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NHS Kirklees Annual Report 2009/10


Annual Report 2009/10 contents

Page Welcome

3

All about us

4

NHS Kirklees - a commissioning organisation

6

Working with our partners

9

Improving health for all

10

Improving our services

12

Listening to you

15

Risk management

20

Emergency planning

21

Primary care developments

22

Valuing our staff

23

Our new headquarters – a positive impact on the environment

26

Our directorates and the Board

27

Director of Financeâ€&#x;s report

28

Remuneration report

32

Declarations of interest Statements

2


Welcome Welcome to the fourth annual report for NHS Kirklees. Since the Primary Care Trust was formed in October 2006 we have made measurable progress in improving the performance of the local NHS here in Kirklees and in 2008/09 the quality of services as assessed by the Care Quality Commission were judged to be „goodâ€&#x;. Our role is to ensure that high quality, safe and responsive health services are provided for local people when they need them and to improve the health of our local population by supporting people to adopt healthy lifestyles and reduce the health inequalities that exist across Kirklees. In 2008/09 we published our first five year strategic plan which sets out our plans and priorities up to 2014. During 2009/10 we have continued to make good progress in delivering these plans and we are pleased to share some of these achievements in this report. There are many factors that affect peopleâ€&#x;s health and we know that we cannot deliver all of this on our own. We continue to enjoy strong and productive partnerships with Kirklees Council, our main provider organisations, other public sector organisations, the voluntary sector and the business community. Another key factor in our success is the close working relationship we have with local doctors, nurses and other health care professionals which has contributed to our success. It is important we listen and respond to what local people are telling us and later in this report there are some examples of how we have involved you in evaluating and changing services. Our achievements have only been possible by our dedicated staff who work hard to ensure that we use the resources provided to us in the best possible way and that what we do makes a difference. We are proud of our achievements and pleased to report these to you.

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All about us NHS Kirklees covers a population of both urban and rural communities with a total population of nearly 425,000 (Family Health Services, 2006). Of that population a quarter are aged under 19 and a quarter are aged over 65 years. By 2025, the population is predicted to increase by 7%. This is mainly in those aged over 65 years. Kirklees has pockets of relative deprivation for both children and older people. This is generally concentrated in and around Huddersfield town centre and Dewsbury in particular. Across Kirklees 27% of children aged 0 -15 years were classed as living in poverty and 21% of those aged over 65 years. Kirklees has a diverse ethnic mix, with a higher proportion of the population coming from ethnic minorities than for England as a whole. Ethnicities present in Kirklees include those of Pakistani origin, Indian origin and African-Caribbean origin but the largest group remains of white origin. Many of the people living within our boundaries identify closely with the locality in which they live, rather than with Kirklees as a whole. Together with Kirklees Council, we recognise this by working in partnership in the seven distinct localities that make up the district. These localities are: The Valleys Huddersfield North Huddersfield South Denby Dale and Kirkburton Dewsbury and Mirfield Spenborough Batley, Birstall and Birkenshaw. We are committed to working in partnership because we know that this is the way to achieve real success for Kirklees. In particular, we have a strong relationship with Kirklees Council, including a joint Director of Public Health and other shared posts. This partnership is helping us to focus our attention on improving health and reducing health inequalities that exist across Kirklees. We also work with other key stakeholders such as Calderdale and Huddersfield NHS Foundation Trust, the Mid Yorkshire Hospitals NHS Trust and the South West Yorkshire Partnership NHS Foundation Trust, as well as the community and voluntary sectors.

Our vision and values Working together to achieve the best health and well-being for all the people of Kirklees Recognising that people are at the heart of everything we do; Supporting people in taking responsibility for their own health and well-being;

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Encouraging innovation and continuous improvement and celebrate the contribution made by our staff; Encouraging open, clear and honest communication; Valuing diversity and challenge discrimination; Showing understanding, dignity and respect for all our clients, partners and staff; and Being accountable for the decisions we make, the work we do, the resources we use and our impact on the environment.

