Annual Report 2009/10 by The Clatterbridge Cancer Centre

The Centre for cancer care 2009/10 Annual Report and Accounts

2009/10

Annual Report & Accounts Presented to Parliament pursuant to Schedule 7, paragraph 25(4) of the National Health Act 2006.

Contents Annual Report Chairman & Chief Executive Statement Directors’ Report Operating & Financial Review (OFR) Patient Care Developing our Services Governance

6 8 9 12 16 28

Quality Report Review of Quality Performance 2009/10 Priorities for Improvement Statements of assurance from the Board Other Information Performance against key national priorities and national core standards Annex Statements

52 56 61 66 69 71

Annual Accounts Foreword to the Accounts Statement of accounting officer’s responsibilities Statement of Directors’ responsibilities Independent Auditor’s Report Statement of Internal Control Notes to the Accounts Remuneration Report

77 78 79 80 82 105 109

Introduction Chairman & Chief Executive Statement Reaching the end of the financial year 2009/10 is an opportune time to reflect on the work of the Trust during the course of the year. I am pleased to report that Clatterbridge Centre for Oncology (CCO) continues to provide the highest quality clinical care possible and in recognition of this the Care Quality Commission has awarded the Trust its ‘excellent’ rating for both the quality of services and for the use of resources; the two areas it assessed for the year 2008/09. In March 2010 the Trust was advised by the Care Quality Commission (CQC) that our registration had been agreed and that they have registered us with standard restrictive conditions only. Standard restrictive conditions cover what regulated activities can be carried out at the Trusts premises, these are stated below: x x

Treatment of disease, disorder or injury Diagnostic and screening procedures

Monitor has awarded the organisation the best rating possible for financial risk and confirmed that the Trust delivered it mandatory services. CCO is achieving the majority of the required operating standards in respect of relevant NHS targets. However we continue to be tested by the challenge of meeting the new 62 day cancer waiting time target, falling just short of the operating standard in two quarters of 2009/10. In large part this is due to late referrals from secondary care. We continue to work with our colleagues in the healthcare system to ensure that our patients receive timely treatment and the Trust delivers sustainable achievement of the required standard. The Trust has continued to meet the challenge of the mandated infection control targets. We have achieved both targets for Clostridium difficule and MRSA and I am pleased to report that again MRSA bacteraemia infections have remained at zero throughout the year. Furthermore, the Trust has achieved a strong balance sheet with a surplus of £3,270k, which has enabled us to continue our investment programmes to upgrade facilities and services at the centre. Construction work has now been completed on the remodelled Sulby Ward to include more single rooms and en-suite facilities and a dedicated Teenage and Young Adult Unit. This four-bedded facility will accommodate patients aged 16-24 years, offering privacy and independence - as well as additional space for overnight stays by family members. We are grateful for the additional funding received from the Teenage Cancer Trust towards the cost of this unit. We are the only Trust in the UK to provide low energy proton treatments for eye cancers and we receive patients not only from the UK but also from many other parts of the world. New forms of proton treatment are now available to deal with other types of tumours. We are currently, in conjunction with Alder Hey Children’s NHS Foundation Trust, making a bid to the Department of Health for a high energy proton treatment machine which will be capable of treating many other types of tumour. In particular proton therapy has significant benefits for the treatment of children and young people. The cost of these machines however is significantly greater than the Linear Accelerator radiotherapy machines we currently operate. 5 6

High energy proton therapy facilities cost in excess of £100m. We will not know until later in the year whether or not we will be asked by the Department of Health to compete to provide this service for the people in Merseyside & Cheshire but also for patients throughout the North of England. One of the key drivers for the Trust Board has been to try and deliver our services as near as possible to the patient. We already have eight chemotherapy clinics located in acute hospitals throughout Cheshire and Merseyside and the Isle of Man but all our radiotherapy is undertaken at the Clatterbridge site. With this in mind we have commenced building a Satellite Radiotherapy Centre ‘Clatterbridge Cancer Centre – Liverpool’ on the Walton/Aintree Hospital site in North Liverpool. The cost of the project will be met by the Trust with the help of charitable funds. Our colleagues from the Marina Dalglish Appeal are working hard to raise a significant proportion of the money required to ensure that this facility is completed by the end of 2010 and opened for the use of patients early in 2011. Needless to say we are most grateful for all their hard work. Clearly 2009/10 has been a productive year for the Trust but there are significant challenges facing the Trust in the coming years. The most significant of these relate to the financial pressures which the NHS is almost certainly likely to experience. How these pressures will impact on our services is still not known but they are likely to create a more demanding environment in which we will have to operate. Nevertheless, we are confident that with the support of our Governors and Members and the exceptional level of commitment and hard work of our Staff 20010/11 will prove to be an equally successful year for the Trust.

Alan White, Chairman

Andrew Cannell, Chief Executive

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Directors’ Report Background Information Clatterbridge Centre for Oncology was licensed as a Foundation Trust from 1st August 2006. Our vision during 2009/10 as an NHS Foundation Trust is to provide ‘world class cancer care.’ Fundamental to our success in achieving our vision has been our focus on delivering our strategic objectives. These are: x x x x

To be the provider of choice for non-surgical (solid tumour) cancer services to the population of Cheshire and Merseyside. This is our core service To develop key partnerships that will further strengthen core business To remain the employer of choice for staff both within the local, general employment market, and nationally for staff with specific expertise in cancer services To become an organisation that is fully responsive and accountable to its membership.

Trust profile Clatterbridge Centre for Oncology (CCO) is one of the largest cancer centres in the UK – registering over 8,300 new patients each year and providing more than 131,000 attendances for treatment. In addition to the facilities provided on the main Clatterbridge site, many of our out-patient and treatment clinics are run in the surrounding general hospitals of Merseyside, Cheshire and the Isle of Man where we serve a population of 2.3 million. We employ over 650 staff and volunteers and spend approximately £64m per year on all aspects of cancer treatment, diagnosis and care. The cancer centre is located on the Clatterbridge Health Park in Bebington, Wirral. Within the centre we provide a range of radiotherapy and chemotherapy treatments in out-patient and in-patient settings. We also provide out-patient consultations and support services. The treatment centre has undergone significant financial investment over the past five years and now hosts one of the best equipped radiotherapy centres in the UK. Research and development, including participation in national and international clinical trials, is an important feature of the cancer centre.

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Operating & Financial Review (OFR) Financial Summary The Trust has again had a successful year and has achieved or exceeded all of its key financial targets. The Trust’s financial position is detailed in the accounts included as part of this report, however the table below summarises performance in the key areas.

Financial Target

Outcome

Planned income & expenditure surplus of £2.9m Earnings Before Interest, Tax, Depreciation and Amortisation (EBITDA) of £7.16m I&E surplus margin of 4.8% EBITDA margin of 11.5%

Achieved actual surplus of £3.27m Achieved actual EBITDA of £8.06m

Return of Assets employed of 9.0%

Achieved return of 10.9%

Liquid ratio of 74.8 days (measures liquidity of the Trust. The higher the ratio the more liquid the Trust

Achieved ratio of 92.1 days

Overall Financial Risk Rating determined by the Independent Regulator (Monitor) of 5. (where 5 represents the lowest financial risk and 1 highest)

Achieved Financial Risk Rating of 5.

Prudential Borrowing Limit (PBL) The long term prudential borrowing limit is set by Monitor. The Trusts current cumulative long Term limit is £14.5m.

CCO has taken out a loan of £5m in 2009/10 against the PBL limit. In addition the long term obligations relating to finance leases (£0.5m) is scored against the PBL. The total of £5.5m is well within the permissible limit. Private Patient income of £0.349m represents approximate 0.6% of total Trust clinical income. Therefore the Trust has remained within the Private Patient Income Cap.

Private Patient Income Cap: Under the terms of authorization as a Foundation Trust private patient income must Not exceed 2.2% of total clinical income

Achieved margin of 6.5% Achieved margin of 12.5%

Key Financial Risks The majority (91%) of the Trust’s income is received for the provision of non-surgical cancer treatments to the residents of Merseyside, Cheshire, and parts of Lancashire, North Wales and the Isle of Man. Approximately 28% of the Trust’s clinical income is funded by Payment by Results (PbR) national tariffs, with the remainder from locally determined prices. Both PbR and the local tariff arrangements are based on the principle that the Trust is reimbursed based on activity performed. Therefore a reduction in activity levels represents a financial risk to the Trust. However the Trust is able to mitigate in part against this risk by: x x x

Where possible, employing contract tolerances to reduce in year income volatility Agreeing local tariffs with commissioners for 72% of clinical income that are not, therefore, subject to the same degree of price volatility as the nationally determined tariffs within Payment by Results Agreeing cancer drug developments to ensure drug funding based on actual drug usage. 8 9

A key concern for the forthcoming financial years will be the likely reduction in public expenditure on the NHS. The Trust is working with commissioners and other stakeholders across the health economies as part of the North West Quality, Innovation, Productivity and Prevention (QIPP) process to ensure quality cancer services can be maintained whilst increasing productivity and efficiency. Therefore another key financial risk is the delivery of the Trust’s cost improvement programme (CIP) and improvements in unit efficiency. However the target was achieved in 2009/10 and the entire 2010/11 programme has been identified. Activity As noted above, the majority of the Trust’s income is derived from providing non surgical cancer treatments and support (such as Radiotherapy, Chemotherapy, palliative care, diagnostic imaging, psychiatric and other support). During 2009/10 the Trust has continued to experience steady growth for its Chemotherapy services in particular. Radiotherapy activity reduced in the initial part of the year and although started to increase in the latter part of the year, cumulative activity was less than planned. The number of patients admitted to the hospital as in-patients also fell in year. Proton therapy has continued to increase on last year as per plan, with a steady increase in referrals from outside the usual Liverpool referral pathway. Activity

2009/10 Actual

2009/10 Plan

% Variance

% Growth Forecast 2010/11

Chemotherapy attends Radiotherapy attends Proton therapy attends In-patient spells Out-patient consultations

33,297 97,586 634 4,531 66,421

31,472 101,168 578 4,859 66,041

5.6% -3.5% 9.7% -6.7% 1.0%

3.0% 1.6% 0.0% 1.0% 1.0%

Forecast growth is related to the increase in estimated numbers of our relevant catchment population, and is based on the same assumptions that underpin the Trust’s 3 year Forward Plan. The percentage growth represents an average of the previous few years rather then a projection based solely on the last 12 months. Due to relatively low patient numbers (circa 100 – 120 p.a.) the Proton Therapy activity is quite volatile year on year and therefore no growth is assumed for 2010/11. Other Income and Non-healthcare Activities As noted above, the majority of the Trust’s income is derived from providing clinical cancer services. In addition, the remaining 9% of income is derived from: x x x x x x

Undertaking research & development Education and training External drug sales to the private sector Hosting non-clinical services, such as the National Cancer Services Analysis Team. In CCO’s accounts income for these services matches expenditure and therefore there is no impact on the Trust’s EBITDA and overall I&E surplus Support from charities and recharges to other NHS and non-NHS bodies Income to cover depreciation of donated and Government Granted assets. 9

Contractual Commitments & Post Balance Sheet Events The Trust is on target to complete the new Radiotherapy satellite facility in Liverpool to enable clinical services to commence in the final quarter of 2010/11. The Trust have entered phase 4 of the Procure 21 contract and the forecast cost of the building project remains £12.6m. A further £5.3m will be spent on equipping the facility in 2010/11, thanks in great part to a significant donation from the Marina Dalglish appeal. Investment Activity The Trust invested £7 million in buildings and replacement of capital equipment in 2009/10. The main schemes were: x x x x

£4.88m for the Radiotherapy satellite in Liverpool. The unit is expected to be operational by the final quarter of 2010/11 £1.26m Refurbishment of one of the wards (Sulby), including the construction of a dedicated Teenage & Young Adult unit £0.51m purchase of additional building space £0.17m for a new collimator and software to improve stereotactic radiosurgery facilities.

All of the above represented investments in assets that are protected to deliver cancer services to our patients as part of the core business of the Trust, with the expectation that the improvements will build on the existing high standard of care provided. In addition to Radiotherapy satellite, the Trust is planning further capital expenditure in 2010/11 to commence the next phase of the ward refurbishment programme, and continue with its on-going equipment replacement programme. A number of projects are also planned to improve Information Management and Technology services at the Trust. Accounting Policies Accounting policies have been redrafted to comply with International Financial Reporting Standards (IFRS) and a full list of these policies is included as part of the Annual Accounts. Charitable Funding The Board of CCO is also the Corporate Trustee of Clatterbridge Centre for Oncology Charitable Funds. During 2009/10 £458,846 has been spent by the charity in support of the Foundation Trust. The main areas of expenditure were: x x x x x

Contribution to capital (medical equipment): £ 70,000 Research & development: £120,652 Improving patients welfare: £214,716 Improving staff welfare: £10,809 Other direct expenditure: £42,669.

Going Concern The following financial accounts statements have been prepared on a going concern basis. After making enquiries the directors have a reasonable expectation that the NHS Foundation Trust has adequate resources to continue in operational existence for the foreseeable future. For this reason they continue to adopt the going concern basis in preparing the accounts.

Patient Care Performance against key targets 2009/10 18 weeks performance CCO has performed well against the existing requirements to see and treat patients within 18 weeks, whether they are admitted or non admitted. Performance against these key targets is as follows: x 95.4% of admitted patients were seen within 18 weeks from the initial GP referral to treatment (target threshold 90%) x 97.9% of non admitted patients were seen within 18 weeks from initial GP referral to treatment (target threshold 95%). Additionally non Cancer Waiting time’s specific performance can be seen as follows: x No patient has waited longer than 6 weeks (target 13 weeks) for Imaging (CT and MRI at CCO) x We have had no incidence of a MRSA bacteraemia (our target is no more than 2). Cancer Waiting Times performance As of 1st January 2009, the Cancer Reform targets were introduced which changed the reported performance levels for both the 31 day and 62 day cancer waiting times targets, in order to align them with the 18 week pause model. That is, the majority of usable adjustments, such as patient thinking time, time out for patient holidays, medical suspensions, were removed. The impact of this was that reported performance was seen to drop significantly, even though in reality patients were being seen and treated just as quickly as before. Whilst the target rationales were changed for the last quarter of 2008/09, Department of Health recommended that the data for Quarter 1 2009/10 was inappropriate for use due to lack of completed data submissions by all Trusts. Care Quality Commission, whilst ‘suggesting’ targets against National Operating Standards for 2009/10; have not yet finally and formally agreed any of the Cancer Waiting Time targets (this report provides information based on and against those ‘suggested’ targets): x x x

All patients who had suspected cancer and were referred urgently by their G.P.’s were seen within 14 days 97.7% of patients were treated within 31 days from the time of decision to treat for first treatments (target threshold 96%). 98.9% of patients were treated within 31 days from the time of decision to treat for subsequent treatments (target threshold 98%) 11 12

77.6% of patients were treated within 62 days from the date of urgent GP referral (draft target threshold 79%). Pre finalisation of the reallocations submission date 8th July 2010. See below for patients treated within 62 days from the date of urgent GP referral under the ‘classic’ pathway (draft target threshold 79%). The Trust will not be monitored against the 62 day screening pathway since insufficient numbers of patients were referred and therefore the ‘de minimus’ rule comes into being.

The 62 day cancer waiting time standard The Trust has worked particularly hard to deliver the 62-days Cancer Waiting time standard. This standard is a particular challenge for CCO as a tertiary provider of services. The performance has been indicative of the changes in the rationales for measurement against this target and not as a result of patients not being seen just as quickly as before (even with the reduction in threshold). The achievement of the 62 day waiting time standard has remained a high priority for the Trust, this target monitors the maximum waiting time for suspicion of cancer patients from the point of urgent GP referral to the start of treatment. Considerable effort has been put in across the Trust in achieving this target; similarly we have worked hard to build effective working relations with partner NHS Trusts who refer patients into the Trust, to help ensure that patients are referred to us as quickly as possible. Also, following a trend analysis it was evident that the biggest issues for us was around the Urology pathway and the Head & Neck pathway, The Intensive Support Team were invited by CCO to facilitate some work to review these pathways across the region. The outcome from the Intensive Support Team was that there were no recommendations regarding the Urology Pathway which they declared is as efficient as it can be; the issue remains around the delay following Trans-Rectal Ultrasound (TRUS) biopsy to undertake MRI scanning, which requires a planned 28 day delay. With regards to the Head & Neck Pathway, a small number of suggestions were made at the first workshop in January which were then implemented by the second workshop in May. It was agreed at the second workshop that the Head and Neck pathway is now as efficient as possible for this very complex pathway. The table below shows the performance both pre Cancer Reform Strategy Changes and since, for the ‘classic’ 62 day target patient pathway 2009/10). It does not include the performance for the 62 day screening patient pathway since CCO have not received enough referrals to be measured against due to the ‘de minimus’ rule Yearly quarter

Q1 (Apr – Jun) Q2 (Jul – Sep) Q3 (Oct – Dec) Q4 (Jan – Mar) Q1 – Q4 (Apr – Mar)

Trust performance 2008/09 (total)

Trust performance 2009/10 (classic)

92.64% 90.61% 97.32% -

78.9% 78.2% 81.6% 73.8%* 77.6%*

*Pending all reallocations to be submitted agreed and further calculations to be finalised (following 8th July 2010)

12 13

Regulatory ratings The Regulator (Monitor) assesses the performance of Foundation Trusts quantifying performance in three distinct categories: Financial, Governance and Mandatory Services. For both 2008/09 and 2009/10 in their assessments of the annual plan and each quarters performance Monitor determined that the Trust should be awarded ‘green’ for its mandatory services and financial risk rating of ‘5’ (the best possible financial risk rating). Annual Plan 2008/09 Financial 5 risk rating Governance Green risk rating Mandatory Green services

Annual Plan 2009/10 Financial 5 risk rating Governance Green risk rating Mandatory Green services

Q1 2008/09

Q2 2008/09

Q3 2008/09

Q4 2008/09

Green

Q1 2009/10

Q2 2009/10

Q3 2009/10

Q4 2009/10

Amber

Green

Amber

Green

The position in respect of the governance rating for each year is described below. Governance Ratings 2008/09 The Trust received a Green rating for Governance in each quarter of 2008/09 Governance Ratings 2009/10 The Trust received Amber ratings for Governance in quarters 1, 2 and 4. This was due to three separate issues: Firstly, concern expressed by third parties that the Trust was failing to engage fully with some parties in the local health economy in respect of service developments and whether the Board and its Governors had been informed of the full implications of these developments. The Trust developed and implemented a structured programme of engagement which addressed this issue to Monitor’s satisfaction by quarter 3. Secondly the Trust was undertaking a significant investment (the development of a satellite radiotherapy facility at Walton) whilst there was no substantive Chief Executive in post. 13 14

Monitor was satisfied once a substantive appointment (Reported quarter 2) was made that this risk to the organisation was removed. Finally the 62 day ‘classic’ cancer waiting times target threshold against the National Operating Standard has yet to be confirmed by CQC. Following an analysis by CQC of the 2009/10 data after the 11th June 2010, the final agreed threshold for this target along with the actual performance will be published on 16th June 2010. CCO have requested a reduction in the draft threshold for this target which was originally proposed at 79%. (The 62 day screening target will not be assessed due to patient numbers invoking the ‘de minimus rule’). Under the Compliance Framework current performance against the draft threshold is sufficient to generate an Amber rating. The Trust continues to implement its action plan to deliver sustainable achievement of the standard required. However it remains susceptible to late referrals from secondary care leading to a failure.

Care Quality Commission (CQC) Assessment and Review Standards for Better Health Declaration 2008/09 The Trust has declared full compliance for all of the core standards. Care Quality Commission Performance Ratings 2008/09 The Healthcare Commission performance ratings for 2008/09 were published in the autumn of 2008. The ratings are derived from a wide range of indicators and are summarised to a rating on two categories; quality of services and use of resources. Quality of Services:

Excellent

This rating ranks the Trust higher than the average in England. The overall rating is a consolidation of the following areas: Component

Rating

Meeting core standards Existing national targets New national targets

Use of Resources:

Fully Met Fully met Excellent

Excellent

The Trust achieved the best available ranking which is based on Monitor’s assessment of the Trust’s financial performance for the year.

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Care Quality Commission inspection: Hygiene Code In January 2010 the Trust received an unannounced inspection from the CQC in relation to compliance with the Hygiene Code. The CQC assesses the Trust on whether we are meeting the new regulation on HCAIs and following the supporting Code of Practice and related guidance. On inspection, they found no evidence that the trust has breached the regulation to protect patients, workers and others from the risks of acquiring a healthcare associated infection. Independent Risk Management Assessments Achievement of NHSLA level 3 In November 2007 the Trust was successfully assessed against NHSLA level 3 (the highest available) and became the second Trust in the country (not including the pilot Trusts) to gain this level of attainment. The assessment reflects the Trustâ&#x20AC;&#x2122;s robust risk management systems and processes and the extent to which a risk aware culture is embedded in the organisation. Maintenance of ISO 9001:2008 Standard The ISO 9001:2008 Standard is a national (externally assessed) standard based around the principles of customer satisfaction, a systematic approach to management, and encouraging a culture of continual improvement across all departments within the Trust. CCO is thought to have been the first NHS Trust to achieve this accreditation for the organisation as a whole. The accreditation is reviewed periodically and it is pleasing to report that it has been retained throughout 2009/10.

Developing our Services Radiotherapy Radiotherapy continues to be busy with 9 Linear Accelerators and a cobalt unit all operational. 2009 saw an increase in the use of RapidArc which is a way of treating some Intensity Modulated Radiation Treatment (IMRT) patients much more quickly, reducing the time a patient spends on the treatment couch and therefore improving patient experience. The use of this technology is currently being expanded into more anatomical sites having started mainly treating prostate tumours. There have also been some improvements to the Stereotactic Radiosurgery Service (SRS) with the installation of a modified collimator system on one of the Linacs. This makes the switch to SRS much easier and quicker which has enabled more than one patient to be treated in a session, making more efficient use of consultant and other staff time. The radiotherapy development by CCO on the Walton / Aintree site is progressing well with the building taking shape and due for handover in October / November 2010. The construction and equipping of the ÂŁ17.5m satellite unit has been made possible both by the additional financial freedoms available to CCO as a Foundation Trust and the kind generosity of the supporters of the Marina Dalglish appeal. To finance the project CCO has been able to utilise cash surpluses generated since becoming a Foundation Trust, supplemented by a 15 16

£5m loan from the Foundation Trust Financing Facility and the signature donation, expected to be in the region of £3m, from the Marina Dalglish appeal. The commissioning of the equipment at the satellite will begin before the building is formally handed over and it is anticipated that the clinical service will commence in February 2011. The new facility will shorten the journey time of a significant number of patients who currently have to travel to CCO for radiotherapy treatment. There is considerable effort going into streamlining processes to make working across 2 sites as efficient as possible. Chemotherapy The Trust has an excellent track record of delivering chemotherapy treatments as close as possible to the patient. Some 70% of the Trust’s outpatient chemotherapy treatments are already delivered by CCO’s clinical staff in District General Hospitals in the cancer network. This is understood to be one of the most devolved services in the country, and has been promoted as an exemplar of good practice nationally. In 2009-10 the Trust focused on improving the quality of the service that it provides to its patient population and to other healthcare professionals who may treat our patients. Electronic Prescribing Nationally, electronic prescribing has been in the process of development for some time within Chemotherapy, with CCO being key partners in ensuring that this development is a ‘fit for purpose’ system. The pilot phase is complete, and the regimes are now almost built, medical and nursing staff are completing training, and it is hoped for a full roll-out of electronic prescribing across chemotherapy within the next few months. Patient Follow Up Phone Calls A new system of providing patient follow-up phone calls has been implemented for all patients within 48hours of them receiving their first cycle of chemotherapy. Qualitative feedback has suggested that patients find this extremely beneficial. The task is undertaken by the Triage Service. In addition all patients DNA’s are now followed up by the Triage Service. Nurse Led Services The Trust has continued the development of nurse led clinics for both supportive treatments and chemotherapy treatments, supporting a number of nurses to attain the non medical prescribing qualification to enable this development. Triage Service From 5th October a different service model for the Triage service was introduced. The model now used is a 24hour service, with 15 hours per day running as a separate service to both Delamere and Sulby wards. The aims and objectives of developing the service have all been met and are all continually being developed, these being: x To provide access to support and information to all patients, families, and Health care professionals 16 17

x x x x x

To provide constant and knowledgeable information to all who need it To provide a patient focused service To create effective communication between primary, secondary and tertiary service providers To provide training and support for all CCO and acute trust staff where we administer chemotherapy To overall create a fit for purpose service which complies with all recent reports and recommendations which others would aim to replicate.

Impact of the change in service provision The service has had a wide impact on both patients and staff alike. These improvements being: x Speedier answering of calls due to the introduction of the triage clerk x Patients when attending CCO for review have all necessary tests undertaken speedier, and are reviewed quicker due to the introduction of the Triage clerk x Triage nurses are able, due to the extended hours to become more pro-active with patients and staff in other trusts x All staff are competency trained to the same high standard x Introduction of algorithms to be used within the Triage service have helped in the thorough assessment of patients calling the triage service x A more seamless service provision x Staff on Sulby are not taken away from undertaking there normal roles. x Better communication with acute trusts regarding patients being referred by CCO or who are self referring. IM&T Service Plans In 2008/09 the Trust Board approved a new IM&T Strategy for the period 2008-11. The strategy covers business and clinical IM&T systems and service management and focuses on five core dimensions: Business Alignment; Management and Governance; Enterprise Architecture; Organisation and Supply; Portfolio and Financial. The document includes ‘vision statements’ for each of the dimensions and describes plans for the delivery of a range of IM&T projects and initiatives, using a best practice programme and project management approach (MSP and PRINCE 2), with a number of under-pinning principles which are linked to the Trust’s values as described in the Delivery Plan The key themes within the strategy are concerned with improving IM&T service management, project co-ordination and delivery, clinical system integration and remote access to information systems. During 2009/10 the Trust continued to implement its approved IM&T Strategy and further improved on its strong performance against the Information Governance Toolkit. An independent audit of IM&T program and project management arrangements provided an improved rating of ‘significant assurance’. Using guidance from Monitor and Connecting for Health the Trust carried out an EPR options appraisal to confirm the best approach to providing and improving upon its Electronic Patient Record systems from 2012 and beyond. The preferred option was to extend the existing 17 18

supply contract for three years to March 2015 and a rigorous approach to contract review and negotiation has secured a range of system enhancements on a cost-neutral basis. The Trust self-assessment against the Information Governance Toolkit secured a score of 89% (Green rating) a further improvement on the score in 2007/08. The Trust secured at least a level 2 in each of the Data Security assessments. Estates In 2009/10 continued our development of an environment that promotes staff and patient well-being and supports the delivery of our service goals. The Estate Strategy for the Trust has been reviewed and updated and sets out the requirements for the Trust over the next 3 – 5 years and how the Trust’s estates function supports the delivery of the organisations strategic objectives over the medium term. For 2009/10 the two major estates programmes on the Clatterbridge site (i.e. excluding the major radiotherapy development at Walton/Aintree) for the Trust were: (i) Improvement in the quality of the Trust’s in-patient facilities One of the current inpatient wards was fully refurbished during 2009/10. This development has provided an increase in the provision of single rooms and offers benefits in terms of; privacy & dignity, infection control, meeting patient expectations and flexibility in providing single sex accommodation. (ii) Dedicated facilities for teenagers and young adults NICE Improving Outcomes Guidance for Children and Young People was published in 2006 and a North West plan has been developed by the Specialised Commissioning Group (SCG) in conjunction with the four North West Cancer Networks, including North Wales. Local plans have been developed for young peoples cancer services (in the 16 to 24 age group). Key elements of the North West strategy which informed our estates plan were: x x

Treatment and care of young people concentrated in a limited number of Trusts with access to age appropriate facilities, in association with the Principal Treatment Centre at Clatterbridge Centre for Oncology (CCO) Provision of a Teenage and Young Adult Unit at CCO for inpatient chemotherapy and radiotherapy.

As part of the ward refurbishment programme an age specific inpatient unit for 16 – 24 year olds was created in partnership with the Teenage Cancer Trust. Research & Development Research and Development (R&D) is a central component of the Trust’s Vision to provide outstanding cancer care through excellence in treatment, research, education and training. A focused and vibrant research agenda is expected to contribute to the achievement of the Trust’s strategic aims. During 2009/10 we have demonstrated our commitment to R&D in a number of ways, including: 18 19

The recruitment campaign for a Chair of Medical Oncology is underway. This is the first stage of the development of an Academic Unit of Oncology with presence at both the University of Liverpool and CCO with an over-arching strategy

We have expanded the Merseyside and Cheshire Cancer Research Network workforce. Significant investment has been made by the Cheshire and Merseyside Comprehensive Local Research Network; which should correspond to an increase in the local National Institute for Health Research (NIHR) portfolio and subsequent patient recruitment. Our aim is to increase overall accrual to 12.5% by 2011/12. In 2009/10 we are projected to exceed this at ~14% (based on first 9 months data)

Work is ongoing to further develop locally-led physics and radiobiological modelling research aimed at improving radiotherapy treatment. A number of our senior physicists are active members of NIHR Trial Management Groups (TMGs) and the NCRI Clinical & Translational Radiotherapy Research Working Group (CTRRWG) demonstrating a clear commitment to the development of national research programmes

We are making progress against our aim to develop a growing portfolio of locally-led clinical research approved by relevant NIHR Clinical Studies Groups. A number of researchers are currently developing potential NIHR portfolio studies. We have also continued to foster our close working relationship with the Liverpool Cancer Trials Unit (LCTU) as the local provider of trial management support to Chief Investigators

Over the past 12 months the Liverpool Experimental Cancer Centre has expanded its portfolio of early phase clinical research. We have secured funding for an additional research practitioner to support this increase in activity.

Developing our Workforce The Trust has continues to embed its organisational development strategy throughout the year. This set out our approach to issues such as leadership, workforce engagement and other aspects of how we manage and develop our people. Clear goals were outlined within the strategy and progress has been made in a number of areas. Significant progress made, on embedding the core values that have been developed through engagement with our workforce. The values now play a core part in Trust processes and inform decisions made around recruitment, induction, staff awards and internal communication channels. The Trust has also begun a programme of initiatives around employee health & wellbeing, which has seen free health checks, nutritional advice, complementary therapies and a stress awareness campaign. Supporting a strategy to provide managers with the right tools to enable effective management of their people, the Trust successfully implemented the Electronic Staff Record and rapidly completed a subsequent assessment that demonstrated appropriate use of the system. To enable the Trust to be fit for purpose we are currently undertaking a review of the capacity and capability of its HR function. 19 20

Staff Survey The Trust continues to perform well in the national staff survey. Key results are outlined below. The Trust performs an annual review of the results and uses these to inform further workforce development in key areas. In order to monitor results and to learn from staff feedback the Trust adopts a number of methods. The Trust Board receives an annual presentation of both the staff and patient surveys to both review the results and to triangulate the responses. The JCNF receives the survey results and provides direction from a staff side perspective of the key areas for improvement. Key specialist areas are reviewed and taken forward by specific committees e.g. the range of health and safety questions is reviewed by the Trusts Health and Safety Committee which is partly constituted by staff side health and safety representatives. Specific projects are developed involving staff side representation. Following the 2009 results we are currently planning a workshop utilising the experience of staff who have been involved in all parts of the Bullying and Harassment Policy to identify areas of weakness and improvement. Public displays in both patient and staff areas of the summary survey results are done and there are joint presentations / discussions from HR and Patient Experience at departmental meetings. In addition to the above examples the Trust has identified a corporate objective to develop a Health and Wellbeing strategy for the Trust learning from the Boorman review. Discussions with our staff side representatives with regard to staff working extra hours do not identify this as a negative. The question asks a factual question. For a number of our staff, particularly on part time contracts they appreciate the additional flexibility to work additional paid hours. We do not therefore have an action plan to change this result. We do however monitor through our risk management system any issues relating to potential problems with workforce availability that could mean staff working additional hours when this is not their choice. These issues are addressed independently. The Trust continues to develop and monitor its approach to staff stress learning and implementing from best practice identified by the health and Safety Executive and the NHSLA. The Trust has conducted an audit of compliance against its stress policy and as a result has agreed the following actions: x x x

Further promotion of the steps being taken by line managers and the Trust to address stress across the Trust Establish awareness training on stress for all line managers Raise awareness of the support mechanisms available.

