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Annual Report 2011/12


Contents 4

Chairman and Chief Executive's introduction

6

About us

8

Our mission, vision, values and strategic objectives

10

Board of Directors

12

Our services

14

Directors’ reports 14

Service developments

18

Performance

26

Patient experience

30

Human Resources and Organisation Development

35

Foundation Trust

38

Emergency preparedness

40

Environmental sustainability

45

Information Governance

46

Future developments

48

Key financial headlines

53

Chair of Audit Committee's Annual Report

58

Remuneration Report

63

Financial accounts for the period 1 April 2011 to 31 March 2012

104

Useful contacts


4

Annual Report 2011/12

Chairman & Chief Executive’s Introduction We are proud to present the first annual report and accounts for Bridgewater Community Healthcare NHS Trust (Bridgewater). In April 2011 our new Trust was formed by the transfer of PCT provider services from four local boroughs into Ashton, Leigh and Wigan Community Healthcare NHS Trust (ALWCH). To recognise the change, the Trust was renamed as Bridgewater Community Healthcare NHS Trust, with the geographic reference of the Bridgwater Canal, which touches each of the boroughs where we provide comprehensive community health services. In addition to providing community health services to the residents of Ashton, Leigh and Wigan, Halton, St Helens, Trafford and Warrington, we also provide community dental services across a wider footprint, covering Bolton, Tameside, Glossop, Stockport and western Cheshire. All Primary Care Trusts (PCTs) in England were required to find the preferred destination for their community provider services under the Transforming Community Services Programme 2008- 2011. Apart from Trafford, which needed to find a temporary solution, the PCTs covering the above areas chose the aspirant community Foundation Trust ALWCH as the solution that would enable them to transform health service delivery by bringing more care closer to home and improving care for patients by integrating services around the needs of patients and families. Bringing all of these PCT services into a single NHS body over the last 12 months has been a considerable challenge but also a great opportunity. Each of the providers (now known as divisions) had previously reported through the annual reports of their respective PCTs, with the exception of ALWCH, which was an NHS trust in its own right.

This annual report outlines how, by bringing these providers together, we have established a safe and effective organisation, based on the experience and track records of each component part. This has been complex but hugely rewarding. We are now moving forward as one organisation, embarking on our bid for Foundation Trust status. During the final months of the year we were undertaking our public consultation which provided a great opportunity for us to meet with our patients, partners and public. It has been important to listen to their concerns and aspirations for the future as it is only by working together that we will make a positive difference to the health and wellbeing of our communities. Feedback from our patients, staff, partners and colleagues has been overwhelmingly positive and supportive, but we are not complacent and recognise that we have much to do as we work to address the Quality, Innovation, Productivity and Prevention (QIPP) challenge and control our finances well within the constraints necessitated by the economic downturn. To ensure that we are travelling in the right direction, we have spent a considerable amount of time clarifying our vision and our ambitions for the future development of community health services with our staff and patients. As a board we have agreed details of how our aspirations will be achieved over the short and medium term. As a public body, Bridgewater is committed to ensuring all its business is conducted in an open and transparent way. Our board meetings are held in public and decisions regarding investments and expenditure are discussed openly so the public are assured that taxpayers' money is being spent appropriately.


Annual Report 2011/12

Community health services have historically been given a low profile within the NHS but we know from the huge number of compliments we receive how valued they are by our patients, their relatives and carers. In many cases our district nurses, health visitors and therapists enable some of the most vulnerable in our communities to lead independent lives within their own homes. The Trust is justifiably proud of the professionalism, commitment and passion of our staff, which are demonstrated through our patient experience and staff surveys. We are developing our workforce so we can achieve our vision of becoming a leading provider of excellent community health services in the north west and also in the country as a whole. We believe our bid to secure Foundation Trust status for our organisation will provide us with greater freedoms to invest more in the services we know our patients need and want. By giving our patients and members a strong voice in our future, we believe they will guide and support our development and growth as an organisation. So this year we have commenced our membership drive, encouraging our staff, their patients and our public, to sign up and join us in this exciting and challenging programme of development.

Harry Holden, Chairman

5

As well as providing high quality universal services for children and adults, via community nursing, health visiting, therapies and unscheduled care centres, Bridgewater is recognised to provide exemplar services in a number of specific areas. These include prison health, community midwifery and specialist dental care for vulnerable patients. We provide community dermatology services and musculo-skeletal services which were previously only accessible within a hospital setting. Our speech and language therapy services are leading practitioners and our highly skilled district nursing services provide care to some of the most vulnerable patients, up to and including the end of life. During the next 12 months we shall be looking to further develop our clinical networks across the whole trust to evidence what works best, seeking to replicate this success across the breadth of the organisation. We have achieved a great deal in 2011/12, laying firm foundations upon which our Trust is building a strong, vibrant, flexible and innovative organisation which is fit and ready to meet the changing and growing demands for care closer to home.

Dr Kate Fallon, Chief Executive


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Annual Report 2011/12

About us The Trust now known as Bridgewater Community Healthcare NHS Trust (Bridgewater) was established in November 2010. Originally established as Ashton, Leigh and Wigan Community Healthcare NHS Trust it was renamed in May 2011, following the integration of a number of community services into the Trust as part of the Department of Health's Transforming Community Services (TCS) programme. This programme required NHS providers to become separate from primary care trusts (PCTs) and it led to NHS community services provided to the populations of Warrington, Halton, St Helens and Trafford transferring from their respective PCTs to our Trust on 1 April 2011. In addition to this a network of community dental services, covering the above areas plus Bolton, Tameside, Glossop, Stockport and western Cheshire were acquired by the Trust. A great deal of work has been undertaken during 2011/12 to integrate these providers into the Trust and develop corporate support functions to facilitate the delivery of sound governance and best practice across the Trust. Operational business units (divisions) have been established to ensure the continuation of strong local relationships in each borough and to retain a focus on service delivery which is tailored for the specific needs of the communities we serve. Bridgewater now provides a range of core universal and specialised NHS community services for a population of 1,015,370 living in the boroughs of Halton, St Helens, Trafford, Warrington and Wigan. We are called Bridgewater Community Healthcare NHS Trust because of the Bridgewater Canal and its network of links to the communities we serve. The boroughs served by Bridgewater are predominantly urban with some rural stretches and include within their boundaries some of the most deprived communities in England. The high levels of deprivation bring a number of associated health and lifestyle challenges that we must address. The ethnicity of this overall population is predominantly White British, however, there is a high proportion of certain minority communities within discrete parts of the Trust area.


Annual Report 2011/12

The delivery of services is organised into the following five divisions:

Ashton, Leigh and Wigan Halton and St Helens Trafford Warrington Community Dental Network (covers the above areas plus Bolton, Stockport, Tameside, Glossop and western Cheshire) These divisions combined provide 136 different services. Services are delivered from 222 locations in the heart of the communities we serve. Bridgewater currently employs 4,026 staff and has an income of ÂŁ166 million. Like other community healthcare organisations in England, we are accountable to the Secretary of State for Health for providing local NHS services. We work closely with our partners in local authorities, voluntary and statutory organisations across our boroughs and with our patients and public. Bridgewater is also an aspirant Foundation Trust and is working towards achieving this status in April 2013.

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8

Annual Report 2011/12

Our Mission, Vision and Values and Strategic Objectives Our vision is that:

By working with Our mission is:

local people and partners, To improve

we will promote good health

local health and

and be a leading provider

promote wellbeing in

of excellent community

the communities

healthcare services in

we serve.

the North West. Our values are:

Patient Centred Patient care is our priority. Encourage Innovation We encourage and embrace new ideas to deliver improvements in patient care. Open and Honest We communicate clearly to develop relationships based on mutual trust and respect.

Professional We provide a quality service for patients by investing in our staff and recognise and value their contribution. Locally led We will continually develop our knowledge of the communities we serve so that we can be responsive to local need. Efficient We will use our resources wisely to ensure quality patient care and value for money.


Annual Report 2011/12

9

Strategic Objectives Our plans and ambitions for the future are under-pinned by our mission, vision and values. As a provider of community healthcare services, we are committed to excellence at every level. STRATEGIC OBJECTIVE Patients

STRATEGIC INTENTION We will demonstrate improvement in the delivery of high quality, safe, excellent and effective personal community healthcare for our patients. We will make it easier for patients/carers to access our services where and when they need them.

Community

We will work with local communities to improve services that support their health and wellbeing, establishing targets that will demonstrate that we are achieving this. We will engage with stakeholders and the local community to develop a community organisation that supports and enhances improved health within our local communities.

Organisation

We will be financially secure and accountable across our entire organisation. We will deliver value for money by ensuring efficiency in all our activity and processes to enable and drive innovation. We will achieve NHS Foundation Trust status by 2013 and be assessed as a leading provider of community healthcare in the North West by 2015.

People

We will develop world class skills, competencies and experience to deliver high quality care through our workforce planning and education and be seen as the employer of choice. We will engage with our staff, fostering talent and developing leaders, to deliver change, innovation and improvement.

Being a part of and supporting the community we serve As an organisation we aim to make a significant difference to the health and well being of local people, not just through the quality of the health services provided, but by being a good corporate citizen. We work hard to create job opportunities, offer student placements, apprenticeship programmes and support local suppliers. We believe this plays an integral part in supporting the local economy and enhances wellbeing in our communities.


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Annual Report 2011/12

Board of Directors In 2011/12 we completed recruitment to the Board to ensure we are fit for purpose. As of January 2012, the board consists of five Executive Directors and eight Non-Executive Directors, a number granted by the Secretary of State to acknowledge the rapid geographical growth of the Trust. There are three non-voting Directors.

The Board is ultimately accountable for the safe and effective operation of the Trust's services and provides both leadership and strategic direction to the organisation. The Board of Directors meets monthly and members of staff, the public and the media are entitled to attend part one of the meeting, the papers for which are available via the Trust's website.

Board members Details of the Bridgewater Trust Board are provided below, including those directors who served on the board for part of the year 2011/12.

Audit Committee Membership During the course of 2011/12 the membership of the Audit Committee changed as a consequence of the appointment of additional Non-Executive Director positions which allowed wider Board Committee roles to be reviewed. The Chair of the Audit Committee remained unchanged for the full year but the Non-Executive Director members were as follows: Period 1 April to the 31 December 2011 – as shown right ** Period 1 January 2012 to the 31 March 2012 – as shown right ****

Declaration of interests Dr Stephen Ward, Medical Director, registered a potential conflict of interest upon his appointment to the Trust on the 1 July 2011. This is in relation to his wife holding the position of Director of Nursing at Halton and St Helens PCT who are one of this Trust's main commissioners. No other details of company directorships, or other significant interests held by directors, which may have conflicted with their managerial responsibilities, were disclosed during the period covered by this report.


Annual Report 2011/12

Dr Kate Fallon Chief Executive

Harry Holden Chairman

Dorothy Whitaker Vice Chair & Non Executive Director **

11

Bob Saunders Non Executive Director & Chair of the Governance Committee ** and ****

Steve Cash Non Executive Director & Chair of the Performance Committee**

Karen Bliss Non Executive Director & Chair of Audit Committee** and ****

Sue Musson Baron Frankal Non-Executive Director Non-Executive Director Appointed 1 January 2012**** Appointed 1 January 2012

Sally Yeoman Non-Executive Director Appointed 1 January 2012

Keith Hamblett Non-Executive Director Resigned 2 October 2011

Dorian Williams Mike Treharne Executive Nurse/ Director Executive Director of of Governance Finance, Information & Performance/Deputy Chief Executive

Linda Agnew Director of Corporate Development

Steve Ward Colin Scales Executive Medical Director Executive Director of Operations Appointed 1 July 2011 Appointed 24 October 2011

Seamus McGirr Director of Clinical Performance

Christine Samosa Director of Human Resources & Organisational Development Appointed 31 October 2011


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Annual Report 2011/12

Our services Bridgewater offers a diverse range of community healthcare - equating to 136 different services, delivered across the communities we serve. Community services provide care treatment and support for the youngest to the oldest members of our communities and everyone else in between. In many cases we support families and individuals throughout their lives. Our services are characterised by their delivery at home or as close to home as possible rather than being accessed in a hospital setting. Most of the care we provide is delivered in patients' homes or in clinics, health centres, GP practices, community centres and schools. The Trust also includes one inpatient unit, Newton Community Hospital, which has 29 beds plus outpatient facilities and a pharmacy. Some of our services are universal in that they are tailored for and available to the whole population at some time in their life, for example health visiting, district nursing and physiotherapy. Others are highly specialist services supporting the needs of vulnerable individuals including adults with learning disabilities, children with complex health needs and the populations of prisons in the Trust area. We also deliver some services that may traditionally have been delivered in a hospital setting such as palliative care, intermediate care rehabilitation and in some divisions we also provide walk in centres staffed by nurses experienced in the assessment and treatment of minor illness and injury. By educating, empowering and supporting people to manage long-term conditions such as diabetes, chronic obstructive pulmonary disease (COPD), heart failure and renal failure we are using community services to deliver cost effective care outside of hospital settings and contributing to the effective use of NHS resources. Our Community Dental Network provides highly specialised and technically challenging clinical procedures and caters for the specific needs of vulnerable people requiring dental treatment in all the areas served by the Trust.


Annual Report 2011/12

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Summary of services Examples of our services are provided below. Please note as services are delivered according to local need not all services are provided in every area served by the Trust.

Child Health

eg health visiting, school nursing, child development centres, complex needs, safeguarding, child and adolescent mental health, children's community therapy

Health and Wellbeing

eg stop smoking, weight management, health trainers, sexual health.

Urgent Care

eg walk in centres, district nurses (including out of hours), GP out of hours, intermediate care, home-based intravenous therapy.

Long Term Conditions

eg community neurosciences, continence, community matrons, services for people with diabetes, stroke, heart and respiratory problems .

Specialist Services

Offender Health

Dental

eg dermatology, orthopaedic and musculo-skeletal, podiatry, cancer and palliative care, wheelchair and equipment, community physiotherapy, occupational therapy, dietetics, learning disabilities and falls prevention. eg services in prisons and young offender institutions in our area – HM Young Offenders Institute Hindley, Wigan; HM Prison Risley and HM Young Offenders Institute Thorn Cross in Warrington. eg specialist dental services for people with physical and learning disabilities, looked after children and those with anxiety issues. Oral health promotion and prison dental services.


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Annual Report 2011/12

Directors’ reports Service developments On its establishment, through the Department of Health's (DoH) Transforming Community Services programme, Bridgewater inherited a mature and complex set of operational systems from former PCT provider functions that now operate as the five divisions of the Trust. During the year work was undertaken to define the Trust's Operational Framework, focusing on identifying the core elements of an operating model for the five divisions that are part of Bridgewater, whilst recognising the programmes of work that are already in progress under the leadership of the Senior Management Team (SMT). Work has been undertaken through the SMT to refine the divisional structure and the operational delivery model to support it. The Operational Framework aims to: implement a consistent and strong system of internal control enhance performance management systems define clear lines of accountability to the SMT develop a clinical service improvement and leadership model There are many benefits that the diverse range of Bridgewater's geography, large staff numbers and range of services bring to the patients we serve. Clinical professionals working in the same discipline, but in different localities are able to share best practice and work together for mutual patient and professional benefit. A summary of key highlights in service development across the Trust follows.

Pressure Ulcers Lead nurses across each division ensured that the prevention and reporting of pressure ulcers was a top priority. They agreed a system for reporting all pressure ulcers that were grade 2 (small graze) and above. All pressure ulcers were monitored to establish where the patient was when they developed the pressure ulcer and why the pressure ulcer developed. Any deterioration was reported and investigated to find the reasons why. Training packages and guidance were given to staff with the aim of preventing pressure ulcers from developing. More serious pressure ulcers (graded by a clinician as 3 or 4) are reported by all NHS Trusts to their commissioners and the Strategic Health Authority (SHA). Root causes and progress with these are then closely monitored. In total 1,274 pressure ulcer incidents were reported by staff, 241(19%) of these developed or deteriorated while under the care of the Trust, 1,033 (81%) of ulcers developed either at other healthcare providers and transferred into the care of Bridgewater staff, or developed at home and were referred for treatment.


Annual Report 2011/12

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Health Visiting A Trust wide programme to develop a new service model for health visiting services was initiated during the year. The programme supported the objectives of the Department of Health's Call to Action project to reinvigorate health visiting and to recruit more health visitors. Health visiting services also participated in the Listening to the Voice of the Family project and tested a number of methods to capture feedback, from children, families and staff, to support improvements in service delivery. These included trying out SMS texting to capture feedback from families and using an online tool to gather feedback from staff. The Trust also piloted specially designed cards to capture feedback from children on their feelings about the care they receive. In 2012/13 as a phase two Early Implementer Site, we will progress this programme to enhance the public health elements of health visiting work.

Medicines Management and Patient Safety The organisation has worked towards the harmonisation of divisional policies and procedures which are in place to ensure patient safety with regards to prescribed and administered medicines. To ensure patient safety, we have developed a comprehensive incident reporting process for untoward events, adverse drug reactions and errors. We encourage reporting of incidents to promote an open and fair culture of safety. Staff reported 4,981 incidents during 2011/12 of which 677 (14%) were considered incidents that affected patient safety, representing 0.02% of the three million patient contacts during the year. More detail on these developments is available in the Bridgewater Community Healthcare NHS Trust Quality Account.

Clinical Networks Strong and effective clinical engagement is essential if the organisation is to encourage innovation and embrace new ideas to deliver improvements in patient care. This clinical engagement will extend beyond staff employed by the Trust and will include GPs, as commissioners and providers, healthcare professionals working in hospital settings and social care staff. The Trust has already undertaken a great deal of work to establish Clinical Networks which aim to bring together clinicians working in the same or similar clinical areas across the Trust. These networks will be the focus for clinical leadership, service improvement and pathway redesign to ensure that the skills and experiences available across the trust are maximised to the benefit of all clinical areas.


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Annual Report 2011/12

Service developments in divisions Each division had specific objectives designed to improve the quality of services and these were outlined in the 2010/11 Quality Accounts of the relevant Primary Care Trusts. Examples of the range of service developments within our divisions during 2011/12 are outlined below.

Halton and St Helens Continued the development of the Telehealth project.

Developed quality improvement

Ashton, Leigh and Wigan Reduced waiting times for falls and community physiotherapy services by implementing different working practices and implemented a revised waiting system for podiatry.

visits programme. Implemented safeguards within IT systems to eliminate the risk of data loss through portable media devices such as pen drives.

Rolled out Essential Public Health Training across the division and implemented Making Every Contact Count to ensure that more people are signposted to lifestyle services. Reviewed and updated information leaflets for occupational therapy and community neurosciences services.

Trafford Improved the prevention of and management of pressure ulcers.

Warrington

Reduced the incidence of falls and harm from falls by learning through significant event reporting and analysis. Continued to reduce healthcare associated infections (HCAIs).

Strengthened the assessment of children in local authority care and understanding of the experience of children and young people. Demonstrated improvements in the management of pressure ulcers, the co-ordination of care for people with neurological disease and the holistic management of dementia.

Dental Introduced a single system for reporting incidents/complaints. Carried out an audit of infection control standards to ensure compliance with decontamination in dental practice procedures. Implemented patient surveys for the dental network.

