taxpayers’ equity: 56 814 0 0 0 300,253 294,802 *London North West Healthcare NHS Trust was established with originating Public Dividend Capital totalling £294,802,000, equal to the net assets and liabilities of Ealing Hospital NHS Trust and North West London Hospitals NHS Trust, resulting in the Opening Statement of Financial Performance numbers as at 1st October 2014. The Retained earnings and Revaluation Reserve balances reflect transactions that have occurred from 1st October to 31st March 2015 only. All transactions prior to that have been included in the Opening PDC balance, therefore, prior year comparators are only meaningful for the Statement of Financial Performance and have been included where relevant. The notes on pages 60 to 100 form part of this account. The financial statements on pages 54 to 59 were approved by the Audit Governance and Risk Committee and adopted by the Board on 27th May 2015 and signed on its behalf by Chief Executive: Interim Chief Financial Officer: Jacqueline Docherty DBE Simon Crawford 3 June 2015 3 June 2015 London North West Healthcare NHS Trust - six month accounts ended 31 March 2015 57 Statement of changes in taxpayers’ equity for the period ending 31 March 2015 Public Dividend capital £000s Retained earnings £000s Revaluation reserve £000s Other reserves £000s Total reserves £000s 0 0 0 0 0 Retained surplus/(deficit) for the year 0 263,364 0 0 263,364 Net gain on revaluation of property, plant, equipment 0 0 814 0 814 0 (294,802) 0 0 (294,802) 294,802 0 0 0 294,802 New temporary and permanent PDC received - cash 36,075 0 0 0 36,075 Net recognised revenue/(expense) for the period 330,877 (31,438) 814 0 300,253 Balance at 31 March 2015 330,877 (31,438) 814 0 300,253 Balance at 1 October 2014 Changes in taxpayers’ equity for 31 March 2015 Reclassification adjustments Transfers to/(from) other bodies within the resource account boundary Originating capital for Trust established in year London North West Healthcare NHS Trust was formed on 1st October 2014. The assets and liabilities of the two predecessor organisations (Ealing Hospital NHS Trust and North West London Hospitals NHS Trust) were transferred to London North West Healthcare NHS Trust through the issue of new PDC by the Department of Health to London North West Healthcare NHS Trust. The Retained earnings and Revaluation Reserve balances reflect transactions that have occurred from 1st October to 31st March 2015 only. All transactions prior to that have been included in the Opening PDC balance. 58 Statement of cash flows for the period ended 31 March 2015 31 March 2015 £000s Cash flows from operating activities (23,490) Operating (deficit) 6,878 Depreciation and amortisation 6,027 Impairments and reversals Interest paid (3,202) Dividend (paid) (4,410) (Increase) in inventories (124) (Increase) in trade and other receivables (986) (Decrease) in trade and other payables (5,581) Provisions utilised (254) Increase in movement in non cash provisions 3,000 Net cash (outflow) from operating activities (22,142) Cash flows from investing activities 33 Interest received (Payments) for property, plant and equipment (17,471) (Payments) for intangible assets (526) Rental revenue 3,159 Net cash (outflow) from investing activities (14,805) Net cash (outflow) before financing (36,947) Cash flows from financing activities Gross temporary and permanent PDC received Loans repaid to DH - capital investment loans repayment of principal 36,075 (68) Cash transferred to NHS Foundation Trusts or on dissolution 2,877 Capital element of payments in respect of finance Leases and On-SoFP PFI and LIFT (894) Net cash inflow from financing activities 37,990 NET INCREASE IN CASH AND CASH EQUIVALENTS 1,043 Cash and cash equivalents at period end 1,043 London North West Healthcare NHS Trust - six month accounts ended 31 March 2015 59 Notes to the accounts 1. Accounting policies The Secretary of State for Health has directed that the financial statements of NHS trusts shall meet the accounting requirements of the Department of Health Group Manual for Accounts, which shall be agreed with HM Treasury. Consequently, the following financial statements have been prepared in accordance with the DH Group Manual for Accounts 2014-15 issued by the Department of Health. The accounting policies contained in that manual follow International Financial Reporting Standards to the extent that they are meaningful and appropriate to the NHS, as determined by HM Treasury, which is advised by the Financial Reporting Advisory Board. Where the Manual for Accounts permits a choice of accounting policy, the accounting policy which is judged to be most appropriate to the particular circumstances of the trust for the purpose of giving a true and fair view has been selected. The particular policies adopted by the trust are described below. They have been applied consistently in dealing with items considered material in relation to the accounts. 1.1 Accounting convention These accounts have been prepared under the historical cost convention modified to account for the revaluation of property, plant and equipment, intangible assets, inventories and certain financial assets and financial liabilities. 1.1.1 Going concern The Trust recorded an adjusted retained deficit of £24.935m for the six months to March 2015 as agreed with the Trust Development Authority (TDA) The financial statements have been prepared on a going concern basis. In accordance with IAS 1, management has made an assessment of the Trust’s ability to continue as a going concern. For the financial year commencing 1 April 2015, the Trust has forecast a deficit of £88.3 million after a savings requirement of £23 million. This plan is under discussion with the TDA and requires additional cash support through PDC and/or loan funding. The Trust has received written confirmation from the TDA that it is reasonable to expect that this cash financing will be made available such that the organisation is able to meet its liabilities in the next twelve months. 60 The merged Trust will, over the period of Shaping a Healthier Future (SaHF) implementation, deliver substantial clinical innovation, efficiencies and synergies to maintain financial stability. Additionally, the new organisation will be better placed to respond swiftly to the rapidly changing healthcare environment, in effect sustaining long term resilience. 1.2 Acquisitions and discontinued operations Activities are considered to be ‘acquired’ only if they are taken on from outside the public sector. Activities are considered to be ‘discontinued’ only if they cease entirely. They are not considered to be ‘discontinued’ if they transfer from one public sector body to another. 1.3 Movement of assets within the DH Group On 1st October 2014 Ealing Hospital NHS Trust and North West London Hospitals NHS Trust were merged to form London North West Healthcare NHS Trust.Transfers as part of reorganisation fall to be accounted for by use of absorption accounting in line with the Treasury FReM. The FReM does not require retrospective adoption, so prior year transactions (which have been accounted for under merger accounting) have not been restated. Absorption accounting requires that entities account for their transactions in the period in which they took place, with no restatement of performance required when functions transfer within the public sector. Where assets and liabilities transfer, the gain or loss resulting is recognised in the SOCNE/SOCNI, and is disclosed separately from operating costs. Other transfers of assets and liabilities within the Group are accounted for in line with IAS20 and similarly give rise to income and expenditure entries. For transfers of assets and liabilities from those NHS bodies that closed on 1 April 2013, Treasury agreed that a modified absorption approach should be applied. For these transactions and only in the priorperiod, gains and losses are recognised in reserves rather than the SOCNE/SOCNI.” 1.4 Charitable funds For 2014-15, the divergence from the FReM that NHS Charitable Funds are not considered with the NHS Trust’s own accounts, is removed. (See note 1.6) 1.5 Critical accounting judgements and key sources of estimation uncertainty In the application of the NHS Trust’s accounting policies, management is required to make judgements, estimates and assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and other factors that are considered to be relevant. Actual results may differ from those estimates and the estimates and underlying assumptions are continually reviewed. Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period or in the period of the revision and future periods if the revision affects both current and future periods. 1.6 Critical judgements in applying accounting policies The following are the critical judgements, apart from those involving estimations (see below) that management has made in the process of applying the NHS Trust’s accounting policies and that have the most significant effect on the amounts recognised in the financial statements. London North West Healthcare was formed on 1st October 2014 as a result of merger between Ealing Hospital NHS Trust and The North West London Hospitals NHS Trust. All the assets and liabilities of the former Trusts transferred to London North West Healthcare NHS Trust. London North West Healthcare was established under Statutory Instrument 2524 with originating Public Dividend Capital totalling £294,802,000, equal to the net assets/liabilities of the predecessor bodies. Following Treasury’s agreement to apply IFRS 10 to NHS Charities from 1 April 2013, London North West Healthcare has established that as the Trust is the corporate Trustee of the North West London Hospitals General Charitable fund, charity number 1083634 and Ealing Hospital Charitable Fund, charity number 1061321, it effectively has the power to exercise control so as to obtain economic benefits. Total income received across both charities during the period 1st October 2014 to 31st March 2015 was £522,000 which is only 0.2% of London North West Healthcare NHS Trust’s Exchequer Income. There were no substantive legacies or grant income received during the six months from October 2014 to March 2015. IAS 1, Presentation of Financial Statements, says that specific disclosure requirements set out in individual standards or interpretations need to be satisfied if the information is not material and is reiterated in the NHS Manual for Accounts 2014-15. Charitable funds are not considered into London North West Healthcare Trust accounts on grounds of materiality. 