20 21

Staff Survey Data 2008 Response Rate

Trust 58%

2009 National Average Not published

Trust 54%

Trust Improvement/ Deterioration National Average 55%

Decrease in 4% points

Top 4 Ranking Scores

Trust

National Average

Trust

National Average

Staff experiencing harassment, bullying or abuse from patients / relatives in the last 12 months Staff witnessing potentially harmful errors, near misses or incidents in the last month Trust commitment to work-life balance Staff appraised in the last 12 months

10%

15%

14%

Decrease in 4% points

26%

33%

25%

34%

Decrease in 1% points

3.65%

3.46%

3.67%

3.52%

84%

64%

88%

76%

Decrease in 0.02% points Increase in 4% points

Staff suffering work-related stress in last 12 months Staff working extra hours

25%

30%

24%

Increase in 5% points

70%

68%

69%

67%

Staff motivation at work

Not calculated in 2008

3.82%

3.86%

Decrease in 1% points

Impact on health and well-being to perform work or daily activities

Not calculated in 2008

1.58%

1.57%

Bottom 4 Ranking Scores

Service improvements following staff or patient surveys or comments and Care Quality Commission reports Following the review of the annual staff and patient surveys and the â&#x20AC;&#x2DC;real timeâ&#x20AC;&#x2122; patient surveys a number of improvements have been made: Staff Training and development x Improved training for managers on HR and health and safety x Wellbeing at work training for line managers x Personal development review drop in sessions. Staff Support x Provision of holistic therapies including massage and reflexology treatments x Stress awareness day. Bullying and Harassment x The establishment of a Bullying and Harassment Support team x Training for investigators x Training of mediators. 21 22

Patient x Implementation of a pilot ‘opt out’ copying clinical letters project x Improved enforcement of parking in disabled bays x Each department has an action plan to reduce waiting times within the department. x Provision of free tea and coffee for patients waiting for radiotherapy.

Improvements in patient/carer information Throughout 2009/10 we have continued the programme of review of our patient information in order to improve the design and accessibility of information to patients, carers and their families. All of the Trusts core patient information leaflets have been reviewed in conjunction with our Patient Council and are now available to all patients in the new design. Improved governance processes around document control have been put into place. In addition further work has been done to our website ensuring patients and carers have access to appropriate information included Board assurance statements on the quality of its services. During 2009/10 we also started to publish the results of our internal ‘real time’ survey on the public website.

Complaints handling The Trust continues to have a low number of complaints (11 in 2009/10). Complaints are managed by our Patient Experience Manager who provides an integrated complaints, PALs and patient and public involvement service and who forms part of our Clinical Governance Support Team. All complaints are reviewed and responded to by the Chief Executive. Information on complaints and lessons learned are shared with all staff via our Team Brief and information provided to the public via annual clinical governance road shows held in public areas of the Trust. The Council of Governors Patient Experience Committee receives complaints/Pals quarterly reports.

Summary of Complaints 2009/10 Total complaints Received

Subject matter of complaint: Treatment & Care Communication Staff attitude Discharge

5 2 3 1

All complaints are fully investigated and responded to within required timescales.

22 23

Partnerships and alliances In addition to the partnership working with regard to the development of our new satellite radiotherapy centre, further developments in our chemotherapy service and the establishment of a Teenage and Young Adult Unit, the Trust continues to work with partners to develop cancer services. During 2009/10 this has included: Proton Therapy Bid The Trust has joined with Alder Hey Childrenâ&#x20AC;&#x2122;s NHS Foundation Trust and others to bid to the Department of Health to be a national centre for the provision of Proton Therapy services. The key deliverables for providers are: x . x

To implement a facility which will provide services by 2015

To provide services which are fully integrated into the clinical pathways for the management of specific tumours

To specifically provide fully integrated services for Children and Younger Adults.

To contribute to the delivery of a minimum of 1500 adult and paediatric patient treatments per annum

The bid was submitted on 12th March, 2010 and is currently being evaluated for short listing. Following evaluation, a decision will be taken by the Department of Health and the successful organisations requested to develop an outline business case and formally approach the supplier market to prepare detailed costed plans. If successful for short listing, Boards of both organisations will need to decide how they take the bid forward and the legal nature of the venture. Academic Unit of Oncology We continue to work in partnership with Liverpool University to develop an Academic Unit of Oncology and Associated research developments. Sustainability / climate change The importance of Sustainability reporting Sustainability is a national requirement and makes both national and local sense for a number of reasons - financial and non financial: x x

There is a national target to reduce Carbon emissions by 80% by 2050 compared with 1990 levels Some evidence exists that climate change is resulting in increased carbon emissions which is then resulting in the destabilisation of the worldâ&#x20AC;&#x2122;s climate, so reduction in energy which results in carbon emissions is saving the planet as well as potentially reducing costs 23 24

x x x x

There are potential health benefits in that a reduction in carbon emissions through a reduction in levels of active travel will result in lower road traffic accidents and improved air quality Improved energy efficiency has the potential to reduce fluctuation in price and availability of fuels derived from and which produce carbon The NHS is a large organisation and should be at the forefront of these types of initiatives The NHS should set examples to not only partner organisations and the population but be the public sector exemplar, demonstrating that healthy people depend on a healthy environment.

Monitoring what organisations do in relation to how they utilise precious energy resource will ultimately increase awareness of the production of carbon and through targeted measures ensures improvement in sustainability. Plans for Sustainability CCO is developing a Carbon Reduction Strategy which will set out the organisations plans on how to tackle Sustainability over the period required by the Government. There are 10 key areas for improvement. The following is a summary of some of the initial proposals that CCO will consider taking forward, in the context of the type of services it provides (Radiotherapy is a high user of energy, significantly so in comparison to other â&#x20AC;&#x2DC;usualâ&#x20AC;&#x2122; services provided in most hospitals which require normal amounts of energy for which to run services such as wards, operating theatres, radiology, pathology, offices, etc) plus the fact that CCO is on a shared site with multiple partners makes it more complex and increasingly important to ensure partnership working; which has begun): Item

Current Situation

Proposals for improvement

Energy and Carbon Management

Display Energy Certificate in place

New Satellite Centre will have similar Display Energy Certificate in place

Carbon Reduction Committee input into Electricity purchasing

CCO will utilise this in future

Continual replacement of high frequency lighting through upgrade or replacement scheme

Ongoing

All new build CCO commissioned building will include achievement of BREEAM Plan already in place to work in partnership with site relevant partners and wider community to achieve energy and carbon usage reduction; group formed Initiation of energy audits

24 25

Item

Current Situation

Proposals for improvement

Energy and Carbon Management (contâ&#x20AC;Ś.)

Procurement and Food

Travel and Transport

Raise awareness of staff through a programme of awareness; switching off lights, computers, printers, etc, in order to save energy

Currently no embedded carbon improvement measures within any of the CCO contracts

CCO is currently on a site that is placed in a fairly rural location and poorly served by public transport. The centre is also a regional centre and patients travel large distances. As many patients are treated as close to home as possible for Chemotherapy; this is not possible for Radiotherapy currently

Plan to investigate use of alternative renewable energy sources such as solar and wind Plans to review and implement appropriate carbon reduction measures into SLAs with provider organisations; goods, supplies, clinical services, etc. Identification of carbon efficiencies in Capital schemes Plan to work with WUTH to develop a whole systems approach to transport

The new Satellite Radiotherapy Centre North Mersey will significantly reduce travel times for 2/3rds of CCO patients requiring Radiotherapy treatment Development of a travel plan for staff Development of alternative methods of working for some groups of staff where appropriate, such as working from home, wider use of teleconferencing

Water

Currently no water developments other than metered usage

Options for Travel Choice Schemes

Automatic cut off taps in some areas through ward upgrades

Ongoing through upgrades

Plan for replacement of bottled water with filtered tap supplies

Plan to be finalised Review of potential for access to the bore hole at CCO Review of Rain harnessing in new buildings Review of implementation of leak detection monitoring

25 26

Item

Current Situation

Proposals for improvement

Waste

Waste audits currently in place Further review of waste segregation to take place

Designing the built environment

Organisation and workforce development

CCO currently is undertaking a major ward refurbishment programme with energy saving initiatives being introduced as appropriate

Further options for waste recycling to be undertaken through service contracts Ongoing, to be included in all refurbishments or upgrades

The new Radiotherapy Satellite centre will achieve excellence for BREEAM

Adoption of BREEAM for all new future builds

CCO has adopted a number of schemes over previous years with some limited advancements being made; this is a good basis on which to move forward

Further encouragement of staff to embrace â&#x20AC;&#x2DC;green issuesâ&#x20AC;&#x2122; through introduction and adoption of Organisational Development Plan Further adoption of Travel Plans for both Clatterbridge and North Mersey Sites Potential further investment of appropriate technology to facilitate different ways of working

Partnerships and networks

CCO has commenced discussions with WUTH and other organisations on the Clatterbridge site to review and implement energy and procurement strategies in order to improve sustainability

Ongoing with key deliverables expected

Governance

The Estates Steering Group has been tasked with producing and implementing, following board approval, the outcomes of the Carbon Reduction Strategy. Monitoring of progress will take place via the Estates Steering group, which has Executive membership. Performance and issues will be escalated through Executive Management Team to Board for significant decision making requirements.

Future requirements following Board Approval of the Carbon Reduction Strategy will be:

26 27

x Enhancement of the Board Sustainability Board Champion role x Progress monitoring against the Sustainability Development Management Plan to Board incl. appropriate Key Performance Indicators

Item

Current Situation

Proposals for improvement

Finance

There is currently financial support to ensure appropriate reviews mechanisms are able to evaluate and support the Carbon Reduction Strategy

Initial discussions regarding reviews have been undertaken and supported financially as part of the Estates Strategy, discussions with the Carbon Trust and Radiotherapy Satellite Business Case (as examples) and this approach will continue having proved successful already.

All refurbishments, upgrade and new builds taken into consideration any additional funding requirements to include potential impacts from sustainability

Further use will be made of BREEAM, external contracts, Service Level Agreements, Service budgets and Travel Plans for the future.

Governance NHS Foundation Trust Code of Governance The Monitor Foundation Trust Code of Governance includes a code provision (C.2.1 “….All [other] Executive Directors should be appointed by a committee of the Chief Executive, the Chairman and Non-Executive Directors and subject to re-appointment at intervals of no more than five years). The Board considered this code provision at its meeting in March 2007 and was informed that with an employment contract of any type, there is only one way to terminate without incurring a financial penalty and that is by following due process, i.e. clear and documented performance management. The financial penalty associated with ending a rolling contract could be significantly higher than a standard contract. The Board therefore agreed that it would not comply with this code provision. All other requirements of the Code of Governance have been met in full. Council of Governors Working together with the Board During the last year our Board of Directors and Governors have worked together in a number of ways to ensure that the Governors’ views are understood and that they receive appropriate support. The Chief Executive prepares a report with updates on performance, strategic and operational issues for each of the Council of Governors meetings. Both Executive Directors and Non-Executive Directors attend the Council of Governors’ meetings and its committees. In addition to attendance at these meetings, the Board uses opportunities to work with the Governors, as it did at a joint ‘away day’ held on 26th March which focused on the strategic development of the organisation.

In January 2010 the Senior Governor was invited to attend Trust Board meetings to ensure transparency between the Trust Board and Council of Governors. To supplement the attendance of the Chair of Audit Committee at the Council meetings, the Trust implemented the attendance of a ‘public’ governor at the Audit Committee. This ensures that any matters identified are considered and where any action or improvement is needed. The Council of Governors have the responsibility to hold the Board of Directors to account for the performance of the Trust, to ensure this happens a ‘public’ governor has been invited to attend the Integrated Governance Committee. This gives the Council the opportunity to receive detailed information on a selection of key performance indicators and the Trusts approach to key areas. The Senior Governor and Chair’s of the Council of Governors Committees have met with the Chairman throughout the year to ensure Governors are kept up to date on any developments within the Trust. Council of Governors’ roles and responsibilities and working arrangements The Governors are elected as part of an independent process managed by Electoral Reform Services, in line with the Trust constitution. The Council of Governors meets at least 3 times per year in public and fulfils its legal obligations as outlined in the constitution. In addition to Council meetings, there are three Committees – Membership, Communications and Fundraising, Patient Experience and Strategy. The Council of Governors has approved its standing orders which includes the development of its sub committees. Each of these committees has identified an Executive and a NonExecutive Director for advice purposes. In addition the Director of Nursing & Quality has a specific role in supporting and working with the Council of Governors playing a key role in developing links between the Board committees and the Council of Governors ensuring that key strategic themes are being addressed. During this financial year the Auditors were not requested to provide any non-audit services. Composition of the Council of Governors The Council is made up of 28 Governors, public, staff and nominated organisations, serving a fixed three year term of office. Liverpool Sefton St Helens & Knowsley Warrington & Halton Chester, Ellesmere Port & Vale Royal Wirral, Wales and the rest of England Staff governors Nominated organisations Total:

3 2 2 2 2 4 6 7 28

28 29

Governors Name

Elected public Elected staff Nominated

Representing

Member of Committee See key

Year Terms ends

Michael Ashley Trevor Benn

Elected public Elected public

4 4

Peter Benson Andrea Chambers MichĂ¨le Christopherson Stuart Clutton Alan Comyns

Elected staff

Kerry Connon Nicola Cook

Elected public Nominated

Warrington & Halton Wirral, Wales and the rest of England Non Staff Manx Cancer Help Association Sefton Warrington & Halton Chester, Ellesmere Port & Vale Royal Sefton Macmillan Cancer Support

3 3

ST PE (Chair)

2010 2011

4 4 4 4 4

4 1 3 3 3

PE ST PE MCF MCF

2011 2012 2012 2011 2011

4 4

2 2

2010 2012

Liverpool Liverpool

1 4

Elected staff Elected staff

Aintree University Hospitals NHS Foundation Trust Doctor Non Clinical

ST ST (Chair), N&R MCF ST, MCF (Chair), N&R

Reg Cox (until Sept 09) Mary Doddridge

Elected public Elected public

John Earis (until Sept 09) Doug Errington Deborah Ferns (until Mar 10) Cathy Gritzner (from Sept 09) Tom Fisher

Nominated

4 4

4 3

PE, ST, N&R MCF

2010 2011

Nominated

Wirral PCT

2012

Elected public

Wirral, Wales and the rest of England St Helens & Knowsley Other Clinical Cheshire & Merseyside Cancer Network Task Force Liverpool

PE, N&R

2011

Denys Floyd Philip Mayles Ray Murphy

Elected public Elected staff Nominated

4 4 4

4 3 2

MCF ST, MCF ST

2011 2010 2012

Ernie Natrass (until June 09) *Gill Oliver

Elected public

MCF

2010

Chester, Ellesmere Port and Vale Royal Radiographer

MCF

2012

Kate Perkins (until Sept 09) Cherry Povall Susan Ramsay

Elected staff

2009

Metropolitan Borough of Wirral Wirral, Wales and the rest of England Nurse

4 4

1 3

2011 2010

Kate Smith

Elected staff

Richard Sturgess (from Sept 09) Yvonne Tsao (from Sept 09) Margaret Warriner Alistair Watson (until Jan 10) Ewan Wilkinson (until Sept 09) Eleanor Williams (until Jan 10)

Nominated

Elected public

Aintree University Hospitals NHS Foundation Trust Liverpool

Elected public Nominated

St Helens & Knowsley University of Liverpool

Nominated Elected public

Elected public Elected public Elected public

Elected public

Nominated Elected public

*Senior Governor PE Patient Experience ST Strategy

Meetings held

Meetings attended

2009 2010 2009

PE (Chair until Sept 09)

2012

4 2

4 1

PE, MCF

2010 2012

Liverpool PCT

ST (Chair)

2009

Wirral, Wales and the rest of England

2011

MCF N&R

2012

Membership, Communication & Fundraising Nomination & Remuneration

We would like to express our thanks to former public Governors Reg Cox and Eleanor Williams, staff Governors Deborah Ferns, Kate Perkins and former nominated Governors John Earis, Ewan Wilkinson and Alistair Watson. Each served as a Governor during 2009/10 for a period of time, but they have since resigned from their roles, not been re-elected or reappointed. We would like to offer our sympathies to the family of former Governor Ernie Natrass, who sadly passed away in August 2009. 29 30

Elections An election process was completed in August 2009 and the outcomes were announced at the Annual Members Meeting on 24th September 2009. Declaration of Interests A copy of the Register of Interests is available via the Trust website www.ccotrust.nhs.uk, alternatively you can contact Andrea Leather on 0151 482 7799 to request a copy.

Board of Directors Board of Directors – Composition, backgrounds and interests Non Executive members of the Board including the Chairman are appointed (and removed) by the Council of Governors at a General Meeting, as outlined in the constitution. The Nomination / Appointment Committee for the Non Executive Directors is made up of the Chairman (or the Vice Chairman if the Chairman is standing for re-appointment) and at lease three elected Governors. This Nomination Panel is responsible for appointing Non Executive Directors by identifying appropriate candidates through a process of open competition, which takes account of the policy maintained by the Council of Governors and the skills and experience required. The Nominations Committee followed the re-appointment process described in the Trust’s constitution for the re-appointment of Alan White and Carol Eastwood in October 2009. These re-appointments were approved by the Council of Governors at its meeting in October 2009. The Senior Independent Director – Douglas Buchanan was appointed as such on 5th April 2006. The Board annually reviews the independence of directors and at it’s meeting in March 2010 reviewed all Non Executive Directors and considers them all to be Independent Directors. Alan White – Chairman Re-appointed by the Council of Governors (3rd term of office, 3 years) until July 2013. Alan was appointed as Chairman in 1999. Alan retired from Local Government following 10 years as Chief Executive of Wirral Metropolitan Council, the eighth largest organisation of its type in England, employing over 17,000 staff and with an operational budget of £360m, the chief executive role was both challenging and high profile. He led a successful bid for ‘City Challenge’ status as an inner city re-generation initiative developed by the then Secretary of State, Michael Heseltine. The initiative depended on the development of new partnerships between Wirral MBC and major business corporations, which included Lever Bros, General Motors and Mobil Oil. As Chair of the ‘City Lands Board’, the organisation established to lead the implementation, Alan led a 5-year programme of investment, which generated £37m of public sector and some £285m of private sector investment. 30

Andrew Cannell – Chief Executive (from 19th October 2009) (Deputy Chief Executive / Director of Finance until 7th June, Acting Chief Executive 8th June – 18th October 2009) Andrew was appointed as Chief Executive in October 2009. Prior to that he had occupied the role of Director of Finance since July 2003 and the Deputy Chief Executive role from February 2008. He is an IPFA qualified accountant who has worked almost exclusively in the NHS since 1983. Before joining the Trust he worked in a senior role as a “Link Accountant” at the North West Regional Office and Greater Manchester SHA. Prior to that he worked for a number of years as Deputy Director of Finance and then Acting Director of Finance at the Manchester Children’s Hospital NHS Trust. Dr David Husband – Medical Director David has been Medical Director since 2000. Following a degree in Biochemistry, he trained in medicine at the University of Leeds. Post-graduate training in general internal medicine and endocrinology and diabetes followed in Leeds and Newcastle. David came to Clatterbridge to train in Clinical Oncology in 1985 and was appointed Consultant in Clinical Oncology in 1992. He has served on the Board in various capacities since 1996, having been Clinical Director of Radiotherapy from 1996-2001 and Medical Director since December 2000. He continues to work as a clinician with interests in head and neck oncology and neuro oncology and attends clinics with clinicians from Wirral Hospital, the Countess of Chester, Royal Liverpool University Hospital, Walton Neurology and Neurosurgery, University Hospitals Aintree, and St Helens and Knowsley Trusts. During a varied career David has worked in some 20 Hospitals. Silas Nicholls – Director of Operations & Performance Silas is an experienced general manager with fifteen years of experience in a range of health care management posts both in the NHS and in the private sector. Silas joined the Trust in February 2008 from Bolton Hospitals NHS Trust where he was the Divisional General Manager for Surgery & Anaesthesia. Helen Porter – Director of Nursing & Quality Helen has been a cancer nurse for over 25 years. She has worked within 4 cancer centres holding a variety of clinical and non-clinical posts. She has played a role in the national and international cancer nursing agenda through being on the committees of the RCN Cancer Nursing society; RCN Haematology Society and the International Society of Nurses in Cancer Care. She has been at the Trust since August 2000 joining as Director of Nursing. Four of these years were also spent as the Lead Cancer Nurse for the Merseyside and Cheshire Cancer Network. Douglas Buchanan – Vice Chairman, Senior Independent Director Re-appointed by the Council of Governors (3rd term of office, 3 years) until January 2011. Douglas has been a Non-Executive Director since 1995 and was appointed as Vice Chairman in April 2004. He is a retired surgeon whose medical career started in Edinburgh in 1966. He enjoyed a successful 11 years working as a surgeon for the mining industry in Zambia and latterly as their Chief Medical Officer. On return to the UK in 1986, Douglas joined the British Council where in 1990 he was appointed to the post of Director of the 31

Health Work of the Council. During his work at the British Council, Douglas visited 35 countries working with health professionals up to ministerial level. In 1996 he organised a seminar on the UK NHS reforms held at the World Bank in Washington. The UK team included Sir Alan Langlands, the CEO of the NHS and Sir Nigel Crisp, and then CEO of the Oxford Radcliffe Hospital. Carol Eastwood Appointed by the Council of Governors (2nd term of office, 3 years) until January 2013. In September 2007 Carol retired as a Vice President in Corporate Information Services in Astra Zeneca, one of the worlds leading pharmaceutical companies. She joined ICI from university as a research scientist and was appointed as Chief Analyst for Zeneca Specialities in 1995. Carol has been a member of many different external committees, including European Research programmes, Information Governance in the Pharmaceutical industry and Regulatory Compliance. She was appointed Non-Executive Director February 2007. Louise Martin Re-appointed by the Council of Governors (2nd term of office, 3 years) until November 2010. Louise was appointed as a Non-Executive Director at the Trust in April 2001. She has worked within the UK National Health Service for 15 years in a number of clinical and managerial posts. In 1998 Louise left the NHS to head the project company managing the delivery of a major first-wave PFI scheme at South Manchester University Hospitals NHS Trust. Louise now works for Health Care Projects Ltd, a subsidiary of ‘Innisfree’ the Infrastructure Investment Company, where she acts as Project Director. Graham Morris Re-appointed by the Council of Governors (2nd term of office, 3 years) until November 2012. Graham became a Non-Executive Director in December 2005. He is a qualified accountant (FCCA) and worked for 33 years in the electricity industry. During that time Graham gained extensive experience of finance, regulation and corporate strategy, heading up the finance function of SP Manweb plc following Scottish Power’s take-over. During this period he also worked in America, working on the merger of PacifiCorp, an American subsidiary acquired by Scottish Power in 1999. Following his return from America, Graham helped set up a joint venture company Selectusonline Ltd – a procurement consultancy that can harmonise specifications and aggregate volumes within the utilities sector. Graham is currently Director of Finance and Information Governance for Urgent Care 24 Ltd, a not-for-profit social enterprise, committed to carrying on business in relation to health and well-being for the benefit of the community. Vicky Tagart Re-appointed by the Council of Governors (2nd term of office, 3 years) until November 2010. With a background in biological research, she has held senior HR positions in both the pharmaceutical and chemical industries. Prior to her appointment at the Trust she was a lay chair for the NHS complaints procedure and was appointed as a Non Executive Director in December 2000. She is a trained advisor for Citizens Advice and specialises in advising on employment issues. 32 33

Yvonne Bottomley – Director of Finance (from 8th March 2010) Yvonne commenced her career in finance in local government, qualifying as an accountant in 1989. After qualifying she held a number of senior positions in local government including Director of Corporate Services. Yvonne moved sectors to the NHS in 2010 and was appointed as Director of Finance at Clatterbridge Centre for Oncology. She is also a governor and Chair of the Finance Committee at Priestly College in Warrington. John Andrews – Acting Director of Finance (8th June 2009 to 7th March 2010) John has worked within the Trust’s Finance department at a senior level since 1995. He is an IPFA qualified accountant who has spent his entire career to date in the NHS. His substantive role is as Deputy Director of Finance, but he covered the role of acting Director of Finance for 9 months. Dawn Jennings – Director of Human Resources (non voting) Dawn joined the Trust in December 2005. She is a Fellow of the Chartered Institute of Personnel & Development and has held a variety of Human Resources (HR) posts in both the public and private sector. Immediately prior to taking up this post, Dawn was Associate Director of HR at the Christie Hospital in Manchester. Prior to her NHS experience, Dawn worked within various business areas of the Automobile Association, including Insurance and Retail, and served six years with the Royal Air Force. Darren Hurrell – Chief Executive (until 2nd August 2009) Darren was appointed as Chief Executive in July 2007. He started his career in the NHS in 1990, prior to this he worked for Newcastle University as well as spending some time living in Canada. He has undertaken a number of managerial posts in the NHS including gaining experience in managing mental health services, community services, acute care and specialist cancer care. He took up the post of Chief Executive in July 2007.

Declaration of Interests The Chairman has no other significant commitments. A copy of the Register of Interests is available via the Trust website www.ccotrust.nhs.uk, alternatively you can contact Andrea Leather on 0151 482 7799 to request a copy. Board & Committee meetings Appropriate Board Roles and Structure The Trusts Board and Committee structure has been developed around the Integrated Governance Model defined in the Integrated Governance Handbook 2005. During 2009 it was concluded that two of the previous ‘task and finish’ committees; Vision 2020 and Human Resources had in the main fulfilled and met their purpose therefore there was no longer a requirement for the Committees to continue. Any outstanding areas of work have been transferred to other Committees for ongoing monitoring. 33 34

It is good corporate governance to have regular reviews of the Committee structure to ensure that the organisation has in place appropriate structures to enable it to fulfil its purpose and the effectiveness of the Trust’s system of internal control. In January 2010 the Board approved a revised committee structure as follows: x x x x x x

Monthly Board meetings, except August (all meetings are closed to the public) Audit Committee (5 times per year) Integrated Governance Committee (bi-monthly) Remuneration Committee (Ad hoc) Nominations Committee (Ad hoc) ‘Task and Finish’ Committees: q Information Management & Technology (IM&T – quarterly) q Research & Development (at least 2 per year).

The Board delegates specific functions to its committees identified within their terms of reference. The terms of reference of all Board committees are reviewed regularly as part of the annual review of the Constitution and Corporate Governance Manual (standing orders and standing financial instructions) and updated to reflect changes in the operating environment and best practice. Throughout 2009/10 the Board embedded a system whereby there is a review of each Board meeting focusing on the content and performance of the Board agenda and the discussions and challenge. Performance evaluation of the Chair is undertaken by the Vice Chair/Senior Independent Director who then reviews the results with the nominations committee of the Council of Governors. The Chair undertakes the performance evaluations of the non-executive directors. In addition, to enable Governors to observe the performance of the NEDS, the NEDs attend the Council of Governors meetings and during 2009/10 the Trust Board has invited Governors to attend the Trust Board and the Audit Committee. It is the responsibility of the Chief Executive to review the performance of the executive directors. Board Development Following the learning Review carried out in 2008/09 this year has seen the implementation of the resulting Board development programme. This has been developed to reflect the needs of the directors and to respond to the changes in the national context. This is demonstrated by one Board development session concentrating on the national quality agenda and the Boards responsibility in relation to quality. In light of the above, the Trust considers that it operates a balanced and unified Board with particular emphasis on achieving an appropriate balance of skills and experience. This is reviewed as part of the Board development programme, as well as whenever a vacancy arises.

34 35

Audit Committee The Audit Committee â&#x20AC;&#x201C; chaired by Graham Morris - provides the central means by which the Trust Board ensures effective internal control arrangements are in place. In addition, the Audit Committee provides a form of independent check upon the executive arm of the Board. During this year the Audit Committee undertook the following pieces of work to ensure the effective discharge of its responsibilities: x x x x x x x

Committee review of the financial statements Setting and reviewing progress of the annual internal audit plan using a risk-focused approach, linked to the controls assurance framework Receiving regular reports from both Internal Audit and External Auditors Agreeing and reviewing the work of the Trustâ&#x20AC;&#x2122;s counter fraud officer Undertaking a self assessment of its work and effectiveness, and identifying any training needs Reviewing and updating its terms of reference Approving bad debt write offs and contract extensions.

Integrated Governance Committee The role of the Integrated Governance Committee is: x To provide strategic oversight to all areas of governance within the Trust, by giving carefully consideration to the Clinical, Organisational and Performance arrangements in place x To ensure organisation-wide co-ordination and prioritisation of risk management issues, encouraging and fostering a greater awareness and ownership of Objectives, Risks and Controls x To oversee on behalf of the Boards, the management of healthcare and organisational risk. During this year the Integrated Governance Committee delivered against its terms of reference in particular focusing on: x

x x x x x x x

Maintaining an overview of the strategies within its remit (e.g. Clinical Governance, Risk Management, Patient and Public Involvement, Infection Control) ensuring structures and systems are in place to ensure effective governance and to receive performance reports related to these strategies Implementing and monitoring the Trusts integrated Governance development plan Ensuring compliance with Standards for Better Health Receiving assurance that the Trust meets all relevant statutory and regulatory obligations Receiving assurance of the adequacy of systems for quality assurance, managing risk and control of the environment Ensuring that the Trust has an effective corporate risk register Keeping the Board fully informed of all significant risks which may impact on the Trusts strategic direction and business planning process and to report to the Board on the management of significant risks Ensuring that the Trust has structures, processes and controls in place to assure and demonstrate the continued quality of its services and to monitor their performance. 35 36

Remuneration Committee The Remuneration Committee consists of the Chairman and other Non-Executive Directors and decides the terms and conditions of office including the remuneration and allowances of all the Directors, including pension rights and any compensation payments. The Committee is chaired by the Chairman and has met on 5 occasions, see above table. Nomination Committee The Nomination / Appointment Committee for a Chief Executive is made up of the Non Executive Directors, chaired by the Chairman. The appointment is subject to the approval of a majority of the members of the Council of Governors present and voting at a general meeting. The Nomination / Appointment Committee for the Directors is made up of a committee consisting of the Chairman, the Chief Executive and the other Non Executive Directors. During 2009/10 the Board was required to appoint a new Chief Executive and an Executive Director (Finance). The process for both appointments was: Chief Executive Formal Interviews – 29th September 2009 Approved by the Council of Governors – 19th October 2009 The interview panel consisted of Alan White (Chairman), Douglas Buchanan, Graham Morris, external representative Kathryn Thomson, Chief Executive, Liverpool Women’s NHS Foundation Trust. Also in attendance were representatives from the Council of Governors: Gill Oliver, Senior Governor, Tom Fisher, Public Governor and Douglas Errington, Staff Governor. Executive Director (Finance) Formal Interviews – 8th February 2010 Reported to the Council of Governors – 15th March 2010 The interview panel consisted of Alan White (Chairman), Graham Morris, Andrew Cannell and external representative Paul Havey, Director of Finance, Lancashire Teaching Hospitals NHS Foundation Trust. Also in attendance was Simon Potts, Gatenby Sanderson (Recruitment & Search Consultants) This process for both appointments followed the recruitment process outlined in the Trust’s constitution. Attendance at Board of Directors and Board Committee meetings For the period 1st April 2009 to 31st March 2010 the Board of Directors held 11 Trust Board meetings which are non public.

36 37

Board of Directors

Audit

Integrated Governance

Remuneration Committee

IM&T*

R&D*

Vision 2020

Reputation Management

No. of meetings held for 2009/10

Andrew Cannell Helen Porter Silas Nicholls David Husband Yvonne Bottomley Dawn Jennings (non voting) Darren Hurrell John Andrews

Alan White Louise Martin Vicky Tagart Douglas Buchanan Carol Eastwood Graham Morris

11 8

NON EXECUTIVE DIRECTORS 5 2 4 -

NB.

EXECUTIVE DIRECTORS

1/1

Investment Committee

0 2/2

1 1 -

0/1 -

1 0

All meetings were quorate.