Supported people to live independently in the community and reduced the incidence of falls and harm from falls.


Annual Report 2011/12

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Annual Report 2011/12

Performance Bridgewater has approximately three million individual clinical contacts per year. We have experienced a year on year improvement in efficiency through greater productivity and improved responsiveness of our service. Fewer people now wait for care and the majority experience improved quality. The numbers of errors, Healthcare Acquired Infections (HCAIs) and incidents as a proportion of our activity continue to reduce. Bridgewater is at the forefront of improving and developing the way community trusts monitor performance. The development of our Bridgewater performance monitoring framework has been supported by existing commissioners and Clinical Commissioning Groups (CCGs). In this, the first year of our contracts Bridgewater agreed activity levels based on established historic, pre-Transforming Community Services, levels. Each of the divisions of Bridgewater has a contractual activity target set by its respective commissioner with each target broadly reflecting the division's size and complexity. It is important to note the quality of data recording needs to be taken into account in the interpretation of the figures. Each division of Bridgewater has in place their own strategies to maintain strong, comprehensive data and data is checked in each division before processing at a Bridgewater level.


Annual Report 2011/12

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Key Performance Indicators and Clinical Quality Dashboards Key Performance Indicators (KPI's) enable organisations to look at the quality of services delivered and ensure that the quality of the services continues to improve. KPI's are set externally by our commissioners and internally by our Board. They are performance managed to ensure achievement and development. Since April 2011, Bridgewater has developed its approach to performance management through the senior management team (SMT) reporting to our Trust Board. Bridgewater has made significant improvements in its underlying infrastructure to allow data collection across all divisions. The 2011/12 indicators covered the major themes of performance, capacity, workforce, quality, finance and patient experience. Whilst the mix of activity is slightly different and reflects the different health needs of each of the areas, specialised services have been developed in each area that we will look to develop across the Trust's footprint for the benefit of the whole Bridgewater population.

Activity Summary At the end of 2011/12 Bridgewater Community NHS Trust was cumulatively 3.93% above planned activity levels, against contracted targets.

Bridgewater Activity Against Target - 2011/12

Activity vs Target for each month

300000 250000 200000

Count of Activity

150000 100000 50000 0

Apr

May

Jun

Jul Aug Nov Dec Oct Sep Within-month Target Within-month Activity

Jan

Feb

Mar 2011/2012


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Annual Report 2011/12

Waiting Times - all Services At the end of 2011/12 Bridgewater had a total of 11401 patients waiting for all services. Of these 10618 patients (93%) were waiting for under 11 weeks. Due to the integration of providers, reporting across all divisions commenced in August, therefore the graph does not include the number of patients waiting in Warrington, Halton and St Helens or Trafford before this date.

Patients waiting for under 11 weeks, 11 to 17 weeks or over 18 weeks from referral to treatment (all services)

Bridgewater All Waits 2011/12 14000

12000

Patients Waiting

10000

8000

6000

4000

2000 0 Apr

May

Jun

Jul

Aug Under 11

Sep 11 -17

Oct

Nov Over 18

Dec

Jan

Feb

Mar 2011/2012


Annual Report 2011/12

21

Consultant led Services At the end of 2011/12 Bridgewater had a total of 729 patients waiting for consultant led services. Totals do not include any patients waiting at Trafford division as they do not operate any consultant led services. Halton and St Helens data is included from August onwards as a breakdown is not available prior to this month.

Bridgewater Consultant Led Waits 2011/12 900

Patients waiting for under 11 weeks, 11 to 17 weeks or over 18 weeks from referral to treatment (consultant led services only)

800

Patients Waiting

700 600 500 400 300 200 100 0 Apr

May

Jun

Jul

Aug

Under 11

Sept

Oct

11-17

Nov

Dec

Jan

Over 18

Feb

Mar

2011/2012

Referral to Treatment waiting time target Table: As part of national requirements and in line with NHS organisations the Trust is required to report on the length of time between referral to a service and treatment being received. The Trust achieved all national targets during 2011/12.

THRESHOLDS

REPORTED MARCH 2012

<18.3 weeks

11.7 weeks

All Cancers: 31-day wait for second or subsequent treatment (surgery)

94%

100%

All Cancers: 62-day wait for first treatment (from urgent GP referral to treatment)

85%

100%

All Cancers: 31-day wait (from diagnosis to first treatment)

96%

100%

All Cancer: two week wait from referral to date first seen

93%

100%

WAITING TIMES Referral to Treatment 18 Week Compliance

ACHIEVED?


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Annual Report 2011/12

Compliance with Out of Hours Quality Standards From 1 January 2005, all providers of out of hours (OOH) services have been required to comply with the national quality requirements, first published in October 2004.

Out of Hours Quality standards vs requirements

We are currently reporting on the following standards for out of hours services provided in Warrington and Ashton, Leigh and Wigan divisions.

Green = compliant with target Amber = within 5% - 10% of target Red = more than 10% short of target

QUALITY REQUIREMENTS MONITORED

NATIONAL YEAR END YEAR END QUALITY POSITION POSITION REQUIREMENT ASHTON, LEIGH WARRINGTON STANDARDS AND WIGAN

QR1 - Regularly reporting of quality standards

To be Compliant

QR2 - Supply clinical data GP

95%

Compliant

Compliant

96.43%

98.4%

QR3 - Patient with defined needs

To be Compliant

Compliant

Compliant

QR4 - Clinical audit

To be Compliant

Compliant

Compliant

Min 1%

1.72%

3.45%

QR6 - Complaints procedure in place

To be Compliant

Compliant

Compliant

QR7 - Capacity and demand

To be Compliant

Compliant

Compliant

Max 0.1%

0%

0%

Max 5%

5.21%

0.70%

QR8c - Calls answered within 90 seconds

95%

84.64%

93.8%

QR9a - Emergency assessment within 3 mins

95%

100%

100%

QR5 - Patient experience

QR8a - Engaged calls QR8b - Abandoned calls (excludes Q1 as started reporting in Q2)


Annual Report 2011/12

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Out of Hours Quality standards vs requirements

Green = compliant with target Amber = within 5% - 10% of target Red = more than 10% short of target

QUALITY REQUIREMENTS MONITORED

NATIONAL YEAR END YEAR END QUALITY POSITION POSITION REQUIREMENT ASHTON, LEIGH WARRINGTON STANDARDS AND WIGAN

QR9b - Urgent assessment within 20 minutes

95%

96.72%

93.78%

QR9c - Routine assessment within 60 minutes

95%

92.5%

91.71%

Not Relevant

Not Relevant

Not Relevant

Compliant

Compliant

QR10 - Not applicable as service does not operate a drop in facility QR11 Care provided in an appropriate clinical environment

To be Compliant

QR12a - Emergency appointments within 60minutes (attending OOH Clinic)

95%

97.44%

100%

QR12b - Urgent appointment within 120 minutes (attending OOH Clinic)

95%

97.52%

99.62%

QR12c - Routine appointments within 360 minutes (attending OOH Clinic)

95%

99.81%

99.96%

QR12a - Emergency appointments within 60 minutes (Home visit)

95%

79.17%

100%

QR12b - Urgent appointment within 120 minutes (Home visit)

95%

89.92%

97.52%

QR12c - Routine appointments within 360 minutes (Home visit)

95%

98.56%

99.56%

QR13 - Providing access to interpreter services

To be Compliant

Compliant

Compliant

In relation to Warrington Division results QR8b, QR8c, QR12a and QR12b action plans are in place to address the shortfalls.


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Annual Report 2011/12

Walk In Centres During 2011/12 Department of Health 's (DoH) Operating Framework announced that a set of national clinical quality indicators would be introduced to provide a comprehensive and balanced view of the care delivered within Accident and Emergency Departments (A&E) including walk in centres. Bridgewater has three walk in centres in Leigh, St Helens and Widnes. In June 2011 the DoH published “A&E Clinical Quality Indicators – Best Practice Guidance for Local Publication” with the purpose of supporting providers to publish the data associated with the set of indicators in a dashboard format that is suitable for patients, public, other providers and commissioners. In December 2011 Bridgewater commenced the monthly publication on its website of this data for the three walk in centres. At the end of 2011/12 Bridgewater's walk in centres were compliant across the four national indicators we report on.

Walk In Centre Indicators In March 2012, all three walk in centres were compliant across all four of the national indicators we are required to report on. Walk in Centre name Indicator Percentage of People Seen in 4 Hrs

Leigh

Widnes

St Helens

98.42%

100.00%

99.99%

18 mins 3.04%

15 mins 2.56%

0.68%

0.01%

Target >=95%

Time to treatment decision (median) <=60 mins Unplanned re-attendance rate

<=5%

17 mins 1.7%

Left without being seen

<=5%

0.03%


Annual Report 2011/12

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Business Intelligence Good decision making is essential to developing and maintaining a high quality organisation and services. This must be based on access to good quality up-to-date and relevant information. To support this, the Trust has been engaged in the development of some high level dashboards to provide management with the ability to monitor the delivery of key performance indicators. There is now a programme to determine the detailed dashboard needs of clinicians and managers at all levels of the organisation to support their decision making. As a move towards this goal, we are currently engaged in the development of Service Line Reporting dashboards to support Service Line Management development in the organisation.

Service Line Reporting/Management (SLM) Implementation of SLM will deliver a range of benefits to clinicians, staff and patients and service users. Bridgewater is completing work to align its individual frontline services in each division. This will enable all existing systems in the Trust capturing financial, workforce and operational activity to be integrated and analysed to frontline service level within divisions and across Bridgewater from summer 2012 onwards. In this way there will be a more coherent and clearer understanding of each service from a financial, quality and workforce perspective. This will allow us to ensure services are efficient and cost effective, whilst improving the patient experience.

Foundation Trust (FT) pipeline compliance framework The NHS is moving from a centrally managed system to one which is more responsive to both to the needs of the patient and service user and the wishes of the local community. NHS Foundation Trusts (FTs) are central to this move. Bridgewater is on a programme aiming to become an FT in April 2013. (This is covered in more detail in section 6.5) Monitor authorises FTs on the basis that they are well-governed, financially robust and legally constituted, in accordance with the National Health Service Act 2006, and meet the required quality threshold. Monitor has designed a Compliance Framework to ensure that FTs maintain their viability. As an aspirant FT, Bridgewater is subject to the same monitoring and is expected to complete the Compliance Framework on a monthly basis and submit the information to the Strategic Health Authority for external monitoring to be completed. At the end of 2011/12 Bridgewater was fully compliant with all the requirements set out in its Tripartite Formal Agreement and Accountability Agreement.


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Annual Report 2011/12

Patient Experience Bridgewater recognises that measuring and acting upon patient experience is a key driver of quality and thus service improvement. All the divisions within the Trust have arrangements in place to monitor patient experience including the use of patient surveys, comment cards, SMS texting, mystery shopping, telephone interviews and quality improvement visits. During the past year the Bridgewater Service Experience Group has commenced the development of a common approach to monitoring, reporting on and acting on patient experience within the organisation. Survey results During 2011/12 more than 12,000 survey responses were received by Halton and St Helens Division from their 'Talk to usâ&#x20AC;Ś' programme with the overall satisfaction rate at 94%. Warrington Division carries out generic and service specific surveys using patient tracking devices and has recorded an overall satisfaction rate of 94%. Within Trafford Division, 2,300 respondents participated in two patient experience surveys in which we achieved a continued 95% overall level of satisfaction. Ashton, Leigh and Wigan Division received more than 2,100 responses with a 93% overall level of satisfaction. The Dental Network has commenced a cycle of patient surveys to capture areas of good practice or concern. Around 400 patients were consulted in the first survey which reported the overall satisfaction rate of 97%.


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27

Patient Advice and Liaison (PALS) During 2011/12 we received 1631 contacts across Bridgewater. These are summarised by division below:

DIVISION

ASHTON, LEIGH & WIGAN

DENTAL

HALTON & ST HELENS

NUMBER OF CONTACTS

454

27

772

TRAFFORD WARRINGTON

102

276

TOTAL

1631

Nearly 60% of the contacts were requests for advice and information, including signposting to other organisations. Some of the issues raised include: Difficulties contacting the physiotherapy department â&#x20AC;&#x201C; which led to a review of the administration support for the Outpatient Physiotherapy Service. Issues around availability of routine podiatry appointments and provision of home visits by the podiatry service. Requests for more home visits from district nurses. We aim to learn from complaints as a part of improving our patients' experience. During 2011/12 we received 137 complaints. These are summarised by division below:

DIVISION

ASHTON, LEIGH & WIGAN

DENTAL

HALTON & ST HELENS

NUMBER OF COMPLAINTS

27

8

48

TRAFFORD WARRINGTON

32

22

TOTAL

137


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Annual Report 2011/12

The complaints were divided across a range of issues. Themes are summarised in this table.

THEME OF COMPLAINT

NUMBER

Aspects of clinical treatment

61

Attitude of staff

28

Communication/information to patients

20

Aids and appliances, equipment, premises

11

Appointments, delay/cancellation

7

Policy and commercial decisions of trusts

4

Patients' privacy and dignity

2

Admissions, discharge and transfer arrangements

2

Consent to treatment

1

Failure to follow agreed procedures

1

Patient Stories A patient story is presented to the Board each month. This is a compelling way to illustrate the patient's experience and enables the Board to gain a meaningful understanding of how people feel about using our services. Examples of patient stories include: A patient's experience of our stroke service at home. An ear care service patient presenting their positive experience of the service. A school nursing service complaint regarding communication of information to a special needs pupil


Annual Report 2011/12

29


30

Annual Report 2011/12

Human Resources and Organisation Development Workforce and organisational development Bridgewater is committed to the continued development of our staff to ensure the delivery of world class healthcare. We recognise that to deliver the ambitions set out in our strategy and plans, we must review and develop our existing workforce capacity and capability. Effective management of our workforce will be vital to sustaining operational performance during this financially challenging period. We are also committed to helping our staff manage their work and home lives.

Key Achievements during 2011/12 During the year we introduced a Work-based Development Programme that supports existing staff at pay bands 1 to 4 to gain an apprenticeship qualification that is relevant to their role. During the year 43 staff from across the Trust commenced courses in a variety of subject areas including health and social care, business administration and customer service. In March 2012, we became one of the first Trusts in the north west to sign up to the NHS Apprenticeship Promise. This initiative led by the Strategic Health Authority supports Trusts to attain a 'gold-standard' training model for clinical and non-clinical staff at pay bands 1 to 4 who do not have a professional qualification. This will further enhance the skills, knowledge and performance of staff in these roles. Bridgewater is now a Health and Safety Executive accredited provider of First Aid at Work initial training, requalification training and Emergency First Aid at Work courses. A total of 34 staff have now completed First Aid at Work and 64 have completed Emergency First Aid at Work. We introduced a bespoke mandatory training e-learning programme for all staff in the Trust. A review after six months indicated that staff prefer this method of learning to face-to-face mandatory training as it has saved money and released more time for staff to focus on delivering patient care. The training covers customer care and complaints; equality and diversity; fire safety; risk management; health and safety; infection control; information governance; lone worker and security awareness and safeguarding adults and children. Throughout 2011/12 90% of staff were compliant with their mandatory training requirement. The first Bridgewater training needs analyses have been completed to allow Learning and Development to plan how to best use our funding to cater for the development needs of our staff and to equip them with the skills required for planned service developments. The Trust secured funding from NHS North West to further develop in-house mediation services for staff. This will ensure the availability of a number of trained personnel who undertake the role of mediator to assist in early conflict resolution/relationship management.


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During the year a support booklet for staff covering mental health and wellbeing was launched to signpost staff to self help materials, wellbeing services plus local and national support groups. We have also signed up to the Macmillan Cancer Toolkit which helps employers to support people with cancer and their carers. In March 2012, 35 staff took part in a two day Root Cause Analysis training course and as a result we have developed a Bridgewater pool of investigators who can be used across all divisions to investigate incidents. The IT Training Team continues to achieve accreditation with the British Computer Society and 55 staff successfully passed their European Computer Driving Licence this year. A further 56 staff have successfully passed examinations in one of the applications covered by the NHS Microsoft Office Skills Training course which was introduced in 2011. We have progressed integrating HR functions following the transfer of providers into the Trust on April 2011. This includes integrating Recruitment and Workforce Information teams from across the Trust to form one corporate service and transferring staff records from Halton and St Helens; Warrington and Dental divisions onto the same electronic staff records system as Ashton, Leigh and Wigan. At the end of the financial year we were finalising the transfer of payroll to provide a single, payroll, expenses and pensions service based at Whiston Hospital. This change was scheduled to take effect from 1 April 2012.


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Annual Report 2011/12

Results of the 2011 Staff Survey Bridgewater is committed to listening to its staff and encourages participation in the national NHS staff survey and in quarterly Trust surveys. The results of the first Bridgewater national NHS Staff Survey were published in March 2012. The results of the survey have been communicated to staff via a new â&#x20AC;&#x153;Listening to Youâ&#x20AC;? approach so that staff can clearly see that the results of the surveys are being listened to and that action plans are being developed for areas where results indicate we need to improve. The response rate within the Trust to the 2011 national NHS Staff Survey was 47%. This is above the lower end of the range of responses for PCTs and mental health trusts but below the median for both types of NHS organisation which stands at 62% and 56% respectively. The four key findings for which Bridgewater compares most favourably with other community trusts in England are detailed below: no staff who responded had experienced physical violence from staff in the last 12 months the percentage of staff working extra to their contracted hours was below average compared to other community trusts 99% of staff who responded stated that they had reported errors, near misses or incidents witnessed in the last month 75% of staff who responded stated that they are using flexible working options to help balance their work and home lives The four key findings for which Bridgewater compares least favourably with other community trusts in England are in relation to: staff feeling there are good opportunities to develop their potential at work ensuring there is good communication between senior management and staff staff feeling that their role makes a difference to patients hand washing materials always being available It is not possible to benchmark this data against the 2010 NHS Staff Survey as the organisation was not in existence in its current form prior to April 2011. It is proposed that the 2011 NHS Staff Survey data for Bridgewater is used as a baseline for benchmarking future NHS Staff Survey results. The key findings where we performed less well than other community trusts will be used as a starting point for the organisation to focus on and identify specific actions to improve staff perceptions of the organisation in the future.


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Relationships with Trade Unions We have a strong and positive relationship with our trade union colleagues. The strength of this level of partnership has had real benefits for our staff. We are keen to ensure that effective partnership working is further developed from this sound basis. Trade union representation has been a feature of a number of working groups to ensure that partnership working is applied to everything we do. The organisation recognises several trade unions as the collective consultation and negotiating representatives of staff. We have a number of 'Divisional' Partnership Forums which feed into an overall 'Corporate' Partnership Forum. We will continue to promote and support the benefits of trade union membership and the representatives will continue to play an essential role in promoting good employee relations, supporting effective change management, the learning and development agenda, the negotiation of terms and conditions and developing best practice in employment. We have a number of working groups which operated in partnership with trade union colleagues. These are working on developing policies for the Trust, workforce planning and development and ensuring staff health and wellbeing.