1.6.1 Key sources of estimation uncertainty The following are the key assumptions concerning the future and other key sources of estimation uncertainty at the end of the reporting period, that have a significant risk of causing a material adjustment to the carrying amounts of assets and liabilities within the next financial year. A model provided by the Department of Health has been used to calculate the effect of bringing the PFI scheme on to the Trust balance sheet. This is not expected to yield a result that is materially different from other means of calculation. A full asset valuation and review of remaining lives of the Trust’s estate was conducted by professional Chartered Surveyors Debenham Tie Leung, (DTZ) using data from BCIS (Building Cost Information Services) and RICS (Royal Institute of Chartered Surveyors). The Trust has used the DTZ valuation in its 2014/15 six months accounts. The impact of the assessment of the Trust’s estate will be an overall decrease in the valuation as at 31st March 2015 and will result in a depreciation profile that is a more accurate reflection of the useful economic life of the land and buildings. The methodology adopted meets the requirements of International Accounting Standards (IAS) 16; Property, Plant and Equipment and does not deviate from the principles therein. Provisions for credit notes have been made in order to ensure that any charges arising from subsequently cancelling disputed NHS invoices or refunding SLA contractual and over performance values are chargeable against the correct financial period and are included within the amounts disclosed for NHS payables and receivables. London North West Healthcare NHS Trust - six month accounts ended 31 March 2015 61 Data for the pension provision is provided by NHS Pensions and uses data tables of expected lives for males and females provided by the National Statistics Office. The provision has been discounted at a rate of 1.3% 1.7 Revenue Revenue in respect of services provided is recognised when, and to the extent that, performance occurs, and is measured at the fair value of the consideration receivable. The main source of revenue for the Trust is from commissioners for healthcare services. Revenue relating to patient care spells that are partcompleted at the year end are apportioned across the financial years on the basis of costs incurred to date compared to total expected costs. Where income is received for a specific activity that is to be delivered in the following year, that income is deferred. The NHS Trust receives income under the NHS Injury Cost Recovery Scheme, designed to reclaim the cost of treating injured individuals to whom personal injury compensation has subsequently been paid e.g. by an insurer. The NHS Trust recognises the income when it receives notification from the Department of Work and Pension’s Compensation Recovery Unit that the individual has lodged a compensation claim. The income is measured at the agreed tariff for the treatments provided to the injured individual, less a provision for unsuccessful compensation claims and doubtful debts, currently at 18.9%, an increase from last years rate of 15.8% 1.8 Employee benefits Short-term employee benefits Salaries, wages and employment-related payments are recognised in the period in which the service is received from employees. The cost of leave earned but not taken by employees at the end of the period is recognised in the financial statements to the extent that employees are permitted to carry forward leave into the following period. Retirement benefit costs Past and present employees are covered by the provisions of the NHS Pensions Scheme. The scheme is an unfunded, defined benefit scheme that covers NHS employers, General Practices and other bodies, allowed under the direction of the Secretary of State, 62 in England and Wales. The scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the scheme is accounted for as if it were a defined contribution scheme: the cost to the NHS body of participating in the scheme is taken as equal to the contributions payable to the scheme for the accounting period. For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full amount of the liability for the additional costs is charged to expenditure at the time the Trust commits itself to the retirement, regardless of the method of payment. 1.9 Other expenses Other operating expenses are recognised when, and to the extent that, the goods or services have been received. They are measured at the fair value of the consideration payable. 1.10 Property, plant and equipment Recognition Property, plant and equipment is capitalised if: • it is held for use in delivering services or for administrative purposes; • it is probable that future economic benefits will flow to, or service potential will be supplied to the Trust; • it is expected to be used for more than one financial year; • the cost of the item can be measured reliably; and • the item has cost of at least £5,000; or • Collectively, a number of items have a cost of at least £5,000 and individually have a cost of more than £250, where the assets are functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal dates and are under single managerial control; or • Items form part of the initial equipping and settingup cost of a new building, ward or unit, irrespective of their individual or collective cost. Where a large asset, for example a building, includes a number of components with significantly different asset lives, the components are treated as separate assets and depreciated over their own useful economic lives. Valuation All property, plant and equipment are measured initially at cost, representing the cost directly attributable to acquiring or constructing the asset and bringing it to the location and condition necessary for it to be capable of operating in the manner intended by management. All assets are measured subsequently at fair value. Land and buildings used for the Trust’s services or for administrative purposes are stated in the statement of financial position at their revalued amounts, being the fair value at the date of revaluation less any impairment. Revaluations are performed with sufficient regularity to ensure that carrying amounts are not materially different from those that would be determined at the end of the reporting period. Fair values are determined as follows: Land and non-specialised buildings – market value for existing use expenditure to the extent of the decrease previously charged there. A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a clear consumption of economic benefit should be taken to expenditure. Gains and losses recognised in the revaluation reserve are reported as other comprehensive income in the Statement of Comprehensive Income. Subsequent expenditure Where subsequent expenditure enhances an asset beyond its original specification, the directly attributable cost is capitalised. Where subsequent expenditure restores the asset to its original specification, the expenditure is capitalised and any existing carrying value of the item replaced is writtenout and charged to operating expenses. Specialised buildings – depreciated replacement cost 1.11 Intangible assets HM Treasury has adopted a standard approach to depreciated replacement cost valuations based on modern equivalent assets and, where it would meet the location requirements of the service being provided, an alternative site can be valued. Recognition The Trust have engaged with DTZ Limited, an external independent body, who are RICS qualified practitioners, to carry out a full valuation of the Trust’s Land and Buildings including Dwellings. The calculated value was £364,579,000. Properties in the course of construction for service or administration purposes are carried at cost, less any impairment loss. Cost includes professional fees but not borrowing costs, which are recognised as expenses immediately, as allowed by IAS 23 for assets held at fair value. Assets are revalued and depreciation commences when they are brought into use. Fixtures and equipment are carried at depreciated historic cost as this is not considered to be materially different from fair value An increase arising on revaluation is taken to the revaluation reserve except when it reverses an impairment for the same asset previously recognised in expenditure, in which case it is credited to Intangible assets are non-monetary assets without physical substance, which are capable of sale separately from the rest of the trust’s business or which arise from contractual or other legal rights. They are recognised only when it is probable that future economic benefits will flow to, or service potential be provided to, the trust; where the cost of the asset can be measured reliably, and where the cost is at least £5000. Intangible assets acquired separately are initially recognised at fair value. Software that is integral to the operating of hardware, for example an operating system, is capitalised as part of the relevant item of property, plant and equipment. Software that is not integral to the operation of hardware, for example application software, is capitalised as an intangible asset. Expenditure on research is not capitalised: it is recognised as an operating expense in the period in which it is incurred. Internally-generated assets are recognised if, and only if, all of the following have been demonstrated: • the technical feasibility of completing the intangible asset so that it will be available for use • the intention to complete the intangible asset and use it London North West Healthcare NHS Trust - six month accounts ended 31 March 2015 63 • the ability to sell or use the intangible asset • how the intangible asset will generate probable future economic benefits or service potential • the availability of adequate technical, financial and other resources to complete the intangible asset and sell or use it • the ability to measure reliably the expenditure attributable to the intangible asset during its development Measurement The amount initially recognised for internallygenerated intangible assets is the sum of the expenditure incurred from the date when the criteria above are initially met. Where no internally-generated intangible asset can be recognised, the expenditure is recognised in the period in which it is incurred. Following initial recognition, intangible assets are carried at fair value by reference to an active market, or, where no active market exists, at amortised replacement cost (modern equivalent assets basis), indexed for relevant price increases, as a proxy for fair value. Internally-developed software is held at historic cost to reflect the opposing effects of increases in development costs and technological advances. 1.12 Depreciation, amortisation and impairments Freehold land, properties under construction, and assets held for sale are not depreciated. Otherwise, depreciation and amortisation are charged to write off the costs or valuation of property, plant and equipment and intangible non-current assets, less any residual value, over their estimated useful lives, in a manner that reflects the consumption of economic benefits or service potential of the assets. The estimated useful life of an asset is the period over which the NHS trust expects to obtain economic benefits or service potential from the asset. This is specific to the NHS trust and may be shorter than the physical life of the asset itself. Estimated useful lives and residual values are reviewed each year end, with the effect of any changes recognised on a prospective basis. Assets held under finance leases are depreciated over their estimated useful lives At each reporting period end, the NHS trust checks whether there is any indication that any of its tangible or intangible non-current assets have suffered an impairment loss. If there is indication of an impairment loss, the recoverable amount of the asset 64 is estimated to determine whether there has been a loss and, if so, its amount. Intangible assets not yet available for use are tested for impairment annually. A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a clear consumption of economic benefit should be taken to expenditure. Where an impairment loss subsequently reverses, the carrying amount of the asset is increased to the revised estimate of the recoverable amount but capped at the amount that would have been determined had there been no initial impairment loss. The reversal of the impairment loss is credited to expenditure to the extent of the decrease previously charged there and thereafter to the revaluation reserve. “Impairments are analysed between Departmental Expenditure Limits (DEL) and Annually Managed Expenditure (AME). This is necessary to comply with Treasury’s budgeting guidance. DEL limits are set in the Spending Review and Departments may not exceed the limits that they have been set. AME budgets are set by the Treasury and may be reviewed with departments in the run-up to the Budget. Departments need to monitor AME closely and inform Treasury if they expect AME spending to rise above forecast. Whilst Treasury accepts that in some areas of AME inherent volatility may mean departments do not have the ability to manage the spending within budgets in that financial year, any expected increases in AME require Treasury approval.” 