* IM&T – Information Management & Technology R&D – Research & Development

Membership Membership is open to any individual who is over the age of 16, is entitled under the constitution to be a member of one of the public constituencies or the staff constituencies, and has completed the relevant application form. Our staff membership operates on an ‘opt out’ basis. As with staff all volunteers (with service longer than 12 months) are automatically members unless they choose to ‘opt out’. The term ‘staff’ includes third party service providers to the hospital eg domestics and porters. If members wish to contact their individual Governor or a Director they can do so by contacting Andrea Leather, Corporate Governance Manager on 0151 482 7799 or email andrea.leather@ccotrust.nhs.uk or governor@ccotrust.nhs.uk There is a ‘members only’ section available on the CCO website. 37

Public Constituency Staff Constituency Doctor Nurse Non clinical Other clinical professional Radiographer Non staff Public Constituencies Wirral, Wales and rest of England Liverpool Sefton Warrington and Halton St Helens and Knowsley Chester, Ellesmere Port and Vale Royal

2009/10 (plan)*

2008/10 (actual)

20010/11 (estimated)

48 156 225 120

48 157 280 146

54 170 283 148

137 172

139 114

140 114

1679

1743

830 1105 563 668 632

825 1256 560 679 608

Increase of 208 across all constituencies

Staff constituency members as of March 31, 2010 totalling 884 Public constituency members as of March 31, 2010 totalling 5671

* The Trust set a target within its Annual Plan 2009/10 to focus the recruitment of new members on those under the age of 50 whilst maintaining the public membership with no fewer than 5,500. As outlined in the table above, the number of public members has continued to grow with 493 new members joining the Trust. A large proportion of our members come from our patient population. The number of public members identified as ‘leaving’ is predominantly due to members dying (69 out of 299) rather than opting to stop being a member. This is a significant improvement on previous years. The majority of the remaining 230 have been picked up as being members who have moved home without notifying the Trust. Membership strategy The Membership, Communications and Fundraising committee is responsible for reviewing and implementing the Membership Strategy. Within the review of the strategy, the Committee will ensure it encompasses any new guidance contained within the Monitor Code of Governance. Public Interest Disclosures The Trust has in place a full range of HR policies to support staff and advise managers. The Trust engages in formal and informal consultation with staff to ensure a partnership approach is in place. Formal consultation primarily occurs via the Trust’s JCNF (Joint Consultative and Negotiating Forum) and the LNC (Local Negotiating Forum). Start of Year Events are held with the Chief Executive and Executive Directors to address staff directly when any service changes are proposed (e.g. our plans for a satellite radiotherapy development). In addition the Trust Board engages staff through the Patient Safety Campaign leadership rounds where 38

Executive and Non Executive Directors visit all departments on a rotational basis. Staff are informed about policy changes via the monthly Team Brief which is cascaded throughout the organisation. The Trust has developed an intranet with input from staff across the organisation and give staff access to a variety of information eg rumour board, policies and corporate documents, communications, human resources and learning development. During 2009/10 the Trust did not engage in any public consultations. At present the Trust is considering changing its name and is planning to go out to public consultation primarily with its members and key stakeholders on this proposal during 2010/11. Patient and Public Involvement Activity During 2009/10 the Trust has continued to engage with patients and stakeholders to further develop its services. Activities have included: x

The Trust circulated a copy of its Annual Plan for 2009/10 to all Overview and Scrutiny Committees (OSC’s)

The Trust continues to engage widely with regards to the Satellite Radiotherapy Centre, a recent example is a survey to decide the names of the treatment machines

The Trust has recently held a Patient experience ‘away day’. The information gathered will help us produce a robust Patient and Carer Experience Strategy incorporating the Patient and Public Involvement (PPI) Strategy

The Patient’s council has continued to assist us with: q Local surveys q Lay reading of new documentation q Engaging with current patients q Staff interviews

Since June 2007 the Trust has given every patient completing a course of treatment at the centre a patient experience feedback from to ensure that the Trust has ‘real time’ information about the patient’s experience which it can act upon. This has proved an effective method of monitoring our services and consolidating good work that goes on all around the Centre. Results are available on the Trust website. The views and experiences of people who use our services have influenced our service priorities and plans through a number of mechanisms. These include: x Our Patient and Public Involvement Strategy x Our Governors and members as a Foundation Trust x Patient and carer involvement in specific projects x Responding to complaints and praise. Specific examples of these include: x A major project for CCO is the building of a satellite radiotherapy centre in Liverpool. The prime driver for this initiative is responding to the experiences of our current patients and the length of time that it takes many of them to come to the centre for their daily radiotherapy treatment. In addition we have undertaken a number of PPI 39 40

projects to inform the development and have Governor involvement in the steering and sub groups The Trust works in partnership with its Council of Governors to develop its annual service plans which form the Trusts corporate objectives. Governors have the opportunity to suggest plans and priorities and form an integral part of the approval process for the plans.

Specific examples where patient experience has informed change includes: x The roll out of satellite chemotherapy clinics to reduce travel times for patients x Changes to the Trusts visiting times x Implementation of free tea and coffee for patients waiting for radiotherapy x Redesign of the car park to ensure dedicated free parking for patients and their carers x A privacy and Dignity survey in diagnostic imaging led to changes being made to the patient environment. CCOs stated core purpose is ‘Providing excellent care to people with cancer’. To achieve this we must provide care that is excellent in the view of the patients and carers that use our services. We aim to continue to increase patient and public involvement in the planning and delivery of our services. This is being done in the following ways: x Further development of our PPI strategy x Strong engagement with our Governors in developing our forward plans x Strengthened links with LINKS x Asking all patients who complete an episode of care to complete a ‘Patient feedback form’ which gives the Trust real time feedback. This information is also provided on our website x Engagement with our members directly and through our Governors x Wider stakeholder engagement including commissioner and cancer network involvement in our key projects such as our satellite radiotherapy centre x Engagement events with varied groups (Wirral deaf Society, South Sefton OSC, Clwyd patients council) Local Involvement Network (LINk) The Centre has established relationships with the local LINk groups, in particular Liverpool and Wirral and is looking forward to strengthening this relationship as the groups develop. Sickness Absence Data The Trust continues to drive robust working practices to support sickness absence management. Overall absence for 2009/10 increased slightly by 0.28% from our 2008/09 total figure with the top three reasons for absence being stress/anxiety, musclo-skeletal disorders and surgery. Yearly quarter

Trust performance 2009/10

Q1 (April – Jun) Q2 (July – Sept) Q3 (Oct – Dec) Q4 (Jan – Mar) Full Year

4.79% 3.40% 4.35% 5.16% 4.44%

40 41

Surgery

Respiratory

Stress/Anxiety

Psychological

Other

Pregnancy related

Not Known

Neurological

Musclo-skeletal

Influenza

Musclo-skeletal

Infections

Hypertension

Headache/Migraine

Genito-urinary

Gynaecological

Eyes

Gastro-intestinal

Ears, Nose and

Diarrhoea/Vomitting

Dental pain

Dermatological

Cold

Cold/Influenza

Cancer

0.008 0.007 0.006 0.005 0.004 0.003 0.002 0.001 0 Cardiac/Coronary

Cumulative Absence Rate %

Reasons For Absence 2009/10

Diagnosis

Pro-active engagement with our Occupational Health Provider ensures early diagnosis and support which enables us to support return to work as early as possible. Key changes to the traditional GP sick note system with the new â&#x20AC;&#x153;Fit for Workâ&#x20AC;? notes will no doubt reduce the current referral process further in some of our future cases. We are committed to seeking new holistic approaches towards some of our high priority areas such as stress and anxiety. The Trust already has a Stress Management Policy and provides an Employee Assistance Programme for all staff and members of their household. This is a professional, confidential assistance service for any type of personal problem. To build on this support we will work on the recommendations of the Boorman Review to seek further measures and new initiatives to support the health and wellbeing of our staff throughout 2010. We will also continue to monitor and benchmark our sickness absence data against internal and external sources, utilising national statistics from The NHS Information Centre and manipulating data from our ESR system, to produce accurate sickness management statistics to enable managers to work closely with HR Business Partners to identify trends and employ preventative measures accordingly. Occupational Health Several groups of staff have health assessments on a regular basis. This enables any problems or issues to be highlighted and dealt with swiftly to prevent long term adverse effects on their health. Dependent upon the outcome referrals may be required to occupational health department for further advice. By ensuring such referrals are made in a timely manner the member of staff is seen and advised appropriately. Occupational health holds regular clinics on site and any issues raised are dealt with promptly. Dependent upon the workstation assessments and recommendations following OH advice when reasonably practicable, equipment may be purchased to reduce any impact on the employee within the workplace.

Health and Safety We have a pro-active approach to health and Safety and acknowledge our duty under the appropriate legislation to safeguard patients, staff and visitors. All staff groups have access to our specialist team comprising of health and safety, moving and handling, fire and security .In addition, advice is available from radiation protection, infection control and occupational health. As part of our pro-active approach an annual environmental risk assessment is completed by all departments to identify any potential risks and put controls in place to prevent were possible any injuries or illness to patients, staff and visitors. To support staff with knowledge and information for health and safety, fire, security and manual handling annual training sessions are provided for all staff groups. There were 60 reported staff accidents in 2009/2010 which fell into the following categories manual handling, needle stick, slips, trips, falls and burns. Regular reports on all accidents, dangerous occurrences and ill health are presented at our bimonthly health and safety committee and action plans are implemented. Serious Untoward Incidents In December 2009 the Trust formally reported details of a Serious Untoward Incident (SUI) relating to data loss. The data loss was reported to Monitor and the Information Commissioners Office (ICO) after two paper diaries containing abbreviated patient data went missing from the Delamere Day Case Unit in October\November 2009. The diaries were not located but have been replaced with a secure, electronic system. Following an investigation into the incident, which included a review of the Trustâ&#x20AC;&#x2122;s information governance policies and training arrangements, the ICO concluded that the no further action was required.

Equality and Diversity Clatterbridge Centre for Oncology respects and values the diversity of our patients, relatives, carers, visitors and staff. We are committed to providing our services that are appropriate, accessible, fair and culturally sensitive. We recognise that discrimination is an obstruction to the aims of the Trust, and therefore ensure that we have the appropriate processes and policies in place to ensure equality and diversity is incorporated into all aspects of the Trust's work. We will ensure that all our staff are well trained in respect of equality, diversity and antidiscriminatory behaviour and operate a zero tolerance of discriminatory behaviour, including bullying and harassment. The driving force behind our approach to promoting Equality and Diversity is the membership of the Equality and Diversity Steering Group, which is chaired by the Director of Nursing and Quality and comprises representation from across the Trust. The main aims are to ensure that the Trust, in meeting its social objectives works towards creating an environment that is inclusive, celebrates diversity and which does not discriminate on the grounds of gender, race, nationality, socio-economic background, disability, age, faith, religion, belief or sexual orientation.

42 43

The Single Equality Scheme is approved by the Trust Board and is published, along with employment monitoring statistics and the result of our equality impact assessments on the Trust website. The Trust has: x

x x x x x x x x x x x

A published Single Equality Scheme and action plan which is monitored at our Integrated Governance Board Committee. The section relating to Disability is planned to be further developed in early June 2010. A workshop will be held with representatives from patients, carers and staff who have a disability, are affected by a disability, or have a genuine interest to lead on and inform the creation of our Disability Equality Scheme (as part of the Single Equality Scheme) and action plan, which will be monitored on an annual basis An embedded system of impact assessment for strategies, policies and key documents Ensures training and awareness on equality and diversity ‘from Board to ward’ Regularly reviewed its membership to ensure diversity amongst those it is accountable to Regularly monitored its workforce for equality and diversity Routine environmental assessments including disability access audits Provision of patient information literature in a variety of formats and languages where required An estates strategy that encompasses areas such as disability requirements and privacy and dignity Providing targeted health promotion activities to schools re: smoking cessation reflecting the health inequalities challenges in our population Health promotion activities 2 ticks accreditation Promotion of equality, diversity and human rights is integral to the Trusts stated values, in particular ‘putting people first’. A key driver for the Trust in how it delivers its services very much promotes equality and diversity, this is the provision of care and treatment as close to the patients home as possible. CCO provides its chemotherapy services in local DGHs which helps to ensure equality of access for minority and hard to reach groups. This model of treatment has been further expanded this year. We are currently embarking on a major capital programme to build a satellite radiotherapy centre in Liverpool. The main driver for this is equality of access and reduced travel times (and costs) for patients and carers The Trust participates in the Merseyside and Cheshire Cancer Network health inequalities workstream.

The Trust is committed to increasing the influence of equality, diversity and human rights issues on the planning and delivery of the services. Our approach to this includes: x x x x x x

Utilisation of the NHS North West Equality Performance Improvement Toolkit to ensure we adopt best practice examples Utilising the NHS National Cancer Equality Initiative Ensuring our revised PPI strategy has a strong approach to engagement with all patient groups Improving the monitoring of service users and members to ensure our services reflect the population that we serve and that we have no service inequalities Further engagement with minority groups Further community engagement through our Governors 43 44

We are working in partnership with Greenbank College on an Olympic Inspire Mark accredited project. This entails working with young adults with cancer who have disabilities enabling them to return to sport or vocational activities in a safe and supported manner. What we learn from this patient group will be rolled out to other age groups with similar disabilities.

Performance against these targets will be monitored by the Equality and Diversity Steering Group, and reported quarterly to the Integrated Governance Committee. Equality & Diversity data Staff

2008/09

Staff

2009/10

Membership

2008/09

Membership

2009/10

Age* 0-16

0.03

17-21

0.66

0.77

255

4.65

204

3.59

22+

707

99.24

766

4913

89.70

5122

90.31

White

680

95.37

739

95.42

4787

87.40

4973

87.69

Mixed

0.14

0.26

0.34

0.40

Asian or Asian British

1.96

1.41

0.43

0.49

Black or Black British

0.42

0.65

0.32

0.29

Other

2.10

2.31

0.21

Male

125

17.53

138

17.86

1715

31.31

1758

30.99

Female

588

82.47

637

82.14

3698

67.51

3818

67.32

2.52

2.93

Ethnicity**

Gender***

Trans-gender Recorded Disability

* Please note: For 2008/09, 309 public members have no age recorded and 343 for 2009/10 ** Please note: For 2008/09, 617 public members have no ethnicity recorded and 618 for 2009/10 ***Please note: For 2008/09, 64 public members have no gender recorded and 95 for 2009/10

Governance arrangements As described briefly above; since September 2009 CCO have set up a governance structure to ensure that sustainability becomes part of the core business of CCO. The structure involves the appropriate personnel being members of the Estates Steering Group. This group includes Executive membership with approval of its Estates Strategy at Board level. 44 45

Reporting is via Chair of the group to Executive Team and ultimately through to Board level for recommendation and approval of Estates and Sustainability issues as well as providing assurance for progress against all approved plans. High level strategy as well as detailed plans are also produced, reviewed and managed through the Senior Management and Departmental Heads with regards to operational ‘fit’ and achievement at grass roots level. Hence there is both a top down and bottom up approach to the management of Estates; the same will apply to sustainability in the future. Summary of Performance Area

Waste minimisation and management

- Absolute values for total amount of waste produced by the trust. - Methods of disposal (optional).

Finite Resources

- Water - Electricity - Gas - Other energy consumption.

NonFinancial data (applicable metric) 2008/09

NonFinancial data (applicable metric) 2009/20

169.28 Tonnes

Not yet available

Non Burn treatment Landfill Waste recovery / recycle 14,939 m3 13,443 GJ 16,631 GJ N/A

Non Burn treatment Landfill Waste recovery / recycle Not yet available

Financial data (£k)

2008/09

2009/10

Expenditure on waste disposal.

28,011

Not yet available

- Water - Electricity - Gas - Other energy consumption.

Total 527,162

Not yet available

Remuneration report The Remuneration report can be found at note 3.4 in the enclosed Trust Accounts for the period 1st April 2009 to 31st March 2010 Remuneration of senior managers See note 3.4 in the Annual Accounts Definition of “salary and allowances”/ Compensation for loss of office See note 3.4 in the Annual Accounts Other Remuneration See note 3.4 in the Annual Accounts Benefits in kind See note 4.3 in the Annual Accounts Golden hellos See note 3.4 in the Annual Accounts Pension disclosures See note 3.5 in the Annual Accounts

Statement of accounting officer’s responsibilities See page 78 Annual Accounts Statement of internal control See pages 82-88 Annual Accounts

2009/10

Quality Report

An introduction from the Chief Executive Quality is at the heart of what all our staff aims to achieve for all the patients in our care. It is thanks to the professionalism, expertise and commitment of our staff that we are able to provide a high quality service. We have clearly defined our Core Purpose as providing excellent care to people with cancer. Our Vision is to provide outstanding cancer care through excellence in treatment, research, education and training. Our values, developed with our staff demonstrate our commitment to how we work: x Passionate about what we do x Putting people first x Achieving excellence x Committed to our future x Always improving our care. This year has seen the Trust take forward the aims and objectives of its Quality Strategy. The Trust Board has ensured that Quality is a key agenda item at each Board meeting and it monitors the delivery of the Trustâ&#x20AC;&#x2122;s priorities and initiatives identified in its first Quality Report (2008/09). The Trust Board has reviewed the information that it receives in relation to patient experience and has implemented a process where patient stories are included within the Board reports to enable Board members to hear about the real experiences of our patients. The Board has developed the information that it receives in relation to complaints with full details of each complaint received reported to the Board, not just trends and data. From 2010/11 we plan to also provide this full information to our Council of Governors. Throughout this year we have worked with our staff and our key stakeholders to continue to improve the quality of our services. This year has seen a number of key developments and challenges for the Trust including: x

We are pleased to report that we have reported full compliance with our requirements for delivering same sex accommodation (DSSA). Privacy and dignity has been further enhanced by the first stage of our ward refurbishment program with a marked increase in single rooms

A new challenge for the Trust this year has been the implementation of CQUINS (Commissioning for Quality and Innovation). We have worked closely with our commissioners and the cancer network to ensure that the CQUIN for 2009/10 leads to a real improvement in quality for patients. Our CQUIN enabled the first stage of the development of the Acute Oncology programme recommended in the National Chemotherapy Advisory Group report and the NCEPOD report Systemic Anti-Cancer Therapy; for better, for worse

We have made good progress with the objectives outlined in our Quality Strategy and have met all / almost all of our mandated targets. I am particularly pleased to be able to report again that we have had no cases of MRSA bacteraemia

A particular challenge this year has been the achievement of the 62 day cancer waiting time target and we have worked closely with the DH intensive support team to further deliver improvements in performance 50 50

In 2009 we received our performance rating from the Care Quality Commission and I am pleased to report that we received excellent for quality of services and excellent for use of resources for the 2nd year running. Our infection control inspection by the Care Quality Commission showed no breaches of our duties and we have scored consistently in the top 20% performing Trusts in both the annual staff and patient surveys. Whilst all of the questions in these surveys are important one particular staff survey question provides me with assurance of the quality of care. When staff were asked â&#x20AC;&#x2DC;if a friend or relative needed treatment, I would be happy with the standard of care provided by this Trustâ&#x20AC;&#x2122; 94% replied yes. Our annual PEAT (Patient Environment Action Team) assessment has also demonstrated good performance with excellent ratings being given for environment, food and privacy and dignity.

As Chief Executive I am confident that the Trust provides a high quality service and that these Quality Accounts demonstrate this. To the best of my knowledge the information in these accounts are accurate. In summary, CCO has a good track record in delivering a quality service to our patients. We cannot rest on our laurels and as Chief Executive I have a personal commitment to lead the drive for continual quality improvement. We will continue to deliver against the objectives we have set and will continue to improve quality in the challenging times ahead.

Andrew Cannell Chief Executive Date: 26th May 2010

51 51

Review of Quality Performance 2009/10 Our 2008/09 Quality report identified priorities for improving patient safety, experience and outcomes. Progress against these priorities is outlined below.

Improving Patient Safety Patient Safety First

The Trust has implemented a number of elements of the national Patient Safety First Campaign. The Trust Board has committed to lead on the establishment of Patient Safety Leadership Walkrounds to ensure that all staff members have the opportunity to raise any safety concerns directly with Board members. All executive and non-executive directors take part and during 2009/10 nine walkrounds took place in 9 clinical departments in the Trust. Issues raised during each walkround are summarised and a report is provided to each staff member who attended. Agreed actions are followed up and progress reported to the area 1 month and 4 months following the walkround. Examples of issues raised during the Patient Safety Leadership Walkrounds: Handwriting legibility on prescriptions - handwriting legibility on scripts was identified as a potential patient safety issue however checks are in place to prevent errors translating into patient harm and E-Prescribing, which will be implemented across the Trust in the coming months should eliminate this problem. Nurse staffing levels - staff highlighted that agency staff are not able to provide the full services provided by CCO nursing staff which adds to ward pressures and ultimately patient safety. The use of agency staff has greatly reduced since this walkround as many more nursing staff have been employed following the Trust Boardâ&#x20AC;&#x2122;s approval of an increase in the staffing establishment. Feedback on the value of this approach has been very high from both staff and Board members. The second Patient Safety First initiative that the Trust has implemented is Intervention 2: Deterioration. This involves the Trust monitoring and reporting monthly on the number of Cardiac Arrest Calls; Number of rapid response Calls; percentage of patients with observations complete; percentage of trigger patients receiving an appropriate response. The Trust has been piloting the use of the SBAR tool and will include this in the monitoring and reporting for 2010/11. All results and trends are reviewed by the Acutely Unwell Steering group led by the Critical Care Nurse specialist to ensure any actions are taken forward. Examples of results include: Percentage of patients with observations complete: Using the Patient Safety First Campaign Chart Checker adapted for CCO, 30 sets of patient observations/MEWS records for each of the three in-patient wards are reviewed (by the wards) per month. In addition, each set of patient records reviewed during the monthly Global Trigger Tool review are assessed against the CCO Chart Checker.

The Critical Care Nurse Practitioner provided additional training to ward staff following the outcome of the initial GTT reviews and is monitoring the chart checker results closely along with carrying out independent MEWS audits. The monthly chart checker results from each of the three inpatient wards, all have shown an improvement since January 2010. The Trust has been focused over the last year in improving the quality of care for acutely ill patients and this initiative has formed a valuable piece of that work. Other elements have included: Improving the identification of deteriorating patients: Throughout the year we have worked hard to improve the skills and competencies of our nursing workforce. We have appointed a new role of Critical Care Clinical Nurse Specialist who has led a program of training and development. Six staff nurses attended an HDU course during the year and key staff undertook a work based training program at Aintree University NHS Foundation Trust to further develop skills in trachyostomy management. All ward nursing staff have undergone training in the use of an early warning system and our subsequent clinical audit has shown a clear improvement in patient monitoring. We have also invested in medical equipment to further improve the care of this vulnerable patient group including a high specification blood gas monitor. Implementation of the Global Trigger Tool The IHI Global Trigger Tool (GTT) for Measuring Adverse Events provides an easy-to-use method for accurately identifying adverse events (harm) and measuring the rate of adverse events over time. Tracking adverse events over time is a useful way to tell if changes being made are improving the safety of the care processes. A review of 8 records per month is undertaken which reflects the size of the Trust. The use of the tool this year has proved to be valuable in identifying a baseline of harm incidents to enable the Trust to focus on areas for improvement. All harm events identified have been temporary. Areas that have been identified through the use of the tool are: x x x x x

Delays Opiate toxicity PEG infections Cannulation Pressure ulcer.

All of these areas have triggered initiatives to reduce harm. Nursing Quality Metrics The quality of nursing care is critical to the safety of patients admitted to the Trust. This year we have focused on the development of a series of nursing metrics which are both of meaning to our patient population and the nature of the nursing care that we provide, and, where possible, provides us with an opportunity to benchmark against other hospitals. We have been reviewing the available tools and in particular the Nursing Assessment and Accreditation Scheme (Salford Royal NHS Foundation Trust) , the Advancing Quality Metrics and the recently published High Impact Changes for Nursing by the Department of Health, and have developed Quality in Nursing at Clatterbridge (QINC). The QINC tool will be piloted 53 53

for 6 months from May 2010 with a full Matron’s audit of all wards every three months. From July 2010 the project will focus on identifying specific areas for targeted improvements. From the preliminary work these are expected to be: x x x

Nursing documentation Management of pressure ulcers, aiming for zero tolerance Improvements to pain assessment implementing the new EPAT tool.

Improving Patient Experience Understanding the experience of patients in our care is fundamental to being able to identify areas for improvement. The use of the national patient surveys provides a valuable mechanism to review the whole Trust’s performance but does not provide the level of detail at departmental level. During 2009/10 we have continued to roll out our ‘real time’ patient survey program. This program provides every patient with the opportunity to complete a survey form at any point in their stay with us. The information gathered from the survey is reported both at Trust and departmental level. The questions have been developed in conjunction with our Patient Council to ensure that they are meaningful. Each department is required to review its performance and develop action plans for improvement. It is important that patients see the results of the survey and therefore these are displayed in each clinical area. A summary of the key questions is also put on our website. These can be found at http://www.ccotrust.nhs.uk During this time period we received a total of 2968 forms, compared to 2352 forms for the previous year. The chart below gives an example of some the 29 questions we ask and their results for the last 12 months.

Patient Feedback Survey 2009/10 I felt safe Information w as good Dept w as clean Toilets w ere clean Parking w as easy

Always

I w as treated w ith courtesy and respect

Usually Sometimes

I had confidence in staff

Never

Staff introduced themselves

N/A

Staff w ashed their hands Staff respected my privacy

20%

40%

60%

54 54

80%

100%

Problem areas that have been identified through the survey are around waiting times. 49% of patients who were asked about waiting times felt that they sometimes had to wait; only 20% never had to wait. This question was changed in January this year from ‘I had to wait’ to ‘I had to wait more than twenty minutes after my appointment time’ to enable us to identify where the problem is occurring on a regular basis. Patients often tell us that they don’t mind waiting if they are kept informed of why they are waiting and the approximate delay. During this year 45% of patients asked felt they were always kept informed. Parking remains a problem. Patients tell us that they are grateful for the free parking, but at certain times of the day it is impossible to find a space in the patient car parking area. We are currently undertaking a car-park accessibility audit which will hopefully lead to some improvements by deterring staff and professional visitors from parking in the patient’s parking area. A key focus for the Trust this year has been the development of a satellite radiotherapy centre in Liverpool. Many of our patients have long travel times and may need to receive treatment every day for up to 6 weeks. To improve the experience of receiving radiotherapy for these patients this centre is being built with the main driver being to reduce travel times and improve access. The centre will open early 2011. Patients and governors have been involved in every stage of the project to ensure that the design of the facility optimises the patient experience. Improving Clinical Effectiveness PROMS During 2009/10 we have commenced working on the development of validated cancer specific PROMS (Patient Reported Outcome Measures) tools that will enable us to proactively monitor patient reported outcomes and to develop action plans to further improve outcomes. There are currently no nationally validated tools for cancer. Initial scoping work has been undertaken for us by Keele University and we hope to have tools available to pilot during 2010/11.

The Trust has been put forward via the Merseyside and Cheshire Cancer Network to take part in phase 2 of the Quality in Cancer Nursing – Nurse Sensitive Outcome Indicators for Ambulatory Chemotherapy project being run by the National Nursing Research Unit, Kings College London and the University of Southampton. Mortality reviews The Trust Board regularly monitors the Trust’s HSMR (hospital standardised mortality rate). Whilst our HSMR rate is low we feel that it is important to strive to understand the cause of patient death in our population. To enable us to achieve this we have commenced this year a detailed review of 30 day mortality following chemotherapy, both radical intent and palliative treatments, over a 12 month period. This is led by the Medical Director. Following the baseline work completed in 2009/10 this project will be further developed. The aim is to present data displayed as control charts, with a 3 monthly moving average, that will identify trends, both by regime and consultant performance.

55 55

Priorities for improvement The Trust Board has agreed the following priorities for quality improvement for 2010/11. The Board will continue to monitor performance against its quality improvement strategy through a quarterly quality report to the Board. In identifying areas for improvement the Trust has undertaken an engagement process with: its staff through its senior managers via the development of departmental Delivery Plans; its Governors at a Board and Governors away day in March; with its lead Commissioner and Cancer Network at its contract quality meetings and with patient and public representatives at a patient experience Workshop in March 2010. Improving Patient Safety Objective: Development of patient safety KPIs including an action planning framework for improvement to include minimisation of avoidable patient harm and elimination of â&#x20AC;&#x2DC;never eventsâ&#x20AC;&#x2122; Rationale for Selection: Improvements in patient safety remain a high priority for the Trust. Focusing on specific KPIs will enable the Trust to set clear objectives and priorities for improvement. Selection and monitoring of KPIs will be generated from workstreams and engagement processes that were in place in 2009/10. The KPIs will include: Patient Safety KPI QINC (Quality in Nursing at Clatterbridge)

Venous thrombosis assessment

Source

Engagement

Advancing Quality High Impact Changes for Nursing Nursing Assessment and Accreditation Scheme (Salford Royal NHS Foundation Trust)

Lead Commissioner

CQUINS

Lead Commissioner

Monitoring of progress Integrated Governance Committee Contract quality meetings with lead commissioner Project steering group Wards Integrated Governance Committee Contract quality meetings with lead commissioner Wards

56 56

Expected areas of improvement Documentation Pain assessment Pressure ulcer prevention (zero tolerance)

Patient Safety KPI HCAI indicators

MEWS SBAR Safety KPIs identified in year Quality KPIs

Source

Engagement

Monitoring of progress

Care Quality Commission

Lead Commissioner

Trust Board

Patient Safety Campaign Global trigger tool Incidents Complaints Contract

Internal

Risk Management Committee Risk Management Committee

Improved use of both tools

Integrated Governance Committee

Waterlow assessment Nutritional screening tool assessment Falls risk assessment

Internal Lead Commissioner

Contract quality meetings with lead commissioner

Contract quality meetings with lead commissioner Never events

Expected areas of improvement

Nationally mandated Contract

Lead Commissioner

Trust Board Contract quality meetings with lead commissioner

Maintain zero performance for MRSA Achievement of C Diff target

Maintain zero tolerance

Improving Patient Experience Objective: Develop a patient and carer experience strategy, including an action planning framework, for improvement to include minimisation of avoidable patient harm and elimination of â&#x20AC;&#x2DC;never eventsâ&#x20AC;&#x2122; Rationale for Selection: Improvements in patient experience remain a high priority for the Trust. Focusing on specific patient engagement and reported experience will enable the Trust to set clear objectives and priorities for improvement. Selection and monitoring of priorities will be generated from workstreams and engagement processes that were in place in 2009/10.

57 57

The key areas will include: Patient Experience Improve responsiveness to personal needs of patients

Source National Patient Survey

Engagement Lead commissioner

Monitoring of progress Monitoring of CQUIN at contract quality meetings with lead commissioner

Expected areas of improvement Maintain high level of performance (nb CCO is in top 20% of all Trusts for all indicators)

Integrated Governance Committee To capture near real time patient experience data in key areas and demonstrate an improvement in reported experience in year

Local Patient Survey (CQUIN)

Reduction of waiting times in departments

Internal patient survey

Developed through patient Experience Workshop with representation from patients, commissioners, carers, and staff. CCO Patients Council

Improved car parking

Monitoring of CQUIN at contract quality meetings with lead commissioner

Targets for improvement to be agreed with commissioner following baseline data.

Integrated Governance Committee Integrated Governance Committee

Reduction of waiting times in departments

Patient Experience Governors Committee Integrated Governance Committee

Patient choice

National patient Survey

Trust Board

Somewhere to keep personal belongings

National patient Survey

Trust Board

Integrated Governance Committee

Hard to reach groups such as men, people with learning disabilities, sensory or literary difficulties, economically deprived are explicitly included

Internal

Council of Governors

Integrated Governance Committee

Improved car parking Improve processes to enable where possible a choice of admission date Improvement on national survey score of 66% through ward refurbishment programme Improvement in patient experience in hard to reach groups

Objective: Roll out of the Acute Oncology Program across the cancer network. Rationale for Selection: The National Chemotherapy Advisory Group report and the subsequent NCEPOD report identified that an acute oncology service will provide assessment within 24 hours to acutely ill patients, thereby reducing the wait for investigations and specialist treatment and resulting in improved clinical outcome, reduced LOS and improved patient experience. The full implementation of acute oncology has been supported by the CQUINS development for both 2009/10 and 2010/11. Acute Oncology Appointment of all medical oncology consultant posts.