Staff benefits, reward and recognition The organisation is committed to improving our performance in health and wellbeing and actively encourages the adoption of healthier lifestyles for staff. During the year the Trust's Health and Wellbeing Group introduced a â&#x20AC;&#x153;Staff Mattersâ&#x20AC;? brand to cover all services and initiatives that will benefit staff, including their health and wellbeing. Each division within Bridgewater held a staff awards ceremony during the year and the trust is currently undertaking a piece of work to develop the reward and recognition programme. This will be developed to ensure that Bridgewater is regarded as a leading employer and can attract and retain the best talent.


34

Annual Report 2011/12

Sickness absence rates DoH reporting standards require that sickness absence data for the annual report 2011/12 is based on the calendar year from 1 January 2011 to 31 December 2011. DoH considers the figures to be a reasonable proxy for financial year equivalents. The sickness absence rate for the trust for this period was 4.23%. The latest data for benchmarking purposes (January 2012) shows the north west average absence rate for NHS Trusts to be 4.9% and the average for community trusts is 5.2%. The number of working days lost due to sickness absence was 12,713 and the average number of working days lost per member of staff during this period was 9.52. Equality, diversity and human rights The organisation is fully engaged with the process of delivering improved health outcomes in service provision and increasing diversity within the workforce for those individuals covered by 'protected characteristics'. These are defined within the Equality Act 2010 as disability; gender reassignment; marriage and civil partnership; pregnancy and maternity; race; religion or belief; sex and sexual orientation. We are using the NHS Equality Delivery System (EDS) process to engage our local divisions with relevant stakeholder groups to ensure that patients from protected and vulnerable groups are able to access services as well as other patients. This will ensure they experience the same levels of satisfaction as other patients and the gap in health inequalities is reduced. EDS also provides a framework for ensuring that we increase the diversity and quality of the working lives of our staff, supporting all staff to better respond to patients' and communities' needs. It also provides assurance that boards and senior leaders are conducting business so that equality issues are advanced within the organisation and in our work with key partners. In early 2012 we engaged with stakeholder groups to identify our equality objectives for the next four years. This information and our current achievement against EDS is available on the equality pages of the Bridgewater website. Work placements The Trust has provided a number of work placements for those members of the local community looking to develop work skills and increase their chances of gaining employment. Ashton, Leigh and Wigan Division has had the opportunity to work in partnership with Wigan Council through the Supported Employment Service to support people who have a disability, through providing work placements as part of their journey to securing paid employment. This partnership working allows opportunities for creating a diverse workforce which reflects the local community. The Trust also attends career fairs, with the aim of supporting local schools and colleges by offering advice for young people interested in pursuing a career within the NHS.


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35

Foundation Trust Bridgewater's driving ambition is to develop a community based organisation that focuses on meeting the needs of our patients, our local population and our staff. Our primary objective is to ensure that we deliver safe and effective care, close to home for the local population. We want our patients, their families, their carers, our staff, our communities and partner organisations to have a greater influence in the future development of the services we provide. We believe that becoming a Foundation Trust will enable us to achieve this through recruiting members who will in turn be able to elect a Council of Governors to represent their views. Bridgewater has identified that there will be significant benefits to our patients,communities, commissioners and partners through achieving Foundation Trust status. Our decision making will be local, as opposed to being dictated by central government, which will enable us to respond more quickly to the needs of both our patients and local communities. Local people and organisations will have a much greater role in the planning and design of our services and in setting our priorities by establishing a membership base and a Council of Governors. Both public and staff members will be able to elect representatives on our Council of Governors. The Council of Governors will represent members, local communities and other organisations and be able to influence key decisions about the Trust and our services and have a say on key appointments. We will be able to plan and manage our finances over a longer period of time and generate a surplus of money which will allow us to invest in new and improved services for patients. We have made significant progress towards achieving our aim of becoming a Foundation Trust. The key developments are outlined below. Tripartite Formal Agreement In May 2011, Bridgewater signed a Tripartite Formal Agreement (TFA) confirming the commitments being made by the Trust, the Strategic Health Authority (NHS North West) and the Department of Health that will enable achievement of NHS Foundation Trust (FT) status for the agreed target date of April 2013. The TFA confirms the date when Bridgewater will submit an â&#x20AC;&#x153;FT readyâ&#x20AC;? application to DoH to begin a formal assessment towards achievement of FT status. The objective of the TFA is to identify the key strategic and operational issues facing the Trust and the actions required at local, regional and national level to address these to meet the standards required to achieve FT status. The agreement also covers the key milestones that will need to be achieved to enable the FT application to be submitted during 2012/13. Every Trust applying for Foundation Trust status has signed a TFA.


36

Annual Report 2011/12

Accountability Agreement In July 2011, Bridgewater signed an Accountability Agreement - a document which details the principles and process by which NHS North West will receive assurance that the Trust will reach Foundation Trust status as determined within the TFA. The agreement provides the framework within which Bridgewater can clearly demonstrate progress and therefore maintain its present operational and strategic independence. It also sets out the project milestones and covenant tests against which NHS North West performance manages Bridgewater. The trajectory for achieving Foundation Trust status presents some challenges for Bridgewater, particularly in this extremely challenging financial climate; however the trajectory must be adhered to in order to meet statutory requirement that all NHS Trusts must become Foundation Trusts by April 2014. The agreement provides the factual and interpretative framework for NHS North West to have confidence that the health economy is on track to deliver a sustainable Foundation Trust and that acknowledgement is made by Bridgewater that NHS North West will intervene if the milestones and agreed trajectory are not met.

Consultation On 1 February 2012 the Trust embarked on a formal 12 week period of consultation to seek the views of staff, patients, local people and partner organisations on its proposals for membership and the governance arrangements for becoming a Foundation Trust. During this period there were plans for 12 public consultation events across the boroughs of Halton, St Helens, Trafford, Warrington and Wigan to allow senior managers to meet with patients, members of the public and key stakeholders. A total of 17 consultation events were also scheduled for staff in all our main community divisions and also for staff in the community dental network. Our Chairman and Chief Executive were also scheduled to attend 16 meetings held by partner and stakeholder organisations. The consultation concluded on 30 April 2012. Following the close of the consultation a summary of the responses and the impact of the feedback on the proposals have been published on the Trust's website.


Annual Report 2011/12

37

Membership The formal consultation was used to launch the recruitment of members for the Foundation Trust. The Trust produced a draft membership strategy in October 2011 and this outlined that our membership will be sub-dived into two constituencies â&#x20AC;&#x201C; Public and Staff. The Trust has set a target of 10,000 public members (not including staff members) to be achieved by 2014. Our immediate target is to achieve 6,000 members by the end of 2012. The strategy outlines plans for engagement with members including: seeking members' perspective on different aspects of our work through surveys, discussion groups and focus groups involving members in workshops and project groups relating to specific areas of service development developing a members' newsletter with information about our services, members' activities and details of involvement opportunities (eg volunteering, special interest groups, support groups, membership recruitment, fundraising) developing e-engagement via our website and seeking members' involvement in developing our website and other communications inviting members to the Annual General Meeting, Annual Members' Meeting and quarterly events promoting the work and services of Bridgewater to promote self care and health and well being governor-led sessions in each constituency which will provide an opportunity for all members to discuss important issues and their views with their governor representative so that they can be fed back to the Council of Governors At 31 March 2012, Bridgewater had 700 registered members and a programme of recruitment activity has been developed.


38

Annual Report 2011/12

Emergency preparedness Our responsibilities Bridgewater Community Healthcare NHS Trust has 'Category One' responder duties under the Civil Contingencies Act 2004 which means it has a statutory responsibility to: assess the risk of emergencies occurring and use this to inform contingency planning put emergency plans and business continuity management arrangements in place arrange to make information available to the public about civil protection matters and maintain arrangements to warn, inform and advise the public in the event of an emergency co-operate and share information with other local responders In a major incident the Trust's main response would include: maintaining essential community health services, particularly for vulnerable patients providing staff to assess and manage the health needs of evacuees in local authority rest centres if required working with hospitals to free up beds for major incident victims by facilitating increased admission avoidance activity and accelerated discharge of patients back home offering mutual aid to other services where appropriate PCT clusters are currently responsible for the leadership, co-ordination and performance management of NHS emergency planning arrangements within their areas. Currently the Trust links with three PCT clusters, each with its own local resilience arrangements as follows: NHS Merseyside - for all NHS incidents and for multi agency incidents in St Helens NHS Cheshire, Warrington and Wirral - for multi agency incidents in Halton and Warrington NHS Greater Manchester - for all multi agency incidents in Trafford and Wigan Developments during the year During 2011/12 the Trust's corporate emergency planning activity has included: quarterly emergency planning meetings for divisional emergency planning leads to ensure that the organisation meets its emergency planning responsibilities a successful internal emergency planning exercise (Exercise Dee) held in March 2012 to test divisional major incident and business continuity arrangements reviewing and updating divisional major incident plans to ensure that they comply with the NHS Emergency Planning Guidance 2005 and other associated guidance participating in external multi-agency emergency planning exercises involving other NHS organisations, emergency services, local authorities and the Environment Agency development of an introduction to emergency planning/business continuity package for the new corporate induction programme, and an annual update for all staff for inclusion within the mandatory on line training package auditing and restructuring of divisional on call manager arrangements


Annual Report 2011/12

39


40

Annual Report 2011/12

Environmental sustainability The NHS aims to reduce its carbon footprint by 10% between 2009 and 2015. Reducing the amount of energy used in Bridgewater will contribute to this goal. There is also a financial benefit which comes from reducing our energy bill. Bridgewater is in the process of developing a process to reduce carbon emissions in line with the NHS target and improve our environmental sustainability. To achieve this, Bridgewater has committed to the development of an Environmental Management System (EMS) to ISO 14001 standards. Obtaining accreditation to international standards demonstrates a strong declaration of social responsibility as well as placing the Trust in a good position to tackle the inevitable environmental challenges that lie ahead. The EMS process considers the need to adapt the organisation's activities and the premises it occupies to mitigate its environmental aspects to minimise its impact on climate change. The EMS is designed to focus on carbon reduction through the management, monitoring and reduction of energy, transport, procurement and waste. The EMS will ensure that the trust ensures implications of climate change will be considered as factors in both service delivery and infrastructure. It will also be considered when planning how we best serve patients through service redesign and in occupying premises. The development of the EMS is on target and due for external independent audit and accreditation in September 2013. Current activities involve the collation of a detailed review of environmental aspects to determine which significant risks require prioritisation. Due to the current stage of EMS activity, and given Bridgewater is a relatively new organisation, data has been provided for this first annual submission for 2011/12 only as data from previous years is not available for comparison.


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41

Sustainable Development Management Plan (SDMP) The Trust recognises an up to date and relevant SDMP is a good way to ensure that an NHS organisation fulfils its commitment to conducting all aspects of its activities with due consideration to sustainability, whilst providing high quality patient care. The development of a SDMP forms part of the EMS process. Risks Associated with Environmental Sustainability The Trust recognises that it has a statutory duty to assess the risks posed by climate change. As such, sustainability risks are assessed and analysed through the EMS process, including the quantification and prioritisation of sustainability risks. This will typically involve the measurement and management of energy, water and waste to reduce the carbon footprint. Procurement of Goods and Services In addition to our focus on carbon reduction, we are also committed to reducing wider environmental and social impacts associated with the procurement of goods and services. This will be set out within our focus on sustainable procurement as part of the EMS process. The Trust has already started to calculate the carbon emissions associated with the goods and services procured. To capture this a process recommended by the NHS Sustainability Unit has been adopted. This data will be used to influence the inclusion of sustainability as a key tenet in the development of the Trust's Procurement Strategy and in the formation of procurement policies. Board Level Support The Executive Director of Finance, Performance and Information is the Board Level lead for sustainability, ensuring that sustainability issues have visibility and ownership at the highest level of the organisation. He is supported in this area by the Associate Director of Estates and Facilities Management, who is also a chartered environmentalist.


42

Annual Report 2011/12

Staff Awareness A sustainable NHS can only be delivered through the efforts of all staff. Reference to sustainability issues, such as carbon reduction, are being included in job descriptions for all roles and elements of sustainability are being included in the performance and appraisal process. The Trust's most recent staff awareness campaign was conducted prior to, and on the day of, the NHS Sustainability Awareness Day, held on the 28 March 2012. It is recognised that staff awareness campaigns deliver cost savings and associated reductions in carbon emissions. To formalise the process an e-learning module has been developed, in-house, for staff to view as part of the annual training and development programme.

Transport The NHS places a substantial burden on the transport infrastructure, whether through patient, clinician or other business activity. This generates an impact on air quality and greenhouse gas emissions. It is therefore important that we consider what steps are appropriate to reduce or change travel patterns. During 2011/12 our gross expenditure on business travel was ÂŁ2,589,982. To try and reduce this, the EMS process has a Transport Group that includes staff from the Trust and representatives from local authority partners, whose role is the management of sustainable travel within their boroughs. This group is developing a sustainable transport plan.

Waste The NHS generates a considerable amount of waste. This, in turn, generates an impact on land use taken up by landfill, air quality and greenhouse gas emissions. It is therefore important that we consider what steps are appropriate to reduce the amount of waste we produce. To manage this, the EMS process has a Waste Group that includes staff from across the Trust, whose role is the reduction and safe management of waste. This group is developing a sustainable waste management plan. We are also working with our waste contractors and suppliers to reduce the tonnes of waste we produce and increase the waste that is recovered or recycled. During this year we have recovered or recycled 530.42 tonnes of waste, which is 63% of the total waste we produced.

63%

of waste generated by Bridgewater was recovered or recycled.


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Energy The NHS uses a considerable amount of energy. This in turn generates an impact on air quality and greenhouse gas emissions. It is therefore important that we consider what steps are appropriate to reduce the amount of energy we use. To manage this, the EMS process has an Energy Group that includes staff from across the Trust, whose role is to reduce the amount of energy we use and to increase the percentage of energy generated from renewables. This group is developing a sustainable energy plan. Gas and electric consumption has increased significantly over the last year to 8591MWh. This is due to organisational growth and having taken responsibility for a larger number of premises, staff numbers and services delivered over the last year.

Energy use during 2011/12 (data for the previous years is not available) 10000 9000

7000

Electricity

6000

Other

5000

Renewables

4000

Coal

3000

Gas

2000

Oil

1000

20

11

/1

1 20

10

/1

10 20 0

9/

9 20

08

/0

08 7/

2

0

20 0

TONNES CO2e

8000


44

Annual Report 2011/12

The Climate Reduction Change Energy Efficiency Scheme is a mandatory scheme aimed at improving energy efficiency and cutting emissions in public and private sector organisations. This scheme applies to organisations that use 6,000MWh of electricity per annum. Bridgewater consumes approximately 65% of this figure, therefore at this time Bridgewater does not fall within the remit of the scheme. Energy consumption is being measured from premises occupied and activities undertaken by Bridgewater to establish our greenhouse gas emissions. A plan is being developed to improve energy efficiency and cut emissions. To achieve this Bridgewater is assessing how it can reduce its demand on non-renewable sources of energy through using renewable sources, energy reducing projects and the potential to generate energy through the use of technology. Bridgewater's greenhouse gas emissions for 2011/12 were 4682 Tonnes CO2e.

Sources of greenhouse gas emissions for 2011/12 (data for the previous years is not available) 9000 8000 7000

Tonnes CO2e

Other 6000

Rail

5000

Road Air

4000

Gas

3000

Electricity 2000 1000

Water Bridgewater used an estimated 8285 cubic meters of water during 2011/12 (data for the previous years is not available)

2011/12

2010/11

2009/10

2008/09

2007/08

0


Annual Report 2011/12

45

Information Governance Information governance is the term used to describe the standards and processes for ensuring that organisations comply with the laws, regulations and best practices in handling and dealing with information. Each year our Trust submits scores to the DoH by using the NHS Information Governance Toolkit. This allows NHS organisations and partners to assess themselves against DoH policies and standards. The Trust's Information Governance assessment report overall score for 2011/12 was 66% and was graded green (satisfactory overall). The Trust has not reported any serious untoward incidents involving confidentiality breaches of person identifiable information during 2011/12.


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Annual Report 2011/12

Future developments Following our first year of consolidation under Bridgewater it will be necessary to finalise the establishment of our corporate structures so that we are ready to meet both the health, financial and competitive challenges that lie ahead.

Service development priorities An analysis of current and predicted demographic trends clearly demonstrate that we face increasing challenges from disease associated with smoking and alcohol abuse. We need to plan how we will deliver health and wellbeing in the face of increasing rates of diabetes, heart disease, cancer and conditions such as dementia which are associated with an ageing population. At the same time we are operating in a financial climate which means we must do more with less in an increasingly competitive market place. As a dedicated community trust we are ideally placed to enable transformation of the healthcare system. We are working with our partners in hospital and social care to change the way we deliver services to ensure more care close to home and reduce the need for admissions to hospital. We will improve care for people with long term conditions by promoting self care as a means of supporting people to live independently with long term conditions. We have already piloted the use of Telehealth equipment which allows health professionals to monitor patients' health in their own homes, thereby reducing the number of visits made to a GP and avoiding unnecessary visits to the hospital. We plan to extend this provision to more patients across the Trust area to allow them to manage their condition themselves and allow them to seek early advice from a health professional when they need it. We also plan to improve access to palliative and end of life care to reduce the number of deaths in hospital and increase the level of urgent care which can be provided in the home, for example increasing access to the provision of intravenous antibiotics at home. We also need to continue our work to support children and families during the formative years of a child's life and will continue with the work to develop health visiting services across the Trust. In April 2012 the Trust was accepted onto the prestigious â&#x20AC;&#x153;Call to Actionâ&#x20AC;? Early Implementer Site (EIS) Support and Development which presents a exciting opportunity for us to build on what we have achieved in health visiting within all divisions over the past year.

Developing our Clinical Networks Following the work undertaken during 2011/12 extensive dialogue with staff, six Clinical Networks are to be established. Clinical Network Leads are to be appointed to ensure that the appropriate links are made across services and care pathways. The Clinical Networks have been identified as: Urgent care Children's services Specialist services Offender health Long term conditions Health and wellbeing


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Developing the organisation Following the integration of community providers into the Trust we will be required to continue to develop our structures to support the necessary transformation in service delivery and to share expertise and learning across the Trust. We will also need to leverage the opportunities integration presents for corporate and back office functions through generating efficiencies and using our size to deliver economies of scale. As of 1 April 2012 all divisions will be using the same Ulysses Safeguard Risk Management System to report all actual incidents and near misses where patient safety may have been compromised. We are also developing an e-learning package for clinical staff which will further enhance safe practice in the areas of consent, medicines management, record keeping and venous thromboembolism (deep vein thrombosis).

Community Information Data Set (CIDS) From April 2012 as a provider of community services, Bridgewater should capture the information within the Community Information Data Set (subject to having suitable systems in place). The Community Data Set (CIDS) standard will provide national definitions for key data collected by community services that can be used for secondary purposes, such as commissioning, central returns, audit and research. The data will reflect the key information captured from any patient in receipt of or referred to community healthcare. Once funding approval has been received for the national collection of CIDS via the Secondary Uses Services (SUS), an Information Standards Notice will be issued to mandate the collection of CIDS nationally.