1.13 Donated assets Donated non-current assets are capitalised at their fair value on receipt, with a matching credit to Income. They are valued, depreciated and impaired as described above for purchased assets. Gains and losses on revaluations, impairments and sales are as described above for purchased assets. Deferred income is recognised only where conditions attached to the donation preclude immediate recognition of the gain. 1.14 Government grants The value of assets received by means of a government grant are credited directly to income. Deferred income is recognised only where conditions attached to the grant preclude immediate recognition of the gain. 1.15 Non-current assets held for sale Non-current assets are classified as held for sale if their carrying amount will be recovered principally through a sale transaction rather than through continuing use. This condition is regarded as met when the sale is highly probable, the asset is available for immediate sale in its present condition and management is committed to the sale, which is expected to qualify for recognition as a completed sale within one year from the date of classification. Non-current assets held for sale are measured at the lower of their previous carrying amount and fair value less costs to sell. Fair value is open market value including alternative uses. The profit or loss arising on disposal of an asset is the difference between the sale proceeds and the carrying amount and is recognised in the Statement of Comprehensive Income. On disposal, the balance for the asset on the revaluation reserve is transferred to retained earnings. Property, plant and equipment that is to be scrapped or demolished does not qualify for recognition as held for sale. Instead, it is retained as an operational asset and its economic life is adjusted. The asset is de-recognised when it is scrapped or demolished. 1.16 Leases Leases are classified as finance leases when substantially all the risks and rewards of ownership are transferred to the lessee. All other leases are classified as operating leases. The Trust as lessee Contingent rentals are recognised as an expense in the period in which they are incurred. Where a lease is for land and buildings, the land and building components are separated and individually assessed as to whether they are operating or finance leases. The NHS Trust as lessor Amounts due from lessees under finance leases are recorded as receivables at the amount of the NHS Trust’s net investment in the leases. Finance lease income is allocated to accounting periods so as to reflect a constant periodic rate of return on the Trust’s net investment outstanding in respect of the leases. Rental income from operating leases is recognised on a straight-line basis over the term of the lease. Initial direct costs incurred in negotiating and arranging an operating lease are added to the carrying amount of the leased asset and recognised on a straight-line basis over the lease term. 1.17 Private Finance Initiative (PFI) transactions HM Treasury has determined that government bodies shall account for infrastructure PFI schemes where the government body controls the use of the infrastructure and the residual interest in the infrastructure at the end of the arrangement as service concession arrangements, following the principles of the requirements of IFRIC 12. The Trust therefore recognises the PFI asset as an item of property, plant and equipment together with a liability to pay for it. The services received under the contract are recorded as operating expenses. Property, plant and equipment held under finance leases are initially recognised, at the inception of the lease, at fair value or, if lower, at the present value of the minimum lease payments, with a matching liability for the lease obligation to the lessor. Lease payments are apportioned between finance charges and reduction of the lease obligation so as to achieve a constant rate on interest on the remaining balance of the liability. Finance charges are recognised in calculating the Trust’s surplus/deficit. The annual unitary payment is separated into the following component parts, using appropriate estimation techniques where necessary: Operating lease payments are recognised as an expense on a straight-line basis over the lease term. Lease incentives are recognised initially as a liability and subsequently as a reduction of rentals on a straight-line basis over the lease term. Services received a) Payment for the fair value of services received; b) Payment for the PFI asset, including finance costs; and c) Payment for the replacement of components of the asset during the contract ‘lifecycle replacement’. The fair value of services received in the year is recorded under the relevant expenditure headings within ‘operating expenses’. London North West Healthcare NHS Trust - six month accounts ended 31 March 2015 65 PFI asset The PFI assets are recognised as property, plant and equipment, when they come into use. The assets are measured initially at fair value in accordance with the principles of IAS 17. Subsequently, the assets are measured at fair value, which is kept up to date in accordance with the Trust’s approach for each relevant class of asset in accordance with the principles of IAS 16. PFI liability A PFI liability is recognised at the same time as the PFI assets are recognised. It is measured initially at the same amount as the fair value of the PFI assets and is subsequently measured as a finance lease liability in accordance with IAS 17. An annual finance cost is calculated by applying the implicit interest rate in the lease to the opening lease liability for the period, and is charged to ‘Finance Costs’ within the Statement of Comprehensive Income. The element of the annual unitary payment that is allocated as a finance lease rental is applied to meet the annual finance cost and to repay the lease liability over the contract term. An element of the annual unitary payment increase due to cumulative indexation is allocated to the finance lease. In accordance with IAS 17, this amount is not included in the minimum lease payments, but is instead treated as contingent rent and is expensed as incurred. In substance, this amount is a finance cost in respect of the liability and the expense is presented as a contingent finance cost in the Statement of Comprehensive Income. Lifecycle replacement Components of the asset replaced by the operator during the contract (‘lifecycle replacement’) are capitalised where they meet the Trust’s criteria for capital expenditure. They are capitalised at the time they are provided by the operator and are measured initially at their fair value. The element of the annual unitary payment allocated to lifecycle replacement is pre-determined for each year of the contract from the operator’s planned programme of lifecycle replacement. Where the lifecycle component is provided earlier or later than expected, a short-term finance lease liability or prepayment is recognised respectively. 66 Where the fair value of the lifecycle component is less than the amount determined in the contract, the difference is recognised as an expense when the replacement is provided. If the fair value is greater than the amount determined in the contract, the difference is treated as a ‘free’ asset and a deferred income balance is recognised. The deferred income is released to the operating income over the shorter of the remaining contract period or the useful economic life of the replacement component. Assets contributed by the NHS Trust to the operator for use in the scheme Assets contributed for use in the scheme continue to be recognised as items of property, plant and equipment in the NHS Trust’s Statement of Financial Position. Other assets contributed by the NHS Trust to the operator Assets contributed (e.g. cash payments, surplus property) by the NHS Trust to the operator before the asset is brought into use, which are intended to defray the operator’s capital costs, are recognised initially as prepayments during the construction phase of the contract. Subsequently, when the asset is made available to the NHS Trust, the prepayment is treated as an initial payment towards the finance lease liability and is set against the carrying value of the liability. 1.18 Inventories Inventories are valued at the lower of cost and net realisable value using the first-in first-out (FIFO) cost formula. This is considered to be a reasonable approximation to fair value due to the high turnover of stocks. 1.19 Cash and cash equivalents Cash is cash in hand and deposits with any financial institution repayable without penalty on notice of not more than 24 hours. Cash equivalents are investments that mature in 3 months or less from the date of acquisition and that are readily convertible to known amounts of cash with insignificant risk of change in value. In the Statement of Cash Flows, cash and cash equivalents are shown net of bank overdrafts that are repayable on demand and that form an integral part of the NHS Trust’s cash management. 1.20 Provisions 1.22 Non-clinical risk pooling Provisions are recognised when the NHS Trust has a present legal or constructive obligation as a result of a past event, it is probable that the NHS Trust will be required to settle the obligation, and a reliable estimate can be made of the amount of the obligation. The amount recognised as a provision is the best estimate of the expenditure required to settle the obligation at the end of the reporting period, taking into account the risks and uncertainties. Where a provision is measured using the cash flows estimated to settle the obligation, its carrying amount is the present value of those cash flows using HM Treasury’s discount rate of 2.2% in real terms, 1.3% for employee early departure obligations. The NHS Trust participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both are risk pooling schemes under which the NHS Trust pays an annual contribution to the NHS Litigation Authority and, in return, receives assistance with the costs of claims arising. The annual membership contributions, and any excesses payable in respect of particular claims are charged to operating expenses as and when they become due. When some or all of the economic benefits required to settle a provision are expected to be recovered from a third party, the receivable is recognised as an asset if it is virtually certain that reimbursements will be received and the amount of the receivable can be measured reliably. A restructuring provision is recognised when the Trust has developed a detailed formal plan for the restructuring and has raised a valid expectation in those affected that it will carry out the restructuring by starting to implement the plan or announcing its main features to those affected by it. Whilst the merger of the two legacy Trust’s, Ealing Hospital NHS Trust and North West London Hospitals NHS Trust, was predicated on a business plan which included restructuring, at the reporting date, these plans have not been developed in sufficient detail to give rise to a restructuring provision. The measurement of a restructuring provision includes only the direct expenditures arising from the restructuring, which are those amounts that are both necessarily entailed by the restructuring and not associated with ongoing activities of the entity. 