Source NCAG NCEPOD CQUINs

Engagement Lead commissioner Cancer Network

Monitoring of progress Integrated Governance Committee Monitoring of CQUIN at contract quality meetings with lead commissioner

Expected areas of improvement Reduced patient waits Improved clinical outcomes Improved patient experience

Improving Clinical Effectiveness Objective: Development of a cancer clinical outcome data development programme including an action planning framework for improvement and external benchmarking Rationale for selection: Improvements in patient outcomes remain a high priority for the Trust. Focusing on key clinical outcome measures will enable the Trust to set clear objectives and priorities for improvement. Clinical Outcome measure 30 day mortality

Source

NCAG NCEPOD

Engagement

Council of Governors

Monitoring of progress Integrated Governance Committee Council of Governors Contract quality meetings with lead commissioner

Expected areas of improvement Baseline data being gathered

Clinical Outcome measure 5 year survival

Source

Internal

Engagement

Council of Governors

Monitoring of progress Integrated Governance Committee Council of Governors

Preferred place of care

CQUINs

Lead commissioner Cancer Network

Integrated Governance Committee Contract quality meetings with lead commissioner

Expected areas of improvement Baseline data being gathered. Overall survival (breast and lung cancer) to be reviewed as model sites. Increased percentage of â&#x20AC;&#x153;palliative patients on the end of life care pathway (LCP) at time of death

Statements of Assurance from the Board Information on the review of services During 2009/10 the Clatterbridge Centre for Oncology NHS Foundation Trust provided and/or sub-contracted two NHS services. The Clatterbridge Centre for Oncology NHS Foundation Trust has reviewed all the data available to them on the quality of care in two of these NHS services. The income generated by the NHS services reviewed in 2009/10 represents 100 per cent of the total income generated from the provision of NHS services by the Clatterbridge Centre for Oncology NHS Foundation Trust for 2009/10. The data reviewed covers the three dimensions of quality â&#x20AC;&#x201C; patient safety, clinical effectiveness and patient experience.

Information on participation in clinical audits and national confidential enquiries During 2009/10 four national clinical audits and one national confidential enquiry covered NHS services that Clatterbridge Centre for Oncology NHS Foundation Trust provides. During 2009/10 Clatterbridge Centre for Oncology NHS Foundation Trust participated in 100% national clinical audits and 100% national confidential enquiries of the national clinical audits and national confidential enquiries which it was eligible to participate in. The national clinical audits and national confidential enquiries that Clatterbridge Centre for Oncology NHS Foundation Trust was eligible to participate in during 2009/10 are as follows: National Clinical Audits: x Head and Neck (DAHNO) x Bowel (NBOCAP) x Lung (LUCADA) x Oesophago-gastric. National Confidential Enquiries into Patient Outcome and Death: x Parental Nutrition Study The national clinical audits and national confidential enquiries that Clatterbridge Centre for Oncology NHS Foundation Trust participated in during 2009/10 are as follows: National Clinical Audits: x Head and Neck (DAHNO) x Bowel (NBOCAP) x Lung (LUCADA) x Oesophago-gastric. National Confidential Enquiries into Patient Outcome and Death: x Parental Nutrition Study 61 61

The national clinical audits and national confidential enquiries that Clatterbridge Centre for Oncology NHS Foundation Trust participated in, and for which data collection was completed during 2009/10, are listed below alongside the number of cases submitted to each audit or enquiry as a percentage of the number of registered cases required by the terms of that audit or enquiry. National audit / enquiry National Clinical Audits: Head and Neck (DAHNO)

% submitted

Bowel (NBOCAP)

31.0% Remaining couldn't be uploaded due to secondary hospital not registering the patient. Before CCO can register a patient we need to know both whether the patient was discussed at MDT and whether the patient was an urgent GP referral. 100%

Lung (LUCADA)

99.8%

Oesophago-gastric

92.0% Remaining 14 treatments could not be uploaded as the secondary hospital had not registered the patients. Before CCO could register the patients we needed to specify the specific location within the stomach. 1/1 record submitted 1/1 Consultant questionnaire 1/1 Organisational questionnaire

National Confidential Enquiries into Patient Outcome and Death: x Parental Nutrition Study

The reports of 5 national audit clinical audits were reviewed by the provider in 2009/10 and Clatterbridge Centre for Oncology NHS Foundation Trust intends to take the following actions to improve the quality of healthcare provided: x Continue to provide data to the audits that are relevant to the Trust x Continue to provide accuracy and complete data to the audit that are relevant to the Trust The reports of 34 local clinical audits were reviewed by the provider in 2009/10 and Clatterbridge Centre for Oncology NHS Foundation Trust intends to take the following course of action to improve the quality of healthcare provided. Clinical Audit Clinical Audit

Action

Toxicity of Capecitabine given concurrently with preoperative radiotherapy for locally advanced rectal cancer Clinical Audit on Investigation and Management of Carcinoma of Unknown Origin Triage response to clinical trials patients

The Colorectal TSG have agreed to reduce taking samples to the 2nd and 4th week of Capecitabine as audit found grade 3 blood toxicity are rare New pathway developed for early referral, to be discussed with Cancer Network Improved education and training for Triage staff. Improved documentation / filing Clinical Director to include a section on prescribing prophylactic antibiotics into the next chemotherapy protocol book. No action required

Use of Prophylactic Antibiotics in Chemotherapy Patients Audit of outcomes of stereotactic radiosurgery

62 62

Cervix Brachytherapy audit

Change to the technique for brachytherapy treatment in cervical cancer. This has led to an increase in dose of 3 fractions of brachytherapy to be given to our cervical cancer patients. This brings the total dose administered in line with those recommended by the Royal College of Radiologist’s guidelines. Reminder from Medical Director to clinicians re: assessment Expand the content of the “preference letter” to explain the appointments system Scheduling change for herceptin patients No action required

VTE Audit Radiotherapy appointment times patient survey Chemotherapy wastage at CCO Evaluation of the Neutropenic Fever (NF) pathway at CCO Hip replacement prostate radiotherapy HDR Brachytherapy in rectal cancer Baseline audit of incoming triage calls to CCO after the introduction of the follow up service for new patients Chemotherapy Triage Survey Radiotherapy planning for prostate cancer – rectal dose volume constraints Effectiveness of Connective Tissue Stretching An audit of patients with oesophageal cancer referred for consideration of Radiotherapy

Standardisation of practice No action required No action required Number of small actions Follow up prospective audit

To identify the current trend for gastrostomy tube placement in patients undergoing radiotherapy/chemotherapy at Clatterbridge Centre for Oncology Assessment of patients’ spirituality and spiritual beliefs – staff survey Discharge Care Plan Audit of timings for patients admitted with confirmed or suspected neutropenic sepsis NICE Guidance audits

Clinical Audit

TA137 - Rituximab for the treatment of relapsed or refractory stage lll or lV follicular non-hodgkins lymphoma TA110 - Rituximab for the treatment of follicular lymphoma TA101 - Docetaxel for the treatment of hormone refractory prostate cancer TA124 - Pemetrexed for the treatment of nonsmall-cell lung cancer

TA172 - Head and neck cancer (squamous cell carcinoma) - cetuximab

63 63

Develop guidelines and education Conclusion that a dose of 30gy/10# is an acceptable treatment regime compared with those of longer duration with the potential for more toxicity Further review of process

Re-audit Further training. Further testing with staff A new neutropenic assessment tool is being launched Education and training A sepsis discussion group will be formed

Action

Fully compliant Fully compliant Fully compliant Non-compliant with good clinical reason. 2 patients received Pemetrexed which is against the NICE recommendation. However, the Pemetrexed was given via the off protocol procedure for both patients due to them having had peripheral neuropathy following 1st line carboplatin/vinorelbine Fully compliant

TA181 - Lung cancer (non-small cell, first line treatment) - pemetrexed TA183 - Cervical cancer (recurrent) - topotecan TA169 - Sunitinib for the first-line treatment of advanced and/or metastatic renal cell carcinoma

Fully compliant

TA178 - Renal cell carcinoma - bevacizumab, sorafenib tosylate and sunitinib TA179 - Gastrointestinal stromal tumours sunitinib IP268 - Brachytherapy as the sole method of adjuvant radiotherapy for breast cancer after local excision TA184 - Lung cancer (small cell) - topotecan TA119 - Fludarabine monotherapy for the firstline treatment of chronic lymphocytic leukaemia

Fully compliant Cohort 1 - not applicable. Cohort 2 - 100%. Cohort 3 – 64.0%. Non-compliances: 3 patients were PS2 and 2 patients received 2nd line sunitinib (all with good clinical reasons). Cohort 4 – 95.0% Non-compliance due to 1 patient not being offered sunitinib due to the clinicians concern about toxicity given patient’s comorbidity and altered liver function as per our local protocol. Fully compliant Fully compliant Fully compliant Fully compliant Fully compliant

Information on participation in clinical research The number of patients receiving NHS services provided or sub-contracted by Clatterbridge Centre for Oncology NHS Foundation Trust that were recruited during that period to participate in research approved by a Research Ethics Committee was 1418.

Use of the CQUIN framework A proportion of Clatterbridge Centre for Oncology NHS Foundation Trust’s income in 2009/10 was conditional upon achieving quality improvement and innovation goals agreed between Clatterbridge Centre for Oncology NHS Foundation Trust and any person or body they entered into a contract, agreement or arrangement with for the provision of NHS services, through the Commissioning for Quality and innovation payment framework. Further details of the agreed goals for 2009/10 and for the following 12 month period are available on request from Andrea Leather, Corporate Governance Manager (andrea.leather@ccotrust.nhs.uk) The monetary total for the amount of income in 2009/10 conditional upon achieving quality improvement and innovation goals, and the monetary total for the associated payment in 2009/10 was £245,481

Information relating to registration with the Care Quality Commission (CQC) and periodic/special reviews Clatterbridge Centre for Oncology NHS Foundation Trust is required to register with the Care Quality Commission and its current registration status is full registration without conditions as a service provider from the Care Quality Commission in March 2010 for the treatment of disease, disorder or injury and for diagnostic and screening procedures. The Care Quality Commission has not taken enforcement action against Clatterbridge Centre for Oncology NHS Foundation Trust during 2009/10. Clatterbridge Centre for Oncology NHS Foundation Trust is subject to periodic review by the Care Quality Commission and the last review was for 2008/09. The CQCs assessment of the Clatterbridge Centre for Oncology NHS Foundation Trust following that review was excellent for quality of services and excellent for use of resources. Clatterbridge Centre for Oncology NHS Foundation Trust has not participated in any special reviews or investigations by the CQC during the reporting period.

Information on the quality of data Clatterbridge Centre for Oncology NHS Foundation Trust submitted records during 2009/10 to the Secondary Uses service for inclusion in the Hospital Episode Statistics which are included in the latest published data. The percentage of records in the published data: x which included the patient’s valid NHS Number was: 99.9% for admitted patient care; 99.8% for outpatient care; and 0% for accident and emergency care (we do not provide an A+E service) x which include the patient’s valid General Practitioner Registration Code was: 99.8% for admitted patient care; 99.9% for outpatient care; and 0% for accident and emergency care (we do not provide an A+E service). Clatterbridge Centre for Oncology NHS Foundation Trust’s score for 2009/10 for Information Quality and Records Management assessed using the Information Governance Toolkit was 94.0%. Clatterbridge Centre for Oncology Foundation Trust was subject to the Payment by Results clinical coding audit during the reporting period by the Audit Commission and the error rates reported in the latest published audit for that period for diagnoses and treatment coding (clinical coding) were 6.6%. The results should not be extrapolated further than the actual sample audited and which services were reviewed within the sample.

Coding Accuracy Findings Area audited

Speciality/ chapter/HRG

% procedures coded incorrectly Primary Secondary

% Diagnosis coded incorrectly Primary Secondary

Specialty

370 medical oncology WA immunology, infectious diseases, poisoning, shock FZ34C large intestinal disorders Overall

2.1%

14.0%

6.0%

13.3%

9.1%

3.3% 3.5%

Chapter

HRG Overall

0.4%

% of episodes changing HRG 5.0%

% of spells changing HRG 5.0%

7.5%

5.2%

11.9%

6.8%

0.0%

0.6%

0.0%

10.0%

5.6%

2.1%

6.6%

Other information Safety Indicators

MRSA bacteraemia cases / 10,000 bed days C Diff cases / 1,000 bed days â&#x20AC;&#x2DC;Never Eventsâ&#x20AC;&#x2122; that occur within the Trust Chemotherapy errors (number of errors per 1,000 doses) Radiotherapy treatment errors (number of errors per 1,000 fractions) Falls / injuries / 1,000 inpatient admissions

2009/10

2008/09

2007/08

0.30

0.20

0.60

0.19

0.10

0.05

0.84

0.76

1.17

25.90

32.00

27.00

All indicators: x Data source: CCO 66

Clinical Effectiveness Indicators

HSMR 30 day mortality rate (radical chemotherapy) 30 day mortality rate (palliative chemotherapy) 30 day mortality rate (radical radiotherapy) 30 day mortality rate (palliative radiotherapy)

2009/10

2008/09

2007/08

36.4% 1.2%

39.3% 0.5%

42.0% 1.4%

7.6%

9.0%

7.4%

1.2%

0.9%

1.2%

16.2%

17.1%

19.5%

NB: In last years Quality Report we reported the following figures for 30 day mortality for chemotherapy: Radical: 0.4% Palliative: 8.9% These figures have been amended in the above table. This will be due to the Trust being informed of the date of death after the report was produced. HSMR:

Data source Dr Foster

Mortality rate: x Data definition: unadjusted mortality rate as a percentage of all cases treated in that category. x Data source: CCO

Patient Experience Indicators 2009/10

2008/09

2007/08

At least 80% of patients rate as ‘always’ in the local patient survey programme when asked ‘I was treated with courtesy and respect’

98.0%

97.0%

At least 80% of patients rate as ‘always’ in the local patient survey programme when asked ‘Was the ward / department clean’

92.0%

95.0%

67 67

2009/10

2008/09

2007/08

At least 70% of patients rate as ‘never’ in the local patient survey programme when asked ‘If they had to wait’

16.0%

17.0%

15.0%

At least 80% of patients rate as ‘always’ in the local patient survey programme when asked if ‘I was included in discussions about my care’

87.0%

90.0%

At least 80% of patients rate as ‘always’ in the local patient survey programme when asked if ‘the staff washed their hands’

88.0%

92.0%

90.0%

Patient survey: x Data source: data collected from in-house survey x Survey questions based on annual Care Quality Commission In-patient survey x Target for compliance agreed by the Trust Board as part of our Quality Strategy x Data for 2007/08 only available for part year x In January of this year we changed the question from ‘I had to wait’ to ‘I had to wait more than 20 minutes after my appointment time’ to enable us to better understand the nature of the issue x Variation is not considered to be statistically significant

68 68

Performance against key national priorities and National Core Standards Standards for Better Health declaration

Clostridium difficile

2009/10

2008/09

2007/08

Declared full compliance with all 45 standards that it was required to declare against in its mid year declaration to the CQC. The Trust remained compliant throughout the rest of the year. 8 (target no more than 17)

Declared full compliance with all standards throughout year and at year end

Declared full compliance with all standards except one throughout year and full compliance at year end

7 (target no more than 19)

26 (target no more than 11 cases)

0 (target no more than 2) 100%

93.3% (target threshold 93.0%).

94.7% (target 93.0%)

MRSA

0 (target no more than 2) Maximum waiting 100% time of two weeks from urgent GP referral to date first seen for all urgent suspect cancer referrals Maximum waiting 98.9% (target time of 31 days 98%) for subsequent treatments for all cancers Maximum two 77.6% month wait from *pre-reallocation referral to (draft target treatment 79.0%) for all cancers For admitted 95.4% (target patients, 95.0%) maximum time of 18 weeks from point of referral to treatment

69 69

As at March 95.9% (target 2009, 97.3% 85.0%) (target of 90.0%)

For non-admitted patients, maximum time of 18 weeks from point of referral to treatment Maximum waiting time of 31 days from diagnosis to treatment for all cancers Screening all elective inpatients for MRSA

2009/10

2008/09

2007/08

97.9% (target 95.0%)

98.5% (target 95.0%).

96% (target 90.0%)

97.7% (target 96.0%)

99.8% (target threshold 98.0%).

99.8% (target 98.0%)

114.4%

* to be concluded by 8th July 2010

For screening the percentage is calculated according to Department of Health requirements.

Annex Statements Primary Care Trusts and Local Involvement Networks (LINks)

Statement from NHS Wirral As lead commissioner, NHS Wirral is committed to commissioning high quality services from Clatterbridge Centre for Oncology and we take very seriously our responsibility to ensure that patientsâ&#x20AC;&#x2122; needs are met by the provision of safe, high quality services. The Quality Account, in our opinion, accurately reflects quality performance in 2009/10 and highlights future priorities agreed with commissioners for 2010/11. We are reassured that the Trust Board has reviewed service risks following reported NHS failures such as Mid Staffordshire in order to learn lessons from other organisations. We welcome the Trust Board ensuring that Quality is a key agenda item at each Board meeting and including patient stories within Board reports. We are also pleased that the Trust has established Patient Safety Leadership Walkrounds. We look forward to NHS Wirral senior staff participating in Walkrounds in 2010/11. We note that the use of agency staff has greatly reduced following the Trust Boardâ&#x20AC;&#x2122;s approval of an increase in the nurse staffing establishment. We are also pleased with the development of the Quality in Nursing at Clatterbridge (QINC) tool and look forward to receiving regular reports on the impact it is having on improving patient care particularly in areas highlighted in the Department of Health High Impact Changes for Nursing. We congratulate the Trust on there being no cases of MRSA bacteraemia to report and welcome the continued focus on reducing other Health Care Associated Infections. We have been concerned about performance against the standard for 62 day maximum waits for cancer treatment and are aware that the Trust has worked closely with the Department of Health intensive support team to further deliver improvements in performance. We look forward to seeing future performance is on target. We are pleased to see the progress in capturing near real time patient experience in a structured way to inform action plans and measure improvements as perceived by patients. We have been concerned at patient survey reports highlighting unacceptable waits in Outpatient departments. We will be very interested to monitor the impact of redesigning clinic systems in 2010/11 and hope to hear of improved patient experience through the local CQUIN initiative. The declaration of full compliance in delivering same sex accommodation as at 31st March is most welcome. We have a close working relationship with Clatterbridge Centre for Oncology and meet regularly to receive reports which demonstrate the Trustâ&#x20AC;&#x2122;s performance against a range of quality measures and discuss and agree remedial action where this is deemed necessary. We have collaborated with clinicians and senior managers from the Trust to develop a shared understanding of clinical priorities for quality improvement for inclusion in our 2010/11 contract. We have been very keen to capture feedback from patient experience of services to 71 71

inform how we measure quality improvement in future and welcome the Trust sharing this information with us. We are reassured to see from this Quality Account the high profile given to continuous quality improvement in Clatterbridge Centre for Oncology. NHS Wirral looks forward to continuing to work in partnership with the Trust to assure the quality of services commissioned in 2010/11. Kathy Doran Chief Executive NHS Wirral

Statement from Wirral LINks Wirral LINk appreciated the opportunity to comment on Clatterbridge Centre for Oncology NHS Foundation Trust Quality Accounts 2009/2010. The LINk is aware of the timescales imposed upon the Trust in relation to these Accounts this year however, in future years, would recommend and appreciate ongoing dialogue through the year, to ensure an informed response can be provided. Unfortunately due to the very short timescale given for response, the Wirral LINk is unable to make an informed contribution on these accounts but looks forward to working with the Trust over the coming year on is Quality Accounts for 2010-2011 Karen Prior & Lynda Denman Wirral LINk Support Team

72 72

2009/10

Annual Accounts

For the 12 months ended 31st March 2010

Contents Annual Accounts Foreword to the Accounts Statement of the Chief Executive’s responsibilities as the accounting officer of Clatterbridge Centre for Oncology NHS Foundation Trust Statement of Directors’ responsibilities in respect of the Accounts Independent Auditor’s Report to the Council Statement of Internal Control Statement of Comprehensive Income Statement of Financial Position Statement of Taxpayers Equity Statement of Cash Flows Accounting Policies Notes to the Accounts

78 79 80 82 89 90 91 93 94 105

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

Foreword to the Accounts

Clatterbridge Centre for Oncology NHS Foundation Trust The accounts for the 12 months ended 31 March 2010, have been prepared by the Clatterbridge Centre for Oncology NHS Foundation Trust in accordance with paragraph 24 and 25 of Schedule 7 of the National Health Services Act 2006 in the form which Monitor has, with the approval of the Treasury directed.

Andrew Cannell Chief Executive

Date

76 77

26th May 2010

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

Statement of Chief Executive’s Responsibilities as the Accounting Officer of Clatterbridge Centre for Oncology NHS Foundation Trust The National Health Services Act 2006 states that the Chief Executive is the accounting officer of the NHS Foundation Trust. The relevant responsibilities of accounting officer, including their responsibility for the propriety and regularity of public finances for which they are answerable, and for the keeping of proper accounts, are set out in the accounting officers' Memorandum issued by the Independent Regulator of NHS Foundation Trusts (“Monitor”). Under the National Health Services Act 2006, Monitor has directed the Clatterbridge Centre for Oncology NHS Foundation Trust to prepare for each financial year a statement of accounts in the form and on the basis set out in the Accounts Direction. The accounts are prepared on an accruals basis and must give a true and fair view of the state of affairs of Clatterbridge Centre for Oncology NHS Foundation Trust and of its income and expenditure, total recognised gains and losses and cash flows for the financial year. In preparing the accounts, the Accounting Officer is required to comply with the requirements of the NHS foundation trust Financial Reporting Manual and in particular to: -

observe the Accounts Direction issued by Monitor, including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent basis;

make judgements and estimates on a reasonable basis;

state whether applicable accounting standards as set out in the NHS foundation trust Financial Reporting Manual have been followed, and disclose and explain any material departures in the financial statements; and

prepare the financial statements on a going concern basis

The Accounting Officer is responsible for keeping proper accounting records which disclose with reasonable accuracy at any time the financial position of the NHS Foundation Trust and to enable him to ensure that the accounts comply with requirements outlined in the above mentioned Act. The Accounting Officer is also responsible for safeguarding the assets of the NHS Foundation Trust and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities. To the best of my knowledge and belief, I have properly discharged the responsibilities set out in Monitor's NHS Foundation Trust Accounting Officer Memorandum.

Andrew Cannell Chief Executive

Date

77 78

26th May 2010

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

Statement of Directorsâ&#x20AC;&#x2122; Responsibilities in respect of the Accounts The Directors are required under the National Health Services Act 2006 to prepare accounts for each financial year. Monitor, with the approval of the Treasury, directs that these accounts give a true and fair view of the state of affairs of the Trust and of the income & expenditure of the Trust for that period. In preparing those accounts, the Directors are required to;

select suitable accounting policies, as described on pages 94 -104 and them apply them consistently

make judgements and estimates on a reasonable basis;

state whether applicable accounting standards have been followed, subject to any material departures disclosed and explained in the accounts;

prepare accounts on the going concern basis unless it is inappropriate to presume that the Trust will continue in business.

The Directors are responsible for keeping proper accounting records which disclose with reasonable accuracy at any time the financial position of the Trust and to enable them to ensure that the accounts comply with requirements outlined in the above mentioned direction of Monitor. The Directors are also responsible for safeguarding the assets of the Trust and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities. The Directors confirm to the best of their knowledge and belief that they have complied with the above requirements in preparing the accounts. By Order of the Board

Andrew Cannell Chief Executive

Yvonne Bottomley Director of Finance

78 79

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

Auditors’ Report to the Council of Governors of Clatterbridge Centre for Oncology NHS Foundation Trust We have audited the financial statements of Clatterbridge Centre for Oncology NHS Foundation Trust for the year ended 31 March 2010 under the National Health Service Act 2006. These comprise, the Statement of Comprehensive Income, the Statement of Financial Position, the Cash flow Statement, the Statement of Changes in Taxpayers’ Equity and the related notes. These financial statements have been prepared under the accounting policies relevant to NHS Foundation Trusts set out therein. This report is made solely to the Council of Governors of Clatterbridge Centre for Oncology NHS Foundation Trust (‘the Trust’), as a body, in accordance with the National Health Service Act 2006. Our audit work has been undertaken so that we might state to the Council of Governors of the Trust, as a body, those matters we are required to state to it in an auditor’s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Trust and the Trust's Governors as a body, for our audit work, for this report, or for the opinions we have formed.

Respective responsibilities of directors and auditors As described on page 78 the Accounting Officer is responsible for the preparation of the financial statements in accordance with directions issued by Monitor. Our responsibilities, as independent auditors, are established by statute, the Code of Audit Practice issued by Monitor and our profession’s ethical guidance. We report to you our opinion as to whether the financial statements give a true and fair view of the state of affairs of the Trust and its income and expenditure for the year ended 31 March 2010 We review whether the statement on internal control on pages 82 to 88 reflects compliance with Monitor’s guidance issued in the NHS Foundation Trust Financial Reporting Manual. We report if it does not meet the requirements specified by Monitor or if the statement is misleading or inconsistent with other information we are aware of from our audit of the financial statements. We are not required to consider, nor have we considered, whether the directors’ statement on internal control covers all risks and controls. We are also not required to form an opinion on the effectiveness of the Trust’s corporate governance procedures or its risk and control procedures. Our review was not performed for any purpose connected with any specific transaction and should not be relied upon for any such purpose. We read the information contained in the Annual Report and consider the implications for our report if we become aware of any apparent misstatements or material inconsistencies with the statement of accounts.

Basis of audit opinion We conducted our audit in accordance with the National Health Service Act 2006 and the Code of Audit Practice issued by Monitor, which requires compliance with relevant auditing standards issued by the Auditing Practices Board. An audit includes examination, on a test basis, of evidence relevant to the amounts and disclosures in the financial statements. It also includes an assessment of the significant estimates and judgements made by the Directors in the preparation of the financial statements, and of whether the accounting policies are appropriate to the Trust's circumstances, consistently applied and adequately disclosed. We planned and performed our audit so as to obtain all the information and explanations which we considered necessary in order to provide us with sufficient evidence to give reasonable assurance that the financial statements are free from material misstatement, whether caused by fraud or other irregularity or error. In forming our opinion we also evaluated the overall adequacy of the presentation of information in the financial statements.

79 80

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

Opinion In our opinion the financial statements give a true and fair view of the state of affairs of Clatterbridge Centre for Oncology NHS Foundation Trust as at 31 March 2010 and of its income and expenditure for the year then ended.

Certificate We certify that we have completed the audit of the accounts in accordance with the requirements of the National Health Service Act 2006 and the NHS Foundation Trust Audit Code of Practice issued by Monitor.

Date: 7th June 2010 Trevor Rees (Senior Statutory Auditor) for and on behalf of KPMG LLP, Statutory Auditor Chartered Accountants St Jamesâ&#x20AC;&#x2122; Square Manchester M2 6DS

80 81

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

Statement of Internal Control Scope of responsibility As Accounting Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the NHS foundation trustâ&#x20AC;&#x2122;s policies, aims and objectives, whilst safeguarding the public funds and departmental assets for which I am personally responsible, in accordance with the responsibilities assigned to me. I am also responsible for ensuring that the NHS foundation trust is administered prudently and economically and that resources are applied efficiently and effectively. I also acknowledge my responsibilities as set out in the NHS Foundation Trust Accounting Officer Memorandum. The purpose of the system of internal control The system of internal control is designed to manage risk to a reasonable level rather than to eliminate all risk of failure to achieve policies, aims and objectives; it can therefore only provide reasonable and not absolute assurance of effectiveness. The system of internal control is based on an ongoing process designed to identify and prioritise the risks to the achievement of the policies, aims and objectives of Clatterbridge Centre for Oncology NHS Foundation Trust, to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically. The system of internal control has been in place in Clatterbridge Centre for Oncology NHS Foundation Trust for the year ended 31 March 2010 and up to the date of approval of the annual report and accounts. Capacity to handle risk The Trust is committed to providing high quality services in a safe and secure environment. As Chief Executive I have overall responsibility and accountability for all aspects of risk management within the Trust, making sure that the organisational structure and resources are in place to ensure this occurs. Senior leadership is delegated through the directors and operationally through departments and committee structures. This covers all aspects of governance relating to our service delivery, including: infection control, clinical care, radiation protection, Standards for Better Health, Care Quality Commission Regulatory Requirements, finance, contracts, information technology, health and safety, cancer standards peer review, research, and employment practices. The Audit Committee has overarching responsibility for ensuring that risk is managed effectively within the organisation. This role is supported by Board committees that oversee specific aspects of the risk portfolio. The system provides a central steer whilst supporting local ownership in managing and controlling risks to which the Trust may be exposed. These systems are further supported by the evaluation of the effectiveness of risk management and control systems and implementation of recommendations from external assessments to promote both organisational and individual learning and the dissemination of good practice within the Trust. Bespoke learning and development is provided according to individual role requirements such as Trust Board members, senior managers and all staff.

81 82

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

The Risk Management Strategy is underpinned by a number of risk related policies and procedures which provide further information and guidance to staff in the management of risk. The Trust is committed to continually reviewing its risk management process and endeavours to ensure that it learns from best practice. A key example of this is the adoption of the Integrated Governance Model as defined in the Integrated Governance Handbook (DH 2005). The risk and control framework The key elements of the Trust’s Risk Management Strategy are to manage and control identified risks, whether clinical, non-clinical or financial, appropriately. This is achieved through a sound organisational framework which promotes early identification of risk, the coordination of risk management activity, the provision of a safe environment for staff and patients, and the effective use of financial resources. It ensures that staff are aware of their roles and responsibilities and outlines the structures and processes through which risk is assessed, controlled and managed. The Trust Board approved a revised Risk Management Strategy in February 2010. The Trust Board determines the risk appetite of the Trust. Levels of acceptable risk are determined by working within agreed Trust policies and procedures. An acceptable risk is one which has been accepted after proper evaluation, with all the possible controls in place. Risks are identified through feedback from many sources such as, formal risk assessment, the assurance framework, incident reporting, audit data, complaints, legal claims, patient and public feedback, stakeholder/partnership feedback and internal/external assessment. The Trust Board has endorsed the Quality Strategy, the Operational Budget Plan and the Risk Management Strategy. In addition, a range of Trust-wide policies and procedures further supports the risk management processes. The Trust has embedded an assurance framework at a corporate level and across all areas of the organisation. The corporate assurance framework identifies those risks deemed as strategically significant to the Trust’s objectives, the controls in place to manage / mitigate those risks and the assurances received by the Trust. All Board members have been involved in the development, identification, quantification and prioritisation of the risks and the subsequent action planning to address areas for improvement. Significant risks are escalated to the Trust Board as they arise and subsequent updates are made to the Assurance Framework. Each high scoring risk has an individual risk mitigation plan developed by the responsible Executive Director. Each directorate is also required to develop a directorate level assurance framework to support the delivery of the directorate objectives. This further embeds the organisation wide risk aware culture. The Trust has appointed an Executive Director as the Senior Information Risk Officer. Risks relating to data are assessed through the completion of the Department of Health’s Information Governance Toolkit. The Trust has assessed itself as securing a score of 94% (a “Green” rating) against the Department of Health’s Information Governance Toolkit in 2009/10; The Trust achieved Level 2 against the requirements of the Information Governance Statement of Compliance as required by Monitor’s Compliance Framework, where relevant information risks identified in the course of the Trust’s incident reporting processes are investigated and lessons learned. The implementation of the Trust’s IM&T Strategy, including the application of data security principles continues to be subject to scrutiny at the Information Management & Technology (IM&T) Committee of the Trust Board. 82 83

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

The Trust identified a risk in year relating to the management of paper diaries following a data loss incident. Risk mitigations were put in place following a detailed review. The Information Commissioners office was fully informed and concluded that no further action was required. With respect to public involvement, the Trust has both a Patient & Public Involvement Strategy and a Membership Strategy. The latter has been implemented and 5671 public members have been recruited to date. Elections for places within the Council of Governors are undertaken each year in conjunction with the Electoral Reform Services and the governance infrastructure was in place to enable the Trust to operate effectively as an NHS Foundation Trust from 1st August 2006. This work strengthens the input of patients, the public and staff into the strategic decision making of the Trust. The risk and control framework continues to be reviewed and developed. In 2010/11 this will include: x x x x x x

Annual review of the approved Trust Board committee structure in line with the principles of Integrated Governance to ensure its continued effectiveness. Continue to develop the operation of the Trustâ&#x20AC;&#x2122;s Risk Register Continue to maintain full compliance with the new regulatory requirements set out by the Care Quality Commission to ensure ongoing full registration without conditions The Trust continues to work and develop arrangements with third party organisations within the local health economy and on a wider scale to ensure delivery of quality healthcare services and secure appropriate funding. Continuous improvements will be made in 2010/11 in order to continue to meet all standards and indicators To keep under review any new and emerging risks that have been identified during 2009/10 such as maintaining income flows and key relationships with commissioners and implications of Payment by Results for specific cancer related services, the development of the proposed satellite radiotherapy centre at Walton/Aintree. To identify future risks which may affect the Trust such as the proposal by commissioners to develop a second satellite facility at the Royal Liverpool Hospital with the provider being chosen through competitive tender and the challenging funding outlook which may adversely impact on the income secured from the Trustâ&#x20AC;&#x2122;s commissioners. The Trust Board will continue to review all significant risks monthly at its Board meeting ensuring risk mitigation plans are in place and that the Board approves any changes to the assessment of risk based on the impact and the efficacy of the controls in place. During 2009/10 the structure of the Board papers was further revised to ensure that each paper has an equality impact assessment completed. This continues to ensure that equality impact assessments are integrated into core Trust business. In 2010 the Trust will undertake a detailed equality impact assessment of the satellite development at Aintree/Walton and any further planned developments such as the development of the Strategic Outline case for the re-location of CCO.