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NHS Kirklees – A commissioning organisation NHS Kirklees is responsible for improving the health and well being of local people and making sure that services are in place to meet your needs. We commission services from others, including GPs, dentists, pharmacists, opticians, voluntary organisations and local and specialist hospitals. We are accountable for making sure that these services are accessible, high quality and safe. So that we understand your needs we need to: have a good understanding of public expectations and political drivers have active engagement with local people involve clinical leaders in assessing local needs and shaping priorities. Other key factors which drive our strategic decision making are the national and local priorities, local population characteristics and needs as shown in the Joint Strategic Needs Assessment (JSNA). The process for developing the JSNA has enabled us to identify key issues for specific populations such as people with disabilities, women of child bearing age and older people. It also looks at conditions such as heart disease, stroke, obesity, diabetes and dementia as well as wider living and working factors including employment, housing and educational attainment and personal behaviours such as smoking, alcohol, food and nutrition. We are proud of our achievements and can demonstrate how we have made and are continuing to make progress against the priorities identified last year. We have commissioned a range of new services to respond to the needs of our population for example: an adult weight management service a range of services to address the growing problem of alcohol misuse, ranging from services in primary care to specialist alcohol treatment services services to support people with long term conditions, including the introduction of a new primary care based system that will let us identify those people most at risk of worsening health in the future so we can take action to support them further developments in telehealth and telecare that will improve our ability to deliver services and support people in their own homes and to let them take more control over managing their own care. In addition to these new services, we have reviewed and improved existing services, for example, services for people with breathing problems and mental health services for children and young people. However, there still remains more to do. In particular we face significant challenges around managing our money and meeting increasing performance targets. To address these, we will focus on commissioning services to meet our four strategic goals, which are: Goal 1

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Raise male and female life expectancy at birth so that it is not significantly below the national average in any part of Kirklees. Goal 2 Improve health outcomes for children and young people, working in partnership to improve life chances and safeguard children. Goal 3 Target individuals and populations to tackle health and well being inequalities, focusing on the priority issues identified locally. Provide advice, support and care to these individuals, families and communities, in the form of high quality targeted interventions known to work, to increase the control they have over their own health and wellbeing. Goal 4 Empower those people in Kirklees with a long term condition to exercise control over their own lives and be central to the decision making about their own care, so preventing problems arising or worsening and enabling them to independently manage their own health and well being. Kirklees Community Healthcare Services (KCHS) Kirklees Community Healthcare Services (KCHS) is the part of NHS Kirklees responsible for providing services directly to patients. In common with the rest of the country the provider and commissioning arms are separating to increase transparency and accountability. KCHS is now in a contractual relationship with NHS Kirklees. KCHS provide community services such as district nursing, health visiting, school nursing, therapy services, chlamydia screening and stop smoking support across Kirklees. The majority of our care takes place in patient‟s homes, with services able to respond to each persons unique circumstances. Services provided by KCHS extend to include the provision of ward based care in Holme Valley Hospital and intermediate care in partnership with nursing homes throughout Kirklees. Minor surgical procedures are also carried out in Holme Valley Hospital, Dewsbury Health Centre and Moorfields Primary Care Centre. As a new and vibrant organisation, KCHS has concentrated on providing the best quality care, whilst using technology to allow it to be as efficient and productive as possible. KCHS has tried to capture its very essence by choosing „Caring for you, locally‟ as its motto. These words describe the strengths: our experience in delivering first class healthcare and vast local knowledge. Over the last year KCHS has concentrated on delivering the following: making sure that the organisation constantly improves services and that safety and quality are at the centre of everything we do. rolling out an ambitious programme of mobile technology to allow front line services to have immediate access to all their clinical records in patient‟s homes. This is one of the largest uses of this technology in the country. working very closely with partners, in particular in social care, to make sure a seamless service is provided, reducing duplication and improving efficiency. empowering service and clinical leaders to take more decisions based on the health needs they are dealing with, making sure the interests of the patient are best served.

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The pace of change for community services continues, and by making sure the patient remains at the centre of everything, KCHS will be well placed to provide the best and most cost effective services.