1.21 Clinical negligence costs The NHS Litigation Authority (NHSLA) operates a risk pooling scheme under which the Trust pays an annual contribution to the NHSLA which in return settles all clinical negligence claims. The contribution is charged to expenditure. Although the NHSLA is administratively responsible for all clinical negligence cases the legal liability remains with the NHS Trust. The total value of clinical negligence provisions carried by the NHSLA on behalf of the Trust is disclosed at note 27. 1.23 Carbon reduction commitment scheme (CRC) CRC and similar allowances are accounted for as government grant funded intangible assets if they are not expected to be realised within twelve months, and otherwise as other current assets. They are valued at open market value. As the NHS body makes emissions, a provision is recognised with an offsetting transfer from deferred income. The provision is settled on surrender of the allowances. The asset, provision and deferred income amounts are valued at fair value at the end of the reporting period. 1.24 Contingencies A contingent liability is a possible obligation that arises from past events and whose existence will be confirmed only by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control of the NHS Trust, or a present obligation that is not recognised because it is not probable that a payment will be required to settle the obligation or the amount of the obligation cannot be measured sufficiently reliably. A contingent liability is disclosed unless the possibility of a payment is remote. A contingent asset is a possible asset that arises from past events and whose existence will be confirmed by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control of the NHS trust. A contingent asset is disclosed where an inflow of economic benefits is probable. Where the time value of money is material, contingencies are disclosed at their present value. 1.25 Financial assets Financial assets are recognised when the NHS trust becomes party to the financial instrument contract London North West Healthcare NHS Trust - six month accounts ended 31 March 2015 67 or, in the case of trade receivables, when the goods or services have been delivered. Financial assets are derecognised when the contractual rights have expired or the asset has been transferred. Financial assets are classified into the following categories: financial assets at fair value through profit and loss; held to maturity investments; available for sale financial assets, and loans and receivables. The classification depends on the nature and purpose of the financial assets and is determined at the time of initial recognition. Financial assets at fair value through profit and loss Embedded derivatives that have different risks and characteristics to their host contracts, and contracts with embedded derivatives whose separate value cannot be ascertained, are treated as financial assets at fair value through profit and loss. They are held at fair value, with any resultant gain or loss recognised in calculating the NHS trust’s surplus or deficit for the year. The net gain or loss incorporates any interest earned on the financial asset. Held to maturity investments Held to maturity investments are non-derivative financial assets with fixed or determinable payments and fixed maturity, and there is a positive intention and ability to hold to maturity. After initial recognition, they are held at amortised cost using the effective interest method, less any impairment. Interest is recognised using the effective interest method. Available for sale financial assets Available for sale financial assets are non-derivative financial assets that are designated as available for sale or that do not fall within any of the other three financial asset classifications. They are measured at fair value with changes in value taken to the revaluation reserve, with the exception of impairment losses. Accumulated gains or losses are recycled to surplus/deficit on de-recognition. Loans and receivables Loans and receivables are non-derivative financial assets with fixed or determinable payments which are not quoted in an active market. After initial recognition, they are measured at amortised cost using the effective interest method, less any 68 impairment. Interest is recognised using the effective interest method. Fair value is determined by reference to quoted market prices where possible, otherwise by valuation techniques such as recent market transactions. The effective interest rate is the rate that exactly discounts estimated future cash receipts through the expected life of the financial asset, to the initial fair value of the financial asset. At the end of the reporting period, the NHS trust assesses whether any financial assets, other than those held at ‘fair value through profit and loss’ are impaired. Financial assets are impaired and impairment losses recognised if there is objective evidence of impairment as a result of one or more events which occurred after the initial recognition of the asset and which has an impact on the estimated future cash flows of the asset. For financial assets carried at amortised cost, the amount of the impairment loss is measured as the difference between the asset’s carrying amount and the present value of the revised future cash flows discounted at the asset’s original effective interest rate. The loss is recognised in expenditure and the carrying amount of the asset is reduced directly. If, in a subsequent period, the amount of the impairment loss decreases and the decrease can be related objectively to an event occurring after the impairment was recognised, the previously recognised impairment loss is reversed through expenditure to the extent that the carrying amount of the receivable at the date of the impairment is reversed does not exceed what the amortised cost would have been had the impairment not been recognised. 1.26 Financial liabilities Financial liabilities are recognised on the statement of financial position when the NHS Trust becomes party to the contractual provisions of the financial instrument or, in the case of trade payables, when the goods or services have been received. Financial liabilities are de-recognised when the liability has been discharged, that is, the liability has been paid or has expired. Loans from the Department of Health are recognised at historical cost. Otherwise, financial liabilities are initially recognised at fair value. Financial guarantee contract liabilities Financial guarantee contract liabilities are subsequently measured at the higher of: • The premium received (or imputed) for entering into the guarantee less cumulative amortisation. The amount of the obligation under the contract, as determined in accordance with IAS 37 Provisions, Contingent Liabilities and Contingent Assets. Financial liabilities at fair value through profit and loss Embedded derivatives that have different risks and characteristics to their host contracts, and contracts with embedded derivatives whose separate value cannot be ascertained, are treated as financial liabilities at fair value through profit and loss. They are held at fair value, with any resultant gain or loss recognised in the NHS Trust’s surplus/deficit. The net gain or loss incorporates any interest payable on the financial liability. Other financial liabilities After initial recognition, all other financial liabilities are measured at amortised cost using the effective interest method, except for loans from Department of Health, which are carried at historic cost. The effective interest rate is the rate that exactly discounts estimated future cash payments through the life of the asset, to the net carrying amount of the financial liability. Interest is recognised using the effective interest method. 1.27 Value added tax Most of the activities of the Trust are outside the scope of VAT and, in general, output tax does not apply and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or included in the capitalised purchase cost of fixed assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT. 1.28 Foreign currencies The Trust’s functional currency and presentational currency is sterling. Transactions denominated in a foreign currency are translated into sterling at the exchange rate ruling on the dates of the transactions. At the end of the reporting period, monetary items denominated in foreign currencies are retranslated at the spot exchange rate on 31 March. Resulting exchange gains and losses for either of these are recognised in the Trust’s surplus/deficit in the period in which they arise. 1.29 Third party assets Assets belonging to third parties (such as money held on behalf of patients) are not recognised in the accounts since the Trust has no beneficial interest in them. Details of third party assets are given in Note 36 to the accounts. 1.30 Public dividend capital (PDC) and PDC dividend Public dividend capital represents taxpayers’ equity in the NHS Trust. At any time the Secretary of State can issue new PDC to, and require repayments of PDC from, the Trust. PDC is recorded at the value received. As PDC is issued under legislation rather than under contract, it is not treated as an equity financial instrument. As a consequence of merger of Ealing Hospital NHS Trust and North West London Hospitals NHS Trust, The Secretary of State for Health, in exercise of the powers conferred by sections 27 and 272(7) of, and paragraph 1(7) of Schedule 5 to, the National Health Service Act 2006(a) issued London North West Healthcare NHS Trust Origination Capital of £294,802,000. An annual charge, reflecting the cost of capital utilised by the Trust, is payable to the Department of Health as public dividend capital dividend. The charge is calculated at the real rate set by HM Treasury (currently 3.5%) on the average carrying amount of all assets less liabilities (except for donated assets and cash balances with the Government Banking Service). The average carrying amount of assets is calculated as a simple average of opening and closing relevant net assets. 1.31 Losses and special payments Losses and special payments are items that Parliament would not have contemplated when it agreed funds for the health service or passed legislation. By their nature they are items that ideally should not arise. They are therefore subject to special control procedures compared with the generality of payments. They are divided into London North West Healthcare NHS Trust - six month accounts ended 31 March 2015 69 different categories, which govern the way that individual cases are handled. Losses and special payments are charged to the relevant functional headings in expenditure on an accruals basis, including losses which would have been made good through insurance cover had the Trust not been bearing their own risks (with insurance premiums then being included as normal revenue expenditure). 