The Foundation Trust is fully compliant with the core Standards for Better Health.

83 84

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

As an employer with staff entitled to be members of the NHS Pension Scheme, control measures are in place to ensure all employer obligations contained within the Scheme regulations are complied with. This includes ensuring that deductions from salary, employerâ&#x20AC;&#x2122;s contributions and payments in to the Scheme are in accordance with the Scheme rules, and that member Pension Scheme records are accurately updated in accordance with the timescales detailed in the Regulations. Control measures are in place to ensure that all the organisationâ&#x20AC;&#x2122;s obligations under equality, diversity and human rights legislation are complied with. These include regular reports to the Trusts Integrated Governance Committee from the Equality and Diversity steering group which monitors compliance with our legal obligations. The Trust publishes its Single Equality Scheme together with staff data on its website. Clatterbridge Centre for Oncology NHS Foundation Trust is classed as a Category 1 Responder under the Civil Contingencies Act 2004 and has a duty to produce and review its emergency and business continuity plans in the light of emerging local, regional and national guidance. The Trust Board approved a revised Major Incident Plan in February 2010. This plan ensures compliance with the requirements of the Civil Contingencies Act and is based on the assessment of risk that the Trust faces. The Trust has developed a Carbon Reduction Strategy with 10 key areas for improvement identified based on an assessment of the type of services that we provide. Review of economy, efficiency and effectiveness of the use of resources As the Accounting Officer, I am responsible for ensuring that the organisation has arrangements in place to secure value for money in the use of resources. The Trust achieves this through the following systems: x x x x

Setting and monitoring the delivery of strategic and operational objectives Monitoring and review of organisational performance Delivery of efficiency savings Workforce review.

Annually the Trust produces a service strategy which incorporates a supporting financial plan for approval by the Board of Directors. The strategy approved by the Board of Directors informs the detailed annual financial and performance plans. The Board monitors performance monthly through the corporate Finance & Performance Report, which provides information on current and forecast financial performance, achievement of savings targets, capital investment, contract activity and performance against key targets. Reports on specific issues relating to economy, efficiency and effectiveness are commissioned by the Audit Committee from the Trustâ&#x20AC;&#x2122;s Internal Auditors and it also receives reports from the External Auditors as required. The Audit committee monitors closely the implementation of Audit recommendations. Effective performance has been demonstrated through: x x

The achievement of the majority of key NHS targets: The highest possible financial risk rating of 5 as determined by the independent regulator Monitor. 84 85

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

Annual Quality Report The Trust Board has reviewed the Quality Accounts and is assured that the Accounts present a balanced view. It has achieved this by ensuring that the report includes information on both good performance and areas for improvement and that the majority of indicators that have been included relate to the performance of the whole Trust. The Trust Board has received assurance that there are appropriate controls in place to ensure the accuracy of data. The Board has reviewed its systems, processes, controls and assurances in data quality. This has included: x x x x x

Corporate leadership of data quality is the responsibility of the Director of Finance who has overall strategic responsibility for data quality and information governance. This responsibility is not delegated Policies and processes are in place to ensure data quality such as the Data Quality Policy, the Clinical Coding Policy and Procedure, the IM&T Strategy and the Risk Management Strategy Staff responsible for managing data are appropriately trained and skilled appropriate to their level of responsibility A comprehensive audit programme Quarterly reporting of quality metrics to the Trust Board in order to review the data and identify trends and issues during the year.

Review of effectiveness As Accounting Officer, I have responsibility for reviewing the effectiveness of the system of internal control, including that of the Quality Accounts. My review of the effectiveness of the system of internal control is informed by the work of the internal auditors and the executive managers within the NHS foundation trust who have responsibility for the development and maintenance of the internal control framework, and comments made by the external auditors in their management letter and other reports. I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the Board, the audit committee and a plan to address weaknesses and ensure continuous improvement of the system is in place. The Board of Directors reviews performance across a range of indicators, which include both corporate and national objectives and those measures of performance included in the Quality Accounts: Achievement of both local & national objectives and measures of performance is an important function of the Trust Board; in ensuring our effectiveness in doing this a number of measures are in place across the Trust: x

Individual department have as series of key performance indicators which are monitored on a monthly basis. In addition to this there is also a trust wide set of key performance indicators that are reviewed each month at Trust Board, these cover waiting times, infections control as well as finance

85 86

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

x x x

x x x x x x

Weekly performance management meetings take place to manage performance against waiting times as well as ensuring that forward planning around service capacity takes place Three times a year the executive directors meet with each clinical department to formally review performance against objectives, management of clinical governance & risk, financial management and delivery against national waiting time targets An “amber” rating by Monitor for quarters 1, 2 and 4 and a ‘green’ rating for quarter 3 in 2009/10 for governance. The ‘amber’ rating in quarter 1 relates to stakeholder engagement and no substantive Chief Executive in post whilst undertaking a significant investment, both have subsequently been rectified by the Trust. The ‘amber’ rating in quarters 2 and 4 relates to the 62 day ‘classic’ cancer waiting times target which has yet to be confirmed by the Care Quality Commission A “green” rating by Monitor for each quarter in 2009/10 for the provision of mandatory services Achievement of all key financial duties and a Monitor financial risk rating of 5 for each quarter in 2009/10 Regular Audit Committee review to ensure up to date and relevant financial policies and procedures are maintained Compliance with Standards for Better Health Core Standards throughout 2009/10 The Trust has been granted full registration without conditions as a service provider from the Care Quality Commission in March 2010 for the treatment of disease, disorder or injury and for diagnostic and screening procedures The Trust Board receives a quarterly Quality Report which is built on the structure of the annual Quality accounts to ensure that progress against priorities and monitoring of performance measures in reviewed throughout the year.

The Audit Committee provides a central means by which the Trust Board ensures effective internal control mechanisms are in place. This includes receiving and reviewing reports from both Internal Audit and our External Auditors: x Internal Audit concluded that the systems and processes in place regarding the Assurance Framework are designed and operated to meet the requirements of the Statement of Internal Control. The overall assessment was that an assurance framework has been established which is designed and operating to meet the requirements of the SIC and provide reasonable assurance that there is an effective system of internal control to manage the principle risks identified by the organisation. They have also provided significant assurance regarding the systems and processes underpinning the Standards for Better Health mid year declaration, and significant assurance overall across a range of individual opinions arising from risk based audit assignments reported throughout the year. The Trust Board has received external assurance of its systems of internal control by: x Accreditation for National Health Service Litigation Authority for Trusts (NHSLA) level 3 x Maintaining a special quality management accreditation (ISO9001:2008) across the whole Trust from the British Standards Institute (BSI).

86 87

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

Conclusion In conclusion, the Trust has a sound system of Internal Control in place, which is designed to manage the key organisational objectives and minimise the Trust exposure to risk. No significant internal control issues have been identified.

Name:

ANDREW CANNELL Chief Executive

Signature: Date:

87 88

26th May 2010

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

STATEMENT OF COMPREHENSIVE INCOME FOR THE YEAR ENDED 31st March 2010

Operating Income Operating expenses Operating Surplus (Deficit) Finance Costs Finance income Finance expense - financial liabilities Finance expense – Unwinding of discount on provisions PDC Dividends payable Net Finance costs

2010 £ 000s

2009 £ 000s

64,599

61,138

(60,508)

(56,205)

4,091

4,933

50 (20)

556 (31)

0 (851) (821)

0 (927) (402)

3,270

4,531

934

(96) 0 (70) 0

(300) 0 0 0

4,082

4,231

4,082

4,231

Other Comprehensive Income: Revaluation gains/(losses) and impairment losses on Intangible assets. Revaluations gains/(losses) and impairment losses on Property, plant and equipment. Revaluation gains/(losses) and impairment losses arising from classifying non current assets as assets held for sale. Increase in the donated asset reserve due to the receipt of donated assets Reduction in the donated assets reserve in respect of depreciation, impairment and /or disposal of donated assets Additions/(reductions) in other reserves Other recognised gain and losses Actuarial gains/(losses) on defined pension schemes Total Comprehensive Income /(expense) for the period Prior period adjustments Total Comprehensive Income /(expense) for the year The notes on pages 105 to 143 form part of these accounts

88 89

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

STATEMENT OF FINANCIAL POSITION AS AT 31st March 2010 31st March 2010 £ 000s 5 37,375 0 0 37,380

31st March 2009 £ 000s 9 31,863 0 0 31,872

1 April 2008 £ 000s 14 33,837 0 0 33,851

331 2,670 0 24,065 27,066

404 2,343 0 18,171 20,918

332 3,376 0 11,998 15,706

(7,514) (107) 0 0 (567) (4,083) (12,271)

(6,745) (100) 0 (316) (517) (2,605) (10,283)

(7,248) (95) 0 0 (452) (3,750) (11,545)

Total Assets less current liabilities

52,175

42,507

38,012

Non-current liabilities Borrowings Provisions Other liabilities Total non-current liabilities

(5,447) (6) (164) (5,617)

(507) (502) (561) (1,570)

(607) (11) (958) (1,576)

TOTAL ASSETS EMPLOYED

46,558

40,937

36,436

FINANCED BY (taxpayers equity) Public dividend capital Revaluation reserve Donated asset reserve Income and expenditure reserve TOTAL TAXPAYERS’ EQUITY

21,245 6,881 2,554 15,878 46,558

21,245 5,648 1,721 12,323 40,937

21,245 5,971 2,021 7,199 36,436

NOTE

NON-CURRENT ASSETS Intangible Assets Property Plant and Equipment Other Financial Assets Other Assets Total non-current assets CURRENT ASSETS Inventories Trade and other receivables Other financial assets Cash and cash equivalents Total current assets CURRENT LIABILITIES Trade and other payables Borrowings Other financial liabilities Provisions Tax payable Other liabilities Total current liabilities

The financial statements on pages 89–93 were approved by the Board on 26th May 2010 and signed on its behalf.

Signed Date 26th May 2010

Chief Executive

89 90

Total Total

90 90

£ 000s £ 000s Taxpayers’ Taxpayers’ Equity Equity at 1atApril 1 April 2009 2009 – as– previously as previously stated stated 40.937 40.937 Prior Prior period period adjustment adjustment 1,539 1,539 Taxpayers’ Taxpayers’ Equity Equity at 1atApril 1 April 2009 2009 - restated - restated 42,476 42,476 Surplus/(deficit) for the yearyear Surplus/(deficit) for the 3,270 3,270 Revaluation gains/(losses) andand impairment losses on intangible assets Revaluation gains/(losses) impairment losses on intangible assets 0 0 Revaluation gains/(losses) andand impairment losses, property, plant andand equipment Revaluation gains/(losses) impairment losses, property, plant equipment 934934 Increase in the donated asset reserve duedue to receipt of donated assets Increase in the donated asset reserve to receipt of donated assets 44 44 Reduction in the donated asset reserve in respect of depreciation, impairment and/or Reduction in the donated asset reserve in respect of depreciation, impairment and/or disposal of on assets. disposal of donated on donated assets. (96)(96) Additions/(reduction) in other reserves Additions/(reduction) in other reserves 0 0 Other recognized gains andand losses Other recognized gains losses (70)(70) Actuarial gains/(losses) on defined benefit pension schemes Actuarial gains/(losses) on defined benefit pension schemes 0 0 Transfer to the income andand expenditure account in respect of assets disposed of of Transfer to the income expenditure account in respect of assets disposed 0 0 Transfer of the excess of current costcost depreciation overover historical costcost depreciation to to Transfer of the excess of current depreciation historical depreciation the the income andand expenditure reserve income expenditure reserve 0 0 Public Dividend Capital received Public Dividend Capital received 0 0 Public Dividend Capital repaid Public Dividend Capital repaid 0 0 Public Dividend Capital repayable (creditor) Public Dividend Capital repayable (creditor) 0 0 Public Dividend Capital written off off Public Dividend Capital written 0 0 Other transfers between reserves Other transfers between reserves 0 0 Movements on other reserves Movements on other reserves 0 0 Taxpayers’ Equity at 31 2010 46,558 Taxpayers’ Equity at March 31 March 2010 46,558

STATEMENT STATEMENT OFOF CHANGES CHANGES IN TAXPAYERS IN TAXPAYERS EQUITY EQUITY

0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 21,245 21,245

0 0 0 0 0

(96)(96) 0 0 0 0 0 0 0 0 (355) 0 0 (355) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6,881 6,881 2,554 2,554

0 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0 0

355355 0 0 0 0 0 0 0 0 0 0 0 0 15,878 15,878

0 0 0 0 (70)(70) 0 0 0 0

RevaluationDonated DonatedOther Other Income Income & & Public Public Revaluation reserve reserve asset asset Reserves Reserves expenditure expenditure Dividend Dividend reserve reserve reserve reserve Capital Capital £ 000s £ 000s £ 000s £ 000s £ 000s £ 000s £ 000s £ 000s £ 000s £ 000s 5,648 5,648 1,721 1,721 0 0 12,323 12,323 21,245 21,245 1,231 1,231 308308 0 0 0 0 0 0 6,879 6,879 2,029 2,029 0 0 12,323 12,323 21,245 21,245 0 0 0 0 0 0 3,270 3,270 0 0 0 0 0 0 0 0 0 0 0 0 357 577 0 0 357 577 0 0 0 0 0 44 0 0 0 44 0 0 0 0

Clatterbridge Clatterbridge Centre Centre for for Oncology Oncology NHS NHS Foundation Foundation Trust Trust st Accounts Accounts for for thethe year year ended ended 31st31 March March 2010 2010

Total Total

£ 000s £ 000s Taxpayers’ Equity at 1 April 2009 – as previously stated 40.937 Taxpayers’ Equity at 1 April 2008 – as previously stated 36,436 Prior period adjustment 1,539 Prior period adjustment Taxpayers’ Equity at 1 April 2009 - restated 42,476 0 Taxpayers’ Equity at 1 April 2008 - restated 36,436 Surplus/(deficit) for the year 3,270 Surplus/(deficit) for the year 4,531 Revaluation gains/(losses) and impairment losses on intangible assets 0 Revaluation gains/(losses) and impairment losses on intangible assets 0 Revaluation gains/(losses) and impairment losses, property, plant and equipment 934 Revaluation gains/(losses) and impairment losses, property, plant and equipment 0 Increase in the donated asset reserve due to receipt of donated assets 44 Increaseininthe thedonated donatedasset assetreserve reserveindue to receipt of donatedimpairment assets 0 Reduction respect of depreciation, and/or Reduction the donated asset reserve in respect of depreciation, impairment and/or disposal of on in donated assets. (96) disposal of on donated assets. (300) Additions/(reduction) in other reserves 0 Additions/(reduction) in other reserves Other recognized gains and losses (70) 0 Other recognized gains and losses 0 Actuarial gains/(losses) on defined benefit pension schemes 0 Actuarial gains/(losses) on defined benefit pension schemes 0 Transfer to the income and expenditure account in respect of assets disposed of 0 Transfer to the income and expenditure account in respect of assets disposed of 0 Transfer of the excess of current cost depreciation over historical cost depreciation to Transfer of the excess of current cost depreciation over historical cost depreciation to the income and expenditure reserve 0 the income and expenditure reserve 270 Public Dividend Capital received 0 Public Dividend Capital received 0 Public Dividend Capital repaid 0 Public Dividend Capital repaid 0 Public Dividend Capital repayable (creditor) 0 Public Dividend Capital repayable (creditor) 0 Public Dividend Capital written off 0 Public Dividend Capital written off 0 Other transfers between reserves 0 Other transfers between reserves 0 Movements on other reserves 0 Movements on other reserves 0 Taxpayers’ Equity at 31 March 2010 46,558 Taxpayers’ Equity at 31 March 2009 40,937

STATEMENT OF CHANGES IN TAXPAYERS EQUITY STATEMENT OF CHANGES IN TAXPAYERS EQUITY

0 0 0 0 0 0 0 0 0 0 0 0 0 0 21,245 21,245

(355) 0 (323) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6,881 2,554 5,648 1,721

0 0 0 0 0 0 0 0

355 0593 0 0 0 0 0 0 0 0 0 0 0 15,878 12,323

Revaluation Donated Other Income & Public Revaluation asset DonatedReserves Other expenditure Income & Public reserve Dividend reserve asset Reserves expenditure Dividend reserve reserve Capital reserve reserve Capital £ 000s £ 000s £ 000s £ 000s £ 000s £ 000s £ 000s £ 000s £ 000s £ 000s 5,648 1,721 0 12,323 21,245 5,971 2,021 0 7,199 21,245 1,231 308 0 0 0 0 0 0 0 0 6,879 2,029 0 12,323 21,245 5,971 2,021 0 7,199 21,245 0 0 0 3,270 0 0 0 0 4,531 0 0 0 0 0 0 0 0 0 0 0 357 577 0 0 0 0 0 0 0 0 0 44 0 0 0 0 0 0 0 0 0 0 0 (96) 0 0 0 (300) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (70) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Clatterbridge Clatterbridge Centre for Centre Oncology for Oncology NHS Foundation NHS Foundation Trust Trust st Accounts Accounts for the year for the ended year31 ended 31st2010 March March 2010

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

Statement of Cash Flows for the Year Ended 31st March 2010 2009/10 ÂŁ 000s

2008/09 ÂŁ 000s

4,091

4,933

3,075 900 0 (96) 0 (327) 0 73 1,104 746 (812) 50 (9) 8,795

3,299 483 0 (300) 0 1,033 0 (72) (503) (1,542) 807 65 270 8,473

Cash flow from investing activities Interest received Purchase of Property ,Plant and Equipment Sales of Property ,Plant and Equipment Purchase of intangible assets Net cash generated from (used in) investing activities

50 (6,966) 0 0 (6,916)

556 (1,803) 0 0 (1,247)

Cash flow from financing activities Loans received Public dividend capital repaid Capital element of finance lease rental payments Interest element of finance lease PDC Dividend paid Net cash generated from (used) in financing activities

5,000 0 (114) (20) (851) 4,015

0 0 (95) (31) (927) (1,053)

Increase / (decrease) in cash and cash equivalents

5,894

6,173

Cash and cash equivalents at 1 April 2009

18,171

11,998

Cash and cash equivalents at 31 March 2010

24,065

18,171

CASH FLOWS FROM OPERATING ACTIVITIES Operating surplus (deficit) from continuing operations Non-cash income and expense Depreciation and amortisation Impairments Reversals of impairments Transfer from the donated asset reserve Amortisation of government grants (Increase) / decrease in trade and other receivables Increase / decrease in other assets (Increase) / decrease in inventories Increase / (decrease) in trade and other payables Increase / (decrease) in trade and other liabilities Increase / (decrease) in provisions Tax (paid) / received Other movements in operating cash flows Net cash inflow / (outflow) from operating activities

92 93

NOTE

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

1. Accounting policies and other information Monitor has directed that the financial statements of NHS foundation trusts shall meet the accounting requirements of the NHS Foundation Trust Annual Reporting Manual which shall be agreed with HM Treasury. Consequently, the following component financial statements: x

Balance Sheet

Income statement

Statement of changes in equity and

Cash flow statement

Together with these accounting policies, have been prepared in accordance with the 2009/10 NHS Foundation Trust Annual Reporting Manual issued by Monitor. The accounting policies contained in that manual follow International Financial Reporting Standards (IFRS) and HM Treasuryâ&#x20AC;&#x2122;s Financial Reporting Manual to the extent that they are meaningful and appropriate to NHS foundation trusts. The accounting policies have been applied consistently in dealing with items considered material in relation to the accounts. 1.1 Income Income 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 income for the trust is under contracts from commissioners in respect of healthcare services. Where income is received for a specific activity that is to be delivered in the following financial year, that income is deferred. Income from the sale of non-current assets is recognised only when all material conditions of sale have been met, and is measured as the sums due under the sale contract. 1.2 Expenditure Short â&#x20AC;&#x201C; 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 annual leave entitlement 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. Pension costs NHS Pension Scheme 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, in England and Wales. It is not possible for Clatterbridge Centre for Oncology NHS Foundation Trust to determine its share of the underlying scheme liabilities. Therefore, the scheme is accounted for as a defined contribution scheme. 93 94

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

Employers pension cost contributions are charged to operating expenses as and when they become due. Additional pension liabilities arising from early retirements are not funded by the scheme except where the retirement is due to ill-health. The full amount of the liability for the additional costs is charged to operating expenses at the time the trust commits itself to the retirement, regardless of the method of payment. Expenditure on other goods and services Expenditure on goods and services is recognised when, and to the extent that they have been received, and is measured at the fair value of those goods and services. Expenditure is recognised in operating expenses except where it results in the creation of a non-current asset such as property, plant and equipment. 1.3 Property, Plant and Equipment Recognition Property, Plant and Equipment is capitalised where: x

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 be provided 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 is at least ÂŁ5,000; or

It forms part of a group of assets which individually have a cost of more than ÂŁ250, collectively have a cost of at least ÂŁ5,000, and 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

It forms part of the initial setting-up cost of a new building or refurbishment of a ward or unit, irrespective of individual or collective cost.

Measurement Valuation On initial recognition, all Property, Plant and Equipment assets are measured at cost, representing the costs 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. Any costs arising from financing the construction of the asset are not capitalised but are charged to the income and expenditure account in the year to which they relate. Land and buildings are revalued every five years. A three yearly interim valuation is also carried out. Valuations are carried out by professionally qualified, external valuers in accordance with the Royal Institute of Chartered Surveyors (RICS) Appraisal and Valuation Manual. The valuations are carried out on the Modern Equivalent Asset basis which assumes that buildings would be replaced by structures utilising current building techniques and materials. Land is valued on an existing use basis primarily determined by market valuation. 94 95

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

Assets in the course of construction are valued at cost and are valued by professional valuers as part of the five or three-yearly valuation or when they are brought into use. Plant and equipment (including IT equipment) used in the Trust tends to be highly specialised in nature with no reliable means of ascertaining a market value. In accordance with IAS 16, these assets are carried at Depreciated Replacement Cost (DRC) and are not subject to revaluation. Subsequent expenditure Where subsequent expenditure enhances an asset beyond its original specification, the directly attributable cost is added to the asset’s carrying value. Where a component of an asset is replaced, the cost of replacement is capitalised if it meets the criteria for recognition above. The carrying amount of the part replaced is de-recognised. Depreciation Items of Property, Plant and Equipment are depreciated over their remaining useful economic lives in a manner consistent with the consumption of economic or service delivery benefits. Freehold land is considered to have an infinite life and is not depreciated. Property, Plant and Equipment that has been reclassified as “Held for Sale”, ceases to be depreciated upon reclassification. Assets in the course of construction, and residual interests in off-balance sheet PFI contract assets, are not depreciated until the asset is brought into use or reverts to the Trust, respectively. Revaluation and impairment Increases in asset values arising from revaluations are recognised in the revaluation reserve, except where, and to the extent that, they reverse an impairment previously recognised in operating expenses, in which case they are recognised in operating income. Decreases in asset values and impairments are charged to the revaluation reserve to the extent that there is an available balance for the asset concerned, and thereafter are charged to operating expenses. Gains and losses recognised in the revaluation reserve are reported in the Statement of Comprehensive Income as an item of “other comprehensive income”. De-recognition Assets intended for disposal are reclassified as “Held for Sale” once all of the following criteria are met: x The asset is available for immediate sale in its present condition subject only to terms which are usual and customary for such sales x The sale must be highly probable i.e.: q Management are committed to a plan to sell the asset; q An active programme has begun to find a buyer and complete the sale; q The asset is being actively marketed at a reasonable price; q The sale is expected to be completed within 12 months of the date of classification as “Held for Sale”; and q The actions needed to complete the plan indicate it is unlikely that the plan will be dropped or significant changes made to it. 95 96

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

Following re-classification, the assets are measured at the lower of their existing carrying amount and their “fair value less costs to sell”. Depreciation ceases to be charged and the assets are not revalued, except where the “fair value less costs to sell” falls below the carrying amount. Assets are de-recognised when all material sale contract conditions have been met. Property, plant and equipment which is to be scrapped or demolished does not qualify for recognition as “Held for Sale” and instead is retained as an operational asset and the asset’s economic life is adjusted. The asset is de-recognised when scrapping or demolition occurs. Donated Assets Donated non-current assets are capitalised at their current value on receipt and this value is credited to the donated asset reserve. Donated non-current assets are valued and depreciated as described above for purchased assets. Gains and losses on revaluations are also taken to the donated asset reserve and, each year, an amount equal to the depreciation charge on the asset is released from the donated asset reserve to the income and expenditure account. Similarly, any impairment on donate assets charged to the income and expenditure account is matched by a transfer from the donated asset reserve. On sale of donated assets, the net book value of the donated asset is transferred from the donated asset reserve to the Income and Expenditure Reserve. Private Finance Initiative (PFI) transactions PFI transactions which meet the IFRIC 12 definition of a service concession, as interpreted in HM Treasury’s FReM, are accounted for as “on-Statement of Financial Position” by the Trust. The underlying assets are recognised as Property, Plant and Equipment at their fair value. An equivalent financial liability is recognised in accordance with IAS 17. The annual contract payments are apportioned between the repayment of the liability, a finance cost and the charge for services. The finance charge is calculated using the effective interest rate for the scheme. The service charge is recognised in operating expenses and the finance cost is charged to Finance Costs in the Statement of Comprehensive Income. 1.4 Intangible assets Recognition Intangible assets are non-monetary assets without physical substance which are capable of being sold separately from the rest of the Trust's business or which arise from contractual or other legal rights. They are recognised only where it is probable that future economic benefits will flow to, or service potential be provided to the Trust, and where the cost of the asset can be measured reliably, and is at least £5,000. Where internally generated assets are held for service potential, this involves a direct contribution to the delivery of services to the public. Internally generated intangible assets Internally generated goodwill, brands, mastheads, publishing titles, customer lists and similar items are not capitalised as intangible assets. 96 97

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

Expenditure on research is not capitalised. Expenditure on development is capitalised only where all of the following can be demonstrated: x The project is technically feasible to the point of completion and will result in an intangible asset for sale or use x The Trust intends to complete the asset and sell or use it x The Trust has the ability to sell or use the asset x How the intangible asset will generate probable future economic or service delivery benefits e.g. the presence of a market for it or its output, or where it is to be used for internal use, the usefulness of the asset x Adequate financial, technical and other resources are available to the Trust to complete the development and sell or use the asset and x The Trust can measure reliably the expenses attributable to the asset during development. Software Software which is integral to the operation of hardware e.g. an operating system is capitalised as part of the relevant item of Property, Plant and Equipment. Software which is not integral to the operation of hardware e.g. application software, is capitalised as an intangible asset. Measurement Intangible assets are recognised initially at cost, comprising all directly attributable costs needed to create, produce and prepare the asset to the point that it is capable of operating in the manner intended by management. Subsequently intangible assets are measured at fair value. Increases in asset values arising from revaluations are recognised in the revaluation reserve, except where, and to the extent that, they reverse an impairment previously recognised in operating expenses, in which case they are recognised in operating income. Decreases in asset values and impairments are charged to the revaluation reserve to the extent that there is an available balance for the asset concerned, and thereafter are charged to operating expenses. Gains and losses recognised in the revaluation reserve are reported in the Statement of Comprehensive Income as an item of “other comprehensive income”. Intangible assets held for sale are measured at the lower of their carrying amount or “fair value less costs to sell”. Amortisation Intangible assets are amortised over their expected useful economic lives in a manner consistent with the consumption of economic or service delivery benefits.

97 98

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

1.5 Government grants Government grants are grants from Government bodies other than income from primary care trusts or NHS trusts for the provision of services. Grants from the Department of Health, including those for achieving three star status, are accounted for as Government grants as are grants from the Big Lottery Fund. Where the Government grant is used to fund revenue expenditure it is taken to the Statement of Comprehensive Income to match that expenditure. Where the grant is used to fund capital expenditure the grant is held as deferred income and released to the operating income over the life of the asset in a manner consistent with the depreciation charge for that asset. 1.6 Inventories Inventories are valued at the lower of cost and net realisable value. The cost of inventories is measured using the weighted average cost method. 1.7 Financial instruments and financial liabilities Recognition Financial assets and financial liabilities which arise from contracts for the purchase or sale of non-financial items (such as goods or services), which are entered into in accordance with the Trust’s normal purchase, sale or usage requirements, are recognised when, and to the extent which, performance occurs i.e. when receipt or delivery of the goods or services is made. Financial assets or financial liabilities in respect of assets acquired or disposed of through finance leases are recognised and measured in accordance with the accounting policy for leases described at 1.9 below. All other financial assets and financial liabilities are recognised when the Trust becomes a party to the contractual provisions of the instrument. De-recognition All financial assets are de-recognised when the rights to receive cashflows from the assets have expired or the Trust has transferred substantially all of the risks and rewards of ownership. Financial liabilities are de-recognised when the obligation is discharged, cancelled or expires.

Classification and Measurement Financial assets are categorised as: x ‘Fair Value through Income and Expenditure’ x Loans and receivables or x ‘Available-for-sale financial assets’. 98 99

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

Financial liabilities are classified as: x ‘Fair value through Income and Expenditure’ or x ‘Other Financial liabilities’. Financial assets and financial liabilities at ‘Fair Value through Income and Expenditure’ Financial assets and financial liabilities at ‘fair value through income and expenditure’ are financial assets or financial liabilities held for trading. A financial asset or financial liability is classified in this category if acquired principally for the purpose of selling in the short-term. Derivatives are also categorised as held for trading unless they are designated as hedges. Derivatives which are embedded in other contracts but which are not ‘closely-related’ to those contracts are separated-out from those contracts and measured in this category. Assets and liabilities in this category are classified as current assets and current liabilities. These financial assets and financial liabilities are recognised initially at fair value, with transaction costs expensed in the income and expenditure account. Subsequent movements in the fair value are recognised as gains or losses in the Statement of Comprehensive Income. Loans and receivables Loans and receivables are non-derivative financial assets with fixed or determinable payments with are not quoted in an active market. They are included in current assets. The Trust’s loans and receivables comprise: current investments, cash at bank and in hand, NHS debtors, accrued income and ‘other debtors’. Loans and receivables are recognised initially at fair value, net of transactions costs, and are measured subsequently at amortised cost, using the effective interest method. The effective interest rate is the rate that discounts exactly estimated future cash receipts through the expected life of the financial asset or, when appropriate, a shorter period, to the net carrying amount of the financial asset. Interest on loans and receivables is calculated using the effective interest method and credited to the income and expenditure account. Available-for-sale financial assets Available-for-sale financial assets are non-derivative financial assets which are either designated in this category or not classified in any of the other categories. They are included in long-term assets unless the Trust intends to dispose of them within 12 months of the balance sheet date. Available-for-sale financial assets are recognised initially at fair value, including transaction costs, and measured subsequently at fair value, with gains or losses recognised in reserves and reported in the Statement of Comprehensive Income as an item of “other comprehensive income”. When items classified as ‘available-for-sale’ are sold or impaired, the accumulated fair value adjustments recognised in reserves are transferred from reserves and recognised in “Finance Costs” in the Statement of Comprehensive Income. 99 100

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

Other financial liabilities All other financial liabilities are recognised initially at fair value, net of transaction costs incurred, and measured subsequently at amortised cost using the effective interest method. The effective interest rate is the rate that discounts exactly estimated future cash payments through the expected life of the financial liability or, when appropriate, a shorter period, to the net carrying amount of the financial liability. They are included in current liabilities except for amounts payable more than 12 months after the balance sheet date, which are classified as long-term liabilities. Interest on financial liabilities carried at amortised cost is calculated using the effective interest method and charged to Finance Costs. Interest on financial liabilities taken out to finance Property, Plant and Equipment or intangible assets is not capitalised as part of the cost of those assets. Determination of fair value For financial assets and financial liabilities carried at fair value, the carrying amounts are the full value of cash in the balance sheet. Impairment of financial assets At the balance sheet date, the Trust assesses whether any financial assets, other than those held at ‘fair value through income and expenditure’ is impaired. Financial assets are impaired and impairment losses are recognised if, and only 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 cashflows 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 the Statement of Comprehensive Income and the carrying amount of the asset is reduced through the use of an allowance account. Trade Receivables A provision for impairment against a trade receivable is established when the Trust considers it will not be able to collect all amounts due according to the original terms of the contract. The Trust will take the following factors into consideration when determining a trade receivable to be impaired: x significant financial difficulties of the debtor x probability that the debtor will enter bankruptcy or financial reorganisation and x default or delinquency in payment (more than 60 days overdue) The carrying amount of the asset is reduced through the use of an allowance account for trade receivables (Bad Debt Provision), and the amount of the loss is recognised in the Statement of Comprehensive Income. If the trade receivable becomes uncollectible, it is

100 101

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

written off against the Bad Debt Provision. Any subsequent recoveries of amounts previously written off are credited to the Statement of Comprehensive Income. 1.8 Leases Finance Leases Where substantially all risks and rewards of ownership of a leased asset are borne by the Trust, the asset is recorded as Property, Plant and Equipment and a corresponding liability is recorded. The value at which both are recognised is the lower of the fair value of the asset or the present value of the minimum lease payments, discounted using the interest rate implicit in the lease. The implicit interest rate is that which produces a constant periodic rate of interest on the outstanding liability. The asset and liability are recognised at the inception of the lease, and are de-recognised when the liability is discharged, cancelled or expires. The annual rental is split between the repayment of the liability and a finance cost. The annual finance cost is calculated by applying the implicit interest rate to the outstanding liability and is charged to Finance Costs in the Statement of Comprehensive Income. Operating Leases Other leases are regarded as operating leases and the rentals are charged to operating expenses on a straight-line basis over the term of the lease. Operating lease incentives received are added to or subtracted from the lease rentals as appropriate and charged to operating expenses over the life of the lease. Leases of land and buildings Where a lease is for land and buildings, the land component is separated from the building component and the classification for each is assessed separately. Leased land is treated as an operating lease. 1.9 Provisions The Trust provides for legal or constructive obligations that are of uncertain timing or amount at the balance sheet date on the basis of the best estimate of the expenditure required to settle the obligation. Where the effect of the time value of money is significant, the estimated risk-adjusted cash flows are discounted using HM Treasuryâ&#x20AC;&#x2122;s discount rate of 2.2% in real terms. 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. Although the NHSLA is administratively responsible for all clinical negligence cases, the legal liability remains with the Trust. The total value of clinical negligence provisions carried by the NHSLA on behalf of the Trust is disclosed at note 22.