Patient Choice and Any Qualified Provider As the government seeks to extend patient choice we will need to continue to prepare ourselves for the introduction of the Any Qualified Provider (AQP) model. This is a method of commissioning NHS services that allows patients to choose from a list of providers who they wish to provide their care. Providers can be from the NHS, private or voluntary sectors. In preparation for the introduction of AQP in selected services we will, through our service line management approach, identify how we can achieve best for value for money and ensure we provide the required quality standards for patient care.


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Annual Report 2011/12

Key Financial Headlines 2011/12 Introduction The Trust has produced its first set of annual accounts as Bridgewater Community Healthcare NHS Trust incorporating the combined financial results of the geographical community service and dental divisions which came together on 1 April 2011. Accounting Policies The accounts have been prepared to comply with International Financial Reporting Standards (IFRS) as modified by the Department of Health Manual For Accounts. Key Financial Targets The Trust has achieved its key financial targets for 2011/12 with regard to reported surplus, capital expenditure target, also known as Capital Resource Limit (CRL), and cash target, also described as External Financing Limit (EFL). The table below presents these key results.

Target £000

Achieved £000 (Under)/Over Shoot £000

Surplus

1,666

1,804

138

Capital Resource Limit (CRL)

1,064

1,046

(18)

External Financing Limit (EFL)

(1,666)

(1,714)

(48)

Surplus The reported surplus of £1.804m is over planned levels due mainly to gaining additional income in the last quarter of the financial year. Break even duty and performance As shown in the table above the Trust has achieved a surplus of income over expenditure of £1,804k. This builds on the surplus achieved for 2010/11 of £388k as Ashton Leigh and Wigan Community Healthcare NHS Trust, and puts the Trust in a strong position to achieve its cumulative breakeven duty, ie to break even over a three or exceptionally a five-year period. The significant increase in surplus for 2011/12 reflects turnover having increased by approximately three times as the Trust now comprises five divisions compared to only one in 2010/11. Capital Resource Limit (CRL) The Trust's CRL is set by the DoH. The performance criteria allows for an under shoot against CRL but not an overshoot as the limit is designed to test the Trust's ability to manage within a fixed capital budget. The CRL has been comfortably achieved with only a small under shoot of £18k. The makeup of capital expenditure is summarised by scheme in the Capital Expenditure section of this report. External Financing Limit (EFL) The Trust's EFL is set by the DoH. The performance criteria allows for an under shoot against EFL but not an overshoot as the limit is designed to test the Trust's ability to manage its cash inflows/outflows within a fixed cash budget. The Trust had a negative EFL for 2011/12 which represents a target to generate a cash inflow of £1,666k or more. The table above shows that a cash inflow of £1,714k was generated. This represents a comfortable achievement of EFL with only a small undershoot of £48k.


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Capital Cost Absorption Rate The Trust is required to absorb the cost of capital at 3.5% of average relevant net assets. This means that the Trust should pay a dividend to the DoH of 3.5% of average relevant net assets. There was no dividend payment made or required for 2011/12 as the Trust had negative average relevant net assets. The calculation of average relevant net assets excludes cash held by the Trust at the Government Banking Service (GBS) which was £4,445k and coupled to the fact that the Trust did not hold any estate assets this resulted in a negative calculation. Treasury Policies and Cash The Trust had an end of year cash target of £4,443k. Actual cash was £4,491k supporting the comfortable undershoot of £48k against EFL. The Trust did not have any requirements for short-term loans during 2011/12 nor placed any funds for investment purposes during 2011/12. Better Payment Practice Code (BPPC) The Trust is required to pay all undisputed invoices within contract terms or in 30 days where there are no terms agreed. The Trust is measured separately for payment of NHS and Non NHS invoices. The results for 2011/12 are presented in the table below which shows underperformance in both categories although payment performance for non NHS Payables is significantly better than for NHS. The poor performance reflects a number of issues during the year, the key ones being: a change of service provider for making payments in relation to Ashton, Leigh and Wigan Division failure across most divisions to embrace proper use of the electronic purchase order system for procurement of goods and services an inability to resolve inter NHS disputes with other organisations quickly enough to enable invoices to be paid promptly

Target/Description

Number £000s Current Current Year Year

Number Prior Year

£000s Prior Year

Non-NHS Payables Total Non-NHS Trade Invoices Paid in the Year

29,532

28,223

7,221

14,496

Total Non-NHS Trade Invoices Paid Within Target

25,412

25,694

7,036

14,362

Percentage of Non-NHS Trade Invoices Paid Within Target

86.0%

91.0%

97.4%

99.1%

1,282

41,996

570

11,316

831

28,574

513

10,893

64.8%

68.0%

90.0%

96.3%

NHS Payables Total NHS Trade Invoices Paid in the Year Total NHS Trade Invoices Paid Within Target Percentage of NHS Trade Invoices Paid Within Target

The Trust is acutely aware of the need to improve the above performance in 2012/13 and beyond and is developing plans to address the issues identified as being responsible for the poor performance in 2011/12.


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Annual Report 2011/12

Income The Trust generated total income in 2011/12 of £166.3m, 89.6% of which came from PCTs. The vast majority of the Trust's healthcare income is through 'block service level agreements'. This provides a level of certainty, as the income levels are not dependent on increases or decreases in activity levels. However, it does represent a risk to the Trust if activity levels increase above agreed levels as the Trust will incur additional costs associated with the additional activity. The balance of the Trust's income was generated as shown in the chart below. This highlights the categorisation of all the Trust's income taken from the accounts.

Sources of Income 2011/12

Strategic health authorities £1.2M (0.8%) NHS trusts £3.1M (1.8%) Primary care trusts £148.9M(89.6%) Foundation trusts £1M(0.6%) Local authorities £5.3M(3.2%) Injury costs recovery £1M(0.6%) Other £3.9M (2.3%) Education Training & Research £1.9M (1.2%)

Expenditure The Trust's main source of expenditure is employee costs (staff) totalling £119.6m, representing 73% of total expenditure. The chart below highlights the breakdown of costs by staff group.

Employee Costs 2011/12

Medical & Dental staff £6.9M (5.8%) Qualified Nursing and Health Visiting staff £50.9M (42.5%) Scientific, Therapeutic and Technical Staff £22.2M (18.6%) Healthcare assistants and other support staff £10.9M (9.1%) Managers and senior managers £7.1M (5.9%) Administration and estates £20.8M (17.4%) Others £0.8M (0.7%)


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Expenditure on operating expenses excluding employee costs amounted to £45m. The chart below provides an analysis of this expenditure by category.

Operating Expenses Excluding Employee Costs 2011/12 Services from other NHS Organisations £6.1M (13.5%) Supplies and services - clinical £10.2M (22.7%) General supplies and services £2.3M (5.2%) Establishment £3.6M (8.0%) Transport £3.0M (6.6%) Premises £14.6M (32.5%) Education and Training £0.4M (0.9%) Other £4.8M (10.6%)

Capital Expenditure The table below shows how the capital budget was spent.

Plant & Machinery

Actual Spend £

Information Technology

Actual Spend £

Newton Medical Equipment

19,000

Cardio Machine

43,000

Patients trolleys

62,000

Domain Controllers

11,000

ECG machines

9,000

Lorenzo

241,000 100,000

Bladder Scanners

18,000

PAROS Notes

IV Therapy Scanning Machine

13,000

Qlikview

Tissue Viability

18,000

Remote Access Solution

Podiatry

20,000

SLM Software

100,000

Toughbooks

237,000

Total Plant & Machinery

159,000

34,000 5,000

Furniture & Fittings

18,000

Virtual Desktop Solution

81,000

Total Furniture & Fittings

18,000

PC Refresh

17,000

Total Capital Expenditure

1,046,000

Total Information Technology

869,000


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Annual Report 2011/12

Events after the Reporting Period There are no events after the end of the reporting period. Going Concern The financial statements have been prepared on a going concern basis. Auditor Disclosures The Trust has made all relevant information available to the external auditors. Future Financial Performance The Trust faces a number of challenges over the next few years: 1. The Trust has signed a formal contract with the DoH and NHS North West that it will achieve Foundation Trust status by April 2013. This will require the Trust to be ready for the application stage by October 2012. 2. The Trust has significant Cost Improvement Programme (CIP) targets for 2012/13 and beyond and this will require the Trust to continue to review all services to ensure that each service is performing efficiently whilst ensuring that quality of service increases. 3. Clinical and patient core pathway supported changes as part of the Transforming Community Services (TCS) may see changes in the way the Trust delivers services to patients but in a way that will improve the patient experience.


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Chair of Audit Committee's Annual Report Introduction The Audit Committee is established under Board delegation with approved terms of reference that are aligned with the DoH and Healthcare Financial Management Association (HFMA) Audit Committee Handbook. The committee has discharged its responsibilities for scrutinising the risks and controls which affect all aspects of the organisation's business, and this report outlines the key issues encountered during the year. The Role of the Audit Committee The aim of the Audit Committee is to provide the Board of Directors with a means of independent and objective review of financial and corporate governance, assurance processes and risk management across the whole of the Trust's activities (clinical and non-clinical) both generally and in support of the Annual Governance Statement. In addition, the committee: provides assurance of independence for external and internal audit ensures that appropriate standards are set and compliance with them is monitored, in nonfinancial, non-clinical areas that fall within the remit of the Audit Committee; and monitors corporate governance (eg compliance with codes of conduct, standing orders, standing financial instructions, maintenance of registers of interests) Constitution of the Audit Committee The committee currently consists of three Non-Executive Directors, one of whom is the Chair, and one of whom is the Chair of the Integrated Governance Committee. It has met on five occasions through the financial year 2011/12. The Chair is a qualified Accountant, and the Director of Finance, Director of Governance, and the Head of Internal Audit of the Trust routinely attend the meetings of the committee. External audit representatives and a representative of the local counter fraud service also routinely attend Audit Committee meetings, as do Trust directors and/or their staff in areas which the Audit Committee consider areas to be of risk or special interest. There has been full compliance with the quorate requirements and regular attendance by those invited by the committee. Minutes of the committee are submitted to the Trust Board meetings and the Chair of the committee reports and comments on key issues as and when necessary.


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Annual Report 2011/12

Key Issues Programme of Work In discharging its duties the committee has met its responsibilities through self assessment and review, requesting assurances from Trust officers and directing and receiving reports from its auditors and fraud specialists. Self Assessment: During the period year, the committee has complied with 'good practice' by: reviewing and approving of the Annual Internal Audit and Counter Fraud plans, and the External Audit plan; scrutinising review of progress against these plans and their outcomes, ie risks identified and action plans agreed holding private meetings with external and internal auditors regularly reviewing the Audit Committee's own workplan reviewing the committee's Terms of Reference Audit Committee Business Counter Fraud During the year, the committee has reviewed the progress of the Local Counter Fraud Specialist's programme of work. This has included review of the Anti-fraud, Corruption and Bribery Policy and response plan in the light of the requirements of the Bribery Act, which came into force in July 2011. The Counter Fraud Plan has been delivered in accordance with the schedule of days agreed with the committee at the start of the financial year. In December 2011, NHS Protect assessed the Trust through its Qualitative Assessment process as achieving a Level 2 rating. NHS Protect's guidance states that â&#x20AC;&#x153;To achieve level 2, effective completion of work across the anti fraud generic areas of action outlined in NHS policy will need to be evident as these are basic requirements for achieving adequate performance. Evidence in support of strong proactive work will be present and the investment given to anti fraud work will be adequate to complete work effectivelyâ&#x20AC;?


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Internal Audit Throughout the year the committee has worked effectively with internal audit to strengthen the Trust's internal control processes. The Internal Audit Plan has been delivered in accordance with the schedule of days agreed with the committee at the start of the financial year. During the year under review, Internal Audit have completed thirteen reviews, covering both clinical and non-clinical systems and processes. The following reports were issued with Significant Assurance during the year: Clinical governance systems and processes Incident Reporting Patient Consent Safeguarding (Children & Vulnerable Adults) CQC Compliance Financial & commercial systems & processes Combined Financial Systems Payroll/ESR Contract Management Strategic Planning and Service Delivery systems & processes QIPP Efficiency Project & Cost Improvement The following reports were issued with Limited Assurance during the year Corporate governance systems & processes IT Asset Management Backup & Resilience Corporate Governance Compliance Information Governance Toolkit Risk Management The committee has ensured that, where gaps in assurance are identified, appropriate action plans are agreed with management, and progress against these plans is regularly reviewed. In accordance with NHS Internal Audit Standards, the Director of Internal Audit is required to provide an annual opinion on the overall adequacy and effectiveness of the Trust's risk management, control and governance processes, based upon the work performed in the year.


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Annual Report 2011/12

For 2011/12 the Director of Internal Audit Opinion is that:

Significant Assurance can be given that there is a generally sound system of internal control designed to meet the Trust's objectives, and that controls are generally being applied consistently. However, some weaknesses in the design or inconsistent application of controls put the achievement of particular objectives at risk

Year end accounts At its meeting on 1 June 2012 the committee considered the Trust's Annual Governance Statement together with a Director of Internal Audit Opinion, final accounts, and associated external audit opinion. The Audit Committee accepted the recommended changes to the presentation of the figures within the final accounts and recommended that the Board adopt the financial statements with the associated changes. The accounts were subsequently adopted by the Board. Conclusion The committee is of the opinion that this annual report is consistent with the draft Annual Governance Statement, Director of Internal Audit Opinion and External Audit Opinion and that there are no matters that the committee is aware of at this time that have not been disclosed appropriately. Karen Bliss Chair of Audit Committee 8 June 2012


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Annual Report 2011/12

Remuneration report The tables shown on the following pages provide information on the remuneration and pension benefits for senior mangers for the year ended 31 March 2012. These tables are subject to External Audit review. The remuneration report includes: Salaries and allowances table Appointments and Remuneration Sub Committee Pension benefits Cash Equivalent Transfer Values (CETV) Real increase in CETV Salaries and allowances – year ended March 2012. Pay Multiples Reporting bodies are required to disclose the relationship between the remuneration of the highestpaid director in their organisation and the median remuneration of the organisation's workforce. The banded remuneration of the highest paid director in Bridgewater Community Healthcare NHS Trust in the financial year 2011-12 was £132,500 (2010-11, £122,500). This was 5.0 times (2010-11, 4.4) the median remuneration of the workforce, which was £26,556 (2011-12, £27,534). In 2011-12, four (2010-11, three) employees received full time equivalent remuneration in excess of the highest-paid director. Full time equivalent remuneration ranged from £138,036 to £160,874 (201011, £138,036 to £138,691). Total remuneration includes salary, non-consolidated performance-related pay, benefits-in-kind as well as severance payments. It does not include employer pension contributions and the cash equivalent transfer value of pensions. The main reason for the increase in the ratio is that the Trust now comprises five divisions compared to only one in 2010/11 meaning that the workforce has increased significantly in the year which has affected the median remuneration of the workforce.

Appointments and Remuneration Sub Committee The Appointments and Remuneration Committee is attended by all Non-Executive Directors and is chaired by the Chairman of the Trust. The committee sets the levels of pay for Executive Directors and senior managers not remunerated under Agenda for Change pay arrangements. The committee approves the proposed appointment of Executive Directors. Contracts for Executive Directors are substantive unless or until the individual elects to resign the role or is removed from the role. Notice periods for such directors are six months. There are no contractual provisions for the early termination of Executive Directors. The Appointments Commission appoints Non-Executive Directors, generally on three year contracts which can be renewed on expiry. Notice periods are generally one month. There are no contractual provisions for the early termination of Non-Executive Directors. Furthermore the committee operates an annual Performance Development Review process whereby each individual has a named “parent”. At the outset, the postholder and parent jointly agree the objectives for the following year and performance against these is then jointly assessed after 12 months elapses. The cycle is then repeated on an ongoing basis.


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Bonus Bonus Benefits Salary at Salary at Other Other Benefits 31.3.2012 Remuneration Payments in Kind at 31.3.2011 Remuneration Payments in Kind at 31.3.2012 31.3.2012 31.3.2011 31.3.2011 at at 31.3.2012 31.3.2011 Bands of Bands of Bands of Bands of Bands of Bands of Bands of Bands of £5,000 £5,000 £5,000 £5,000 £100 £100 £100 £100 £'000s £'000s £'000s £'000s £100's £100's £100's £100's

DIRECTORS

Harry Holden Chairman Kate Fallon Chief Executive Linda Agnew Director of Corporate Development Dorian Williams Executive Nurse / Director of Governance Mike Treharne Director of Finance & Performance

20-25

0

0

0

20-25

0

0

1-2

130-135

0

0

51-52

120-125

0

0

2-3

95-100

0

0

0

90-95

0

0

0

85-90

0

0

51-52

75-80

0

0

0-1

95-100

0

0

0

5-10

0

0

0

80-85

0

0

0

N/a

N/a

N/a

N/a

35-40

0

0

0

N/a

N/a

N/a

N/a

30-35

0

0

57-58

N/a

N/a

N/a

N/a

95-100

0

0

0

N/a

N/a

N/a

N/a

5-10

0

0

0

5-10

0

0

0-1

5-10

0

0

0

5-10

0

0

0

5-10

0

0

5-10

0

0

0

5-10

0

0

0

0-5

0

0

1-2

0-5

0

0

0

0-5

0

0

0

0-5

0

0

0

N/a

N/a

N/a

N/a

0-5

0

0

0

N/a

N/a

N/a

N/a

0-5

0

0

0

N/a

N/a

N/a

N/a

in post from 28/2/2011

Stephen Ward Medical Director* in post from 1/7/2011

Colin Scales Executive Director of Operations* in post from 24/10/2011

Christine Samosa Director of HR and OD* in post from 31/10/2011

Seamus McGirr Director of Clinical Performance* in post from 1/4/2011

Bob Saunders Non-Executive Director Karen Bliss Non-Executive Director Steve Cash Non-Executive Director Dorothy Whitaker Non-Executive Director

0

in post from 1/11/2010

Keith Hamblett Non-Executive Director in post from 1/11/2010 to 31/12/2011

Baron Frankal Non-Executive Director* in post from 1/1/2012

Sue Musson Non-Executive Director* in post from 1/1/2012

Sally Yeoman Non-Executive Director* in post from 1/1/2012

Band of Highest Paid Director's Total Remuneration (£'000s)

130-135

120-125

Median Total Remuneration (£)

26,556

27,534

5.0

4.4

Ratio

All of the above directors were in post for the 24 month period from 1 April 2010 to 31st March 2012 except where indicated. * New posts in 2011/12. Of the three Non-Executive Directors in post from 1/1/2012, two were recruited to fill new posts.