1.32 Research and development Research and development expenditure is charged against income in the year in which it is incurred, except insofar as development expenditure relates to a clearly defined project and the benefits of it can reasonably be regarded as assured. Expenditure so deferred is limited to the value of future benefits expected and is amortised through the SOCNE/SOCI on a systematic basis over the period expected to benefit from the project. It should be revalued on the basis of current cost. The amortisation is calculated on the same basis as depreciation, on a quarterly basis. 1.33 Accounting standards that have been issued but have not yet been adopted The Treasury FReM does not require the following Standards and Interpretations to be applied in 201415. The application of the Standards as revised would not have a material impact on the accounts for 2014-15, were they applied in that year: IFRS 9 Financial Instruments - subject to consultation IFRS 13 Fair Value Measurement - subject to consultation IFRS 15 Revenue from Contracts with Customers subject to consultation 2. Operating segments As per NHS guidance, The Trust is considered to have only one segment i.e. that of healthcare provision. However, the Board reviews financial performance by Community and Acute Services. Some categories of income are not uniformally credited to individual services, for example some cost per case activity is credited to ‘central income’ and other cost per case activity is credited to individual services. The same is true for some expenditure categories, for example certain overheads are charged to ‘corporate’ whereas other overheads are charged to individual services. Therefore the operating deficit includes a significant number of estimates and adjustments and should be treated as an inidcator of costs only. However, on a Trust level, the total net deficit of £24.935m is the same as the Trust’s overall reported adjusted deficit. Community Services 31 March 2015 £000s Income Expenditure Operating deficit Acute Services Total 31 March 2015 31 March 2015 £000s £000s 66,253 287,012 353,265 (75,838) (302,362) (378,200) (9,585) (15,350) (24,935) Net Assets are not reported by segment. 3. Income generation activities The Trust undertakes income generation activities with an aim of achieving profit, which is then used in patient care. The Trust received income of £11.170m from income generation activities. This includes £1.4m from Drug manufacturing scheme and Pharmacy services provided, £1.0m from recharges to the Trust’s outsourced pathology provider and £0.9m from car parking income. Summary table - drug manufacturing scheme 31 March 2015 £000s 70 Income 902 Full cost 824 Surplus 78 4. R evenue from patient care activities 6. Overseas visitors disclosure 31 March 2015 £000s NHS Trusts 432 NHS England 50,227 Clinical Commissioning Groups 246,009 Foundation Trusts 226 NHS Other (including Public Health England and Prop Co) 1,041 Non-NHS: Local Authorities 7,075 Private patients 2,368 Overseas patients (non-reciprocal) Injury costs recovery 550 1,031 Other 563 Total Revenue from patient care activities 31 March 2015 £000s Income recognised during period ended 31 March 2015 (invoiced amounts and accruals) 550 Cash payments received in-period (re receivables at 31 March 2014) 625 Cash payments received in-period (iro invoices issued 2014-15) 368 Amounts added to provision for impairment of receivables (re receivables at 31 March 2014) 109 Amounts added to provision for impairment of receivables (iro invoices issued 2014-15) 169 Amounts written off in-period (irrespective of year of recognition) 103 309,522 5. Other operating revenue 31 March 2015 £000s Education, training and research 16,923 Non-patient care services to other bodies 605 Income generation 11,170 Rental revenue from operating leases 3,160 Other revenue 5,350 Total other operating revenue Total operating revenue 37,208 346,730 London North West Healthcare NHS Trust - six month accounts ended 31 March 2015 71 7. Operating expenses 8. Operating leases 31 March 2015 £000s Trust Chair and Non-executive Directors Supplies and services - clinical Supplies and services - general Consultancy services Establishment Transport Service charges - ON-SOFP PFIs and other service concession arrangements Premises Hospitality Insurance Legal Fees Impairments and reversals of receivables Depreciation Amortisation Impairments and reversals of property, plant and equipment Audit fees Other auditor’s remuneration Clinical negligence Research and development (excluding staff costs) Education and training Change in discount rate Other Total operating expenses (excluding employee benefits) 33 71,288 11,059 682 3,587 2,175 1,065 11,245 76 243 541 798 6,544 334 6,027 140 10 7,047 333 1,006 (21) 4,545 128,757 Employee benefits Employee benefits excluding Board members Board members 240,744 Other £000s Payments recognised as an expense Minimum lease payments Contingent rents Sub-lease payments Total 241,463 Total operating expenses 370,220 31 March 2015 Total £000s 793 0 0 793 Payable: No later than one year Between one and five years After five years 275 128 0 275 128 0 Total 403 403 Total future sublease payments expected to be received: 0 8.2 Trust as lessor 31 March 2015 £000 Recognised as revenue Rental revenue 3,160 Total 3,160 Receivable: No later than one year Between one and five years After five years 3,160 0 0 Total 3,160 719 Total employee benefits 72 8.1 Trust as lessee 9 Employee benefits and staff numbers 9.1 Employee benefits 31 March 2015 Total £000s Permanently employed £000s Other £000s Salaries and wages Social security costs Employer contributions to NHS BSA - Pensions division Termination benefits 207,232 16,063 18,851 105 158,520 14,607 18,014 105 48,712 1,456 837 0 Total employee benefits 242,251 191,246 51,005 788 770 18 241,463 190,476 50,987 31 March 2015 Total Number Permanently employed Number Other Number Average staff numbers Medical and dental Ambulance staff Administration and estates Healthcare assistants and other support staff Nursing, midwifery and health visiting staff Nursing, midwifery and health visiting learners Scientific, therapeutic and technical staff Social care staff Other 1,393 0 2,061 1,292 3,462 0 1,416 0 0 1,182 0 1,727 983 2,810 0 1,247 0 0 211 0 334 309 652 0 169 0 0 TOTAL 9,624 7,949 1,675 27 25 2 Employee benefits - gross expenditure Employee costs capitalised Gross employee benefits excluding capitalised costs 9.2 Staff numbers Of the above - staff engaged on capital projects London North West Healthcare NHS Trust - six month accounts ended 31 March 2015 73 9.3 Staff sickness absence and ill health retirements 31 March 2015 Number Total days lost 63,526 Total staff years 7,862 Average working days lost 8.08 8.08 days represents the average number of days lost per full time equivalent employee for the calendar year January to December 2014. 31 March 2015 Number 0 £000s 0 Number of persons retired early on ill health grounds Total additional pensions liabilities accrued in the period 9.4 Exit Packages agreed in period ended 31 March 2015 31 March 2015 Exit package cost band (including any special payment element) Number of compulsory redundancies Cost of compulsory redundancies Total number of exit packages Total cost of exit packages Number £s Number £s Less than £10,000 0 0 0 0 £10,000-£25,000 1 12,463 1 12,463 £25,001-£50,000 0 0 0 0 £50,001-£100,000 1 92,198 1 92,198 £100,001 - £150,000 0 0 0 0 £150,001 - £200,000 0 0 0 0 >£200,000 0 0 0 0 Total number of exit packages by type (total cost 2 104,661 2 104,661 Redundancy and other departure costs have been paid in accordance with the provisions of the NHS Scheme. Exit costs in this note are accounted for in full in the year of departure. Where the Trust has agreed early retirements, the additional costs are met by the Trust and not by the NHS pensions scheme. Ill-health retirement costs are met by the NHS pensions scheme and are not included in the table. 74 9.5 Exit packages - Other departures analysis 31 March 2015 Agreements Number Total value of agreements £000s Voluntary redundancies including early retirement contractual costs 0 0 Mutually agreed resignations (MARS) contractual costs 0 0 Early retirements in the efficiency of the service contractual costs 0 0 Contractual payments in lieu of notice 0 0 Exit payments following employment tribunals or court orders 0 0 Non-contractual payments requiring HMT approval* 0 0 Total 0 0 This disclosure reports the number and value of exit packages agreed in the year. Note: the expense associated with these departures may have been recognised in part or in full in a previous period. 9.6 Pension costs Past and present employees are covered by the provisions of the NHS Pensions Scheme. Details of the benefits payable under these provisions can be found on the NHS Pensions website at www.nhsbsa. nhs.uk/pensions. The scheme is an unfunded, defined benefit scheme that covers NHS employers, GP practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the scheme is accounted for as if it were a defined contribution scheme: the cost to the NHS Body of participating in the scheme is taken as equal to the contributions payable to the scheme for the accounting period. In order that the defined benefit obligations recognised in the financial statements do not differ materially from those that would be determined at the reporting date by a formal actuarial valuation, the FReM requires that “the period between formal valuations shall be four years, with approximate assessments in intervening years”. An outline of these follows: a) Full actuarial (funding) valuation A valuation of the scheme liability is carried out annually by the scheme actuary as at the end of the reporting period. This utilises an actuarial assessment for the previous accounting period in conjunction with updated membership and financial data for the current reporting period, and are accepted as providing suitably robust figures for financial reporting purposes. The valuation of the scheme liability as at 31 March 2015, is based on valuation data as 31 March 2014, updated to 31 March 2015 with summary global member and accounting data. In undertaking this actuarial assessment, the methodology prescribed in IAS 19, relevant FReM interpretations, and the discount rate prescribed by HM Treasury have also been used. The latest assessment of the liabilities of the scheme is contained in the scheme actuary report, which forms part of the annual NHS Pension Scheme (England and Wales) Pension Accounts, published annually. These accounts can be viewed on the NHS Pensions website. Copies can also be obtained from The Stationery Office. b) Accounting valuation The purpose of this valuation is to assess the level of liability in respect of the benefits due under the scheme (taking into account its recent demographic experience), and to recommend the contribution rates. London North West Healthcare NHS Trust - six month accounts ended 31 March 2015 75 The last published actuarial valuation undertaken for the NHS pension scheme was completed for the year ending 31 March 2012. The scheme regulations allow contribution rates to be set by the Secretary of State for Health, with