101 102

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

Non-clinical risk pooling The Trust participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both are risk pooling schemes under which the 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 when the liability arises. 1.10 Contingencies Contingent assets (that is, assets arising from past events whose existence will only be confirmed by one or more future events not wholly within the Trust’s control) are not recognised as assets, but are disclosed in note 26 where an inflow of economic benefits is probable. Contingent liabilities are not recognised, but are disclosed in note 26 unless the probability of a transfer of economic benefits is remote. Contingent liabilities are defined as: x Possible obligations arising from past events whose existence will be confirmed only by the occurrence of one or more uncertain future events not wholly within the Trust’s control or x Present obligations arising from past events but for which it is not probable that a transfer of economic benefits will arise or for which the amount of the obligation cannot be measured with sufficient reliability. 1.11 Public dividend capital Public dividend capital (PDC) is a type of public sector equity finance based on the excess of assets over liabilities at the time of establishment of the predecessor NHS trust. HM Treasury has determined that PDC is not a financial instrument within the meaning of IAS 32. A charge, reflecting the forecast cost of capital utilised by the Trust, is paid over as public dividend capital dividend. The charge is calculated at the rate set by HM Treasury (currently 3.5%) on the average relevant net assets of the Trust. Relevant net assets are calculated as the value of all assets less the value of all liabilities, except for donated assets and cash held with the Office of the Paymaster General / Government Banking Service. In accordance with the requirements laid down by the Department of Health (as the issuer of PDC), the dividend for the year is calculated on the actual average net assets as set out in the ‘pre-audit’ version of the annual accounts. The dividend thus calculated is not revised should any adjustment to net assets occur as a result of the audit of the annual accounts. 1.12 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.

102 103

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

1.13 Corporation Tax The Trust is a Health Service Body within the meaning of s519A ICTA 1988 and accordingly is exempt from taxation in respect of income and capital gains within categories covered by this. There is a power for the treasury to disapply the exemption in relation to specified activities of a Foundation Trust (s519A (3) to (8) ICTA 1988). Accordingly, the Trust is potentially within the scope of corporation tax in respect of activities, which are not related to, or ancillary to, the provision of healthcare, and where the profits there from exceed £50,000 per annum. 1.14 Foreign exchange The functional and presentational currencies of the Trust are sterling. A transaction which is denominated in a foreign currency is translated into the functional currency at the spot exchange rate on the date of the transaction. Where the Trust has assets or liabilities denominated in a foreign currency at the balance sheet date: x Monetary items (other than financial instruments measured at “fair value through income and expenditure”) are translated at the spot exchange rate on 31 March; x Non-monetary assets and liabilities measured at historical cost are translated using the spot exchange rate at the date of the transaction; and x Non-monetary assets and liabilities measured at fair value are translated using the spot exchange rate at the date the fair value was determined. Exchange gains or losses on monetary items (arising on settlement of the transaction or on re-translation at the balance sheet date) are recognised as income or expense in the period in which they arose. Exchange gains or losses on non-monetary assets and liabilities are recognised in the same manner as other gains and losses on these items. 1.15 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. However, they are disclosed in a separate note to the accounts in accordance with the requirements of HM Treasury’s Financial Reporting Manual.

103 104

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

2. Operating segments The Trust considers that all of its activities fall within the single category of the provision of healthcare services. This is an aggregate of all the specialty services provided by the Trust, both at its main Clatterbridge site, and at clinics held at other hospitals in the region. The large majority of the Trust’s income originates from within the UK Government. The main expenses incurred are the cost of staff involved in the production or support of healthcare services, together with the related supplies and overheads necessary to establish this production. The business activities which earn revenue and incur expenses are therefore of one broad combined nature and because of this, it is considered appropriate to aggregate these activities into the single segment of Healthcare. The Trust’s operating results are reviewed on a monthly basis by its Board of directors which is chaired by the Chairman and includes executive directors as well as senior professional non-executive directors. The Trust Board reviews the financial position of the Trust as a whole – rather than any individual components included in the totals – in its roles of making decisions and allocating resources. This process implies a single operating segment under IFRS 8. The monthly finance report prepared for the Trust Board contains detailed performance and activity information together with expenditure reports covering all areas of the Trust. All of this information is summarised into single Income & Expenditure, Balance Sheet and Cash Flow reports for the whole Trust. The Board acting in its role as Chief Operating decision maker therefore only considers one segment of healthcare in its decision-making process. The single segment of healthcare has therefore been identified consistent with the core principle of IFRS 8 which is to enable users of the financial statements to evaluate the nature and financial effects of business activities and economic environments. 2.1 Income from activities comprises Elective income Non-elective income Outpatient income A & E income Other NHS clinical income * Total income at full tariff PBR claw back Income from Activities Private patients Other non-protected clinical income * * Other non-protected income covers income from Welsh commissioners

2009/10 £ 000s 4,145 3,185 8,586 0 40,536 56,452 0 56,452 349 2,021 58,822

2008/09 £ 000s 4,652 3,519 6,953 0 37,280 52,404 0 52,404 274 1,734 54,412

The figures quoted for 2009/10 are based upon income received in respect of actual activity undertaken within each category. The Terms of Authorisation set out the mandatory goods and services that the Trust is required to provide (protected services). All of the income from activities shown above is derived from the provision of protected services.

104 105

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

2.2 Private Patient Income

2009/10 £ 000s 349 58,822 0.59%

Private patient income Total patient related income Proportion as a percentage

2008/09 £ 000s 274 54,412 0.50%

Base Year 2002/03 £ 000s 520 23,697 2.19%

Section 44 of the National Health Services Act 2006 requires that the proportion of private patient income to the total patient related income of NHS Foundation Trusts should not exceed its proportion whilst the body was an NHS Trust in 2002/03 (Private Patient Cap). The proportion in 2002/03 was 2.2%. The above note shows that the Trust was compliant in 2009/10.

2.3 Operating lease Income

There was no operating lease income

2.4 Revenue from patient care services NHS Foundation Trusts NHS Trusts Strategic Health Authorities Primary Care Trusts Local Authorities Departmental of Health - grants Departmental of Health - other NHS other Non NHS- Private patients Non NHS – Overseas’ patients NHS injury scheme Non NHS Other

2009/10 £ 000s 17 0 0 56,047 0 0 0 0 349 0 0 2,409 58,822

2008/09 £ 000s 348 0 0 50,852 0 0 997 0 274 0 0 1,941 54,412

* Non NHS other covers income from non English UK Commissioners.

2.5 Other Operating Income Research and Development Education and Training Charitable and other contributions to expenditure Transfers from the donated asset reserve in respect of depreciation of donated assets Non-patient care services to other bodies Other Total

2009/10 £ 000s 535 967 0

2008/09 £ 000s 357 1,115 0

96 0 4,179 5,777

300 0 4,954 6,726

Other Income includes R&D Cancer Network £1,173k (2008/09 £729k), National Cancer Analysis Team £623k (2008/09 £824k), and Sales of drugs to private hospitals of £709k (2008/09 £851k)

105 106

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

3. Operating Expenses 3.1 Operating expenses comprise Services from NHS Foundation Trusts Services from other NHS Trusts Services from other NHS bodies Purchase of healthcare from non NHS bodies Executive Directors' costs Non Executive Directors' costs Staff costs Drugs costs Supplies and services - clinical (Excluding drug costs) Supplies and services - general Establishment Research and Development Transport Premises Bad debts Other impairment of financial assets Depreciation and amortisation Amortisation of intangible assets Impairments of property, plant & equipment Audit fees – statutory audit Audit fees – regulatory reporting Other Auditors remuneration: further assurance services Other Auditors remuneration: other services Clinical negligence Legal fees Consultancy costs Training, courses and conferences Patients travel Other

2009/10 £ 000s 5,165 1,610 0 0 615 119 26,643 15,817 2,334 410 993 0 10 1,824 71 0 3,071 4 900 44 0 3 77 99 24 50 100 47 478 60,508

2008/09 £ 000s 4,408 1,822 0 0 578 118 24,848 14,452 2,291 203 1,158 0 6 1,941 (23) 0 3,294 5 483 40 0 21 66 54 0 0 19 44 377 56,205 Restated

Audit Remuneration

2009/10

Internal audit services Other services: Board review

‘2008/09

77 3

66 21

538 0 0

526 0 0

538

526

3.2 Arrangements containing an operating lease Minimum lease payments Contingent rents Less sub-lease payments

106 107

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

3.3 Arrangements containing an operating lease Future minimum lease payments due: Not later than one year Later than one year and not later than five years Later than five years

545 1972 0

62 457 0

Total

2,517

519

Total of future minimum sublease lease payments to be received at the balance sheet date.

107 108

109

Salary

Total

0 0 0 0 0 0 0 21,245

0 (70) 0 0

0 0 0 0 0 0 0 46,558

(355) 0 0 0 0 0 0 6,881 40-45 15-20 10-15 10-15 10-15 10-15

0 0 0 0 0

0 0 0 0 0 0 0 2,554

0 0 0 0

(96) 160-165

0 0 0 0 0 0 0 0

0 0 0 0 0

90 108

355 0 0 0 0 0 0 15,878

0 0 (70) 0 0

Donated Other Income & asset Reserves expenditure 2008/09 reserve reserve Other Benefits in £ 000s £ 000s £ 000s remuneration kind 1,721 0 12,323 (bands of (bands of 308 0 0 £5,000) £5,000) 2,029 0£000 12,323 £000 0 0 3,270 0 0 0 577 0 0 44 0 0

1) All Board members are appointed by the Board on permanent contracts. 2) All non Executive Board members are appointed by the Council of Governors for an initial period of 3 years which is renewable subject to satisfactory performance. 3) The following changes have occurred since 1st April 2009:a) D. Hurrell left the board on 2.08.09 as Chief Executive. b) A.Cannell was Director of Finance from 1.04.09 until 7.06.09, then Acting Chief Executive from 8.06.09 until 19.10.09, then Chief Executive from 20.10.09 c) J. Andrews was Acting Director of Finance from 8.6.09 until 7.03.10. d) Y.Bottomley joined the board on 8.03.10 as Director of Finance. e) D.Jennings left the Board on 11.03.10 as Director of Human Resources

The aggregate amount of remuneration and other benefits received by Directors during the financial year was £506,020. Employer contributions to a pension scheme in respect of directors was £67,763.

(96) 155-160 15-20 85-90 70-75 75-80

Revaluation Public reserve Dividend Capital Benefits in £ 000s £ 000s kind Salary 5,648 21,245 (bands of (bands of 1,231 £5,000) 0 £5,000) 6,879 £000 £000 21,245 0 0 115-120 0 0 90-95357 0 0 0

0 0 0 0 0

3,270 0 934 44

2009/10 Other £ 000s remuneration 40.937 (bands of £5,000) 1,539 £000 42,476

Taxpayers’ Equity at 1 April 2009 – as previously stated (bands of £5,000) Prior period adjustment £000 Taxpayers’ Equity at 1 April 2009 - restated Executive Directors Surplus/(deficit) for the year D Hurrell -gains/(losses) Chief Executiveand impairment losses on intangible assets 35-40 Revaluation A Cannell Chief Executive 105-110 Revaluation gains/(losses) and impairment losses, property, plant and equipment J Andrews – Acting Director Financedue to receipt of donated assets 60-65 Increase in the donated assetofreserve Reduction in the donatedofasset reserve in respect of depreciation, impairment Y Bottomley – Director Finance 5-10and/or disposal of on -donated assets. D Husband Medical Director 15-20 Additions/(reduction) other reserves H Porter - Director ofinNursing & Quality 85-90 Other recognized gains and losses D Jennings - HR Director 100-105 Actuarial gains/(losses) on defined benefit pension schemes S Nicholls - Director of Operations 80-85 Transfer to the income and expenditure account in respect of assets disposed of Transfer of the excess of current cost depreciation over historical cost depreciation to Non Executive Directors the income and expenditure reserve A White - Chairman 40-45 Public Dividend Capital received G Morris - Non Executive Director 15-20 Public Dividend Capital repaid D Buchanan Non Executive Director 10-15 Public Dividend Capital repayable (creditor) L Martin - NonCapital Executive Director 10-15 Public Dividend written off V Tagart - Nonbetween Executive Director 10-15 Other transfers reserves C Eastwood Non Executive Director 10-15 Movements on other reserves Taxpayers’ Equity at 31 March 2010

Name and title

Salary and Allowances

3.4 Remuneration Report

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010 Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010 STATEMENT OF CHANGES IN TAXPAYERS EQUITY

110

Total

Public Dividend Capital Lump sum £ 000s at age 60 21,245 related to accrued 0 pension at 21,245 31 March 2010 0 (bands of0 £5,000) 0 £000 0

Revaluation reserve

Donated Other Income & asset Reserves expenditure reserve reserve £ 000s £ 000s £ 000s Real 1,721 0 12,323 Cash increase in Employer's 308 0 0 Equivalent contribution Cash Transfer Equivalent to 2,029to 0 12,323 Value at 31 stakeholder Transfer 0 0 3,270 March 2009 Value pension 0 0 Round0to 577 0 nearest 0 £00) £00044 £0000 £000

90 109

Real Increase in CETV This reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period.

valued are the member's accrued benefits and any contingent spouse's pension payable from the scheme. A CETV figure is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies. The CETV figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries.

£ 000s £ 000s Lump sum Total Taxpayers’ Equity at 1 April 2009 – as previously stated 40.937 at age 60 accrued Cash5,648 1,231 Prior period adjustment 1,539 Equivalent Real related to pension at increase in real age 60 at Transfer to 6,879 Taxpayers’ Equity at 1 April 2009 - restated 42,476 Value at 31 pension at increase in 31 March 0 Surplus/(deficit) for the year 3,270 age 60 pension 2010 March 2010 0 Revaluation gains/(losses) and impairment losses on intangible assets 0 (bands of (bands of (bands of 357 £2,500) £2,500) £5,000) Revaluation gains/(losses) and impairment losses, property, plant and equipment 934 0 Name in and £000 £000 £00044 £000 Increase thetitle donated asset reserve due to receipt of donated assets Reduction in Chief the donated asset and/or D HurrellExecutive until reserve 2.08.09 in respect of depreciation, 0-2.5 impairment 0-2.5 30-35 90-95 503 422 20 0 disposal of on donated assets. 0 (96) (96) A Cannell - Chief Executive 2.5-5 12.5-15 30-35 80-85 0 598 469 1060 0 0 0 0 0 0 Additions/(reduction) other of reserves 0 0 J Andrews – Acting in Director Finance from 8th June th 2009 until 7 March 2010 0-2.5 5-7.5 15-20 45-50 231 167 41 0 Other recognized gains and losses 0 0 0 0 (70) (70) 0 Actuarial gains/(losses) definedfrom benefit pension schemes 0-2.5 Y Bottomley – Director on of Finance 8th March 2010 0-2.5 0-5 0 0-5 0 1 0 0 1 0 0 0 0 Transfer to the- income and expenditure account in respect of assets of D Husband Medical Director 2.5-5 disposed 7.5-10 55-60 0 175-180 0 1,475 1,288 0 1220 0 0 Transfer of -the excess of current cost depreciation over historical H Porter Director of Nursing & Quality 0-2.5cost depreciation 0-2.5 to 25-30 85-90 518 462 34 0 the Dincome and expenditure reserve 355 Jennings - HR Director until 11.03.10 0-2.5 2.5-5 0-5 0 10-15 0 69 (355) 53 0 12 0 0 0 0 0 0 Public Dividend Capital received 0 0 S Nicholls – Director of Operations 0-2.5 2-5.5 5-10 15-20 86 65 17 0 0 0 0 0 Public Dividend Capital repaid 0 0 0 0 0 0 Public Dividend Capital repayable (creditor) 0 0 0 0 0 0 Public Dividend Capital written off 0 0 As Non-Executive members do not receive pensionable remuneration, there are no entries in respect of pensions for Non-Executive members. 0 0 0 0 Other transfers between reserves 0 0 0 0 0 0 Movements on other reserves 0 0 Cash Equivalent Transfer Values 6,881 at a particular 2,554 point in time. 0 The benefits 15,878 21,245 Taxpayers’ Equity at 31 March 46,558 A Cash Equivalent Transfer Value2010 (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member

3.5 Pension entitlements

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

3.6 Remuneration Committee and Terms of Service The Remuneration Committee is made up of the Chairman and Non-Executive Directors only. Acting in accordance with Department of Health Guidelines, the committee determines the remuneration of Senior Managers and Executive Directors. The Chief Executive of the Trust joins the Committee when the remuneration of other Executive Directors is being reviewed. The Chief Executive and Executive Directors are employed under permanent contracts of employment and (apart from the Medical Director) they have been recruited under national advertisements. The position of Medical Director is an internal appointment open to competition between senior medical staff. The employment of Senior Managers and Executive Directors may be terminated with three months notice as a result of a disciplinary process, if the Trust is dissolved as a statutory body, or if they choose to resign. None have contracts of service, and none has a contract that is subject to any performance conditions. The position of Chair and NonExecutive Directors are recruited through national advertisements. Appointments are made on fixed term contracts (normally for three years), which can be renewed on expiry. Terms of appointment and remuneration for Non-Executive Directors are set by the Council of Governors. Details of the remaining terms of the Chair and Non-Executive Directors are as follows: Name

First Appointed

Extended To

Alan White Douglas Buchanan Graham Morris Louise Martin Vicky Tagart Carol Eastwood

23.08.1999 01.12.1995 01.12.2005 01.04.2001 01.12.2000 01.02.2007

30.11.2002 30.11.1997 30.11.2009 31.03.2005 30.11.2003 31.01.2010

31.07.2013 01.01.2011 30.11.2012 30.11.2010 30.11.2010 31.01.2013

The Remuneration Committee will be responsible for agreeing remuneration and terms of employment for the Chief Executive and other Directors, in accordance with: 1) Legal requirements 2) The principles of probity 3) Good people management practice 4) Proper corporate governance The membership of the Remuneration Committee, number of meetings held and attendance can be found on page 38 of the Annual Report.

Signed Andrew Cannell Chief Executive

Date

110 111

26th May 2010

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

4. Staff Costs and Numbers 4.1 Staff costs Salaries and wages Social Security costs Employer contributions to NHS Pension scheme Other Pension Costs Termination benefits Agency and contract staff Employee benefits expense

2009/10 £ 000s 22,570 1,552 2,587 0 0 549

2008/09 £ 000s 21,169 1,462 2,354 0 0 441

27,258

25,426

All employer pension contributions in 2009/10 were paid to the NHS Pensions Agency.

4.2 Average number of persons employed (Wte basis) Medical and dental Ambulance staff Administration and estates Healthcare assistants & other support staff Nursing, midwifery & health visiting staff Nursing, midwifery & health visiting learners Scientific, therapeutic and technical staff Social care staff Bank and agency staff Other Total

2009/10 Total Number 56 0 184 56 138 0 199 0 0 20 653

2008/09 Total Number 52 0 163 49 119 0 186 0 0 20 593

4.3 Employee Benefits

None (2008/09 – None)

4.4 Retirements due to ill-health

This note discloses the number and additional pension costs for individuals who retired early on ill health grounds during the year. There was one such retirement, at an additional cost of £304.18 (2008/09 – none). This information has been supplied by the NHS Pensions Agency.

111 112

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

4.5 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.pensions.nhsbsa.nhs.uk. 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, 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. The scheme is subject to a full actuarial valuation every four years (until 2004, every five years) and an accounting valuation every year. An outline of these follows: a) Full actuarial (funding) 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 to be paid by employers and scheme members. The last such valuation, which determined current contribution rates was undertaken as at 31 March 2004 and covered the period from 1 April 1999 to that date. The conclusion from the 2004 valuation was that the scheme had accumulated a notional deficit of £3.3 billion against the notional assets as at 31 March 2004. However, after taking into account the changes in the benefit and contribution structure effective from 1 April 2008, the scheme actuary reported that employer contributions could continue at the existing rate of 14% of pensionable pay. On advice from the scheme actuary, scheme contributions may be varied from time to time to reflect changes in the scheme’s liabilities. Up to 31 March 2008, the vast majority of employees paid contributions at the rate of 6% of pensionable pay. From 1 April 2008, employee’s contributions are on a tiered scale from 5% up to 8.5% of their pensionable pay depending on total earnings. b) Accounting valuation A valuation of the scheme liability is carried out annually by the scheme actuary as at the end of the reporting period by updating the results of the full actuarial valuation. Between the full actuarial valuations at a two-year midpoint, a full and detailed member data-set is provided to the scheme actuary. At this point the assumptions regarding the composition of the scheme membership are updated to allow the scheme liability to be valued. The valuation of the scheme liability as at 31 March 2008, is based on detailed membership data as at 31 March 2006 (the latest midpoint) updated to 31 March 2008 with summary global member and accounting data. 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) Resource Account, published annually. These accounts can be viewed on the NHS Pensions website. Copies can also be obtained from The Stationery Office. c) Scheme provisions The scheme is a “final salary” scheme. Annual pensions are normally based on 1/80th of the best of the last 3 years pensionable pay for each year of service. A lump sum normally equivalent to 3 years pension is payable on retirement. 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. On death, a pension of 50% of the member’s pension is normally payable to the surviving spouse.

112 113

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010 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 yearâ&#x20AC;&#x2122;s pensionable pay for death in service, and five times their annual pension for death after retirement, less pension already paid, subject to a maximum amount equal to twice the memberâ&#x20AC;&#x2122;s final yearâ&#x20AC;&#x2122;s pensionable pay less their retirement lump sum for those who die after retirement, is payable. 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 the statement of comprehensive income at the time the Trust commits itself to the retirement, regardless of the method of payment. The scheme provides the opportunity to members to increase their benefits through money purchase additional voluntary contributions (AVCs) provided by an approved panel of life companies. Under the arrangement the employee/member can make contributions to enhance an employee's pension benefits. The benefits payable relate directly to the value of the investments made.

113 114

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

5. Finance Income Interest on loans and receivables Interest on available for sale financial assets Interest on held-to-maturity financial assets Other gains Available for sale financial assets and liabilities held at fair value through income and expenditure account - fair value gains - fair value losses Net gains / losses on available for sale financial assets through income and expenditure Other (e.g. bank interest)

6.1 Finance Costs - Interest expense Loans from the Foundation Trust Financing Facility Commercial loans Overdrafts Finance leases Other

6.2 Impairment of assets (PPE & Intangibles) Loss or damage from normal operations Changes in market price Other

2009/10 £ 000s 0 0 0 0

2008/09 £ 000s 0 0 0 0

0 0

0 50 50

0 556 556

2009/10 £ 000s 0 0 0 20 0 20

2008/09 £ 000s 0 0 0 31 0 31

2009/10 £ 000s 0 0 900 900

2008/09 £ 000s 0 0 483 483

6.3 Better Payment Practice Code Better Payment Practice Code – measure of compliance

2009/10 Number £000

2008/09 Number £000

Total Non-NHS trade invoices paid in year Total Non- NHS trade invoices paid within target Percentage of Non-NHS trade invoices paid within target

7,026 6,283 89.4%

13,315 12,327 92.6%

6,463 6,119 94.7%

9,870 9,276 94.0%

Total NHS trade invoices paid in year Total NHS trade invoices paid within target Percentage of NHS trade invoices paid within target

1,428 1,194 83.6%

27,167 26,214 96.5%

1,049 1,001 95.4%

22,709 22,405 98.7%

The Better Payment Practice Code requires the Trust to aim to pay all undisputed invoices by the due date or within 30 days of receipt of goods or a valid invoice, whichever is later.

114 115

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

6.4 The late payment of commercial debts (interest) Act 1998 Amounts included within other interest payable arising from Claims made under this legislation Compensation paid to cover debt recovery costs under this legislation

2009/10 £ 000s

2008/09 £ 000s

No interest or compensation has been paid under the Late Payment of Commercial Debts (Interest) Act 1998 during 2009/10 or 2008/09

6.5 Management costs

2009/10 £ 000s

Management costs Income Management costs as % of income

2,736

2,312

64,599

61,138

4.2%

3.8%

Management costs are defined as those on the management costs website at www.dh.gov.uk/policyandguidance/organisationpolicy/financeandplanning/nhsmanagementcosts/fs/en

115 116

2008/09 £ 000s

117

Software Licenses

Licenses and Trademarks

9 0 9 5 0 5

- Purchased at 1st April 2009 (restated)

- Donated at 1st April 2009 (restated)

Total at 1st April 2009 (restated)

- Purchased at 31st March 2010

- Donated at 31st March 2010

Total at 31st March 2010

Net book value

116 90

Taxpayers’ Equity at 1 April 2009 – as previously stated Prior period adjustment £ 000s £ 000s Taxpayers’ at 1as April 2009stated - restated Gross Cost atEquity 1 April 2009 previously 27 0 Surplus/(deficit) for the year Prior Period adjustments 0 0 Revaluation Impairments gains/(losses) and impairment losses on intangible assets 0 0 Revaluation gains/(losses) and impairment losses, property, plant and equipment Reclassifications 0 0 Increase in the donated asset reserve due to receipt of donated assets Other in year revaluation 0 0 Reduction the donated asset reserve in respect of depreciation, impairment and/or Additions –in purchased 0 0 disposal of on donated assets. Additions – donated 0 0 Additions/(reduction) in other reserves Disposals 0 0 Other recognized gains and losses Gross cost 31st March 2009 27 0 Actuarial gains/(losses) on defined benefit pension schemes Transfer to the income and expenditure account in respect of assets disposed of Amortisation at 1st April 2009 as previously Transfer of the excess of current coststated depreciation over historical 18 cost depreciation0to Prior Period adjustments the income and expenditure reserve Provided during the year received 4 0 Public Dividend Capital Impairments 0 0 Public Dividend Capital repaid Reversal of Impairments 0 0 Public Dividend Capital repayable (creditor) Reclassifications 0 0 Public Dividend Capital written off Other in year revaluation 0 0 Other transfers between reserves Disposals 0 0 Movements on other reserves AmortisationEquity as at 31st 2010 2010 22 0 Taxpayers’ atMarch 31 March

7.1 Intangible fixed assets 2009/10

7. Intangible Fixed Assets

0 00 00 00 00 00 00 21,2450 00

0 46,558

0 00 00 00 0

0 0 0 0 0

(355) 0 0 0 0 0 0 0 0 0 0 0 0 6,881 0

Revaluation Public reserve Dividend Capital Development Goodwill £ 000s £ 000s Expenditure 5,648 21,245 1,231 0 £ 000s £ 000s 6,879 21,245 0 0 0 0 0 0 0 0 0 0 357 0 0 0 0 0

(96) 0 0 0 (70) 00 0

£ 000s 40.937 1,539 £ 000s 42,476 0 3,270 0 0 0 934 0 44

Patents

Total

Clatterbridge Centre for Oncology NHS Foundation Trust Clatterbridge Centre foryear Oncology Foundation Accounts for the ended NHS 31st March 2010 Trust Accounts for the year ended 31st March 2010 STATEMENT OF CHANGES IN TAXPAYERS EQUITY

0 00 00 00 00 00 00 2,5540

(96) 00 00 00 0

Donated asset reserve Other £ 000s 1,721 308 £ 000s 2,029 0 0 0 0 0 577 0 44

0 0 4 0 0 0 0 0 0 0 0 0 0 022

0 0 0 0 0 0 027 0

355 0 0 0 0 0 0 15,878

0 0 (70) 0 0

Income & expenditure reserve Total £ 000s £ 000s 0 12,323 0 0 £ 000s 0 12,323 27 0 3,270 0 0 0 0 0 0 0 0 0

Other Reserves

118

Software Licenses

Licenses and Trademarks

9 0 9

- Purchased at 31st March 2009

- Donated at 31st March 2009

Total at 31st March 2009

- Donated at 1st April 2008

Total at 1st April 2008

- Purchased at 1st April 2008

Net book value

117 90

Taxpayers’ Equity at 1 April 2009 – as previously stated Prior period adjustment £ 000s £ 000s Gross Cost at 1 April 2008 as previously stated Taxpayers’ Equity at 1 April 2009 - restated 27 0 Prior Period adjustments 0 0 Surplus/(deficit) for the year Impairments 0 0 Revaluation gains/(losses) and impairment losses on intangible assets Reclassifications 0 Revaluation gains/(losses) and impairment losses, property, plant and equipment 0 Other in year revaluation 0 0 Increase in the donated asset reserve due to receipt of donated assets Additions – purchased Reduction in the donated asset reserve in respect of depreciation, 0impairment and/or 0 Additionsof – donated disposal on donated assets. 0 0 Disposals Additions/(reduction) in other reserves 0 0 Grossrecognized cost 31st March 2009 Other gains and losses 27 0 Actuarial gains/(losses) on defined benefit pension schemes Transfer to the income andasexpenditure account in respect of assets Amortisation at 1st April 2008 previously stated 13 disposed of 0 Transfer of the excess of current cost depreciation over historical cost depreciation0to Prior Period adjustments 0 the income and expenditure reserve Provided during the year 5 0 Public Dividend Capital received Impairments 0 0 Public Dividend Capital repaid Reversal of Impairments 0 0 Public Dividend Capital repayable (creditor) Reclassifications 0 0 Public Dividend Capital written off Other in year revaluation 0 0 Other transfers between reserves Disposals 0 0 Movements on other reserves Amortisation as at 31st March 20009 18 0 Taxpayers’ Equity at 31 March 2010

7.2 Intangible fixed assets 2008/09

0 0 0 0 0 0 0 0 0 0 0 0 0 0 21,245

0 0 0 0 0 0 0 0 0 0 0 0 0 46,558

00 00 00 0 00

0 0 0 0 0 (355) 0 0 0 0 0 0 0 0 0 0 0 0 0 6,881

Revaluation Public reserve Dividend Development Goodwill Capital Expenditure £ 000s £ 000s 5,648 21,245 1,231 0 £ 000s £ 000s 6,879 21,2450 0 0 0 00 0 0 00 357 0 0 0 0 0 0 0

(96) 0 00 (70) 0 0 00

£ 000s 40.937 1,539 £ 000s 42,476 0 0 3,270 00 0 934 0 44

Patents

Total

0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,554

(96) 0 0 0 0 0 0 0 0

Donated asset Other reserve £ 000s 1,721 308 £ 000s 2,029 0 0 0 0 0 577 0 44 0

0 5 0 0 0 0 0 0 0 0 0 0 0 18 0

00 00 027 0 013

355 0 0 0 0 0 0 15,878

0 0 (70) 0 0

Income & expenditure Total reserve £ 000s £ 000s 0 12,323 0 £ 000s 0 027 12,323 00 3,270 00 0 00 0 00 0

Other Reserves

119

Land

Buildings excluding dwellings

Dwellings

646

24,280

2,459

670

21,151

20,541

1,958

(308)

5,811

1,243

0 0 0 0 0 0 0 0 0 0 0 0 1,243 46,558

(96) 0 0 0 (70) 5,811 0 0 0 0 0 0 0 0 0 0 (85) 0 15,774 0 0 6,908 21,245

5,785

5,690

6,979

1,596

14,263

0 0 0(85) 0 21,559 0 14,263 0 0

150

(355) 0 0 00 0 0 00 00 0 0 6,881

00 00 00 0 0 0

Revaluation Public Plant & Transport reserve Dividend machinery equipment Capital £ 000s £ 000s 5,648 £ 000s £ 000s £ 000s 21,245 40.937 1,231 21.242 0 0 1,539 1,243 6,879 0 0 0 21,245 42,476 21,242 00 0 3,270 1,243 00 0208 0 4,876 0 0 357 0 44 934 0 0 00 0 44

Assets under construction & payments account £on000s

Total

1,035

1,439

0 0 404 0 0 0 0 0 0 01,567 0 1,439 2,554

1,163

(96) 0 0 0 02,602 0 1,163 0

0 0 0 0 0 0 0 0

0 0 0 0 0

37,375

2,554

670

34,151

33,402

2,029

646

355 03,071 0 0 (1,071) 0 0 (85) 17,395 0 0 30,727 15,878

15,480

11890

0(137) 0 (85) (70) 54,770 0 15,480 0

Donated Other Income & Information Reserves Furnitureexpenditure & Total asset technology fittings reserve reserve £ 000s £ 000s £ 000s 0 12,323 £1,721 000s £ 000s £ 000s 3082,602 0 0 54 47,343 2,029 0 0 0 12,323 1,539 54 48,882 02,602 0 3,270 0 0 0 0 06,966 0 577 0 0 0 44 0 44 0 0 0(900)

A revaluation of land and buildings was undertaken in 2009/10 by qualified external valuers (DTZ Ltd). Previous 5 yearly revaluations have been undertaken by the District Valuers Office. The revaluation identified assets which previously had no value in the accounts. This adjustment to opening balances results in the Prior Period Adjustment above.