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Annual Report 2011/12

Pension Benefits – year ended March 2012

EXECUTIVE DIRECTORS

Lump sum Real Real Real Total CETV CETV at aged 60 increase/ accrued increase/ increase/ Cash Cash (decrease) (decrease) Pension at related to (decrease) Equivalent Equivalent accrued in CETV in Pension in Pension aged 60 at Transfer Transfer at aged 60 lump sum 31.3.2012 Pension at Value at Value at 31.3.2012 at aged 60 31.3.2011 31.3.2012 Bands of £2,500 £'000s

Bands of £2,500 £'000s

Bands of £5,000 £'000s

Bands of £5,000 £'000s

2.5-5

7.5-10

55-60

165-170

1,218

0-2.5

5-7.5

25-30

80-85

2.5-5

10-12.5

30-35

0-2.5

0-2.5

0-2.5

Colin Scales Executive Director of Operations

£'000s

£100's

1,067

119

502

409

81

95-100

595

461

120

30-35

90-95

567

489

63

0-2.5

50-55

160-165

1,208

1,106

51

-2.5-0

-2.5-0

10-15

35-40

162

129

13

Christine Samosa Director of HR and OD

0-2.5

0-2.5

30-35

95-100

555

457

35

Seamus McGirr Director of Clinical Performance

0-2.5

0-2.5

30-35

100-105

588

507

65

Kate Fallon Chief Executive Linda Agnew Director of Corporate Development Dorian Williams Executive Nurse / Director of Governance Mike Treharne Director of Finance & Performance Stephen Ward Medical Director

£100's

There are no entries in respect of pensions for Non-Executive Directors as they do not receive pensionable remuneration. Additionally there were no contributions to Stakeholder Pensions on behalf of any of the Directors of the Trust.


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Cash Equivalent Transfer Values (CETV) The benefits valued are the member's accumulated benefits and any contingent spouse's pension payable from the scheme. A CETV is a payment made by a pension scheme, or arrangement to secure pension benefits in another pension scheme or arrangement when a 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 scheme, not just their service in a senior capacity to which the 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 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.

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 pension scheme or arrangement). There has been a change in the actuarial factors set by the Government Actuary's Department (GAD) with effect from 8 December 2011. NHS Pensions has used the most recent set of actuarial factors produced by GAD when calculating the CETV for inclusion in the remuneration report. Therefore, the GAD factors used as at March 31 2012 are different from those used as at 31 March 2011 when common market valuation factors were utilised.


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Annual Report 2011/12


Annual Report 2011/12

Financial Accounts for the period 1 April 2011 to 31 March 2012

Foreword To The Statements Bridgewater Community Healthcare NHS Trust These accounts for the year ended 31 March 2012 have been prepared by Bridgewater Community Healthcare NHS Trust under section 98(2) of the National Health Service Act 1977 (as amended by section 24(2), schedule 2 of the National Health Service and Community Care Act 1990) in the form which the Secretary of State has, with the approval of the Treasury, directed.

63


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Annual Report 2011/12

Statement Of The Chief Executive's Responsibilities As The Accountable Officer Of The Trust The Chief Executive of the NHS has designated that the Chief Executive should be the Accountable Officer to the trust. The relevant responsibilities of Accountable Officers are set out in the Accountable Officers Memorandum issued by the Department of Health. These include ensuring that: there are effective management systems in place to safeguard public funds and assets and assist in the implementation of corporate governance; value for money is achieved from the resources available to the trust; the expenditure and income of the trust has been applied to the purposes intended by Parliament and conform to the authorities which govern them; effective and sound financial management systems are in place; and annual statutory accounts are prepared in a format directed by the Secretary of State with the approval of the Treasury to give a true and fair view of the state of affairs as at the end of the financial year and the income and expenditure, recognised gains and losses and cash flows for the year. To the best of my knowledge and belief, I have properly discharged the responsibilities set out in my letter of appointment as an Accountable Officer.

Signed

Date: 7 June 2012

Chief Executive


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Statement Of Directors' Responsibilities In Respect Of The Accounts The directors are required under the National Health Service Act 2006 to prepare accounts for each financial year. The Secretary of State, with the approval of the Treasury, directs that these accounts give a true and fair view of the state of affairs of the trust and of the income and expenditure, recognised gains and losses and cash flows for the year. In preparing those accounts, directors are required to: apply on a consistent basis accounting policies laid down by the Secretary of State with the approval of the Treasury; make judgements and estimates which are reasonable and prudent; state whether applicable accounting standards have been followed, subject to any material departures disclosed and explained in the accounts. The directors are responsible for keeping proper accounting records which disclose with reasonable accuracy - the financial position of the trust and to enable them to ensure that the accounts comply with at any time requirements outlined in the above mentioned direction of the Secretary of State. They 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 they have complied with the above requirements in preparing the accounts. By order of the Board

7 June 2012 Date

7 June 2012 Date

Chief Executive

Finance Director


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Annual Report 2011/12

Governance Statement Scope of responsibility The Board is accountable for systems of internal control. As Accountable Officer, and Chief Executive of this Board, I have responsibility for maintaining a sound system of internal control that supports the achievement of the organisation's policies, aims and objectives. I also have responsibility for safeguarding the public funds and the organisation's assets for which I am personally responsible as set out in the Accountable Officer Memorandum. The Internal Audit function has completed its Annual Opinion for 2011/12 and stated Significant Assurance overall.

The governance framework of the organisation The Board meets on a monthly basis and delegates certain risk-related responsibilities in order to receive reports from its sub-committees; the Integrated Performance Committee and the Integrated Governance Committee. The Integrated Governance Committee is the High Level Risk Committee as required by the NHS Litigation Authority Risk Management Standards, meets on a quarterly basis, and receives minutes and exception reports on Health, Safety & Security, Medicines Management, Information Governance, Medical Device Groups, Patient Experience, and Incident Reporting. It also receives the full Assurance Framework for review and evaluation and submits a report to the Board. In between the quarterly Integrated Governance Committee meetings, the Senior Management Team also receives exception information from Directors in order to report exceptions and concerns directly to the Board. There was a full quorum of Board members at the 11 meetings held. Overall, there were 8 (7%) apologies out of an expected 116 attendances by all the Board members. Only one Board member missed 3 meetings with 5 other different members missing 1 meeting each during the year. 5 Audit Committee reports have been received by the Board at their 11 meetings during 2011/12. Notable points raised by the Audit Committee over the year are included within the Audit Committee Chair's Annual Audit Report.


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Risk assessment There are two types of risk monitored within the Trust: Strategic Risk: Risks identified on the Assurance Framework that may foreseeably impede the ability of the organisation to meet its objectives. These are derived by the SMT and members of the Board from outstanding strategic principal risks recorded on the Assurance Framework from the previous financial year, and the principal risks to the Objectives identified as part of the Integrated Business Planning process (including sense-checking the narrative within the Integrated Business Plan). Operational Risk: Risks identified by operational staff and managers that may foreseeably impede the safe delivery of high quality service to patients. The implication being that a high operational risk could adversely affect staffs ability to meet the organisational objectives. The Trust uses a consistent risk assessment methodology defined in the Risk Management Strategy for all risk (both Strategic and Operational), based on: Hazard identification Impact evaluation Identification of Controls, Assurance and any gaps in these, Using the National Patient Safety Agency Risk Matrix for grading and initially prioritising risks, and Treating Control and Assurance gaps through Action Plans with completion dates to reach tolerable levels of risk as a target Risk Registers are 'live' databases that change regularly as risks are reviewed and treated and, as such, individual risks escalate or decrease in priority over the period. During 2011/12 the Trust identified a range of significant potential risks at different points and the Board monitored the management of these, some of which are detailed later in this document. There were 3 Extreme Risks (graded as 15+ using the NPSA 5 x 5 matrix) in April 2011, reaching 5 in August 2011, and being reduced via treatment and review to 2 in November 2011, 1 in February 2012 and 0 at the end of March 2012. The Trust Caldicott Guardian is in receipt of any breaches of patient confidentiality that requires notification to the Information Commissioner. There have been no such notifications during 2011/12.


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Annual Report 2011/12

The risk and control framework Risk is inherent within much of the work that a healthcare organisation delivers, as a result, there are many risks that cannot be avoided, although their occurrence may be made less likely or their adverse outcomes managed to a tolerable level. The most common and key Controls that the Board employs are policies and procedures, with staff training on these across any given task or discipline. 2011/12 has been a transitional year for the Trust in terms of harmonising its approach to policies across a range of Divisions that joined as at 1st April 2011. Divisions have continued with existing operational processes so long as they were considered safe (based on evidence received by the Integrated Performance Committee and the Integrated Governance Committee) until Trust-wide review of these documents could take place during the latter part of the year and into 2012/13. The Trust engages discipline specialists from across the Divisions to additionally offer advice to management on expected operational Controls to mitigate risks i.e. Health and Safety, Medicines Management, Information Governance, Security etc. The online Ulysses Safeguard Risk Management System acts as a central database for collating and reporting Divisional operational risks and the Interim Head of Risk for Ashton, Leigh and Wigan is responsible for the management of this software and embedding it across the Trust. A project was successfully completed at the end of 2011/12 to ensure that this system was available to all staff across all Divisions for 2012/13. The software enables the production and availability of incident, risk, and national alert reports to all staff and management across the Trust. All managers across the Trust have a responsibility for the safety of their staff and patients, and the safe and effective delivery of care as part of the Trust Objectives. Anything that presents a foreseeable hazard to these is risk assessed and recorded on the Risk Management System or, if something adverse has occurred it is recorded on the same system as an incident. Being in receipt of significant operational risks as they arise in Divisions and are reported, the Senior Management Team offers immediate advice, intervention or support to mitigate the issue. Controls and Assurance that affect local operational process are managed and recorded by managers at a divisional level.

Review of the effectiveness of risk management and internal control The internal audit function reviewed risk management processes across each Division, focussing on the Risk Registers in each. Limited Assurance was reached during this transitional period when 2 of the 5 Divisions were maintaining Risk Registers on separate Risk Management Systems that were inconsistent with the accepted Ulysses Safeguard Risk Management System. The specific High risks identified, and graded by the internal auditors, were: Divisions may be failing to identify a number of operational risks that could have an impact on operations and service provisions. Appropriate mitigations may not be in place for potentially high unidentified risks. The Corporate team at the Trust is not made aware of potentially extreme risks in a timely manner. This could lead to insufficient monitoring taking place. The risks identified by internal audit confirmed the priorities of the Executive Nurse/Director of Governance and have been treated by the approval of a consistent Trust Risk Management Strategy and the successful release of the Ulysses Safeguard Risk Management System across the remaining Divisions. In order to gain continued assurance on embedding risk management across the Trust, the Executive Director of Operations (appointed during 2011/12) has directed and is monitoring the improvement of operational risk management at a divisional level.


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During 2011/12 the Internal Audit function reviewed the following areas and offered Significant Assurance: Care Quality Commission - Compliance with Regulations Integration Plan Progress Board Reporting/Performance Management Framework Essence of Care Standards Newton Hospital Essence of Care Standards - Dermatology Incident Reporting Patient Consent Safeguarding (Children & Adults) Combined Financial Systems QIPP/Cost Improvement Contracting Payroll/HR (ESR) Limited Assurance was received for the following range of internal audits: Corporate Governance compliance Information Governance toolkit IT Asset Management Backup and resilience Divisional risk register local management These offer no significant issues or risks to the organisation and, in some cases the recommended actions were complete before publishing the final report, or the exceptions contained in the report referred to historical legacies from the transfer of provider services from the PCT management


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Significant Issues At the end of March 2012 the Assurance Framework was identified by the Board as representing the principal strategic risks to the Trust. At that time the March Corporate Risk Report to the Board identified that there were no Extreme Risks, however, a number of risks had been treated and reduced during the year that had been escalated to Extreme. The following significant risks were managed over the period: End of Quarter 1 Strategic Risk: Failure to safeguard children and vulnerable adults. Capacity issues within Health Visiting posing a gap in Control. Recruitment into vacant posts reduced the likelihood of this occurring and the level of risk, although Safeguarding remains a significant area of risk for monitoring purposes given its potential outcome. Strategic Risk: Failure to manage potential disinvestments by the commissioners. Initiating the LTFM development during the year reduced the potential impact of this on the Trust to a tolerable inyear level. End of Quarter 2 Operational Risk: Receiving insufficient information from a sending Prison to enable effective assessment of a patient. Offender Healthcare reduced this risk by accessing prisoner's electronic clinical data rather than relying on paper records which were often delayed during prisoner transfer. End of Quarter 3 Operational: Failure to consistently provide Stroke rehabilitation services to enable patients to be assessed within stroke pathway guidelines and for timely ongoing rehab programmes pre and post discharge. In order to reduce the risk, additional funding was obtained from the inpatient facility commissioning this service in order to increase capacity to meet demand. Accountable Officer : Dr Kate Fallon (Chief Executive) Organisation: Bridgewater Community Healthcare NHS Trust

Signature Date: 7 June 2012


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Independent Auditor's Report To The Directors Of Bridgewater Community Healthcare NHS Trust I have audited the financial statements of Bridgewater Community Healthcare NHS Trust for the year ended 31 March 2012 under the Audit Commission Act 1998. The financial statements comprise the Statement of Comprehension Income, the Statement of Financial Position, the Statement of Changes in Taxpayers' Equity, the Statement of Cash Flows and the related notes. The financial reporting framework that has been applied in their preparation is applicable law and the accounting policies directed by the Secretary of State with the consent of the Treasury as relevant to the National Health Service in England. I have also audited the information in the Remuneration Report that is described as having been audited. This report is made solely to the Board of Directors of Bridgewater Community Healthcare NHS Trust in accordance with Part II of the Audit Commission Act 1998 and for no other purpose, as set out in paragraph 45 of the Statement of Responsibilities of Auditors and Audited Bodies published by the Audit Commission in March 2010.

Respective responsibilities of Directors and auditor As explained more fully in the Statement of Directors' Responsibilities, the Directors are responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view. My responsibility is to audit and express an opinion on the financial statements in accordance with applicable law and International Standards on Auditing (UK and Ireland). Those standards require me to comply with the Auditing Practices Board's Ethical Standards for Auditors.

Scope of the audit of the financial statements An audit involves obtaining evidence about the amounts and disclosures in the financial statements sufficient to give reasonable assurance that the financial statements are free from material misstatement, whether caused by fraud or error. This includes an assessment of: whether the accounting policies are appropriate to the Trust's circumstances and have been consistently applied and adequately disclosed; the reasonableness of significant accounting estimates made by the Trust; and the overall presentation of the financial statements. In addition, I read all the financial and non-financial information in the annual report to identify material inconsistencies with the audited financial statements. If I become aware of any apparent material misstatements or inconsistencies I consider the implications for my report.

Opinion on financial statements In my opinion the financial statements: Give a true and fair view of the financial position of Bridgewater Community Healthcare NHS Trust as at 31 March 2012 and of its expenditure and income for the year then ended; and Have been prepared properly in accordance with the accounting policies directed by the Secretary of State with the consent of the Treasury as relevant to the National Health Service in England.

Opinion on other matters In my opinion: The part of the Remuneration Report to be audited has been prepared properly in accordance with the requirements directed by the Secretary of State with the consent of the Treasury as relevant to the National Health Service in England; and The information given in the annual report for the financial year for which the financial statements are prepared is consistent with the financial statements.


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Matters on which I report by exception I report to you if: In my opinion the governance statement does not reflect compliance with the Department of Health Guidance; I refer the matter to the Secretary of State under section 19 of the Audit Commission Act 1998 because I have a reason to believe that the Trust, or an officer of the Trust, is about to make, or has made, a decision involving unlawful expenditure, or is about to take, or has taken, unlawfully action likely to cause a loss or deficiency; or I issue a report in the public interest under section 8 of the Audit Commission Act 1998. I have nothing to report in these respects.

Conclusion on the Trust's arrangements for securing economy, efficiency and effectiveness in the use of resources Respective responsibilities of the Trust and Auditor The Trust is responsible for putting in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources, to ensure proper stewardship and governance, and to review regularly the adequacy and effectiveness of these arrangements. I am required under Section 5 of the Audit Commission Act 1998 to satisfy myself that the Trust has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources. The Code of Audit Practice issued by the Audit Commission requires me to report to you my conclusion relating to proper arrangements, having regard to relevant criteria specified by the Audit Commission. I report if significant matters have come to my attention which prevent me from concluding that the Trust has put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources. I am not required to consider, nor have I considered, whether all aspects of the Trust's arrangements for securing economy, efficiency and effectiveness in its use of resources are operating effectively.

Scope of the review of arrangements for securing economy, efficiency and effectiveness in the use of resources I have undertaken my audit in accordance with the Code of Audit Practice, having regard to the guidance on the specified criteria, published by the Audit Commission in October 2011, as to whether the Trust has proper arrangements for: Securing financial resilience; and Challenging how it secures economy, efficiency and effectiveness. The Audit Commission has determined these two criteria as those necessary for me to consider under the Code of Audit Practice in satisfying myself whether the Trust put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2012. I planned my work in accordance with the Code of Audit Practice. Based on my risk assessment, I undertook such work as I considered necessary to form a view on whether, in all significant respects, the Trust had put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources.

Conclusion On the basis of my work, having regard to the guidance on the specified criteria published by the Audit Commission in October 2011, I am satisfied that, in all significant respects, Bridgewater Community Healthcare NHS Trust put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources for the year ending 31 March 2012.


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Certificate I certify that I have completed the audit of the accounts of Bridgewater Community Healthcare NHS Trust in accordance with the requirements of the Audit Commission Act 1998 and the Code of Audit Practice issued by the Audit Commission.

Mark Heap District Auditor nd

2 Floor, Aspinall House, Aspinall Close, Middlebrook, BOLTON, BL6 6QQ. 7 June 2012


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Annual Report 2011/12

Statement of Comprehensive Income for year ended 31 March 2012

Employee benefits Other costs Revenue from patient care activities Other Operating revenue

NOTE

2011-12 ÂŁ000

10.1 8 5 6

(119,506) (45,015) 164,309 1,995

Operating surplus/(deficit) Investment revenue Surplus/(deficit) for the financial year Public dividend capital dividends payable

12 35.2

Retained surplus/(deficit) for the year

2010-11 ÂŁ000 (restated)* (39,842) (12,338) 51,937 643

1,783

400

21 1,804 0

0 400 (15)

1,804

385

0 0 0 0 0 0 0 0 1,804

0 0 0 0 0 0 0 0 385

Other Comprehensive Income

Impairments and reversals Net gain/(loss) on revaluation of property, plant & equipment Net gain/(loss) on revaluation of intangibles Net gain/(loss) on revaluation of financial assets Net gain/(loss) on other reserves Net gain/(loss) on available for sale financial assets Net actuarial gain/(loss) on pension schemes Reclassification adjustment on disposal of available for sale financial assets Total comprehensive income for the year *

The prior year retained surplus has reduced by ÂŁ3,000 as a result of the change in accounting treatment of the donated asset reserve.

Financial performance for the year Retained surplus/(deficit) for the year

1,804

Retained surplus / (deficit)

1,804

PDC dividend: balance receivable/(payable) at 31 March 2012 The notes on pages 75 to 97 form part of this account.