the consent of HM Treasury, and consideration of the advice of the Scheme Actuary and appropriate employee and employer representatives as deemed appropriate. c) Scheme provisions The NHS Pension Scheme provided defined benefits, which are summarised below. This list is an illustrative guide only, and is not intended to detail all the benefits provided by the Scheme or the specific conditions that must be met before these benefits can be obtained: The Scheme is a “final salary” scheme. Annual pensions are normally based on 1/80th for the 1995 section and of the best of the last three years pensionable pay for each year of service, and 1/60th for the 2008 section of reckonable pay per year of membership. Members who are practitioners as defined by the Scheme Regulations have their annual pensions based upon total pensionable earnings over the relevant pensionable service. With effect from 1 April 2008 members can choose to give up some of their annual pension for an additional tax free lump sum, up to a maximum amount permitted under HMRC rules. This new provision is known as “pension commutation”. Annual increases are applied to pension payments at rates defined by the Pensions (Increase) Act 1971, and are based on changes in retail prices in the twelve months ending 30 September in the previous calendar year. From 2011-12 the Consumer Price Index (CPI) has been used and replaced the Retail Prices Index (RPI). Early payment of a pension, with enhancement, is available to members of the scheme who are permanently incapable of fulfilling their duties effectively through illness or infirmity. A death gratuity of twice final year’s pensionable pay for death in service, and five times their annual pension for death after retirement is payable. Members can purchase additional service in the NHS Scheme and contribute to money purchase AVC’s run by the Scheme’s approved providers or by other Free Standing Additional Voluntary Contributions (FSAVC) providers. 10. Better payment practice code Measure of compliance 31 March 2015 Number 31 March 2015 £000s Total Non-NHS trade invoices paid in the period 70,581 164,083 Total Non-NHS trade invoices paid within target 26,498 95,349 37.54% 58.11% Total NHS trade invoices paid in the period 2,081 11,201 Total NHS trade invoices paid within target 489 1,436 23.50% 12.82% Non-NHS payables Percentage of NHS trade invoices paid within target NHS payables Percentage of NHS trade invoices paid within target The better payment practice code requires the NHS body to aim to pay all valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later. 76 11. Investment revenue 31 March 2015 £000s Interest revenue Bank interest 33 Subtotal 33 Total investment revenue 33 12. Other gains and losses 31 March 2015 £000s Gain/(Loss) on disposal of assets other than by sale (PPE) (78) Total (78) 13. Finance costs 31 March 2015 £000s Interest Interest on loans and overdrafts 24 Interest on obligations under finance leases 77 Interest on obligations under PFI contracts: - main finance cost 2,086 - contingent finance cost 1,015 Total interest expense Provisions - unwinding of discount Total 3,202 75 3,277 London North West Healthcare NHS Trust - six month accounts ended 31 March 2015 77 £000’s 0 0 0 0 0 Additions of assets under construction 0 0 0 13,958 Additions purchased 0 2,833 Reclassifications 0 20,244 Disposals other than for sale 0 Upward revaluation/positive indexation £000’s £000’s £000’s £000’s £000’s 0 0 0 0 0 0 0 0 13,958 0 1,999 0 0 0 4,832 0 (22,810) 2,089 0 56 403 (18) 0 0 0 (330) 0 0 0 (330) 505 (306) 615 0 0 0 0 0 814 Transfers (to)/from other public sector bodies under absorption accounting 63,081 351,738 5,630 32,642 89,179 0 46,706 4,050 593,026 At 31 March 2015 63,586 374,509 6,245 23,790 92,937 0 46,762 4,453 612,282 Depreciation At 1 October 2014 0 0 0 0 0 0 0 0 0 Disposals other than for sale 0 0 0 0 (249) 0 0 0 (249) Impairments 0 6,027 0 0 0 0 0 0 6,027 Charged during the period 0 2,671 40 0 2,205 0 1,508 120 6,544 Transfers (to)/from other public sector bodies under absorption accounting 10,391 60,632 0 0 67,342 0 39,207 3,294 180,866 At 31 March 2015 10,391 69,330 40 0 69,298 0 40,715 3,414 193,188 Net book value at 31 March 2015 53,195 305,179 6,205 23,790 23,639 0 6,047 1,039 419,094 53,195 225,448 6,205 23,790 22,388 0 6,043 Owned - donated 0 7,046 0 0 419 0 4 0 7,469 Owned - government granted 0 3,191 0 0 38 0 0 0 3,229 31 March 2015 Cost or valuation: At 1 October 2014 0 Plant & machinery Total Assets under construction & payments on account £000’s Furniture & fittings Dwellings £000’s Information technology Buildings excluding dwellings £000’s Transport equipment Land 14. Property, plant and equipment Asset financing: Owned - purchased 932 338,001 Held on finance lease 0 0 0 0 794 0 0 107 901 On-SOFP PFI contracts 0 69,494 0 0 0 0 0 0 69,494 53,195 305,179 6,205 23,790 23,639 0 Total at 31 March 2015 78 6,047 1,039 419,094 Land Buildings excluding dwellings Dwellings Assets under construction & payments on account Plant & machinery Transport equipment Information technology Furniture & fittings Total Revaluation reserve balance for property, plant & equipment £000’s £000’s £000’s £000’s £000’s £000’s £000’s £000’s £000’s 0 0 0 0 0 0 0 0 0 Movements (revaluation) 505 (306) 615 0 0 0 0 0 814 At 31 March 2015 505 (306) 615 0 0 0 0 0 814 31 March 2015 At 1 October 2014 Additions to assets under construction in 2014-15 £000’s Land Buildings excl dwellings Dwellings 0 5,756 0 Plant and machinery 8,202 Balance as at YTD 13,958 London North West Healthcare NHS Trust - six month accounts ended 31 March 2015 79 Buildings excluding dwellings Dwellings Assets under construction & payments on account Transport equipment Information technology Furniture & fittings Total £000s £000s £000s £000s £000s £000s £000s £000s £000s 62,846 327,852 5,375 32,359 88,154 137 45,778 Additions of assets under 0 construction Additions purchased 0 Additions - non cash donations 0 (i.E. Physical assets) Reclassifications 0 Revaluation 235 At 30 September 2014 63,081 0 0 14,085 0 0 0 0 14,085 505 0 0 0 0 0 334 142 0 0 914 0 0 45 1,753 187 13,224 10,157 351,738 0 255 5,630 (13,802) 0 32,642 549 0 0 0 89,179 137 14 0 46,706 14 29 0 10,647 4,050 593,163 52,414 (763) 7,765 0 (38) 0 0 0 0 65,306 137 0 0 0 0 37,600 0 0 3,199 169,047 (801) 0 7,765 0 (1,266) 0 0 0 2,482 60,632 291,106 38 0 5,630 52,690 208,026 Owned - Donated 0 Owned - Government granted 31 October 2014 Plant & machinery Land 14.2 Property, plant and equipment prior-year Cost or valuation: At 1 April 2014 Depreciation At 1 April 2014 10,391 Revaluation 0 Impairments/negative 0 indexation charged to operating expenses Reversal of impairments 0 charged to operating expenses Charged during the period 0 At 30 September 2014 10,391 Net book value at 30 52,690 September 2014 3,976 566,477 0 (1,266) 0 0 0 0 32,642 2,036 0 67,342 137 21,837 0 1,607 39,207 7,499 6,258 95 3,294 181,003 756 412,160 5,630 32,642 20,466 0 7,492 632 327,578 7,186 0 0 486 0 4 124 7,800 0 3,373 0 0 41 0 3 0 3,417 Held on finance lease 0 0 0 0 844 0 0 0 844 On-SOFP PFI contracts 0 72,521 0 0 0 0 0 0 72,521 Total at 30 September 2014 52,690 291,106 5,630 32,642 21,837 0 7,499 Asset financing: Owned - Purchased 80 756 412,160 Of the totals as at 31st March 2015, £53.195m related to land valued at open market value and £6.2m related to dwellings valued at open market value. The fair value of buildings excluding dwellings is £305.179m Land and buildings were revalued as at 31st March 2015 by DTZ, the Trust’s appointed valuers. The valuation was undertaken by surveyors who were suitably experienced and qualified members of the Royal Institute of Chartered Surveyors (RICS). The valuation was carried out in accordance with the RICS Appraisal and Valuation Manual insofar as these terms are consistent with the agreed requirements of the Department of Health and HM Treasury. 14.3 Details of asset lives Buildings and dwellings between 22 and 90 years. Plant and machinery between 5 and 15 years. Information technology between 5 and 10 years. Furniture and fittings is between 1 and 10 years. Software licenses between 3 and 10 years. London North West Healthcare NHS Trust - six month accounts ended 31 March 2015 81 15. Intangible non-current assets 31 March 2015 Computer Licenses £000’s Total £000’s At 1 October 2014 0 0 Additions purchased 167 167 18 18 Transfer from other public sector bodies under absorption accounting Reclassifications 6,185 6,185 At 31 March 2015 6,370 6,370 0 0 Amortisation At 1 October 2014 Charged during the period Transfer from other public sector bodies under absorption accounting 334 334 3,857 3,857 At 31 March 2015 4,191 4,191 Net Book Value at 31 March 2015 2,179 2,179 Asset Financing: Net book value at 31 March 2015 comprises: Purchased 2,179 2,179 Total at 31 March 2015 2,179 2,179 Computer Licenses £000’s Total £000’s 6,010 6,010 Additions purchased 189 189 Reclassifications (14) (14) 15.2 Intangible non-current assets - prior year 2014-15 At 1 April 2014 Transfer from other public sector bodies under absorption accounting 6,185 6,185 At 30 September 2014 6,185 6,185 Amortisation At 1 April 2014 3,518 3,518 339 339 Transfer from other public sector bodies under absorption accounting 3,857 3,857 At 30 September 2014 3,857 3,857 Net book value at 30 September 2014 2,328 2,328 Purchased 2,328 2,328 Total at 30 September 2014 2,328 2,328 Charged during the year Asset Financing: Net book value at 30 September 2014 comprises: 82 16. Analysis of impairments and reversals recognised in 31 March 2015 31 March 2015 Total £000s Property, plant and equipment impairments and reversals taken to SoCI Changes in market price 6,027 Total charged to annually managed expenditure 6,027 Total impairments of property, plant and equipment charged to SoCI 6,027 Total impairments charged to SoCI - AME 6,027 Overall total impairments 6,027 17. Commitments 17.1 Capital commitments Contracted capital commitments at 31 March not otherwise included in these financial statements: 31 March 2015 Total £000 Property, plant and equipment 21,800 Total 21,800 18. Intra-Government and other balances Current receivables Non-current receivables £000s £000s £000s £000s 0 0 9,331 0 1,136 0 69 0 0 0 101 0 Balances with NHS bodies inside the departmental group 32,452 0 11,124 1,273 Balances with bodies external to government 15,566 0 92,189 57,520 At 31 March 2015 49,154 0 112,814 58,793 Balances with other central government bodies Balances with local authorities Balances with NHS bodies outside the departmental group Current Non-current payables payables London North West Healthcare NHS Trust - six month accounts ended 31 March 2015 83 19. Inventories Drugs £000s Consumables £000s Work in Progress £000s Energy £000s Total £000s 0 0 0 0 0 124 0 0 0 124 Transfers (to)/from other public sector bodies under absorption accounting 4,279 3,506 0 125 7,910 Balance at 31 March 2015 4,403 3,506 0 125 8,034 Balance at 1 October 2014 Additions 20. Trade and other receivables Current Non-current 31 March 2015 1 October 2014 £000s £000s 31 March 2015 1 October 2014 £000s £000s 32,452 22,176 0 0 0 877 0 0 16,795 10,702 0 0 0 0 0 0 3,461 12,200 0 0 (6,187) (5,389) 0 0 2,633 1,353 0 0 0 5,525 0 72 Total 49,154 47,444 0 72 Total current and non current 49,154 47,516 NHS receivables - revenue NHS prepayments and accrued income Non-NHS receivables - revenue Non-NHS receivables - capital Non-NHS prepayments and accrued income Provision for the impairment of receivables VAT Other receivables Included in NHS receivables are prepaid pension contributions: 0 The great majority of trade is with Clinical Commissioning Groups (CCGs) . As CCGs are funded by Government to buy NHS patient care services, no credit scoring of them is considered necessary. 