464

- Donated at 31st March 2010

Total at 31st March 2010

464

- NBV Finance lease at 312 March 2010

- Purchased at 31st March 2010

3,200

- Donated at 1st April 2009

Total at 1st April 2009

- NBV Finance lease at 1 April 2009

Cost / valuation at 1st April 2009 as previously stated

£ 000s £ 000s £ 000s Taxpayers’ Equity at 1 April 2009 – as previously stated 3,200 19,002 0 Prior period adjustment Prior period adjustments 0 1,539 0 Taxpayers’ Equity at 1 April 2009 - restated Cost or valuation at 1 April 2009 as restated 3,200 20,541 0 Surplus/(deficit) for the year Additions – purchased 0 assets 1,882 0 Revaluation gains/(losses) and impairment losses on intangible Additions – donated 0 0 0 Revaluation gains/(losses) and impairment losses, property, plant and equipment Impairments 0 (900) 0 Increase in the donated asset reserve due to receipt of donated assets Reclassifications 0 158 0 Reduction in the donated asset reserve in respect of depreciation, impairment and/or Revaluation surpluses disposal of on donated assets. (2,736) 2,599 0 Disposals Additions/(reduction) in other reserves 0 0 0 Cost Other / valuation at 31st March 2010 recognized gains and losses 464 24,280 0 Actuarial gains/(losses) on defined benefit pension schemes Accumulated depreciation at 1st April 2009 as previously stated 0 0 0 Transfer to the income and expenditure account in respect of assets disposed of Prior Period adjustments 0 0 0 Transfer of the excess st of current cost depreciation over historical cost depreciation to 0 0 0 Accumulated depreciation at 31 March 2009 the income and expenditure reserve Provided during the year 0 1,071 0 Public Dividend Capital received Impairments 0 0 0 Public Dividend Capital repaid Revaluation surpluses 0 (1,071) 0 Public Dividend Capital repayable (creditor) Disposals 0 0 0 Public Dividend Capital written off Accumulated depreciation at 31 March 2010 0 0 0 Other transfers between reserves Net book value Movements on other reserves - Purchased at 1st April 2009 3,200 17,937 0 Taxpayers’ Equity at 31 March 2010

8.1 Property, plant and equipment 2009/10

Clatterbridge Centre for Oncology NHS Foundation Trust Clatterbridge Centre for year Oncology Accounts for the endedNHS 31stst Foundation March 2010 Trust Accounts for the year ended 31 March 2010 STATEMENT OF CHANGES IN TAXPAYERS EQUITY

120

Buildings

11990

Taxpayers’ Equity at 1 April 2009 – as previously stated excluding Prior value period adjustment Net book dwellings Dwellings Land Taxpayers’ Equity at 1 April 2009 - restated st - Protected assets at 31 March 2010 464 24,280 0 Surplus/(deficit) for the year st 0 0 0 - Unprotected assets at 31 March 2010 Revaluation gains/(losses) and impairment losses on intangible assets st 0 TotalRevaluation at 31 March 2010 gains/(losses) and impairment losses, property,464 plant and 24,280 equipment Increase in the donated asset reserve due to receipt of donated assets Reduction in the donated asset reserve in respect of depreciation, impairment and/or disposal of on donated assets. Additions/(reduction) in other reserves Other recognized gains and losses Actuarial gains/(losses) on defined benefit pension schemes Transfer to the income and expenditure account in respect of assets disposed of Transfer of the excess of current cost depreciation over historical cost depreciation to the income and expenditure reserve Public Dividend Capital received Public Dividend Capital repaid Public Dividend Capital repayable (creditor) Public Dividend Capital written off Other transfers between reserves Movements on other reserves Taxpayers’ Equity at 31 March 2010

8.2 Analysis of Tangible Fixed Assets

0 0 0 0 0 (355) 0 0 0 0 0 0 6,881

0 0 0 0 0 0 0 0 0 0 0 0 21,245

(96) 0 (70) 0 0 0 0 0 0 0 0 0 46,558

Total

Revaluation Public reserve Dividend Capital £ 000s £Assets 000sunder £ 000s construction 5,648 21,245 40.937 & payments Plant & Transport 1,231 0 1,539 on account machinery equipment 6,879 21,245 42,476 0 0 0 0 0 3,270 5,811 5,785 00 0 0 5,785 0 357 0 934 5,811 0 0 44

0 0 0 0 0 0 0 2,554

(96) 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0 0

355 0 0 0 0 0 0 15,878

0 0 (70) 0 0

Donated Other Income & asset Reserves expenditure reserve reserve £ 000s £ 000s £ 000s 1,721 0 12,323 Information Furniture & 308 0fittings 0Total technology 2,029 0 12,323 0 0 24,744 0 0 3,270 0 12,631 01,035 0 0 0 37,375 5771,035 0 0 44 0 0

121

Land

Buildings excluding dwellings

Dwellings

3,200

- Donated at 31st March 2009

Total at 31st March 2009

3,200

- Purchased at 31st March 2009

- NBV Finance lease at 312 March 2009

3,200

Total at 1st April 2008

- Donated at 1st April 2008

Cost / valuation at 1st April 2008 as previously stated

19,002

1,651

17,351

18,963

2,488

120 90

£ 000s £ 000s £ 000s Taxpayers’ Equity at 1 April 2009 – as previously stated 3,200 18,202 0 Prior period adjustment Prior period adjustments 0 761 0 Taxpayers’ Equity at 1 April 2009 - restated Cost or valuation at 1 April 2008 as restated 3,200 18,963 0 Surplus/(deficit) for the year Additions – purchased 0 560 0 Revaluation gains/(losses) and impairment losses on intangible assets Additions – donated 0 0 0 Revaluation gains/(losses) and impairment losses, property, plant and equipment Impairments 0 (483) 0 Increase in the donated asset reserve due to receipt of donated assets Reclassifications 0 960 Reduction in the donated asset reserve in respect of depreciation, impairment and/or 0 Revaluation surpluses 0 0 0 disposal of on donated assets. Disposals 0 0 0 Additions/(reduction) in other reserves Cost / valuation at 31st March 2009 3,200 20,000 0 Other recognized gains and losses Actuarial gains/(losses) on2008 defined benefitstated pension schemes 0 Accumulated depreciation at 1st April as previously 0 0 Transfer to the income and expenditure account in respect of 0assets disposed of Prior Period adjustments 0 0 st of current cost depreciation over historical cost depreciation to Transfer of the excess 0 0 0 Accumulated depreciation at 31 March 2008 the income and expenditure reserve Provided during the year 0 998 0 Public Dividend Capital received Impairments 0 0 0 Public Dividend Capital repaid Reclassifications 0 0 0 Public Dividend Capital repayable (creditor) Disposals 0 0 0 Public Dividend Capital written off Accumulated depreciation at 31 March 2009 0 998 0 Other transfers between reserves Net book value Movements on2008 other reserves - Purchased at 1st April 3,200 16,475 0 Taxpayers’ Equity at 31 March 2010 - NBV Finance lease at 1 April 2008 0 0 0

Prior Year

8.3 Property, plant and equipment 2008/09

1,243

960

1,890

6,979

6,908

8,869

295

0 00 00 0 (454) 0 14,263 0 0 8,574 21,245 0

12,827

0 0

0 0 0 0 0 0 0 46,558

0 0 (454) 0 21,242 0 0 12,827 00

(960)

0 (96) 0 0 (70) 1,243 0 0 0 0

0 00

(355) 0 0 0 0 0 0 0 0 0 0 0 0 6,881 0

Revaluation Public Plant & Transport reserve Dividend machinery equipment Capital £ 000s £ 000s £ 000s £ 000s £ 000s 5,648 21,245 40.937 21,696 0 1,231 0 1,539 960 0 0 6,879 21,245 0 42,476 960 21,696 00 0 3,270 1,243 0 00 0 0 0 0 0 357 0 934 0 0 00 0 44

Assets under construction & payments account £on000s

Total

Clatterbridge Centre for Oncology NHS Foundation Trust st Foundation Trust Clatterbridge Centre foryear Oncology NHS Accounts for the ended 31 March 2010 Accounts for the year ended 31st March 2010 STATEMENT OF CHANGES IN TAXPAYERS EQUITY

1,439

1,845

757

0 406 0 0 0 0 0 0 0 1,163 0 0 1,845 2,554 0

(96) 0 0 0 2,602 0 0 757 0 0

0 0 0 0 0 0 0 0

0 0 0 0 0

31,863

1,722

30,141

33,837

2,783

13,638

355 3,294 0 0 0 0 0 (454) 0 16,478 0 0 31,054 15,878 0

0 0 0(454) 48,341 (70) 0 13,638 0 0

Donated Other Income & Information Furniture & Total asset Reserves expenditure technology fittings reserve reserve £ 000s £ 000s £ 000s £1,721 000s £ 000s £ 000s 0 12,323 2,602 54 46,714 308 0 0 0 2,029 0 0 12,323 761 2,602 47,475 0 0 54 3,270 0 0 1,803 0 0 0 0 0 577 0 0 0 0 44 0 0 0(483)

122

Buildings excluding dwellings

121 90

Equity at 1 April 2009 – as previously statedLand Dwellings st Prior period adjustment - Protected assets at 31 March 2009 3,200 19,002 0 Taxpayers’ Equity at 1 April 2009 - restated st - Unprotected assets at 31 March 2009 0 0 0 Surplus/(deficit) for the year st 3,200 0 Total at 31 March 2009 Revaluation gains/(losses) and impairment losses on intangible assets19,002 Revaluation gains/(losses) and impairment losses, property, plant and equipment Increase in the donated asset reserve due to receipt of donated assets Reduction in the donated asset reserve in respect of depreciation, impairment and/or disposal of on donated assets. Additions/(reduction) in other reserves Other recognized gains and losses Actuarial gains/(losses) on defined benefit pension schemes Transfer to the income and expenditure account in respect of assets disposed of Transfer of the excess of current cost depreciation over historical cost depreciation to the income and expenditure reserve Public Dividend Capital received Public Dividend Capital repaid Public Dividend Capital repayable (creditor) Public Dividend Capital written off Other transfers between reserves Movements on other reserves Taxpayers’ Equity at 31 March 2010

Taxpayers’ Net book value

8.4 Analysis of Tangible Fixed Assets

0 0 0 0 0 (355) 0 0 0 0 0 0 6,881

0 0 0 0 0 0 0 0 0 0 0 0 21,245

(96) 0 (70) 0 0 0 0 0 0 0 0 0 46,558

Total

Revaluation Public reserve Dividend Assets under Capital £ 000s £ 000s £construction 000s & payments Plant & Transport 5,648 21,245 40.937 on account machinery equipment 1,231 0 1,539 0 0 0 6,879 21,245 42,476 1,243 6,979 0 0 0 3,270 6,979 00 0 0 1,243 357 0 934 0 0 44

Clatterbridge Centre for Oncology NHS Foundation Trust st Foundation Trust Clatterbridge Oncology NHS AccountsCentre for thefor year ended 31 March 2010 Accounts for the year ended 31st March 2010 STATEMENT OF CHANGES IN TAXPAYERS EQUITY

0 0 0 0 0 0 0 2,554

(96) 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0 0

355 0 0 0 0 0 0 15,878

0 0 (70) 0 0

Donated Other Income & asset Reserves expenditure reserve reserve £ 000s £ 000s £ 000s Information Furniture & 1,721 0fittings 12,323Total technology 308 0 0 0 0 22,202 2,029 0 12,323 1,439 0 9,661 0 0 3,270 0 31,863 01,439 0 0 577 0 0 44 0 0

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

8.5 Economic life of Property, Plant and Equipment

Minimum

Life Years

Land Buildings excluding dwellings Dwellings Assets under construction Plant & Machinery Transport Equipment Information Technology Furniture & Fittings

Infinite 5 n/a 0 4 n/a 3 n/a

Maximum Life Years Infinite 90 n\a 0 10 n/a 10 n/a

8.6 Property valuations All Buildings and Land have been revalued in 2009/10, by a professional valuer, on the basis of Modern Equivalent Asset. The revaluation was accounted for in year. The alternative site method was not used. Further details of the valuation approach are included under note 1.3 (Accounting policies)

8.7 Non-Property valuations Plant and equipment (including IT equipment) used in the Trust tends to be highly specialised in nature with No reliable means of ascertaining a market value. In accordance with IAS16,these assets are carried at Depreciated Replacement Cost (DRC) and are not subject to revaluation.

122 123

124

Buildings excluding dwellings

Dwellings

0 0 0 0

Total at 1st April 2009

- Purchased at 31st March 2009

- Donated at 31st March 2009

Total at 31st March 2009

Cost / valuation at 1st April 2009 as previously stated

670

646

123 90

£ 000s £ 000s £ 000s Taxpayers’ Equity at 1 April 2009 – as previously stated 0 646 0 Prior period adjustment Prior period adjustments 0 0 0 Taxpayers’ Equity at 1 April 2009 - restated Cost or valuation at 1 April 2009 as restated 0 646 0 Surplus/(deficit) for the year Additions – purchased 0 61 0 Revaluation gains/(losses) and impairment losses on intangible assets Additions – donated 0 0 0 Revaluation gains/(losses) and impairment losses, property, plant and equipment Impairments 0 0 0 Increase in the donated asset reserve due to receipt of donated assets Reclassifications 0 0 and/or 0 Reduction in the donated asset reserve in respect of depreciation, impairment Revaluation surpluses 0 85 0 disposal of on donated assets. Disposals 0 0 0 Additions/(reduction) in other reserves Cost / valuation at 31st March 2010 0 792 0 Other recognized gains and losses Actuarial gains/(losses) on2009 defined benefitstated pension schemes 0 Accumulated depreciation at 1st April as previously 0 0 to the income and expenditure account in respect of assets disposed Prior Transfer Period adjustments 0 0 of 0 st of current cost depreciation over historical cost depreciation to Transfer of the excess 0 0 0 Accumulated depreciation at 31 March 2009 the income and expenditure reserve Provided during the year 0 122 0 Public Dividend Capital received Impairments 0 0 0 Public Dividend Capital repaid Reclassifications 0 0 0 Public Dividend Capital repayable (creditor) Disposals 0 0 0 Public Dividend Capital written off Accumulated depreciation at 31 March 2010 0 122 0 Other transfers between reserves Net book value Movements on 2009 other reserves - Purchased at 1st April 0 646 0 Taxpayers’ Equity at 31 March 2010 - Donated at 1st April 2009 0 0 0

Land

9.1 Net book value of assets held under finance leases 2009/10

0 0 0 0 0 0 0 46,558

(96) 0 (70) 0 0

£ 000s 40.937 1,539 42,476 3,270 0 934 44 0

0 0 0 0 0 0 0 0) 0 0 0 0 0 21,245 0

0 0 0 0 0

(355) 0 0 0 0 0 0 0 0 0 0 0 0 6,881 0

00 00

Revaluation Public Plant & Transport reserve Dividend machinery equipment Capital £ 000s £ 000s £ 000s £ 000s 5,648 21,245 0 0 1,231 0 0 0 0 6,879 21,245 0 0 0 00 0 0 0 00 0 0 0 0 357 0 0 0 00 0

Assets under construction & payments account £on 000s

Total

Clatterbridge Centre for Oncology NHS Foundation Trust st Clatterbridge Oncology NHS Foundation AccountsCentre for thefor year ended 31 March 2010 Trust Accounts for the year ended 31st March 2010 STATEMENT OF CHANGES IN TAXPAYERS EQUITY

0 0 0 0 0 0 0 2,554

(96) 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0 0

670

646

355 122 0 0 0 0 0 0 0 122 0 0 646 15,878 0

0 85 0 0 (70) 792 0 0 0 0

Donated Other Income & Information Furniture & Total asset Reserves expenditure technology fittings reserve reserve £ 000s £ 000s £ 000s £ 000s £ 000s £ 000s 1,721 0 12,323 0 0 308 0 0 646 0 12,323 0 2,029 0 0 0 0 0 0 3,270 646 0 0 0 0 0 61 0 0 577 0 0 0 0 0 44 0 0 0

125

Buildings excluding dwellings

Dwellings

0 0 0 0 0

- Donated at 1st April 2008

Total at 1st April 2008

- Purchased at 31st March 2009

- Donated at 31st March 2009

Total at 31st March 2009

646

90 124

Taxpayers’ Equity at 1 April 2009 – as previously stated £ 000s £ 000s £ 000s period Cost /Prior valuation at 1stadjustment April 2008 as previously stated 0 0 0 Taxpayers’ Equity at 1 April 2009 - restated Prior period adjustments 0 0 0 Surplus/(deficit) theasyear Cost or valuation at 1 Aprilfor 2008 restated 0 0 0 Revaluation gains/(losses) and impairment losses on intangible Additions – purchased 0 assets 0 0 Revaluation and equipment Additions – donated gains/(losses) and impairment losses, property, plant 0 0 0 Increase in the donated asset reserve due to receipt of donated assets Impairments 0 0 0 Reduction in the donated asset reserve in respect of depreciation, impairment and/or Reclassifications 0 646 0 disposal of on donated assets. Revaluation surpluses 0 0 0 Additions/(reduction) in other reserves Disposals 0 0 0 Other recognized gains and losses Cost / valuation at 31st March 2009 646 0 Actuarial gains/(losses) on defined benefit pension schemes 0 Accumulated depreciation at 1st April 2008 as previously stated 0 0 0 Transfer to the income and expenditure account in respect of assets disposed of Prior Period adjustments 0 cost depreciation 0 Transfer of the excess of current cost depreciation over historical to 0 st the income and expenditure reserve Accumulated depreciation at 31 March 2008 0 0 0 Public Dividend Provided during the year Capital received 0 0 0 Public Dividend Capital repaid Impairments 0 0 0 Public Dividend Capital repayable (creditor) Reclassifications 0 0 0 Public Dividend Capital written off Disposals 0 0 0 Other transfers between reserves Accumulated depreciation at 31 March 2009 0 0 0 Net book value Movements on other reserves - Purchased at 1st April 2008 at 31 March 2010 0 0 0 Taxpayers’ Equity

Land

9.2 Net book value of assets held under finance leases 2008/09

0 0 0 0 0 0 0 46,558

(96) 0 (70) 0 0

Total

0 0 0 0 0 0 0 0 0 0) 0 0 0 21,245 0

0 0 0 0 0

0 0 0 0 00 00

(355) 0 00 00 00 00 00 0 6,881 0

Revaluation Public reserve Plant & Transport Assets under Dividend machinery equipment construction Capital payments £ 000s £ 000s £& 000s on account 5,648 21,245 40.937 £ 000s £ 000s £ 000s 1,231 0 1,539 0 0 0 6,879 21,245 0 42,476 0 0 0 0 0 3,270 0 0 0 0 0 0 0 0 357 0 0 934 0 0 0 0 44 0 0 0

Clatterbridge Centre for Oncology NHS Foundation Trust st Foundation Trust Clatterbridge Centre Oncology NHS Accounts for thefor year ended 31 March 2010 Accounts for the year ended 31st March 2010 STATEMENT OF CHANGES IN TAXPAYERS EQUITY

0 0 0 0 0 0 0 2,554

(96) 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0 0

355 0 0 0 0 0 0 15,878

646

0 0 0 0 (70) 0 646 0 0

646

Donated Other Income & asset Reserves expenditure Information Furniture & Total reserve technology fittingsreserve £ 000s £ 000s £ 000s 1,721 0 12,323 £ 000s £ 000s £ 000s 308 0 0 0 0 2,029 0 12,323 0 0 0 0 3,270 0 0 0 0 0 0 0 577 0 0 0 0 44 0 0

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

10.1 Non-current assets for sale and assets in disposal groups 2009/10 There are none. 10.2 Non-current assets for sale and assets in disposal groups 2008/09 There are none. 10.3 Liabilities in disposal groups 2009/10 There are none. 10.4 Liabilities in disposal groups 2008/09 There are none. 11.1 Investments â&#x20AC;&#x201C; carrying amount There are none. 11.2 Investment Property expense There are none. 11.3 Investment Property Income There are none. 12.1 Fair value of investments in associate (and joined controlled operations) There are none. 12.2 Disclosure of aggregate amounts for assets and liabilities of jointly controlled operations There are none.

125 126

127

31st March 2010 £ 000s 331

st 31 March 2009 £ 000s 404

Total current trade and other receivables

Accrued income Corporation tax receivable Finance lease receivables PDC receivables Other receivables 2,343

2,670

90 126

0 0 0 0 899

0 0 0 0 967

Taxpayers’ Equity at 1 April 2009 – as previously stated 0 Work-in-progress 0 Prior period adjustment Finished goods 0 0 Taxpayers’ Equity at 1 April 2009 - restated Inventories carried at fair value less costs to sell 0 0 Surplus/(deficit) for the year Revaluation gains/(losses) and impairment losses on intangible assets Total 404 331 Revaluation gains/(losses) and impairment losses, property, plant and equipment Increase in the donated asset reserve due to receipt of donated assets Reduction in the donated asset reserve in respect of depreciation, impairment and/or disposal on donated assets.receivables 14.1 of Trade and other Additions/(reduction) in other reserves Current Other recognized gains and losses st 31 Actuarial gains/(losses) on defined benefit pension schemes March 31st March Transfer to the income and expenditure account in respect of 2010 assets disposed 2009 of Transfer of the excess of current cost depreciation over historical cost depreciation to £ 000s £ 000s the income and expenditure reserve 829 NHS receivables 434 Public Dividend Capital received 0 Other receivables with related parties 0 Public Dividend repaid Provisions forCapital impaired receivables (331) (226) Public Dividend Capital repayable (creditor) Prepayments:1,205 1,236 Public Dividend Capital written off Other between reserves PFItransfers prepayments:Movements on other reserves 0 Prepayments – Capital Contributions 0 Taxpayers’ Equity at 31 March 2010 0 Prepayments – Lifecycle replacements 0

Materials

13.1 Inventories

3,376

0 0 0 0 1,286

0 0 0 0 0

0 0 0 00 21,245 0 0

1,244

£ 000s

0 0 0 00

0 0 0 0 0 46,558 0

£ 000s 5,648 1,231 6,879 0 0 357 0

Revaluation reserve

Donated asset reserve £ 000s 1,721 308 2,029 0 0 577 44

0 0 0 0 0 0 6,881

0 0 0 0 0

0 0 0 2,554 0

0 0

£ 000s £ 000s (355) 0 0 0 0 0 0 0 0 0 0 0

0 0 (96) 0 0 0 Non current 0 0 0 st 31st 0 31 0 0 March 1 April March 0 2008 0 2010 0 2009

Public Dividend Capital £ 000s 21,245 0 21,245 0 0 0 0

£ 000s 0 1,007 0 0 0 (161)

(96) 0 (70) 0 1 April 20080

40.937 0 1,539 0 42,476 0 3,270 0 332 934 44

1 April 2008 £ 000s £ 000s 332

Total

Clatterbridge Centre for Oncology NHS Foundation Trust st Clatterbridge Foundation Trust Accounts Centre for the for yearOncology ended 31NHS March 2010 Accounts for the year ended 31st March 2010 STATEMENT OF CHANGES IN TAXPAYERS EQUITY

0 0 0 0 0 0 0 0

0 0 0 0 0

£ 000s 0 0 0 0 0 0 0

Other Reserves

355 0 0 0 0 0 0 15,878

0 0 (70) 0 0

Income & expenditure reserve £ 000s 12,323 0 12,323 3,270 0 0 0

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

14.2 Provision for impairment of receivables

Balance at 1 April 2009 Increase in provision Amount utilised Unused amounts reversed Balance at 31 March 2010

14.3 Analysis of impaired receivables

Ageing of impaired receivables By up to three months By three to six months By more than six months Total Ageing of non- impaired receivables By up to three months By three to six months By more than six months Total

14.4 Finance lease receivables There are none.

15. Other assets There are none.

127 128

31st March 2010

31st March 2009

£ 000s 226 327 34 (256) 331

£ 000s 261 (23) (12) 0 226

31st March 2010 £ 000s

31st March 2009 £ 000s

179 129 23 331

71 89 66 226

205 12 3 220

25 0 115 140

129

31st March 2010 £ 000s 471

Total

3,748

Total

128

3,351 0 397 0

Deferred income Deferred PFI credits Deferred Government Grants Net Pension Scheme Liability

2,605

2,208 0 397 0

3,750

3,353 0 397 0

0 0

0 0 0 0 0 0 0 0 0

0 0 0

00 00

00 357 0 0

0 0 0 0

Revaluation

Donated

164

0 0 164 0

561

0 0 561 0

0 (355) 0 0 0 0 0 0 0 0 0 0 Non - current st st 31 March March 31 0 0 2010 2009 6,881 21,245

Public

Other

0 0

0 0 0 0

0 0 958 0 958

0 0 0 0 0 0 1 April 0 2008 2,554

(96) 0 0 0 0

0 0 577 44

0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0 0

Non - currentasset Current reserve Reserves Dividend st st st 31 March 1 April 1 April 31 March 31 March reserve 2010 2009 2008 Capital 2009 2008 £ 000s £ 000s £ 000s £ 000s £ 000s £ 000s £ 000s £ 000s £ 000s £ 000s 5,648 1,721 0 21,245 40.937 0 463 345 0 0 1,231 308 0 0 1,539 0 2,886 2,470 0 0 6,879 2,029 0 0 21,245 0 0 42,476 0 0

Taxpayers’ at 1 April 2009 – as previously stated Receipts Equity in advance PriorNHS period adjustment 4,012 payables Taxpayers’ 1 April 2009 - restated AmountsEquity due toat related parties 0 Surplus/(deficit) for the year Trade Payables - Capital 1,176 625 3,2702,394 Revaluation gains/(losses) and impairment losses on intangible assets 0 270 1,357 Other trade payables 0 Revaluation gains/(losses) and impairment losses, property, plant and equipment 934 452 567 Taxes payable 517 Increase in the donated asset reserve due to receipt of donated assets 441,769 833 Other payables 2,771 Reduction in the donated asset reserve in respect of depreciation, impairment and/or 0 Accruals 0 0 disposal of on donated assets. (96) 0 PDC payable 0 Additions/(reduction) in other reserves 0 0 0 Reclassified to liabilities held in disposal groups in year 0 Other recognized gains and losses (70) 0 Total 8,416 7,262 Actuarial gains/(losses) on defined benefit pension schemes 07,700 Transfer to the income and expenditure account in respect of assets disposed of 0 Transfer of the excess of current cost depreciation over historical cost depreciation to the income and expenditure reserve 0 Public Dividend Capital received 0 16.2 Early retirement detail included in NHS payables above Public Dividend Capital repaid 0 There are none. Public Dividend Capital repayable (creditor) 0 Public Dividend Capital written off 0 17. Otherbetween liabilities Other transfers reserves 0 Current st 31 March 31st March 10April Movements on other reserves 2010 2009 2008 Taxpayers’ Equity at 31 March 2010 46,558

STATEMENT IN TAXPAYERS EQUITY 16.1 Trade OF andCHANGES other payables

Clatterbridge Centre for Oncology Foundation Clatterbridge Centre for Oncology NHSNHS Foundation TrustTrust Accounts for year the year ended 31st March Accounts for the ended 31st March 20102010

355 0 0 0 0 0 0 15,878

0 0 (70) 0 0

Income & expenditure reserve £ 000s 12,323 0 12,323 3,270 0 0 0

130

st 31 March 2010 0

Revaluation Donated Other Public reserve asset Reserves Dividend reserve Capital Non £- current 000s £ 000s £ 000s £ st000s £ 000s 31 March 31st March 1 April 1 April 5,648 1,721 0 21,245 40.937 2010 2008 2009 2008 1,231 308 0 0 1,539 0 0 0 0 6,879 2,029 0 0 21,245 0 42,476 0 0 0 0 0 0 0 3,270 0 5,000 0 0 0 0 0 0 0 0 0 0 357 577 0 0447 934 95 507 607 0 44 0 0 0 44 0 0 0

Total

129

Reduction in the donated asset reserve in respect of depreciation, impairment and/or 107 5,447 Totalof on donated assets. 100 507 disposal 0 0 (96) 607 0 (96) 95 0 0 0 Additions/(reduction) in other reserves 0 0 Other recognized gains and losses 0 0 0 0 (70) 0 0 0 st gains/(losses) on defined benefit pension schemes Actuarial 0 0 On 1 . March 2010, the Trust took out a loan in the sum of £5 million from the Department of Health Foundation Trust Financing Facility for the specific 0 0 0 Transfer income and expenditure in respect of assets disposed of built at Aintree. 0 0 purposetoofthe funding expenditure on the account new Radiotherapy Centre currently being Transfer of the excess of current cost depreciation over historical cost depreciation to the income and expenditure reserve 0 (355) 0 0 0 0 0 0 Public Dividend Capital received 0 0 0 0 0 Public Dividend Capital repaid 0 0 0 0 0 Public Dividend Capital repayable (creditor) 0 0 0 0 0 Public Dividend Capital written off 0 0 0 0 0 Other transfers between reserves 0 0 0 0 0 Movements on other reserves 0 0 6,881 2,554 0 21,245 Taxpayers’ Equity at 31 March 2010 46,558

Current 31st March Taxpayers’ Equity at 1 April 2009 – as previously stated 2009 PriorBank period adjustment overdrafts 0 Taxpayers’ Equity at 1 April 2009 - restated 0 Drawdown to committed facility 0 Surplus/(deficit) for the year 0 Loans from Foundation Financing Facility 0 Revaluation gains/(losses) and impairment losses on intangible assets 0 Other Loans 0 Revaluation gains/(losses) impairment losses, property, plant and equipment 107 Obligations under financeand leases 100 Increase in the donated asset reserve due to receipt of donated assets 0 Obligations under Private Finance Initiative contracts 0