0


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75

Statement of Financial Position as at 31 March 2012 31 March 2012

NOTE Non-current assets: Property, plant and equipment 13 14 Intangible assets investment property 19 Other financial assets 18.1 Trade and other receivables Total non-current assets Current assets: 17 Inventories 18.1 Trade and other receivables Other financial assets 19 20 Other current assets 21 Cash and cash equivalents Total current assets Non-current assets held for sale 22 Total current assets Total assets Current liabilities Trade and other payables Other liabilities Provisions Borrowings Total current liabilities Non-current assets plus/less net current assets/liabilities Non-current liabilities Trade and other payables Other Liabilities Provisions Borrowings Total non-current liabilities Total Assets Employed:

23 24 29 25

23 24 29 25

FINANCED BY: TAXPAYERS' EQUITY Public Dividend Capital Retained earnings Revaluation reserve Other reserves Total Taxpayers' Equity:

£000

1 April 2011 (restated) £000

Merger adjustments £000

31 March 2011 (restated) £000

31 March 2010 (restated) £000

1,307 4 0 0 455 1,766

377 8 0 0 228 613

0 0 0 0 0 0

377 8 0 0 228 613

489 12 0 0 200 701

0 12,321 0 0 4,491 16,812 0 16,812 18,578

0 1,311 0 0 2,777 4,088 0 4,088 4,701

0 0 0 0 0 0 0 0 0

0 1,311 0 0 2,777 4,088 0 4,088 4,701

0 2,595 0 0 34 2,629 0 2,629 3,330

(14,408) 0 0 0 (14,408)

(2,017) 0 (318) 0 (2,335)

0 0 0 0 0

(2,017) 0 (318) 0 (2,335)

(1,343) 0 (6) 0 (1,349)

4,170

2,366

0

2,366

1,981

0 0 0 0 0 4,170

0 0 0 0 0 2,366

0 0 0 0 0 0

0 0 0 0 0 2,366

0 0 0 0 0 1,981

2,119 2,030 21 0 4,170

2,119 226 21 0 2,366

0 0 0 0 0

2,119 226 21 0 2,366

2,119 (159) 21 0 1,981

The notes on pages 74 to 97 form part of this account. The financial statements on pages 71 to 74 were approved by the Board on 7 June 2012 and signed on its behalf by

Chief Executive: Date:

7 June 2012


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Annual Report 2011/12

Statement of Changes in Taxpayers' Equity For the year ended 31 March 2012

Balance at 1 April 2011 Changes in taxpayers’ equity for 2011-12 Retained surplus/(deficit) for the year Net gain / (loss) on revaluation of property, plant, equipment Net gain / (loss) on revaluation of intangible assets Net gain / (loss) on revaluation of financial assets Net gain / (loss) on revaluation of assets held for sale Impairments and reversals Movements in other reserves Transfers between reserves Release of reserves to SOCI Transfers to/(from) other bodies within the Resource Account boundary Reclassification adjustment on disposal of available for sale financial assets Reserves eliminated on dissolution Originating capital for Trust established in year New PDC Received PDC Repaid In Year PDC Written Off Transferred to NHS Foundation Trust Other Movements in PDC In Year Net Actuarial Gain/(Loss) on Pension Net recognised revenue/(expense) for the year Balance at 31 March 2012 Changes in taxpayers’ equity for 2010-11 Balance at 1 April 2010 Retained surplus/(deficit) for the year Net gain / (loss) on revaluation of property, plant, equipment Net gain / (loss) on revaluation of intangible assets Net gain / (loss) on revaluation of financial assets Net gain / (loss) on revaluation of assets held for sale Impairments and reversals Movements in other reserves Transfers between reserves Reclassification adjustment on disposal of available for sale financial assets Reserves eliminated on dissolution Originating capital for Trust established in year New PDC Received PDC Repaid In Year PDC Written Off Transferred to NHS Foundation Trust Other Movements in PDC In Year Net Actuarial Gain/(Loss) on Pension Net recognised revenue/(expense) for the year Balance at 31 March 2011

Public Dividend capital £000 2,119

Retained earnings £000

Revaluation reserve £000

Other reserves £000

Total reserves £000

226

21

0

2,366

1,804

0

1,804 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

0 0

0

1,804

2,119

2,030

2,119

(159) 385

1,804

21

0

4,170

21

0

1,981 385

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

0

0

0

0

0

0

0 0 0 0 0 0 0 0

0

385

0

0

385

2,119

226

21

0

2,366


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77

Statement Of Cash Flows For The Year Ended 31 March 2012 NOTE Cash Flows from Operating Activities Operating Surplus/Deficit Depreciation and Amortisation Impairments and Reversals Other Gains / (Losses) on foreign exchange Donated Assets received credited to revenue but non-cash Government Granted Assets received credited to revenue but non-cash Interest Paid Dividend paid Release of PFI/deferred credit (Increase)/Decrease in Inventories (Increase)/Decrease in Trade and Other Receivables (Increase)/Decrease in Other Current Assets Increase/(Decrease) in Trade and Other Payables (Increase)/Decrease in Other Current Liabilities Provisions Utilised Increase/(Decrease) in Provisions

2011-12 2010-11 £000 £000 1,783 120 0 0 0 0 0 0 0 0 (11,237) 0 12,046 0 (315) (3)

400 116 0 0 0 0 0 (15) 0 0 1,257 0 673 0 0 312

2,394

2,743

CASH FLOWS FROM INVESTING ACTIVITIES Interest Received (Payments) for Property, Plant and Equipment (Payments) for Intangible Assets (Payments) for Investments with DH (Payments) for Other Financial Assets (Payments) for Financial Assets (LIFT) Proceeds of disposal of assets held for sale (PPE) Proceeds of disposal of assets held for sale (Intangible) Proceeds from Disposal of Investment with DH Proceeds from Disposal of Other Financial Assets Proceeds from the disposal of Financial Assets (LIFT) Loans Made in Respect of LIFT Loans Repaid in Respect of LIFT Rental Revenue

21 (701) 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

Net Cash Inflow/(Outflow) from Investing Activities

(680)

0

NET CASH INFLOW/(OUTFLOW) BEFORE FINANCING

1,714

2,743

CASH FLOWS FROM FINANCING ACTIVITIES Public Dividend Capital Received Public Dividend Capital Repaid Loans received from DH - New Capital Investment Loans Loans received from DH - New Working Capital Loans Other Loans Received Loans repaid to DH - Capital Investment Loans Repayment of Principal Loans repaid to DH - Working Capital Loans Repayment of Principal Other Loans Repaid Cash transferred to NHS Foundation Trusts Capital Element of Payments in Respect of Finance Leases and On-SoFP PFI and LIFT Capital grants and other capital receipts

0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0

Net Cash Inflow/(Outflow) from Financing Activities

0

0

NET INCREASE/(DECREASE) IN CASH AND CASH EQUIVALENTS

1,714

2,743

Cash and Cash Equivalents ( and Bank Overdraft) at Beginning of the Period Opening balance adjustment - TCS Transactions Restated Cash and Cash Equivalents (and Bank Overdraft) at Beginning of the Period Effect of Exchange Rate Changes in the Balance of Cash Held in Foreign Currencies

2,777 0 2,777 0

34

Cash and Cash Equivalents (and Bank Overdraft) at year end

4,491

2,777

Net Cash Inflow/(Outflow) from Operating Activities

34 0


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Annual Report 2011/12

Notes To The Accounts 1.

Accounting Policies The Secretary of State for Health has directed that the financial statements of NHS trusts shall meet the accounting requirements of the NHS Trusts Manual for Accounts, which shall be agreed with HM Treasury. Consequently, the following financial statements have been prepared in accordance with the 2011-12 NHS Trusts Manual for Accounts issued by the Department of Health. The accounting policies contained in that manual follow International Financial Reporting Standards to the extent that they are meaningful and appropriate to the NHS, as determined by HM Treasury, which is advised by the Financial Reporting Advisory Board. Where the NHS Trusts Manual for Accounts permits a choice of accounting policy, the accounting policy which is judged to be most appropriate to the particular circumstances of the Trust for the purpose of giving a true and fair view has been selected. The particular policies adopted by the trust are described below. They have been applied consistently in dealing with items considered material in relation to the accounts.

1.1

Accounting convention These accounts have been prepared under the historical cost convention modified to account for the revaluation of property, plant and equipment, intangible assets, inventories and certain financial assets and financial liabilities.

1.2

Acquisitions and discontinued operations Activities are considered to be ‘acquired’ only if they are taken on from outside the public sector. Activities are considered to be ‘discontinued’ only if they cease entirely. They are not considered to be ‘discontinued’ if they transfer from one public sector body to another.

1.3

Transforming Community Services (TCS) transactions Under the TCS initiative, services historically provided by PCTs have transferred to other providers notably NHS Trusts and NHS Foundation Trusts. Such transfers fall to be accounted for by use of merger accounting. The Treasury FREM provides that where a transfer takes place in 2011-12, the recipient of the transfer will account for transferred activity in full for the period (and the original provider for none) to reflect the position had the transfer always applied.For TCS transactions specifically, it is impracticable to adjust the prior period's revenue account in each body and so restatement is effected by an adjustment to 1 April 2011 opening balances rather than by full restatement of comparators."

1.4

Pooled Budgets The Trust has entered into a pooled budget with Wigan Metropolitan Borough Council. Under the arrangement funds are pooled under S75 of the NHS Act 2006 for Community Equipment Store activities. Note 2 to the accounts provides details of the income and expenditure. The pool is hosted by Wigan Metropolitan Borough Council. Payments for services provided by the Trust are accounted for as income from Local Authorities. The Trust accounts for its share of the assets, liabilities, income and expenditure arising from the activities of the pooled budget, identified in accordance with the pooled budget agreement.

1.5

Critical accounting judgements and key sources of estimation uncertainty In the application of the Trust’s accounting policies, management is required to make judgements, estimates and assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and other factors that are considered to be relevant. Actual results may differ from those estimates and the estimates and underlying assumptions are continually reviewed. Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period or in the period of the revision and future periods if the revision affects both current and future periods.


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1.5.1 Critical judgements in applying accounting policies The following are the critical judgements, apart from those involving estimations (see below) that management has made in the process of applying the Trustâ&#x20AC;&#x2122;s accounting policies and that have the most significant effect on the amounts recognised in the financial statements. Critical judgements have been made in assessing the classification of estates rental charges, between operating and finance leases. Department of Health guidance has been followed in applying IAS1 and merger accounting guidance.

1.5.2 Key sources of estimation uncertainty The nature of transactions incurred during the year is such that there has been a very limited need to make estimations in the accounts and as a consequence there is little risk of estimation uncertainty. The Trust has used estimation in determining a limited value of accruals based on recent historic information.

1.6

Revenue Revenue in respect of services provided is recognised when, and to the extent that, performance occurs, and is measured at the fair value of the consideration receivable. The main source of revenue for the trust is from commissioners for healthcare services. Where income is received for a specific activity that is to be delivered in the following year, that income is deferred. The Trust receives income under the NHS Injury Cost Recovery Scheme, designed to reclaim the cost of treating injured individuals to whom personal injury compensation has subsequently been paid e.g. by an insurer. The Trust recognises the income when it receives notification from the Department of Work and Pension's Compensation Recovery Unit that the individual has lodged a compensation claim. The income is measured at the agreed tariff for the treatments provided to the injured individual, less a provision for unsuccessful compensation claims and doubtful debts.

1.7

Employee Benefit Short-term employee benefits Salaries, wages and employment-related payments are recognised in the period in which the service is received from employees. The cost of leave earned but not taken by employees at the end of the period is recognised in the financial statements to the extent that employees are permitted to carry forward leave into the following period. Retirement benefit costs Past and present employees are covered by the provisions of the NHS Pensions Scheme. The scheme is an unfunded, defined benefit scheme that covers NHS employers, General Practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the scheme is accounted for as if it were a defined contribution scheme: the cost to the NHS body of participating in the scheme is taken as equal to the contributions payable to the scheme for the accounting period. For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full amount of the liability for the additional costs is charged to expenditure at the time the Trust commits itself to the retirement, regardless of the method of payment.

1.8

Other expenses Other operating expenses are recognised when, and to the extent that, the goods or services have been received. They are measured at the fair value of the consideration payable.


80

1.9

Annual Report 2011/12

Property, plant and equipment Recognition Property, plant and equipment is capitalised if: it is held for use in delivering services or for administrative purposes; it is probable that future economic benefits will flow to, or service potential will be supplied to, the Trust; it is expected to be used for more than one financial year; the cost of the item can be measured reliably; and the item has cost of at least £5,000; or Collectively, a number of items have a cost of at least £5,000 and individually have a cost of more than £250, where the assets are functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal dates and are under single managerial control; or Items form part of the initial equipping and setting-up cost of a new building, ward or unit, irrespective of their individual or collective cost. Where a large asset, for example a building, includes a number of components with significantly different asset lives, the components are treated as separate assets and depreciated over their own useful economic lives. Valuation All property, plant and equipment are measured initially at cost, representing the cost directly attributable to acquiring or constructing the asset and bringing it to the location and condition necessary for it to be capable of operating in the manner intended by management. All assets are measured subsequently at fair value. Land and buildings used for the Trust’s services or for administrative purposes are stated in the statement of financial position at their revalued amounts, being the fair value at the date of revaluation less any subsequent accumulated depreciation and impairment losses. Revaluations are performed with sufficient regularity to ensure that carrying amounts are not materially different from those that would be determined at the end of the reporting period. Fair values are determined as follows: Land and non-specialised buildings – market value for existing use Specialised buildings – depreciated replacement cost Until 31 March 2008, the depreciated replacement cost of specialised buildings has been estimated for an exact replacement of the asset in its present location. HM Treasury has adopted a standard approach to depreciated replacement cost valuations based on modern equivalent assets and, where it would meet the location requirements of the service being provided, an alternative site can be valued. Properties in the course of construction for service or administration purposes are carried at cost, less any impairment loss. Cost includes professional fees but not borrowing costs, which are recognised as expenses immediately, as allowed by IAS 23 for assets held at fair value. Assets are revalued and depreciation commences when they are brought into use. Until 31 March 2008, fixtures and equipment were carried at replacement cost, as assessed by indexation and depreciation of historic cost. From 1 April 2008 indexation has ceased. The carrying value of existing assets at that date will be written off over their remaining useful lives and new fixtures and equipment are carried at depreciated historic cost as this is not considered to be materially different from fair value. An increase arising on revaluation is taken to the revaluation reserve except when it reverses an impairment for the same asset previously recognised in expenditure, in which case it is credited to expenditure to the extent of the decrease previously charged there. A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a clear consumption of economic benefit should be taken to expenditure. Gains and losses recognised in the revaluation reserve are reported as other comprehensive income in the Statement of Comprehensive Income.


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Subsequent expenditure Where subsequent expenditure enhances an asset beyond its original specification, the directly attributable cost is capitalised. Where subsequent expenditure restores the asset to its original specification, the expenditure is capitalised and any existing carrying value of the item replaced is writtenout and charged to operating expenses. Use of buildings Bridgewater Community Healthcare does not own any of the buildings from which it provides its services. The Trust has no claim to or controlling influence over the assets for a period of greater than one year. Occupancy charges in relation to occupancy of these premises is charged where required as disclosed in note 9. The Trust expects the estate as agreed with PCTâ&#x20AC;&#x2122;s to transfer towards the end of 2012/13.

1.10 Intangible assets Recognition Intangible assets are non-monetary assets without physical substance, which are capable of sale separately from the rest of the trustâ&#x20AC;&#x2122;s business or which arise from contractual or other legal rights. They are recognised only when it is probable that future economic benefits will flow to, or service potential be provided to, the trust; where the cost of the asset can be measured reliably, and where the cost is at least ÂŁ5,000. Intangible assets acquired separately are initially recognised at fair value. Software that is integral to the operating of hardware, for example an operating system, is capitalised as part of the relevant item of property, plant and equipment. Software that is not integral to the operation of hardware, for example application software, is capitalised as an intangible asset. Expenditure on research is not capitalised: it is recognised as an operating expense in the period in which it is incurred. Internally-generated assets are recognised if, and only if, all of the following have been demonstrated: the technical feasibility of completing the intangible asset so that it will be available for use the intention to complete the intangible asset and use it the ability to sell or use the intangible asset how the intangible asset will generate probable future economic benefits or service potential the availability of adequate technical, financial and other resources to complete the intangible asset and sell or use it the ability to measure reliably the expenditure attributable to the intangible asset during its development Measurement The amount initially recognised for internally-generated intangible assets is the sum of the expenditure incurred from the date when the criteria above are initially met. Where no internally-generated intangible asset can be recognised, the expenditure is recognised in the period in which it is incurred. Following initial recognition, intangible assets are carried at fair value by reference to an active market, or, where no active market exists, at amortised replacement cost (modern equivalent assets basis), indexed for relevant price increases, as a proxy for fair value. Internally-developed software is held at historic cost to reflect the opposing effects of increases in development costs and technological advances.

1.11 Depreciation, amortisation and impairments Freehold land, properties under construction, and assets held for sale are not depreciated. Otherwise, depreciation and amortisation are charged to write off the costs or valuation of property, plant and equipment and intangible non-current assets, less any residual value, over their estimated useful lives, in a manner that reflects the consumption of economic benefits or service potential of the assets. The estimated useful life of an asset is the period over which the Trust expects to obtain economic benefits or service potential from the asset. This is specific to the Trust and may be shorter than the physical life of the asset itself. Estimated useful lives and residual values are reviewed each year end, with the effect of any changes recognised on a prospective basis. Assets held under finance leases are depreciated over their estimated useful lives


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At each reporting period end, the trust checks whether there is any indication that any of its tangible or intangible non-current assets have suffered an impairment loss. If there is indication of an impairment loss, the recoverable amount of the asset is estimated to determine whether there has been a loss and, if so, its amount. Intangible assets not yet available for use are tested for impairment annually. A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a clear consumption of economic benefit should be taken to expenditure. Where an impairment loss subsequently reverses, the carrying amount of the asset is increased to the revised estimate of the recoverable amount but capped at the amount that would have been determined had there been no initial impairment loss. The reversal of the impairment loss is credited to expenditure to the extent of the decrease previously charged there and thereafter to the revaluation reserve.

1.12 Donated assets Following the accounting policy change outlined in the Treasury FREM for 2011-12, a donated asset reserve is no longer maintained. Donated non-current assets are capitalised at their fair value on receipt, with a matching credit to Income. They are valued, depreciated and impaired as described above for purchased assets. Gains and losses on revaluations, impairments and sales are as described above for purchased assets. Deferred income is recognised only where conditions attached to the donation preclude immediate recognition of the gain. This accounting policy change has been applied retrospectively and consequently the 2010-11 results have been restated. 1.13 Government grants Following the accounting policy change outlined in the Treasury FREM for 2011-12, a government grant reserve is no longer maintained. The value of assets received by means of a government grant are credited directly to income. Deferred income is recognised only where conditions attached to the grant preclude immediate recognition of the gain. This accounting policy change has been applied retrospectively and consequently the 2010-11 results have been restated. 1.14 Leases Leases are classified as finance leases when substantially all the risks and rewards of ownership are transferred to the lessee. All other leases are classified as operating leases. The Trust does not have any finance leases. The trust as lessee Operating lease payments are recognised as an expense on a straight-line basis over the lease term. Lease incentives are recognised initially as a liability and subsequently as a reduction of rentals on a straight-line basis over the lease term. Where a lease is for land and buildings, the land and building components are separated and individually assessed as to whether they are operating or finance leases.

1.15 Cash and cash equivalents Cash is cash in hand and deposits with any financial institution repayable without penalty on notice of not more than 24 hours. Cash equivalents are investments that mature in 3 months or less from the date of acquisition and that are readily convertible to known amounts of cash with insignificant risk of change in value.