84 31 March 2015 £000s 1 October 2014 £000s By up to three months 283 1,462 By three to six months 4,684 1,569 0 0 4,967 3,031 31 March 2015 £000s 1 October 2014 £000s Balance at 1 October 2014 0 (5,011) Amount written off during the period 0 168 Amount recovered during the period 0 0 (798) (546) Transfers (to)/from other public sector bodies under absorption accounting (5,389) 0 Balance at 31 March 2015 (6,187) (5,389) 20.2 Receivables past their due date but not impaired By more than six months Total 20.3 Provision for impairment of receivables (Increase)/decrease in receivables impaired Of the £6.187m provision for receivables impaired, £1.5m relates to overseas visitors and private patients and £1.639m to road traffic accident (RTA) income. The impairment for RTA Income is provided for in line with Department of Health Policy, currently at 18.9%. 21. Cash and cash equivalents 31 March 2015 £000s 1 October 2014 £000s 2,877 6,574 (1,834) (3,697) 1,043 2,877 924 2,618 Commercial banks 96 248 Cash in hand 23 11 Cash and cash equivalents as in statement of financial position 1,043 2,877 Cash and cash equivalents as in statement of cash flows 1,043 2,877 4 4 Opening balance Net change in period Closing balance Made up of Cash with Government Banking Service Patients’ money held by the Trust, not included above London North West Healthcare NHS Trust - six month accounts ended 31 March 2015 85 22. Trade and other payables Current Non-current 31 March 2015 £000s 1 October 2014 £000s 31 March 2015 £000s 1 October 2014 £000s 10,772 8,907 0 0 0 15,603 0 0 Non-NHS payables - revenue 39,524 29,883 0 0 Non-NHS payables - capital 6,504 5,545 0 0 44,269 32,428 0 1,692 4,493 4,410 0 0 216 0 0 0 0 0 0 0 NHS payables - revenue NHS accruals and deferred income Non-NHS accruals and deferred income Social security costs PDC dividend payable to DH VAT 4,830 4,715 0 0 Payments received on account 0 0 0 0 Other 0 5,881 0 0 Total 110,608 107,372 0 1,692 Total payables (current and non-current) 110,608 109,064 5,381 5,341 Tax Included above: outstanding pension contributions at the period end 23. Other liabilities Current Non-current 31 March 2015 £000s 1 October 2014 £000s 31 March 2015 £000s 1 October 2014 £000s Other (research and development) 0 2,128 0 0 Total 0 2,128 0 0 Total other liabilities (current and non-current) 0 2,128 86 24. Borrowings Current Loans from Department of Health Non-current 31 March 2015 £000s 1 October 2014 £000s 31 March 2015 £000s 1 October 2014 £000s 136 136 1,273 1,341 1,698 1,656 56,495 57,387 372 85 1,025 1,348 2,206 1,877 58,793 60,076 60,999 61,953 PFI liabilities: Main liability Finance lease liabilities Total Total other liabilities (current and non-current) Borrowings / Loans - repayment of principal falling due in: 31 March 2015 DH £000s Other £000s Total £000s 0-1 years 136 1,761 1,897 1 - 2 years 136 1,959 2,095 2 - 5 years 523 5,896 6,419 Over 5 years 614 49,974 50,588 1,409 59,590 60,999 TOTAL London North West Healthcare NHS Trust - six month accounts ended 31 March 2015 87 25. Deferred revenue Current Non-current 31 March 2015 £000s 31 March 2015 £000s 0 0 Deferred revenue addition 3,839 0 Transfer of deferred revenue 4,867 0 Current deferred income at 31 March 2015 8,706 0 Total deferred income (current and non-current) 8,706 Opening balance at 1 October 2014 26. Finance lease obligations as lessee Amounts payable under finance leases (Other) Minimum lease payments Present value of minimum lease payments 31 March 2015 £000s 31 March 2015 £000s Within one year 704 372 Between one and five years 995 774 After five years 268 251 Less future finance charges (570) 0 Minimum lease payments / present value of minimum lease payments 1,397 1,397 Included in: Current borrowings Non-current borrowings 372 1,025 1,397 88 27. Provisions Balance at 1 October 2014 Arising during the period Utilised during the period Reversed unused Unwinding of discount Change in discount rate Transfers to NHS Foundation Trusts (for Trusts becoming FTs only) Transfers (to)/from other public sector bodies under absorption accounting Balance at 31 March 2015 Expected timing of cash flows: No Later than One Year Later than one year and not later than five years Later than five years Total Early Departure Costs Legal Claims £000s £000s £000s £000s £000s 0 3,250 (254) (250) 75 (21) 0 0 390 (254) 0 75 (21) 0 0 570 0 (250) 0 0 0 0 1,542 0 0 0 0 0 0 748 0 0 0 0 0 4,844 4,163 426 255 0 7,644 4,353 746 1,797 748 3,528 876 3,240 237 876 3,240 746 0 0 1,797 0 0 748 0 0 Other Redundancy Amount included in the provisions of the NHS Litigation Authority in respect of clinical negligence liabilities: As at 31 March 2015 £118,144k The provision of pensions relating to staff refers to pension payments for staff retiring early through ill health. These figures are provided by NHS Pensions Authority. The discount rate for pensions relating to other staff has decreased from 1.8% to 1.3% in line with HM Treasury and Department of Health guidelines. Settlements of these claims are determined using statistics provided by The Office of National Statistics. Legal claims refer to public and employers liability claims and also provisions in relation to ongoing employment cases. Value of these claims will be subject to the relevant judgements or subsequent settlements made by the relevant employment tribunals. The redundancy provision relates to senior management redundancies as a result of merger between Ealing Hospital NHS Trust and The North West London Hospitals NHS Trust. The principal component of “Other” relates to potential liability in relation to the Trust’s managed service for temporary medical staffing. 28. Contingencies 31 March 2015 £000s Contingent liabilities NHS Litigation Authority legal claims (128) Employment tribunal and other employee related litigation (527) Net value of contingent liabilities (655) London North West Healthcare NHS Trust - six month accounts ended 31 March 2015 89 29. PFI and LIFT - additional information The information below is required by the Department of Heath for inclusion in national statutory accounts Charges to operating expenditure and future commitments in respect of ON and OFF SOFP PFI 31 March 2015 £000s Service element of on SOFP PFI charged to operating expenses in period 1,065 Total 1,065 Payments committed to in respect of off SOFP PFI and the service element of on SOFP PFI No later than one year 1,586 Later than one year, no later than five years 6,749 Later than five years 34,662 Total 42,997 The current PFI contract assumed an inflation rate of 2.5% (£42,817k), however if the assumption that the inflation rate was 0%, then total payments would have been £33,838k. Additionally, if inflation was 5%, the payment would have been £60,050k. Imputed “finance lease” obligations for on SOFP PFI contracts due No later than one year 31 March 2015 £000s 5,711 Later than one year, no later than five years 21,883 Later than five years 84,176 Subtotal 111,770 Less: interest element (53,577) Total Present value imputed “finance lease” obligations for on SOFP PFI contracts due Analysed by when PFI payments are due 58,193 31 March 2015 £000s No later than one year 1,657 Later than one year, no later than five years 6,812 Later than five years 49,724 Total 58,193 Number of on SOFP PFI contracts Total number of on PFI contracts 90 1 30. Impact of IFRS treatment - current period 31 March 2015 The information below is required by the Department of Heath for budget reconciliation purposes £000s Revenue costs of IFRS: Arrangements reported on SoFP under IFRIC12 (e.g PFI / LIFT) Depreciation charges Interest expense Impairment charge - AME Other expenditure Impact on PDC dividend payable Total IFRS expenditure (IFRIC12) Revenue consequences of PFI / LIFT schemes under UK GAAP / ESA95 (net of any sublease revenue) Net IFRS change (IFRIC12) 476 3,010 3,035 1,065 146 7,732 (4,408) 3,324 Capital consequences of IFRS : LIFT/PFI and other items under IFRIC12 Capital expenditure 2014-15 505 UK GAAP capital expenditure 2014-15 (Reversionary Interest) 505 31. Financial Instruments 31.1 Financial risk management Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the period in creating or changing the risks a body faces in undertaking its activities. Because of the continuing service provider relationship that the NHS Trust has with Clinical Commissioning Groups (CCGs) and the way those CCGs are financed, the NHS Trust is not exposed to the degree of financial risk faced by business entities. Also financial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which the financial reporting standards mainly apply. The NHS Trust has limited powers to borrow or invest surplus funds and financial assets and liabilities are generated by day-to-day operational activities rather than being held to change the risks facing the NHS Trust in undertaking its activities. The Trust’s treasury management operations are carried out by the finance department, within parameters defined formally within the Trust’s standing financial instructions and policies agreed by the board of directors. The Trust’s treasury activity is subject to review by the Trust’s internal auditors. Currency risk The Trust is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK and sterling based. The Trust has no overseas operations. The Trust therefore has low exposure to currency rate fluctuations. Interest rate risk The Trust borrows from government for capital expenditure, subject to affordability as confirmed by the Trust Development Authority (TDA). The borrowings are for 1 – 25 years, in line with the life of the associated assets, and interest is charged at the National Loans Fund rate, fixed for the life of the loan. The Trust therefore has low exposure to interest rate fluctuations. Credit risk Because the majority of the Trust’s revenue comes from contracts with other public sector bodies, the London North West Healthcare NHS Trust has low exposure to credit risk. The maximum exposures as at 31 March 2015 are in receivables from customers, as disclosed in the trade and other receivables note. Liquidity risk The Trust’s operating costs are incurred under contracts with CCGs, which are financed from resources voted annually by Parliament. The Trust funds its capital expenditure from funds obtained within its prudential borrowing limit. The Trust is not, therefore, exposed to significant liquidity risks. London North West Healthcare NHS Trust - six month accounts ended 31 March 2015 91 31.2 Financial assets At ‘fair value through profit and loss’ Loans and receivables Available for sale £000s £000s £000s Embedded derivatives 0 0 0 Receivables - NHS 0 31,250 0 Receivables - non-NHS 0 12,550 0 Cash at bank and in hand 0 1,043 0 Other financial assets 0 0 0 Total at 31 March 2015 0 44,843 0 31.3 Financial liabilities At ‘fair value through profit and loss’ Other Total £000s £000s £000s Embedded derivatives 0 0 0 NHS payables 0 13,621 13,621 Non-NHS payables 0 73,626 73,626 Other borrowings 0 1,409 1,409 PFI & finance lease obligations 0 59,590 59,590 Other financial liabilities 0 0 0 Total at 31 March 2015 0 148,246 148,246 32. Events after the end of the reporting period There were no adjusting events after the reporting period. 