18. Borrowings

STATEMENT OF CHANGES IN TAXPAYERS EQUITY

Clatterbridge for Oncology NHS Foundation Clatterbridge Centre Centre for Oncology NHS Foundation Trust Trust Accounts the year ended 31st March Accounts for the for year ended 31st March 2010 2010

355 0 0 0 0 0 0 15,878

0 0 (70) 0 0

Income & expenditure reserve £ 000s 12,323 0 12,323 3,270 0 0 0

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

19. Prudential borrowing Limit

Total long term borrowing limit set by Monitor Working capital facility Total prudential borrowing limit

31st March 2010 £ 000s 14,500 4,000

31st March 2009 £ 000s 12,700 4,000

18,500

16,700

507 0 5,047 0 5,554

0 0 507 0 507

0 0

0 0 0

Long term borrowing at 1 April Long term borrowing at start of period for new FT’s Net actual borrowing / (repayment) in year – long term Long term borrowing at 31 March Working capital borrowing at 1 April Working capital borrowing at start of period for new FT’s Net actual borrowing / (repayment) in year – working capital Working capital borrowing at 31 March

The NHS Foundation Trust is required to comply and remain within a prudential borrowing limit. This is made up of two elements: x The maximum cumulative amount of long-term borrowing. This is set by reference to the four ratio tests set out in Monitor’s Prudential Borrowing Code. The financial risk rating set under Monitor’s Compliance Framework determines one of the ratios and therefore can impact on the long-term borrowing limit and x The amount of any working capital facility approved by Monitor. The Trust has a prudential borrowing limit of £14.5 million in 2009/10 ( 2008/09 : £12.7 million) and has borrowed £5 million in 2009/10 (2008/09: £Nil). The Trust did not have a Working Capital Facility in place during 2009/10(2008/09:£Nil). Further information on the NHS Foundation Trusts’ Prudential Borrowing Code and Compliance Framework can be found on the website of Monitor, the Independent Regulator of Foundation Trusts. Actual 4.8 13.4 5.3 0.90%

Financial Ratios Minimum dividend cover Minimum interest cover Minimum debt service cover Maximum debt service to revenue

130 131

2009/10 Approved >1 >3 >2 <2.5%

Actual 10 n/a n/a Nil

2008/09 Approved >1 >3 >2 <3%

132 131

0 0 0 0 0 0 0 21,245

(355) 0 0 0 0 0 0 6,881

Revaluation Public Total PresentDividend value of reserve Minimum lease Capital payments £ 000s ST st £ 000s £31 000s March March 31 5,648 21,245 40.937 2009 2010 1,231 0 1,539 £ 000s £ 000s 6,879 42,476 520 21,245 0 0 0 3,270 0 0 0 0 134 357 0 0 934 386 0 0 0 44 0 0 0 0 0 (96) 0 0 0 0 520 0 0 (70) 134 0 0 0 0 386 0 0 0 0 0 0

Minimum lease payments 31ST March 31st March Taxpayers’ Equity at 1 April 2009 – as previously stated 2010 2009 Prior period adjustment £ 000s £ 000s Taxpayers’ Equity at 1 April 2009 - restated Gross lease obligations 548 607 Surplus/(deficit) for the year Of which liabilities are due: Revaluation - not latergains/(losses) than one yearand impairment losses on intangible assets 137 100 Revaluation gains/(losses) equipment 507 - later than one year andand notimpairment later than 5losses, years property, plant and 411 Increase the5donated - later in than years asset reserve due to receipt of donated assets 0 0 Reduction the donated assettoreserve in respect of depreciation, impairment and/or 0 Financeincharges allocated future periods 0 disposal of on donated assets. Additions/(reduction) in other reserves 548 607 Net lease liabilities Other recognized gains and losses - later than one year and not later than 5 years 137 100 Actuarial gains/(losses) on defined benefit pension schemes - later than one year and not later than 5 years 411 507 Transfer to the income and expenditure account in respect of assets disposed of - later than 5 years 0 0 Transfer of the excess of current cost depreciation over historical cost depreciation to the income and expenditure reserve 0 21.Dividend PFI Obligations Public Capital received 0 Public Dividend Capital repaid 0 There are none. Public Dividend Capital repayable (creditor) 0 Public Dividend Capital written off 0 Other transfers between reserves 0 Movements on other reserves 0 Taxpayers’ Equity at 31 March 2010 46,558

20. Finance lease obligations

Clatterbridge Centre for Oncology NHS Foundation Trust Clatterbridge Centre for NHS Foundation Trust Accounts for Oncology the year ended 31st March 2010 st Accounts for the year ended 31 March 2010 STATEMENT OF CHANGES IN TAXPAYERS EQUITY

0 0 0 0 0 0 0 0

0 0 0 0 0

(96) 0 0 0 0 0 0 0 0 0 0 0 2,554

£ 000s 0 0 0 0 0 0 0

Other Reserves

Donated asset reserve £ 000s 1,721 308 2,029 0 0 577 44

355 0 0 0 0 0 0 15,878

0 0 (70) 0 0

Income & expenditure reserve £ 000s 12,323 0 12,323 3,270 0 0 0

133 0 0 0 0

0 0 6 0 0 6 Pensions relating to former directors £ 000s 0 0 0 0 0 0 0 0 0 0 0 0 0

31st March 2010 0 0 0 0 0 0

6 0 0 6

2 0 2 0 7 (3) 0 0 6

Legal claims £ 000s

1 April 2008

0 0 0 0

Non-current 31st March st 2009 31 March 2010 0 0 0 0 2 0 0 0 500 0 502 0 Agenda for Other change £ 000s £ 000s 0 816 0 0 0 816 0 0 0 0 0 (816) 0 0 0 0 0 0 0 0 11 0 0 11

6 0 0 6

Total £ 000s 818 0 818 0 7 (819) 0 0 6

1 April 2008

132

Clatterbridge Centre for Oncology NHS Foundation Trust is a member of the NHS Litigation Authority (NHSLA) clinical negligence scheme. All clinical negligence claims are therefore recognised in the accounts of the NHSLA, consequently the Trust will have no provision for clinical negligence claims. The NHS litigation Authority is carrying provisions as at 31st March 2010 in relation to ELS of £nil (2008/09 £nil) and in relation to CNST of £84,268 (2008/09 £270,244) making a total of £84,268.

Legal claims consist of amounts due as a result of third party and employee liability claims. The values are based on information provided by the NHS Litigation Authority.

Other provisions utilised during the year represents the repayment of income received for junior medical staff (MADEL) which was provided for at 31st March 2009.

At 1st April 2009 Prior period adjustment At 1 April as restated Change in the discount rate Arising during the year Utilised during the year Reversed unused Unwinding of discount At 31st March 2010 Expected timing of cashflows: Within 1 year 1 - 5 years Over 5 years Total

Pensions relating to former directors Pensions relating to other staff Other legal claims Agenda for change Other Total

Current 31st March 2009 0 0 0 0 316 316 Pensions relating to other staff £ 000s 0 0 0 0 0 0 0 0 0

22. Provisions for Liabilities and Charges

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

134

Total Revaluation Reserve

Broken down into: Commercial banks and cash in hand Cash with Government Banking Service Other Current investments Cash and cash equivalents as in statement of financial position Bank overdraft Cash and cash equivalents as in statement of cash flows

90 133

39 24,026 0 24,065 0 24,065

100 18,071 0 18,171 0 18,171

0 0 0

0 0 (355) 0 0 0 0 0 (355) 6,881 0 0 0 0 0 0 6,881

0 0 0 0 0 0 0 21,245

0 0 0 0 0

0 5,648 0 0 0 0 0 0 2,554

(96) 0 0 0 (323) 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0 0

0 0 0

355 05,648 0 0 0 0 0 15,878

0 0 0 (70) (323) 0 0 0 0

2008/09 2009/10 Total Revaluatio Revaluation, Revaluation Revaluation, Donated Other & n ReserveIncomeReserve, Total Reserve Public Reserve,Revaluation Property Revaluation reserve asset Reserve Reserves Intangiblesexpenditure Property Intangibles Dividend Plant & reserve reservePlant & Capital Equipment Equipment £ 000s £ 000s £ 000s £ 000s £ 000s £ 000s £ 000s £ 000s £ 000s £ 000s £ 000s 5,648 1,721 0 12,323 21,245 40.937 5,971 0 0 5,648 1,231 308 0 05,971 0 1,539 0 0 21,245 1,231 6,879 2,029 0 0 0 12,323 42,476 5,971 0 5,971 0 6,879 0 0 0 3,270 0 3,270 0 0 00 00 0 0 0 0 0 0 0 0 0 0 357 577 0 0 0 934 0 44 0 0 0 44 0 0 0 0 357

£ 000s Taxpayers’ Equity at 1 April 2009 – as previously stated Revaluation reserve at 1 April 2009 5,648 Prior period adjustment PriorTaxpayers’ period adjustment 1,231 Equity at 1 April 2009 - restated Revaluation reserve at 1 April 2009 - restated 6,879 Surplus/(deficit) for the year At start of period for new FT’s 0 Revaluation gains/(losses) and impairment losses on intangible assets Revaluation gains/(losses) and impairment losses on intangible assets 0 Revaluation gains/(losses) and impairment losses, property, plant and equipment Revaluation gains/(losses) and impairment losses property, plant and Increase in the donated asset reserve due to receipt of donated assets equipment 357 Reduction in the donated asset reserve in respect of depreciation, impairment and/or Transfers to the income and expenditure account in respect of assets disposal of on donated assets. (96) disposed of 0 Additions/(reduction) in othercost reserves 0 Transfer of the excess of current depreciation over historical cost Other recognized gainsand andexpenditure losses (70) depreciation to the income reserve. (355) on defined benefit pension schemes 0 OtherActuarial transfersgains/(losses) between reserves 0 Transfer to the income and expenditure account in respect of assets disposed of 0 Movement on other reserves 0 Transfer of the excess of current cost depreciation over historical cost depreciation to the income and expenditure reserve 0 Revaluation reserve at 31 March 2010 6,881 Public Dividend Capital received 0 Public Dividend Capital repaid 0 24. Cash and cash equivalents Public Dividend Capital repayable (creditor) 0 31st March0 31st March Public Dividend Capital written off 2009 2010 Other transfers between reserves 0 £ 000s £ 000s Movements on other reserves 0 Balance at 1 April 11,998 18,171 Taxpayers’ Equity at 31 March 2010 46,558 Net change in year 6,173 5,894 18,171 Balance at 31 March 2010 24,065

STATEMENT OF CHANGES IN TAXPAYERS EQUITY

23. Revaluation reserve

Clatterbridge Centre Centre for for Oncology Oncology NHS NHS Foundation Foundation Trust Trust Clatterbridge Accounts for for the the year year ended ended 31 31stst March March 2010 2010 Accounts

135

Total

134

Revaluation Public reserve Dividend Capital New Radiotherapy Centre at Aintree £ 000s £ 000s £ 000s As at 31 March 2010, the Trust have entered phase 4 of the contract. The latest forecast total cost of 5,648 21,245 Taxpayers’ Equity at 1 April 2009 – as previously stated 40.937 st the project is £12,637k and to 31 March 2010 the Trust have paid £5,811k.The outstanding 1,231 Prior period adjustment 0 1,539 commitment is therefore £6,826k 6,879 21,245 Taxpayers’ Equity at 1 April 2009 - restated 42,476 0 Surplus/(deficit) for the year 0 3,270 st The linear Accelerators other equipment for thisassets project have not formally 0been ordered 0 Revaluation gains/(losses) andand impairment losses on intangible 0 at 31 March 2010, so no commitment has been provided. The latest estimated cost of this equipment is 357 Revaluation gains/(losses) and impairment losses, property, plant and equipment 0 934 £5,300k.TheTrust anticipating substantial contribution appeal. 0 Increase in the donated is asset reserve dueato receipt of donated assets to this cost from the 0 44Marina Dalglish Reduction in the donated asset reserve in respect of depreciation, impairment and/or disposal of on donated assets. 0 0 (96) 0 Additions/(reduction) in other reserves 0 0 25.2 Post Balance Sheet Events Other recognized gains and losses 0 0 (70) 0 Actuarial gains/(losses)ston defined benefit pension schemes 0 0 With effect from 1 . April 2010, the Trust has renewed its Working Capital Facility in the sum of £4 0 Transfer to the income and expenditure account in respect of assets disposed of 0 0 millionofwith National Westminster Bank Plc. Transfer the excess of current cost depreciation over historical cost depreciation to the income and expenditure reserve 0 (355) 0 0 Public Dividend Capital received 0 0 0 Public CapitalAssets repaid and Liabilities 0 0 26. Dividend Contingent 0 Public Dividend Capital repayable (creditor) 0 0 0 Public Dividend Capital written off 0 0 There are no contingent assets or liabilities at 31 March 2010 (2008/09 £nil) 0 Other transfers between reserves 0 0 0 Movements on other reserves 0 0 6,881 21,245 Taxpayers’ Equity at 31 March 2010 46,558

STATEMENT OF CHANGES TAXPAYERS EQUITY 25.1 Contractual CapitalIN Commitments

Clatterbridge Clatterbridge CentreCentre for Oncology for Oncology NHS Foundation NHS Foundation Trust Trust Accounts Accounts for thefor year theended year ended 31st March 31st March 2010 2010

£ 000s 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

(96) 0 0 0 0 0 0 0 0 0 0 0 2,554

Other Reserves

Donated asset reserve £ 000s 1,721 308 2,029 0 0 577 44

355 0 0 0 0 0 0 15,878

0 0 (70) 0 0

Income & expenditure reserve £ 000s 12,323 0 12,323 3,270 0 0 0

Clatterbridge ClatterbridgeCentre Centrefor forOncology OncologyNHS NHSFoundation FoundationTrust Trust st st Accounts Accountsfor forthe theyear yearended ended3131 March March2010 2010

27.1 27.1Related RelatedParty PartyTransactions Transactions Clatterbridge ClatterbridgeCentre CentreforforOncology OncologyNHS NHSFoundation FoundationTrust Trustisisa apublic publicinterest interestbody bodyauthorised authorisedbyby Monitor, Monitor,the theIndependent IndependentRegulator RegulatorforforNHS NHSFoundation FoundationTrusts. Trusts. During Duringthe theyear yearnone noneofofthe theBoard BoardMembers Membersorormembers membersofofthe thekey keymanagement managementstaff staffororparties parties related relatedtotothem, them,has hasundertaken undertakenany anymaterial materialtransactions transactionswith withClatterbridge ClatterbridgeCentre CentreforforOncology Oncology NHS NHSFoundation FoundationTrust. Trust. The TheRegister RegisterofofInterests Interestsforforthe theCouncil CouncilofofGovernors Governorsforfor2009/10 2009/10has hasbeen beencompiled compiledinin accordance accordancewith withthe therequirements requirementsofofthe theConstitution ConstitutionofofClatterbridge ClatterbridgeCentre CentreforforOncology OncologyNHS NHS Foundation FoundationTrust. Trust. The TheDepartment DepartmentofofHealth Healthisisregarded regardedasasa arelated relatedparty. party.During Duringthe theyear yearClatterbridge ClatterbridgeCentre Centre forforOncology OncologyNHS NHSFoundation FoundationTrust Trusthas hashad hada anumber numberofofmaterial materialtransactions transactionswith withthe the Department, Department,and andwith withother otherentities entitiesforforwhich whichthe theDepartment Departmentisisregarded regardedasasthe theparent parent Department. Department. InInaddition, addition,the theTrust Trusthas hashad hada anumber numberofofmaterial materialtransactions transactionswith withother otherGovernment Government Departments Departmentsand andother othercentral centraland andlocal localGovernment Governmentbodies. bodies.Most Mostofofthese thesetransactions transactionshave have been beenwith withHM HMRevenue Revenue&&Customs, Customs,Health HealthCommission CommissionWales Wales(on (onbehalf behalfofofthe theWelsh Welsh Assembly) Assembly)and andNational NationalService ServiceDivision Division(on (onbehalf behalfofofthe theScottish ScottishAssembly). Assembly). The TheTrust Trusthas hasalso alsoreceived receivedrevenue revenuepayments paymentsfrom fromthe theTrusts Trustscharitable charitablefunds, funds,allallofofthe the Trustees Trusteesforforwhich whichare arealso alsomembers membersofofthe theNHS NHSTrust TrustBoard. Board. The TheTrust Trusthas hasalso alsohad hada anumber numberofofmaterial materialtransactions transactionswith withthe theClatterbridge ClatterbridgeCancer Cancer Research Research(CCR), (CCR),which whichisisa arecognised recognisedcharity charitysupporting supportingCancer Cancerresearch. research. Related Related Party Party Transactions:Transactions:Department Department ofof Health Health Other Other NHS NHS bodies bodies Charitable Charitable Funds Funds Other Other NHS NHS Shared Shared Business Business Services Services Value Value ofof balances balances (other (other than than salary) salary) with with related related parties parties in in respect respect ofof doubtful doubtful debts debts atat 3131 March March 2010 2010

2008/09 2008/09 2009/10 2009/10 Income Expenditure Expenditure Income Income Expenditure Expenditure Income £000 £000 £000 £000 £000 £000 £000 £000 2,129 2,129 11 1,225 1,225 22 53,580 53,580 22,991 22,991 58,824 58,824 7,467 7,467 312 312 1111 391 391 00 00 00 311 311 10,030 10,030 00 00 00 4949 Receivables Payables Payables Receivables Receivables Payables Payables Receivables

Other Other balances balances with with related related parties: parties: Department Department ofof Health Health Other Other NHS NHS bodies bodies Charitable Charitable funds funds Other Other

256 256

22 832 832 5252 9090

00 3,673 3,673 00 908 908

00 469 469 9090 4141

00 1,801 1,801 1111 721 721

28.1 28.1PFI PFIschemes schemesdeemed deemedtotobebeoff-balance off-balancesheet sheet There Thereare arenonoPFI PFIschemes schemesdeemed deemedtotobebeoff-balance off-balancesheet sheet(2008/09 (2008/09– –NIL). NIL). 135 135

136

137

Total

136 90

25,530 02,343 0 0 0 0

0 0 0 0

0 0 0 0 0

20,514 (355) 0 0 0 0 0 0 0 0 0 0 0 0 0 6,881 2,554

0 18,171

0 0

(96) 0 0 0 0

0 0

0 0 0 0 0 0 0 0

0 0 0 0 0

0 0

355 0 0 0 0 0 0 0 15,878

(70) 0 0 0

Revaluation Donated Other Income & Public Total Loans and Assets at Held to Available reserve asset Reserves expenditure Dividend Receivables fair value Maturity for sale reserve reserve Capital Through £ 000s £ 000sI&E £ 000s £ 000s £ 000s £ 000s £ 000s £ 000s £0000s £ 000s 5,648 1,721 12,323 21,245 1,2311,465 308 0 0 0 0 0 0 1,465 0 0 0 0 0 6,879 2,029 0 12,323 21,245 0 0 0 0 0 0 0 0 3,270 0 0 0 0 0 0 0 0 0 0 0 357 577 0 0 024,065 24,065 0 0 0 0 44 0 0 0

£ 000s Taxpayers’ Equity at 1 April 2009 – as previously stated 40.937 Trade other receivables (excluding non financial assets) at 31 March 2010 Prior period adjustment 1,539 Other investments (at 31 Mar 2010) Taxpayers’ Equity at 1 April 2009 - restated 42,476 Other Financialfor assets (at 31 Mar 2010) Surplus/(deficit) the year 3,270 Non Current assets held for sale and assets held in disposal group excluding non financial assets Revaluation gains/(losses) and impairment losses on intangible assets 0 (at 31 March 2010) Revaluation gains/(losses) and impairment losses, property, plant and equipment 934 Cash and cash equivalents (at bank and in hand (at 31 March 2010)) Increase in the donated asset reserve due to receipt of donated assets 44 Total at 31 March 2010 25,530 Reduction in the donated asset reserve in respect of depreciation, impairment and/or Trade other receivables (excluding non financial assets) at 31 March 2009 disposal of on donated assets. 0 2,343 (96) Other investments (at March 2009) 0 Additions/(reduction) in 31 other reserves 0 0 Other Financial assets (at 31 March 2009) 0 Other recognized gains and losses 0 (70) Non Current assets held for sale and assets held in disposal group excluding non financial assets (at 31 March Actuarial gains/(losses) on defined benefit pension schemes 0 0 2009) 0 Transfer to the income and expenditure account in respect of assets disposed of 018,171 0 Cash and cash equivalents (at bank and in hand (at 31 Mar 2009)) Transfer of the excess of current cost depreciation over historical cost depreciation to at 31 March 2009 the Total income and expenditure reserve 020,514 0 Public Dividend Capital received 0 0 Public Dividend Capital repaid 0 0 Public Dividend Capital repayable (creditor) 0 0 Public Dividend Capital written off 0 0 Other transfers between reserves 0 0 Movements on other reserves 0 0 21,245 Taxpayers’ Equity at 31 March 2010 46,558

29.1 Financial assets by category

138 90 137

Taxpayers’ Equity at 1 April 2009 – as previously stated Prior period adjustment Taxpayers’ 1 April 2009 - restated LiabilitiesEquity as per at Statement of Financial Position Surplus/(deficit) for the year Borrowings excluding Finance lease and PFI liabilities (at 31 March 2010) Revaluation gains/(losses) impairment Obligations under Financeand leases (31 Marchlosses 2010) on intangible assets Revaluation gains/(losses) impairment and equipment Obligations under Privateand Finance Initiative losses, contractsproperty, (31 marchplant 2010) Increase the donated asset reserve due to receipt of (31 donated Trade in and other payables excluding non financial assets Marchassets 2010) Reduction in the donated reserve in respect of depreciation, impairment and/or Other Financial liabilitiesasset (31 March 2010) disposal of on donated assets. Provision under contract (at 31 March 2010) Additions/(reduction) in other reserves Liabilities in disposal excluding non-financial assets (at 31 March 2010) Other recognized gainsgroups and losses Total at 31 March 2010 Actuarial gains/(losses) on defined benefit pension schemes Borrowings Finance lease andaccount PFI liabilities (at 31 March 2010) Transfer to theexcluding income and expenditure in respect of assets disposed of Transfer of theunder excess of current Obligations Finance leasescost (31 depreciation March 2010) over historical cost depreciation to the Obligations income andunder expenditure reserveInitiative contracts (31 march 2010) Private Finance Public Dividend Capital received Trade and other payables excluding non financial assets (31 March 2010) Public Dividend Capital repaid Other Financial liabilities (31 March 2010) Public Dividend Capital repayable (creditor) Provision under contract (at 31 March 2010) Public Dividend Capital written off Liabilities in disposal groups excluding non-financial assets (at 31 March 2010) Other transfers between reserves Total at 31 March 2009 Movements on other reserves Taxpayers’ Equity at 31 March 2010

29.2 Financial liabilities by category

0 0 0 0 0 0 0 46,558

(96) 0 (70) 0 0

£ 000s 40.937 1,539 42,476 3,270 0 934 44

Total

0 0 0 0 0 0 8,170 0 21,245

(96) 0 0 0 0 0 0 0 0 0 0 0 08,170 0 6,881 2,554

607 (355) 0 0 6,745 0 0 0 818 0 0

607 0 6,745 0 818 0

4,247

0 0 0 0 0 17,882 0 0 0

0 0 0 0 0 017,882 0 0

4,247

0 0 0 0 0 0 0

0 0 0

0 0 0 0 0 0 0 0

0 0 0 0 0

0 0 0 0 0 0 0

0 0 0

0 0 0 15,878

0 0 355 0 0 0 0 0 0 0 0 0

0 0 (70) 0 0

Revaluation Donated Other Income & Public reserve asset Reserves expenditure Dividend Total Loans and Assets at Held reserve to Available reserve Capital Receivables fair value Maturity for sale £ 000s £ 000s £ 000s £ 000s Through£ 000s 5,648 1,721I&E 0 12,323 21,245 1,231 308 0 0 0 6,879 2,029 0 12,323 21,245 £ 000s £ 000s £ 000s £ 000s £ 000s 05,000 0 0 3,270 0 0 5,000 0 0 0 554 0 0 0 0 0 554 0 0 357 577 0 0 0 0 0 0 0 0 08,081 44 0 0 0 0 8,081 0 0

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

29.3 Fair Values

Set out below is a comparison, by category, of book values and fair values of the Trustâ&#x20AC;&#x2122;s financial assets and liabilities as at 31st March 2010.

Fair value of Financial assets at 31 March 2010 Non current trade and other receivables Excluding non financial assets Other Investments Other Total

Book value ÂŁ 000s

Fair value ÂŁ 000s

0 0 0 0

0 0 5,000 0 5,000

Fair value of Financial liabilities at 31 March 2010 Non current trade and other payables excluding non financial liabilities Provisions under contract Loans Other Total

30.1 Changes in the benefit obligation and fair value of plan assets during the year for amounts recognised in the Statement of Financial Position There are None. 30.2 Reconciliation of the present value of the defined benefit obligation and the present value of the plan assets to the assets and liabilities recognised in the balance sheet There are none. 30.3 Amounts recognised in the statement of Comprehensive Income There are none.

138 139

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

31.1 Losses and Special Payments There were 21 cases of losses and special payments totalling £8k paid during 2009/10. (2008/09 31 cases totalling £33k). There were no cases exceeding £250k in year. Note: The total costs included in this note are on a cash basis and will not reconcile to the amounts in the notes to accounts which are prepared on an accruals basis. 32. Discontinued operations There are none. 33. Corporation tax There are no surpluses subject to corporation tax. 34. Other Financial Assets There are none. 35. Other Financial Liabilities There are none.

139 140

141 140

Taxpayers’ Equity at 1 April 2009 – as previously stated Prior period adjustment Taxpayers’ Equity at year 1 April 2009 - restated Due within one Surplus/(deficit) for the year English gains/(losses) NHS Foundation Revaluation andTrusts impairment losses on intangible assets English NHS Trusts Revaluation gains/(losses) and impairment losses, property, plant and equipment Department of Health Increase in the donated asset reserve due to receipt of donated assets English Health Authorities Reduction in Strategic the donated asset reserve in respect of depreciation, impairment and/or disposal of onPrimary donated assets. English Care Trusts Additions/(reduction) in other reserves RAB Special Health Authorities OtherNHS recognized gains and losses WGA bodies Actuarial defined benefit pension schemes Totalgains/(losses) NHS debtorson / creditors Transfer to the income and expenditure account in respect of assets disposed of Other WGA bodies Transfer of the excess of current cost depreciation over historical cost depreciation to TOTAL DUE / OWING the income and expenditure reserve Public Dividend Capital received Reconciliation of Inter Public Dividend Capital repaidWGA Receivables and Payables Public Dividend Capital repayable (creditor) Total NHS Capital Receivables Public Dividend written/ Payables off Less amounts included in other Other transfers between reserves categories: Loans on other reserves Movements Other Equity at 31 March 2010 Taxpayers’ Bad Debt provision – NHS Debtors Credit balance on NHS Debtors ledger Total NHS Receivables / Payables Add back: amounts included in other categories Analysis of other WGA bodies Loans Corporation tax receivable / payable Other tax and social security costs Other receivables / payables Other TOTAL DUE / OWING

STATEMENT OF CHANGES IN TAXPAYERS EQUITY 36.1 Information for the whole Government Accounts (WGA)

0 0 0 0 0 0 0 46,558

0 0 0 163 0 997

997 0 0 0 0 834 0 0 00 21,2450 (257) (5) 572 262

(355) 0 0 0 0 0 0 6,881

0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 2,554 0 0 0 0

0 0 0 611 0 2,853

0 0 0 0 2,242 0 0 0 0 0 0 0 0 2,242 0

4,284

0 0 0 0 0 0

0 355 0 0 0 0 0 0 0 15,878 0 0 0 0

Revaluation Other Income & Public Receivables: Receivables:Donated Payables: Payables: reserve asset Reserves expenditure Dividend amounts amounts amounts amounts reserve falling due falling due reserve falling due falling due Capital after more £ 000s within one £ 000s £ 000s after more £ 000s 000s £ 000s within£one year than one year 1,721year year 5,648 0than one12,323 21,245 40.937 1,231 308 £000 £000 £000 0 £0000 0 1,539 6,879 2,029 0 12,323 21,245 42,476 0 0 0 3,270 0 3,270 26 0 0 0 0 2,902 0 0 0 78 0 415 0 357 577 0 0 934 2 0 0 0 0 44 0 0 44 167 0 2 0 0 0 0 (96) 0 (96) 498 19 0 0 0 0 0 0 63 0 0 00 00 0 0 0 (70) (70) 335 0 0 0 0 0 3,673 0 0 0 834 00 0 0 0 0 0 163 611 0 00

Total

Clatterbridge Clatterbridge Centre Centre forfor Oncology Oncology NHS NHS Foundation Foundation Trust Trust st Accounts Accounts forfor thethe year year ended ended 31st31March March 2010 2010

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

36.2 Information for Whole Government Accounts (WGA)

Income 2009/10 £ 000s

Analysis of inter WGA income and expenditure English NHS Foundation Trusts English NHS Trusts Total NHS & Foundation Trusts Department of Health English Strategic Health Authorities English Primary Care Trusts RAB Special Health Authorities Total RAB bodies WGA Special Health Authorities Other WGA bodies

Expenditure 2009/10 £000s

57 499 556 1,225 1,849 56,356 63 59,493 0 2,720

5,114 1,831 6,945 2 7 163 153 325 3,861 6,368

1,849 0 0 635 0 1,214 0 0 0 0 0

7 0 0 0 0 7 0 0 0 0 0

Schedule of Income & Expenditure with NHS SHAs Total for English SHAs East Midlands SHA East of England SHA London SHA North East SHA North West SHA South Central SHA South East Coast SHA South West SHA West Midlands SHA Yorkshire and the Humber SHA

141 142

Clatterbridge Centre for Oncology NHS Foundation Trust Accounts for the year ended 31st March 2010

37. Financial Instruments IFRS 7, IAS 32 and 39, Accounting for Derivatives and Other Financial Instruments, requires disclosure of the role that financial instruments have had during the period in creating or changing the risks an entity faces in undertaking its activities. Clatterbridge Centre for Oncology NHS Foundation Trust actively seeks to minimise its financial risks. In line with this policy, the Trust neither buys nor sells financial instruments. Financial assets and liabilities are generated by day-to-day operational activities rather than being held to change the risks facing the Trust in undertaking its activities. As allowed by IFRS 7, IAS 32 and 39 debtors and creditors that are due to mature or become payable within 12 months from the balance sheet date have been omitted from all disclosures other than the currency profile. Liquidity risk The Trust's income is negotiated under three year agency purchase contracts with local Primary Care Trusts, which are financed from resources voted annually by Parliament. The Trust receives such contract income in accordance with Payment by Results (PBR), which is intended to match the income received in year to the activity delivered in that year by reference to a National / Local Tariff unit cost. The Trust receives cash each month based on an annually agreed level of contract activity and there are periodic corrections made to adjust for the actual income due under the contract. The Trust’s activity has remained ahead of plan during 2009/10, which has contributed to an increase in cash holdings such that a working capital facility is not required. The Trust presently finances its capital expenditure from internally generated funds. In addition, the Trust can borrow, both from the Department of Health Financing Facility and commercially to finance capital schemes. Financing is drawn down to match the spend profile of the scheme concerned and the Trust is not, therefore, exposed to significant liquidity risks in this area. Interest rate risk The only asset or liability subject to fluctuation of interest rates is cash holdings at the Government Banking Service and at a UK high street bank. The £5 million loan from the Department of Health Financing Facility has been taken on a fixed rate basis to avoid any risk from interest rate fluctuations. Clatterbridge Centre for Oncology NHS Trust is not, therefore, exposed to significant interest rate risk. Note 29.1 and note 29.2 show the interest rate profiles of the Trust's financial assets and liabilities. Foreign currency risk The Trust has negligible foreign currency income, expenditure, assets or liabilities. Credit Risk The Trust has considered credit risk under IFRS 7, and concluded that this note is not applicable to the Trust.

38. Auditors Liability The auditor’s liability for losses in connection with the external audit is not limited.

39. Third Party Assets The Trust held £nil cash at bank and in hand at 31 March 2010 which relates to monies held by Trust on behalf of patients.

142 143

Clatterbridge Centre for Oncology NHS Foundation Trust Clatterbridge Road Bebington, Wirral CH63 4JY Telephone. 0151 334 1155 www.ccotrust.nhs.uk

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