1.16 Provisions Provisions are recognised when the Trust has a present legal or constructive obligation as a result of a past event, it is probable that the Trust will be required to settle the obligation, and a reliable estimate can be made of the amount of the obligation. The amount recognised as a provision is the best estimate of the expenditure required to settle the obligation at the end of the reporting period, taking into account the risks and uncertainties. Where a provision is measured using the cash flows estimated to settle the obligation, its carrying amount is the present value of those cash flows using HM Treasuryâ&#x20AC;&#x2122;s discount rate of 2.2% in real terms.


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When some or all of the economic benefits required to settle a provision are expected to be recovered from a third party, the receivable is recognised as an asset if it is virtually certain that reimbursements will be received and the amount of the receivable can be measured reliably. A restructuring provision is recognised when the Trust has developed a detailed formal plan for the restructuring and has raised a valid expectation in those affected that it will carry out the restructuring by starting to implement the plan or announcing its main features to those affected by it. The measurement of a restructuring provision includes only the direct expenditures arsing from the restructuring, which are those amounts that are both necessarily entailed by the restructuring and not associated with ongoing activities of the entity.

1.17 Clinical negligence costs The NHS Litigation Authority (NHSLA) operates a risk pooling scheme under which the Trust pays an annual contribution to the NHSLA which in return settles all clinical negligence claims. The contribution is charged to expenditure. Although the NHSLA is administratively responsible for all clinical negligence cases the legal liability remains with the trust. The total value of clinical negligence provisions carried by the NHSLA on behalf of the Trust is disclosed at note 29.

1.18 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 as and when they become due.

1.19 EU Emissions Trading Scheme EU Emission Trading Scheme allowances are accounted for as government grant funded intangible assets if they are not expected to be realised within twelve months, and otherwise as other current assets. They are valued at open market value. As the NHS body makes emissions, a provision is recognised with an offsetting transfer from deferred income. The provision is settled on surrender of the allowances. The asset, provision and deferred income amounts are valued at fair value at the end of the reporting period.

1.20 Contingencies A contingent liability is a possible obligation that arises from past events and whose existence will be confirmed only by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control of the trust, or a present obligation that is not recognised because it is not probable that a payment will be required to settle the obligation or the amount of the obligation cannot be measured sufficiently reliably. A contingent liability is disclosed unless the possibility of a payment is remote. Where the time value of money is material, contingencies are disclosed at their present value.

1.21 Financial assets Financial assets are recognised when the Trust becomes party to the financial instrument contract or, in the case of trade receivables, when the goods or services have been delivered. Financial assets are derecognised when the contractual rights have expired or the asset has been transferred. Financial assets are initially recognised at fair value. Financial assets are classified into the following categories: financial assets at fair value through profit and loss; held to maturity investments; available for sale financial assets, and loans and receivables. The classification depends on the nature and purpose of the financial assets and is determined at the time of initial recognition. Loans and receivables Loans and receivables are non-derivative financial assets with fixed or determinable payments which are not quoted in an active market. After initial recognition, they are measured at amortised cost using the effective interest method, less any impairment. Interest is recognised using the effective interest method. Fair value is determined by reference to quoted market prices where possible, otherwise by valuation techniques. The effective interest rate is the rate that exactly discounts estimated future cash receipts through the expected life of the financial asset, to the initial fair value of the financial asset.


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At the end of the reporting period, the Trust assesses whether any financial assets, other than those held at ‘fair value through profit and loss’ are impaired. Financial assets are impaired and impairment losses recognised if there is objective evidence of impairment as a result of one or more events which occurred after the initial recognition of the asset and which has an impact on the estimated future cash flows of the asset. For financial assets carried at amortised cost, the amount of the impairment loss is measured as the difference between the asset’s carrying amount and the present value of the revised future cash flows discounted at the asset’s original effective interest rate. The loss is recognised in expenditure and the carrying amount of the asset is reduced directly, or through a provision for impairment of receivables. If, in a subsequent period, the amount of the impairment loss decreases and the decrease can be related objectively to an event occurring after the impairment was recognised, the previously recognised impairment loss is reversed through expenditure to the extent that the carrying amount of the receivable at the date of the impairment is reversed does not exceed what the amortised cost would have been had the impairment not been recognised.

1.22 Financial liabilities Financial liabilities are recognised on the statement of financial position when the trust becomes party to the contractual provisions of the financial instrument or, in the case of trade payables, when the goods or services have been received. Financial liabilities are de-recognised when the liability has been discharged, that is, the liability has been paid or has expired. Other financial liabilities After initial recognition, all other financial liabilities are measured at amortised cost using the effective interest method, except for loans from Department of Health, which are carried at historic cost. The effective interest rate is the rate that exactly discounts estimated future cash payments through the life of the asset, to the net carrying amount of the financial liability. Interest is recognised using the effective interest method.

1.23 Value Added Tax Most of the activities of the trust are outside the scope of VAT and, in general, output tax does not apply and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or included in the capitalised purchase cost of fixed assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT.

1.24 Foreign currencies The Trust's functional currency and presentational currency is sterling. Transactions denominated in a foreign currency are translated into sterling at the exchange rate ruling on the dates of the transactions. At the end of the reporting period, monetary items denominated in foreign currencies are retranslated at the spot exchange rate on 31 March. Resulting exchange gains and losses for either of these are recognised in the trust’s surplus/deficit in the period in which they arise.

1.25 Public Dividend Capital (PDC) and PDC dividend The Secretary of State has confirmed originating capital debt of £2,119k, equivalent to the transfer value of net assets transferred under the transfer agreement with NHS ALW on 1 November 2010. Public dividend capital represents taxpayers’ equity in the NHS trust. At any time the Secretary of State can issue new PDC to, and require repayments of PDC from, the trust. PDC is recorded at the value received. As PDC is issued under legislation rather than under contract, it is not treated as an equity financial instrument. An annual charge, reflecting the cost of capital utilised by the Trust, is payable to the Department of Health as public dividend capital dividend. The charge is calculated at the real rate set by HM Treasury (currently 3.5%) on the average carrying amount of all assets less liabilities, except for donated assets and cash balances with the Office of the Paymaster General. The average carrying amount of assets is calculated as a simple average of opening and closing relevant net assets.


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1.26 Losses and Special Payments Losses and special payments are items that Parliament would not have contemplated when it agreed funds for the health service or passed legislation. By their nature they are items that ideally should not arise. They are therefore subject to special control procedures compared with the generality of payments. They are divided into different categories, which govern the way that individual cases are handled. Losses and special payments are charged to the relevant functional headings in expenditure on an accruals basis, including losses which would have been made good through insurance cover had NHS trusts not been bearing their own risks (with insurance premiums then being included as normal revenue expenditure).

1.27 Accounting Standards that have been issued but have not yet been adopted The Treasury FReM does not require the following Standards and Interpretations to be applied in 201112. The application of the Standards as revised would not have a material impact on the accounts for 2011-12, were they applied in that year: IAS 1 IAS 12 IAS 19 IAS 27 IAS 28 IFRS 7 IFRS 9 IFRS 10 IFRS 11 IFRS 12 IFRS 13 IPSAS 32

Presentation of financial statements (Other Comprehensive Income) - subject to consultation Income Taxes (amendment) - subject to consultation Post-employment benefits (pensions) - subject to consultation Separate Financial Statements - subject to consultation Investments in Associates and Joint Ventures - subject to consultation Financial Instruments: Disclosures (annual improvements) - effective 2012-13 Financial Instruments - subject to consultation Consolidated Financial Statements - subject to consultation Joint Arrangements - subject to consultation Disclosure of Interests in Other Entities - subject to consultation Fair Value Measurement - subject to consultation Service Concession Arrangement - subject to consultation

1.28 Merger Accounting The Trust transferred the provision of Hospital at Home services during the year to Wrightington, Wigan and Leigh NHS Foundation Trust. This was effective from 1 October 2011. Under merger accounting the Trust had to remove transactions relating to this service for the first six months of the year from its accounts as if the transfer of service has occured on 1 April 2011. These transactions were income of £1,910,000 and expenditure of £1,910,000. Wrightington, Wigan and Leigh NHS Foundation Trust likewise had to account for the service as if it had been providing it from 1 April 2011 and therefore showed income of £1,910,000 and expenditure of £1,910,000 in its accounts for the first 6 months of the year.


86

2.

Annual Report 2011/12

Wigan Metropolitan Borough Council pooled budget Bridgewater Community Healthcare NHS Trust has a pooled budget arrangement with Wigan Metropolitan Borough Council, which is the host. The memorandum account for the pooled budget is: The Trust’s shares of the income and expenditure handled by the pooled budget in the financial year were: 2011-12 £000

2010-11 £000

541 541

309 309

Income Expenditure

Of this funding the Trust contributed £196,400 with the remainder being paid by Ashton, Leigh and Wigan PCT. The Trust has included within its accounts 49% of the actual share of the cash and payable balances of the pooled budget of £16,400.

3.

Operating segments Bridgewater Community Healthcare operates in a single segment, the provision of healthcare community services. There are therefore no reportable segments. Income from transactions with PCTs is in excess of 10% of total income at £148,937,000 (2010/11: £50,213,000).

4.

Income generation activities Bridgewater Community Healthcare does not undertaken any material income generation activities.

5.

Revenue from patient care activities

Strategic health authorities NHS trusts Primary care trusts - non-tariff Foundation trusts Local authorities Department of Health NHS other Non-NHS: Private patients Injury costs recovery Other

6.

2011-12 £000 1,248 3,059 148,937 995 5,253 5 47

2010-11 £000 0 0 50,213 251 658 0 63

4 990 3,771

0 395 357

164,309

51,937

2011-12 £000

2010-11 £000

1,940 17 0 38

344 117 11 171

1,995

643

166,304

52,580

Other operating revenue

Education, training and research Charitable and other contributions to expenditure Non-patient care services to other Other revenue

Total operating revenue


Annual Report 2011/12

7.

87

Revenue

From rendering of services From sale of goods

2011-12 £000

2010-11 £000

166,304

52,580 0

0 Revenue is almost totally from the supply of services. Revenue from the sale of goods is immaterial. The significant increase in revenue for 2011/12 reflects turnover having increased by approximately three times as the Trust now comprises five divisions compared to only one in 2010/11.

8.

Operating expenses (excluding employee benefits) 2011-12 £000

2010-11 £000

2,710 1,087 10 2,286 1,143 57 10,234 2,342 1,327 3,612 2,968 14,613 25 116 4 120 0 247 400 1,714 45,015

0 634 0 305 1,111 46 2,344 737 186 1,412 1,233 3,455 7 112 4 84 50 0 257 361 12,338

Employee benefits Employee benefits excluding Board members Board members Total employee benefits

118,873 633 119,506

39,439 403 39,842

Total operating expenses

164,521

52,180

Services from other NHS trusts Services from PCTs Services from other NHS bodies Services from foundation trusts Purchase of healthcare from non NHS bodies Trust chair and non executive directors Supplies and services - clinical Supplies and services - general Consultancy services Establishment Transport Premises Impairments and Reversals of Receivables Depreciation Amortisation Audit fees Other auditor's remuneration Clinical negligence Education and Training Other

The significant increase in expenditure for 2011/12 reflects spend having increased by approximately three times as the Trust now comprises five divisions compared to only one in 2010/11.


88

9

Annual Report 2011/12

Operating Leases Bridgewater Community Healthcare has included within lease costs occupancy charges in relation to occupancy of premises owned and controlled by Ashton, Leigh and Wigan PCT, Halton and St Helens PCT and Warrington PCT. In the case of properties owned by Trafford PCT, and other PCTs who commission dental services from Bridgewater, occupancy of these buildings is on a very partial basis with other occupants and the cost to Bridgewater is catered for within the commissioners contractor arrangements.

9.1

Trust as lessee

9.2

2011-12 Buildings Other £000 £000

Total £000

2010-11 £000

Payments recognised as an expense Minimum lease payments

12,403

3,376

Total

12,403

3,376

Land £000

Payable: No later than one year Between one and five years After five years

0 0 0

11,828 358 385

196 245 0

12,024 603 385

3,384 636 264

Total

0

12,571

441

13,012

4,284

Trust as lessor Bridgewater Community Healthcare does not have any lease arrangements as a lessor.


Annual Report 2011/12

10

89

Employee benefits and staff numbers

10.1 Employee benefits Total £000

Permanently Employed £000

Other £000

97,501 6,681 12,751 2,241 466

96,831 6,681 12,751 0 466

670 0 0 2,241 0

119,640

116,729

2,911

134

0

134

119,506

116,729

2,777

Employee Benefits 2011-12 Salaries and wages Social security costs Employer contributions to NHS Pensions scheme Other employment benefits Termination benefits Total employee benefits including capitalised costs Employee costs capitalised Total Employee Benefits excluding capitalised costs

Permanently Employed £000

Total £000

Other £000

Employee Benefits 2010-11 Salaries and wages Social security costs Employer contributions to NHS Pensions scheme Other employment benefits Termination benefits

32,726 2,064 4,216 18 818

32,485 2,047 4,184 18 818

241 17 32 0 0

Total employee benefits including capitalised costs

39,842

39,552

290

0

Employee costs capitalised

39,842

Total Employee Benefits excluding capitalised costs

10.2 Staff Numbers

2011-12

2010-11

Total Number

Permanently employed Number

Other Number

Average Staff Numbers Medical and dental Administration and estates Healthcare assistants and other support staff Nursing, midwifery and health visiting staff Nursing, midwifery and health visiting learners Scientific, therapeutic and technical staff Other

75.9 858.8 313.3 1,499.4 7.2 579.7 21.2

71.5 841.3 307.3 1,482.9 7.2 570.8 18.2

4.4 17.5 6.0 16.5 0 8.9 3

7.0 298.0 86.0 401.0 43.0 234.0 0

Total

3,355.5

3,299.2

56.3

1,069.0

3.0

0

3.0

0

Of the above - staff engaged on capital projects

Total Number


90

Annual Report 2011/12

10.3 Staff Sickness absence and ill health retirements

Total Days Lost Total Staff Years Average working Days Lost

2011-12 Number 12,713 1,335

2010-11 Number 9,413 1,046

9.52

9.00

The figures included for 2011-12 are based on the calendar year from 1 January 2011 until 31 December 2011 rather than the financial year. DH considers the resulting figures to be a reasonable proxy for financial year equivalents.

Number of persons retired early on ill health grounds

2011-12 Number 0

2010-11 Number 0

10.4 Exit Packages agreed in 2011-12 2011-12 Exit package cost band (including any special payment element)

2010-11

Number of compulsory redundancies

Number of other departures agreed

Total number of exit packages by cost band

Number of compulsory redundancies

Number of other departures agreed

Total number of exit packages by cost band

Number 0 0 0 0 0 0 0

Number 3 4 6 2 0 0 0

Number 3 4 6 2 0 0 0

Number 2 1 0 0 0 0 0

Number 7 13 11 2 0 0 0

Number 9 14 11 2 0 0 0

0

15

15

3

33

36

0

466

466

35

783

818

Less than £10,000 £10,001-£25,000 £25,001-£50,000 £50,001-£100,000 £100,001 - £150,000 £150,001 - £200,000 >£200,000 Total number of exit packages by type (total cost) Total resource cost (£000s)

Exit costs in this note are accounted for in full in the year of departure. Ill-health retirement costs are met by the NHS pensions scheme and are not included in the table. Of the departures in the table above all 15 departed under the Mutually Agreed Redundancy Scheme (MARS). This disclosure reports the number and value of exit packages taken by staff leaving in the year. Note: The expense associated with these departures has been fully recognised in 2011/12.

10.5 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.nhsbsa.nhs.uk/pensions. The scheme is an unfunded, defined benefit scheme that covers NHS employers, GP practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the scheme is accounted for as if it were a defined contribution scheme: the cost to the NHS Body of participating in the scheme is taken as equal to the contributions payable to the scheme for the accounting period. In order that the defined benefit obligations recognised in the financial statements do not differ materially from those that would be determined at the reporting date by a formal actuarial valuation, the FReM requires that “the period between formal valuations shall be four years, with approximate assessments in intervening years”. An outline of these follows:


Annual Report 2011/12

91

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. The last formal actuarial valuation undertaken for the NHS Pension Scheme was completed for the year ending 31 March 2004. Consequently, a formal actuarial valuation would have been due for the year ending 31 March 2008. However, formal actuarial valuations for unfunded public service schemes have been suspended by HM Treasury on value for money grounds while consideration is given to recent changes to public service pensions, and while future scheme terms are developed as part of the reforms to public service pension provision. Employer and employee contribution rates are currently being determined under the new scheme design. 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. Actuarial assessments are undertaken in intervening years between formal valuations using updated membership data are accepted as providing suitably robust figures for financial reporting purposes. However, as the interval since the last formal valuation now exceeds four years, the valuation of the scheme liability as at 31 March 2012, is based on detailed membership data as at 31 March 2010 updated to 31 March 2012 with summary global member and accounting data. In undertaking this actuarial assessment, the methodology prescribed in IAS 19, relevant FReM interpretations, and the discount rate prescribed by HM Treasury have also been used. The latest assessment of the liabilities of the scheme is contained in the scheme actuary report, which forms part of the annual NHS Pension Scheme (England and Wales) Pension Accounts, published annually. These accounts can be viewed on the NHS Pensions website. Copies can also be obtained from The Stationery Office. c) Scheme provisions The NHS Pension Scheme provided defined benefits, which are summarised below. This list is an illustrative guide only, and is not intended to detail all the benefits provided by the Scheme or the specific conditions that must be met before these benefits can be obtained: The Scheme is a “final salary” scheme. Annual pensions are normally based on 1/80th for the 1995 section and of the best of the last three years pensionable pay for each year of service, and 1/60th for the 2008 section of reckonable pay per year of membership. Members who are practitioners as defined by the Scheme Regulations have their annual pensions based upon total pensionable earnings over the relevant pensionable service. With effect from 1 April 2008 members can choose to give up some of their annual pension for an additional tax free lump sum, up to a maximum amount permitted under HMRC rules. This new provision is known as “pension commutation”. Annual increases are applied to pension payments at rates defined by the Pensions (Increase) Act 1971, and are based on changes in retail prices in the twelve months ending 30 September in the previous calendar year. From 2011-12 the Consumer Price Index (CPI) will be used to replace the Retail Prices Index (RPI). Early payment of a pension, with enhancement, is available to members of the scheme who are permanently incapable of fulfilling their duties effectively through illness or infirmity. A death gratuity of twice final year’s pensionable pay for death in service, and five times their annual pension for death after retirement is payable. 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 employer. Members can purchase additional service in the NHS Scheme and contribute to money purchase AVC’s run by the Scheme’s approved providers or by other Free Standing Additional Voluntary Contributions (FSAVC) providers.