92 33. Related party transactions During the period none of the Department of Health Ministers, Trust board members or members of the key management staff, or parties related to any of them, has undertaken any material transactions with the Trust. The Department of Health is regarded as a related party. During the period the Trust has had a significant number of material transactions with the Department, and with other entities for which the Department is regarded as the parent Department. The most significant (over £100,000) cumulative transactions were as follows: Amounts owed to related party £’000 Amounts due from related party £’000 Barnet CCG - 351 Brent CCG - 7,318 Camden CCG - 152 Central and North West London Mental Health NHS Foundation Trust 287 136 - 232 Chelsea and Westminster Hospital NHS Foundation Trust 146 218 Community Health Partnerships 919 - Department of Health 216 - Central London (Westminster CCG) East and North Herts CCG Ealing CCG Enfield CCG Guy’s and St Thomas’ NHS Foundation Trust Hammersmith and Fulham CCG Harrow CCG 145 - 1,061 12,416 - 108 100 - - 1,145 130 3,997 Health Education England - 1,141 Herts Valley CCG - 405 - 1,457 799 - Hillingdon CCG Hillingdon Hospitals NHS Foundation Trust Hounslow CCG Imperial College Healthcare NHS Trust Nene CCG NHS Business Services Authority NHS England NHS Property Services - 228 1,390 1,963 - 110 2,688 - - 2,651 4,472 - Public Health England - 606 Richmond CCG - 101 Royal National Orthopaedic Hospital NHS Trust - 133 Slough CCG - 482 174 174 University College London NHS Foundation Trust West London CCG - 298 West London Mental Health NHS Trust - 297 London North West Healthcare NHS Trust - six month accounts ended 31 March 2015 93 The Trust has also received revenue and capital payments from a number of charitable funds, of which the trustees are also members of the Trust board. The amounts due or to be paid at the end of the financial year are; Amounts owed to Related Party Amounts due from Related Party £’000 £’000 8 4 55 - North West London Hospitals General Charitable Funds Ealing Hospital Charitable Trust Fund The Trust has incurred transactions with NHS Property Services. Invoices to the value of £4.5m have been received. The Trust has on its Board, a Non-Executive Director who is also a Non-Executive Director at NHS Property Services. 34. Losses and special payments The total number of losses cases in 31 March 2015 and their total value was as follows: Losses Special payments Total losses and special payments 94 Total Value of Cases £s Total Number of Cases 278,284 210 3,622 5 281,906 215 35. Financial performance targets 35.1 Breakeven performance Period ended 31-Mar-15 £000s Turnover 346,730 Retained surplus/(deficit) for the period 263,364 Adjustment for: Adjustments for impairments 6,027 Adjustments for impact of policy change re donated/government grants assets 187 Consolidated budgetary guidance - adjustment for dual accounting under IFRIC12* 289 Absorption accounting adjustment Other agreed adjustments (294,802) 0 Break-even in-period position (24,935) Break-even cumulative position (24,935) *Due to the introduction of International Financial Reporting Standards (IFRS) accounting in 2009-10, the London North West Healthcare NHS Trust’s financial performance measurement needs to be aligned with the guidance issued by HM Treasury measuring Departmental expenditure. Therefore, the incremental revenue expenditure resulting from the application of IFRS to IFRIC 12 schemes (which would include PFI schemes), which has no cash impact and is not chargeable for overall budgeting purposes, is excluded when measuring Breakeven performance. Other adjustments are made in respect of accounting policy changes (impairments and the removal of the donated asset and government grant reserves) to maintain comparability year to year. Period Ended 31-Mar-15 % Materiality test (I.e. is it equal to or less than 0.5%): Break-even in-year position as a percentage of turnover -7.19 Break-even cumulative position as a percentage of turnover -7.19 London North West Healthcare NHS Trust - six month accounts ended 31 March 2015 95 35.2 Capital cost absorption rate The dividend payable on public dividend capital is based on the actual (rather than forecast) average relevant net assets and therefore the actual capital cost absorption rate is automatically 3.5%. 35.3 External financing The Trust is given an external financing limit which it is permitted to undershoot. 31 March 2015 £000s External financing limit (EFL) 37,089 Cash flow financing 36,947 External financing requirement 36,947 Under spend against EFL 142 35.4 Capital resource limit The Trust is given a capital resource limit which it is not permitted to exceed. 31 March 2015 £000s Gross capital expenditure Less: book value of assets disposed of 18,957 (81) Charge against the capital resource limit 18,876 Capital resource limit 19,403 Underspend against the capital resource limit 527 36. Third party assets The Trust held cash and cash equivalents which relate to monies held on behalf of patients or other parties. This has been excluded from the cash and cash equivalents figure reported in the accounts. 31 March 2015 £000s Third party assets held by the Trust 96 4 Remuneration report six months to 31st March 2015 (Subject to Audit) A B C D E Salary Expense Performance Long term All pension payments pay and performance - related (taxable)*** bonuses pay and benefits bonuses (bands of (nearest (bands of (bands of (bands of £5,000) £100) £5,000) £5,000) £2,500) £000 £00 £000 £000 £000 F TOTAL (bands of £5,000) £000 Executive Directors - - - - 120 - 125 3 - - 35-37.5 70 - 75 37 - - 32.5-35 90 - 95 1 - - 35-37.5 100 - 105 - - - 60-62.5 130 - 135 - - - 70-72.5 130 - 135 7 - - - 80 - 85 60 - 65 55 - 60 - - - 32.5-35 27.5-30 95 - 100 85 - 90 90 - 95 - - - 75-77.5 170 - 175 Peter Chairman Worthington Patricia Non-Executive Williamson** Director & Deputy Chair 10 - 15 13 - - - 10 - 15 5 - 10 - - - - 5 - 10 Caroline Corby Stella Dutton David Taube Jeanne Spinks 5 - 10 2 - - - 5 - 10 5 - 10 5 - 10 5 - 10 4 - - - - 5 - 10 5 - 10 Martin West 5 - 10 3 - - - 5 - 10 David Mcvittie Catherine Thorne* Don Fairley Paul Kingsmore Chris Pocklington Tina Benson Arthur Charles Cayley Carole Flowers Kevin Connolly Simon Crawford Chief 120 - 125 Executive Governance 30 - 35 Director HR 55 -60 Director Director of 60 - 65 Estates Deputy Chief 70 - 75 Executive Officer Operational 55 - 60 Director Medical Director 80 - 85 Nursing Director Chief Information Officer Interim Chief Financial Officer Non-Executive Director 5 - 10 *Left in May 2014 **Chairman Duties P7-9, Non Executive director P10-12 ***Expense payments relate to expense allowances that are subject to UK tax As non-executive members do not receive pensionable renumeration, there will be no entries in respect of pensions. London North West Healthcare NHS Trust - six month accounts ended 31 March 2015 97 Real increase in pension at age 60 Real increase in pension lump sum at age 60 Total accrued pension at age 60 at 31st March 2015 Lump sum at age 60 related to accrued pension at 31st March 2015 Cash Equivalent Transfer Value at 31st March 2015 Cash Equivalent Transfer Value at 31st March 2014 Real Increase in Cash Equivalent Transfer Value Employer’s contribution to stakeholder pension** Pensions for the year ended 31st March 2015 - - - - - - - - Governance Director 0 - 2.5 2.5 - 5 35 - 40 105 - 110 632 588 33 4 HR Director 0 - 2.5 0 - 2.5 35 - 40 105 - 110 639 595 32 7 Director of Estates 0 - 2.5 0 - 2.5 50 - 55 155 - 160 1,169 1,101 46 9 Chris Pocklington Deputy Chief 0 - 2.5 Executive Officer 5 - 7.5 40 - 45 125 - 130 718 655 50 10 Tina Benson Operational Director 2.5 - 5 7.5 - 10 25 - 30 85 - 90 422 366 49 8 Arthur Charles Cayley Medical Director 12.5 15 40 - 42.5 80 - 85 230 - 235 - - - 6 Carole Flowers Nursing Director 0 - 2.5 0 - 2.5 55 - 60 165 - 170 1,152 1,088 42 9 Dena Marshall* Director of Transition 0 - 2.5 0 - 2.5 25 - 30 85 - 90 436 432 - - Kevin Connolly Chief Information Officer 0 - 2.5 2.5 - 5 15 - 20 45 - 50 261 234 22 8 Simon Crawford Interim Chief Financial Officer 0 - 2.5 5 - 7.5 65 - 70 205 - 210 1,311 1,213 74 13 Executive Directors David Mcvittie Chief Executive Catherine Thorne Don Fairley Paul Kingsmore *Left May 2014. **Employer’s contribution to stakeholder pension takes into account all contributions made by the newly formed organisation LNWH. No CETV is available for D Mcvittie & C Cayley as they are over 60. As non-executive members do not receive pensionable renumeration, there will be no entries in respect of pensions. 98 2014/15 Band of Highest Paid Director Remuneration (£’000) 270-275 Median Total 39,832.50 Ratio 6.90 Reporting bodies are required to disclose the relationship between the salary of the most highly-paid individual in their organisation and the median earnings of the organisation’s workforce. The banded remuneration of the highest paid director in London North West Healthcare, extrapolated for full financial year as per guidance stipulated in the 2014-15 Manual for Accounts, in the financial year 2014-15 was 270-275. This was 6.90 times the median salary of the workforce, which was £39,832.50 In 2014-15 4 employees received remuneration in excess of the highest paid director. Total remuneration includes salary, non consolidated performance related pay, benefits in kind as well as severance payments. It does not include employer pension contributions and the cash equivalent transfer value of pensions. Prior year figures would not provide meaningful comparisons against the newly formed organisation, London North West Healthcare Trust due to 2014/15 being the first part year as an operational entity and hence have not been disclosed. London North West Healthcare NHS Trust - six month accounts ended 31 March 2015 99 The information in this report is available in large print by calling 020 8869 3552. If you would wouldlike likeaasummary summaryofofthis theAnnual information in language this annual If you Reportcontained in your own please report in your own language, please call 020 8869 2124 and state clearly, call 020 8869 3552 and state clearly in English the language you need and we will in English, the language you need and we will arrange for an interpreter to arrange an interpreter to speak to you. speak to you. 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Gxqh<hqm<miz<?!dr<gTme<!OhSukx<G!fir<gt<!yV!olipqohbIh<hitjv!Wx<hiM! osb<Ouil</! ! +É ´ÉÉ̺ÉHí +¾àú´ÉɱɩÉÉÅ »É©ÉÉʴɺ`ò ©ÉÉʾúlÉÒ{ÉÉà »ÉÉ−÷ÉÅ¶É Xà lÉ©É{Éà lÉ©ÉÉ−÷Ò §ÉɺÉÉ©ÉÉÅ Xà<lÉÉà ¾úÉà«É lÉÉà, HÞí~ÉÉ Hí−÷Ò{Éà 020 8869 3552 ~É−÷ HíÉà±É Hí−÷Éà +{Éà lÉ©ÉÉ−à÷ Wðà §ÉɺÉÉ{ÉÒ Wð°÷−÷ ¾úÉà«É lÉà »~ɺ`ò °÷~Éà +ÅOÉàYð©ÉÉÅ WðiÉÉ´ÉÉà +{Éà lÉ©ÉÉ−÷Ò Xàeàô ´ÉÉlÉ Hí−÷´ÉÉ +©Éà qÖö§ÉÉʺɫÉÉ{ÉÒ ´«É´É»oÉÉ Hí−÷Ò +É~ÉÒ¶ÉÖÅ. ،إذا آﻨﺖ ﺗﺮﻏﺐ ﻓﻲ اﻟﺤﺼﻮل ﻋﻠﻰ ﻣﻠﺨﺺ ﻟﻠﻤﻌﻠﻮﻣﺎت اﻟﺘﻲ وردت ﻓﻲ هﺬا اﻟﺘﻘﺮﻳﺮ اﻟﺴﻨﻮي ﺑﻠﻐﺘﻚ ، اﻟﻠﻐﺔ اﻟﺘﻲ ﺗﺤﺘﺎﺟﻬﺎ، ﺑﺎﻟﻠﻐﺔ اﻹﻧﺠﻠﻴﺰﻳﺔ، واذآﺮ ﺑﻮﺿﻮح020 8869 3552 اﺗﺼﻞ ﻋﻠﻰ رﻗﻢ .وﺳﻮف ﻧﻘﻮم ﺑﺘﻮﻓﻴﺮ ﻣﺘﺮﺟﻢ ﻟﻴﺘﺤﺪث إﻟﻴﻚ ﭼﻨﺎﻧﭽﻪ ﺗﻤﺎﻳﻞ دارﻳﺪ ﮐﻪ ﺧﻼﺻﻪ اﻃﻼﻋﺎت ﻣﻮﺟﻮد در اﻳﻦ ﮔﺰارش ﺳﺎﻻﻧﻪ را ﺑﻪ زﺑﺎن ﺧﻮد داﺷﺘﻪ ﺗﻤﺎس ﺣﺎﺻﻞ ﻧﻤﻮد و ﺑﻄﻮر واﺿﺢ و ﺑﺎ زﺑﺎن020 8869 3552 ﻟﻄﻔﺎ ﺑﺎ ﺷﻤﺎرﻩ ﺗﻠﻔﻦ،ﺑﺎﺷﻴﺪ ﺑﺮ اﻳﻦ اﺳﺎس ﻣﺎ ﺗﺮﺗﻴﺐ ﺣﻀﻮر ﻳﮏ ﻣﺘﺮﺟﻢ. زﺑﺎن ﻣﻮرد ﻧﻴﺎز ﺧﻮد را اﻋﻼم ﻓﺮﻣﺎﺋﻴﺪ،اﻧﮕﻠﻴﺴﯽ .هﻤﺰﻣﺎن را ﺑﻤﻨﻈﻮر ﺻﺤﺒﺖ ﺑﺎ ﺷﻤﺎ ﺧﻮاهﻴﻢ داد 100 Annual Report - 1 October 2014 to 31 March 2015 How to contact us: Trust headquarters - Northwick Park Hospital Watford Road Harrow, HA1 3UJ Telephone: 020 8869 3232 www.lnwh.nhs.uk www.facebook.com/lnwh.nhs Twitter @lnwh_nhs