92

11

Annual Report 2011/12

Better Payment Practice Code

11.1 Measure of compliance 2011-12 Number

2011-12 £000

2010-11 Number

2010-11 £000

Total Non-NHS Trade Invoices Paid in the Year Total Non-NHS Trade Invoices Paid Within Target

29,532 25,412

28,223 25,694

7,221 7,036

14,496 14,362

Percentage of NHS Trade Invoices Paid Within Target

86.05%

91.04%

97.44%

99.08%

1,282 831

41,996 28,574

570 513

11,316 10,893

64.82%

68.04%

90.00%

96.26%

Non-NHS Payables

NHS Payables Total NHS Trade Invoices Paid in the Year Total NHS Trade Invoices Paid Within Target Percentage of NHS Trade Invoices Paid Within Target

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

11.2 The Late Payment of Commercial Debts (Interest) Act 1998 No payments were made for the late payment of commercial debts.

12

Investment Revenue 2011-12 £000

2010-11 £000

Bank interest

21

0

Total investment revenue

21

0

Interest Income


0 0

Asset financing: Owned Total

At 1 April 2011 Movements At 31 March 2012

£000 0 0 0 £000 0 0 0

£000 0 0 0

Revaluation Reserve Balance for Property, Plant & Equipment Land Dwellings Buildings excluding dwellings

0 0

0 0 0

0 0 0

0 0 0

Purchased Donated Total at 31 March 2012

0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0

Depreciation At 1 April 2011 Charged During the Year At 31 March 2012 Net book value at 31 March 2012

£000

0 0 0

0 0 0

£000

£000

Dwellings

Cost or valuation: At 1 April 2011 Additions Purchased At 31 March 2012

2011-12

Buildings excluding dwellings

Land

13.1 Property, plant and equipment

0 0

0 0 0

0 0 0

0 0 0

Assets under construction & payments on account £000

£000 21 0 21

Plant & machinery

290 290

264 26 290

407 50 457 290

588 159 747

£000

Plant & machinery

0 0

0 0 0

0 0 0 0

0 0 0

£000 0 0 0

Transport equipment

£000

Transport equipment

£000 0 0 0

Information technology

1,000 1,000

1,000 0 1,000

132 65 197 1,000

328 869 1,197

£000

Information technology

£000 0 0 0

£000 21 0 21

Total

1,307 1,307 1,307 17 17 17

Furniture & fittings

1,281 26

539 116 655 1,307

916 1,046 1,962

£000

Total

17 0

0 1 1 17

0 18 18

£000

Furniture & fittings

Annual Report 2011/12 93


0 0 0 0

At 1 April 2010 Movements At 31 March 2011

0 0 0

£000 £000 0 0 0

£000 0 0 0

Revaluation Reserve Balance for Property, Plant & Equipment Dwellings Buildings Land excluding dwellings

0 0

0 0 0

0 0 0

0 0 0

Purchased Donated Total at 31 March 2011

Asset financing: Owned

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0

Depreciation At 1 April 2010 Charged During the Year At 31 March 2011 Net book value

£000

0 0 0

0 0 0

£000

£000

Dwellings

Cost or valuation: At 1 April 2010 Additions - purchased At 31 March 2011

2010-11

Buildings excluding dwellings

Land

13.2 Property, plant and equipment

0 0

0 0 0

0 0 0

0 0 0

Assets under construction & payments on account £000

£000 21 0 21

Plant & machinery

181 181

£000 0 0 0

Transport equipment

0 0

0 0 0

152 29 181

0

0

0 0 0 0

£000

Transport equipment

361 46 407 181

588 0 588

£000

Plant & machinery

£000 0 0 0

Information technology

196 196

196 0 196

66 66 132 196

328 0 328

£000

Information technology

£000 0 0 0

21 0 21

£000

Total

377 377

348 29 377

0 0 0

0 0

427 112 539 377

916 0 916

£000

Total

0 0 0 0

0 0 0

Furniture & fittings

£000

Furniture & fittings

94 Annual Report 2011/12


Annual Report 2011/12

95

13.3 Property, plant and equipment The remaining economic lives of property, plant and equipment are within the following ranges: Min life (years) Max life (years) 10 5 5

0 4 5

Plant and machinery Information technology Furniture and fittings

14.1 Intangible non-current assets 2011-12

Software Software Licences & Patents Development Total expenditure internally purchased trademarks generated £000 £000 £000 £000 £000 £000

Cost or valuation: At 1 April 2011 Additions - purchased

0 0

16 0

0 0

0 0

0 0

16 0

At 31 March 2012

0

16

0

0

0

16

Amortisation At 1 April 2011 Charged during the year

0 0

8 4

0 0

0 0

0 0

8 4

At 31 March 2012

0

12

0

0

0

12

NBV at 31 March 2012

0

4

0

0

0

4

Net book value at 31 March 2012 comprises: 4 0 Purchased

0

0

0

4

4

0

0

0

4

0

Total at 31 March 2012

14.2 Intangible non-current assets 2010-11

Software Software Licences & Patents Development Total expenditure internally purchased trademarks generated £000 £000 £000 £000 £000 £000

Cost or valuation: At 1 April 2010 Additions - purchased

0 0

16 0

0 0

0 0

0 0

16 0

At 31 March 2011

0

16

0

0

0

16

Amortisation At 1 April 2010 Charged during the year

0 0

4 4

0 0

0 0

0 0

4 4

At 31 March 2011

0

8

0

0

0

8

Net book value at 31 March 2010

0

8

0

0

0

8

Net book value at 31 March 2010 comprises: 0 8 Purchased

0

0

0

8

0

0

0

8

Total at 31 March 2011

0

8

14.3 Intangible non-current assets The remaining economic lives of property, plant and equipment are within the following ranges: Min life (years) Max life (years) 0 2 Software licences


96

15

Annual Report 2011/12

Commitments

15.1 Capital commitments Bridgewater Community Healthcare does not have any future capital commitments at 31 March 2012 (31 March 2011: £nil).

15.2 Other financial commitments Bridgewater Community Healthcare has not entered into any other contracts where a financial commitment arises on cancellation.

16

Intra-Government and other balances Current Non-current receivables receivables £000 £000 Balances with other Central Government Bodies Balances with Local Authorities Balances with NHS Trusts and Foundation Trusts Balances with Public Corporations and Trading Funds Balances with bodies external to government At 31 March 2012 prior period: Balances with other Central Government Bodies Balances with Local Authorities Balances with NHS Trusts and Foundation Trusts Balances with Public Corporations and Trading Funds Balances with bodies external to government At 31 March 2011

17

Current Non-current payables payables £000 £000

6,505 2,998 1,047 0 1,771

0 0 0 0 455

9,317 178 1,165 0 3,748

0 0 0 0 0

12,321

455

14,408

0

855 107 125 0 224

0 0 0 0 228

537 0 311 0 1,169

0 0 0 0 0

1,311

228

2,017

0

Inventories Bridgewater Community Healthcare does not have any inventories at 31 March 2012 (31 March 2011: £nil).

18.1 Trade and other receivables Non-current

Current 31 March 2012 £000

31 March 2011 £000

31 March 2012 £000

31 March 2011 £000

4,586 2,729 3,261 1,516 0 229 0

948 0 153 175 0 27 8

0 0 0 0 (49) 0 504

0 0 0 0 (24) 0 252

Total

12,321

1,311

455

228

Total current and non current

12,776

1,539

NHS receivables - revenue NHS prepayments and accrued income Non-NHS receivables - revenue Non-NHS prepayments and accrued income Provision for the impairment of receivables VAT Other receivables

The great majority of trade is with Primary Care Trusts, as commissioners for NHS patient care services. As Primary Care Trusts are funded by Government to buy NHS patient care services, no credit scoring of them is considered necessary.


Annual Report 2011/12

97

18.2 Receivables past their due date but not impaired 31 March 2012 £000

31 March 2011 £000

By up to three months By three to six months By more than six months

5,688 490 469

135 16 4

Total

6,647

155

18.3 Provision for impairment of receivables 2011-12 £000

2010-11 £000

Balance at 1 April 2011 Amount written off during the year Amount recovered during the year (Increase)/decrease in receivables impaired

(24) 0 0 (25)

(17) 0 0 (7)

Balance at 31 March

(49)

(24)

The provision for impairment of receivables is in respect of injury cost recovery income due. A percentage of the amount receivable is provided for which is currently set at 10.5%.

19

Other financial assets Bridgewater Community Healthcare had no other financial assets at 31 March 2012 (31 March 2011: £nil).

20

Other current assets Bridgewater Community Healthcare had no other current assets at 31 March 2012 (31 March 2011: £nil).

21

Cash and Cash Equivalents 31 March 2012 £000 2,777 1,714

31 March 2011 £000 34 2,743

Closing balance

4,491

2,777

Made up of Cash with Government Banking Service Commercial banks Cash in hand Cash and cash equivalents as in statement of financial

4,445 0 46 4,491

2,766 11 0 2,777

Cash and cash equivalents as in statement of cash flows

4,491

2,777

Opening balance Net change in year

22

Non-current assets held for sale Bridgewater Community Healthcare had no non-current assets held for sale at 31 March 2012 (31 March 2011: £nil).


98

23

Annual Report 2011/12

Trade and other payables Non-current

Current 31 March 2012 £000

31 March 2011 £000

31 March 2012 £000

605 65 7,237 2,097 280 3,119 986 0 19

526 0 0 717 0 585 188 0 1

0 0 0 0 0 0

0 0 0 0 0 0

0 0

0 0

14,408

2,017

0

0

Total payables (current and non-current)14,408

2,017

NHS payables - revenue NHS payables - capital NHS accruals and deferred income Non-NHS payables - revenue Non-NHS payables - capital Non-NHS accruals and deferred income Social security costs VAT Other Total

24

31 March 2011 £000

Other liabilities Bridgewater Community Healthcare had no other liabilities at 31 March 2012 (31 March 2011: £nil).

25

Borrowings Bridgewater Community Healthcare had no borrowings at 31 March 2012 (31 March 2011: £nil).

26

Deferred income

31 March 2012 £000

31 March 2011 £000

31 March 2012 £000

0

0

0

160

0 0

0

0

Current deferred Income at 31 March 2012

160

0

0

0

Total other liabilities (current and non-current)

160

0

Opening balance at 1 April 2011 Deferred income addition

27

Non-current

Current

31 March 2011 £000

Finance lease obligations as lessee Bridgewater Community Healthcare had no finance lease obligations at 31 March 2012 (31 March 2011: £nil).

28

Finance lease receivables as lessor Bridgewater Community Healthcare had no finance lease receivables at 31 March 2012 (31 March 2011: £nil).


Annual Report 2011/12

29

99

Provisions Comprising: Pensions Relating to Other Staff £000 0 0 0 0

Legal Claims £000 6 0 (3) (3)

Restructuring

£000 318 0 (315) (3)

Pensions to Former Directors £000 0 0 0 0

0

0

0

0

0

Total

Balance at 1 April 2011 Arising During the Year Utilised During the Year Reversed Unused Balance as at 31 March 2012

Amount Included in the Provisions of the NHS Litigation Authority in Respect of Clinical Negligence Liabilities: As at 31 March 2012 As at 31 March 2011

30

£000 312 0 (312) 0

£000 0 914

Contingencies 31 March 2012 £000

31 March 2011 £000

Contingent liabilities Equal Pay Other Amounts Recoverable Against Contingent Liabilities

0 0 0

(2)

Net Value of Contingent Liabilities

0

(2)

The other liability of £2,000 at 31 March 2011 reflected outstanding insurance claims. The probablity of success was over 50% and hence the liability was included as a provision in the financial statements. The contingent liability reflects the potential full value of the claim as notified by the NHS Litigation Authority. Contingent Assets Bridgewater Community Healthcare had no contingent assets at 31 March 2012 (31 March 2011: £nil).

31

Financial Instruments

31.1 Financial risk management Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the period in creating or changing the risks a body faces in undertaking its activities. Because of the continuing service provider relationship that the NHS trust has with primary care trusts and the way those primary care trusts are financed, the NHS Trust is not exposed to the degree of financial risk faced by business entities. Also financial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which the financial reporting standards mainly apply. The NHS Trust has limited powers to borrow or invest surplus funds and financial assets and liabilities are generated by day-to-day operational activities rather than being held to change the risks facing the NHS Trust in undertaking its activities. The Trust’s treasury management operations are carried out by the finance department, within parameters defined formally within the Trust’s standing financial instructions and policies agreed by the board of directors. Trust treasury activity is subject to review by the trust’s internal auditors. Currency risk The Trust is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK and sterling based. The Trust has no overseas operations. The Trust therefore has low exposure to currency rate fluctuations. .


100

Annual Report 2011/12

Interest rate risk The Trust does not have any borrowings and therefore has low exposure to interest rate fluctuations. Credit risk Because the majority of the Trust’s income comes from contracts with other public sector bodies, the Trust has low exposure to credit risk. The maximum exposures as at 31 March 2012 are in receivables from customers, as disclosed in the trade and other receivables note. Liquidity risk The Trust’s operating costs are incurred under contracts with primary care trusts, which are financed from resources voted annually by Parliament . The Trust is not, therefore, exposed to significant liquidity risks

31.2 Financial Assets At ‘fair value through profit and loss’ £000

Loans and receivables

Available for sale

Total

£000

£000

£000

Receivables - NHS Receivables - non-NHS Cash at bank and in hand

0 0 0

7,315 3,261 4,491

0 0 0

7,315 3,261 4,491

Total at 31 March 2012

0

15,067

0

15,067

Receivables - NHS Receivables - non-NHS Cash at bank and in hand

0 0 0

1,108 0 2,777

0 0 0

1,108 0 2,777

Total at 31 March 2011

0

3,885

0

3,885

31.3 Financial Liabilities

NHS payables Non-NHS payables

32

At ‘fair value through profit and loss’ £000 0 0

Other

Total

£000 7,907 3,967

£000 7,907 3,967

Total at 31 March 2012

0

11,874

11,874

NHS payables Non-NHS payables

0 0

1,789 0

1,789 0

Total at 31 March 2011

0

1,789

1,789

Events after the end of the reporting period There are no events after the end of the reporting period.

33

Related party transactions During the year none of the Department of Health Ministers, Trust board members or members of the key management staff, or parties related to any of them, has undertaken any material transactions with Bridgewater Community Healthcare NHS Trust. The Department of Health is regarded as a related party. During the year Bridgewater Community Healthcare NHS Trust has had a significant number of material transactions (totalling £1million or more) with the Department, and with other entities for which the Department is regarded as the parent Department. These entities are:


Annual Report 2011/12

2011/12 £000

North West Strategic Health Authority Ashton, Leigh and Wigan PCT Halton & St Helens PCT Trafford PCT1 Warrington PCT St Helens and Knowlsey NHS Trust Trafford Healthcare NHS Trust NHS Pension Scheme

2010/11 £000

2011/12 £000

101

2010/11 £000

Income

Expenditure

Income

Expenditure

Receivable

Payable

Receivable

Payable

2,696

10

336

6

15

0

7

24

43,568

4,402 48,399

3,705

1,498

1,139

786

19

53,487 19,028 28,518

5,332 112 2,573

320 3 38

0 0 0

1,331 507 2,696

2,527 85 2,499

27 0 0

0 0 0

875

2,603

0

0

696

57

0

0

2,157

0

0

0

12

0

0

0

0

12,751

0

4,216

0

1,548

0

0

In addition, the Trust has had a number of material transactions with other government departments and other central and local government bodies. Most of these transactions have been with the following entities: 2011/12 £000

Halton Borough Council National Insurance Fund

34

2010/11 £000

2011/12 £000

2010/11 £000

Income

Expenditure

Income

Expenditure

Receivable

Payable

Receivable

Payable

2156 0

0 6681

0 0

0 2064

1489 0

0 986

0 0

0 188

Losses and special payments The total number of losses cases in 2011-12 and their total value was as follows:

Losses Special payments Total losses and special payments

Total Value of Cases £s 1,456 0

Total Number of Cases

1,456

94

94 0

The total number of losses cases in 2010-11 and their total value was as follows:

Losses Special payments Total losses and special payments

Total Value of Cases £s 19,862 0

Total Number of Cases

19,862

346

346 0


102

35.

Annual Report 2011/12

Financial performance targets

35.1 Breakeven performance 2011-12 £000

2010-11 £000

166,304 1,804

52,583 388

Break-even in-year position

1,804

388

Break-even cumulative position

2,192

388

2011-12 %

2010-11 %

1.08 1.32

0.74 0.74

Turnover Retained surplus/(deficit) for the year

Materiality test (I.e. is it equal to or less than 0.5%): Break-even in-year position as a percentage of turnover Break-even cumulative position as a percentage of turnover

35.2 Capital cost absorption rate Until 2008/09 the Trust was required to absorb the cost of capital at a rate of 3.5% of forecast average relevant net assets. The rate is calculated as the percentage that dividends paid on public dividendcapital bears to the actual average relevant net assets. From 2009/10 the dividend payable on public dividend capital is based on the actual (rather than forecast) average relevant net assets and therefore the actual capital cost absorption rate is automatically 3.5%. In 2011/12 Bridgewater Community Healthcare did not pay a PDC dividend because the average net assets were negative (£373,000). The PDC dividend paid in 2010/11 was £15,000.

35.3 External financing The Trust is given an external financing limit which it is permitted to undershoot. £000 External financing limit Cash flow financing Finance leases taken out in the year Other capital receipts External financing requirement Undershoot/(overshoot)

2011-12 £000

2010-11 £000

(1,666)

0 (2,743) 0 0

(1,714)

(2,743)

48

2,743

(1,714) 0 0

Due to achieving Trust status mid-year in 2010-11, the DH was unable to set an EFL for the Trust (normally set at the beginning of the financial year) and therefore the Trust had an EFL of zero.


Annual Report 2011/12

103

35.4 Capital resource limit The Trust is given a capital resource limit which it is not permitted to exceed.

Gross capital expenditure Less: book value of assets disposed of Less: capital grants Less: donations towards the acquisition of non-current assets Charge against the capital resource limit Capital resource limit (Over)/underspend against the capital resource limit

36

2011-12 ÂŁ000 1,046 0 0 0

2010-11 ÂŁ000 0 0 0 0

1,046 1,064

0 0

18

0

Third party assets Bridgewater Community Healthcare held no monies on behalf of patients or other parties at 31 March 2012 (31 March 2011: ÂŁnil).


104

Annual Report 2011/12

Useful Contacts If you have any comments on the Annual report and Accounts, require further copies or have any feedback on our services please contact: Bridgewater Community Healthcare NHS Trust Bevan House 17 Beecham Court Smithy Brook Road Wigan WN3 6PR Telephone: 01942 482630 Email: enquiries@bridgewater.nhs.uk

Why not follow us on Twitter www.twitter.co,/Bridgewater_NHS or like us on Facebook www.facebook.com/BridgewaterNHS Copies of this document and more information about Bridgewater Community Healthcare NHS Trust are available at: www.bridgewater.nhs.uk If you would like this document in another language or in a format such as Braille or audio please contact 01942 482655 or email communications@bridgewater.nhs.uk Please contact us if you require any help interpreting this document.

Bridgewater Community Healthcare NHS Trust wishes to thank our Lay Readers who proof read the text of this document and provided invaluable feedback.


Bridgewater Community Healthcare NHS Trust Bevan House 17 Beecham Court Smithy Brook Road Wigan WN3 6PR Tel: 01942 482630 | Fax 01942 482660 Email: enquiries@bridgewater.nhs.uk | www.bridgewater.nhs.uk


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