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Working with our partners Our work with the Kirklees Partnership has enabled the delivery of a joint Sustainable Community Strategy which covers the period 2009 – 2012. This sets out the strategic direction and long term vision for Kirklees. The aim is to promote the social, economic and environmental well-being of the area. The overarching vision for this strategy is: “By 2020 Kirklees is recognised in West Yorkshire and beyond as an area of major success. Its strong economy is supported by an attractive, high quality environment, offering the best of rural and urban living.� Partners such as the council, the NHS, the police and others need to focus on the following five themes: educational attainment low skills and low wage economy infant mortality and health inequalities low confidence in some of our towns community relations. The Local Area Agreement (LAA) focuses partnership working on those priorities which matter most to Kirklees and the partnership. These are grouped into the four themes of partnership working: 1. children and young people 2. safer stronger communities 3. healthier communities and adults 4. economic development and the environment. We also have joint commissioning strategies in place for mental health, learning disabilities, older people and long term conditions, as well as health inequalities and health behaviours.

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Improving health for all Health inequalities is how we describe the differences in health and life expectancy between different groups of people in Kirklees. These have the potential to be changed and one of the main aims of NHS Kirklees is to reduce these differences. For example:      

If you are a man in Dewsbury you are likely to live 4.9 years less than a man in Holme Valley If you are a woman in Batley you are likely to live 4.1 years less than a woman in Holme Valley 1 in 3 of people aged 18-24 smoke compared with 1 in 9 of those aged over 65 7 in 10 of people with heart disease or pain were overweight compared to 3 in 10 people who did not have these problems. This is far worse than it was in 2005 6 in 10 of new local cases of lung cancer were in women aged under 65 which is higher than the national figure People with a physical disability were seven times more likely to feel cut off from others than adults overall.

NHS Kirklees and Kirklees Council has used this type of information to develop our Joint Strategic Needs Assessment that tells us what different health needs are across Kirklees http://www.kirklees.nhs.uk/fileadmin/documents/About_Us/FINAL_Report_JSNA.pdf This is available as either a summary or full version.

The table below shows our priorities for improving health locally For adults For children and young people Who are our target Young adults (18-44), particularly women. People with learning disabilities groups? Older people People with disabilities Being healthy – Improving emotional well-being Reducing the rates of infant what areas of health Reducing obesity mortality are we trying to Helping people to reduce and mange their Improving emotional well-being improve? pain Reducing obesity Dementia Reducing the rates of heart disease and stroke Reducing the rates of diabetes Personal behaviours Improve our diet so we eat healthily Improve our diet so we eat healthily – what do we do that Reduce our alcohol intake Stop smoking can help improve Stop smoking Be more physically active Reduce our health Be more physically active the number of teenage pregnancies Improve sexual health Living and working Housing affordability and adequacy – being Improving educational attainment – what are the other able to have a home Being unhappy and not having factors that we know Employment and income – having a job and friends and family affect health money Making children safe and protecting Isolation and social networks – having friends them from harm - safeguarding and support (child protection) Educational attainment and skills – having qualifications and skills that help you to find a job NHS Kirklees works with partners such as hospitals, community services, the council, the police and voluntary sectors to improve our health priorities. Examples of this include:

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Stroke We are trying to reduce the impact of stroke on local people by: increasing widespread awareness of the signs of stroke making sure that care is delivered promptly in the right place so it is effective in reducing the impact of a stroke preventing a stroke by identifying and supporting people who have risk factors and helping people to learn how to control them. Women of child bearing age working with women of child bearing age who smoke, particularly in Batley and Dewsbury localities providing early support in pregnancy for clinical, health and social issues action to support good nutrition for women before, during and after pregnancy. These activities are crucial in reducing infant deaths, improving infant and family health and reducing smoking related disease in women. In this report you will be able to read about these and other issues and the ways in which we are working to improve the health of local people. Some of the health improvements we have seen since 2008/09 include: rates of death from all cancers have improved and remain better than the national rate over 2,000 people in Kirklees have successfully stopped smoking Kirklees schools all participate in the National Health Schools programme with 77% achieving the status by December 2009.

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Improving our services NHS Kirklees is committed to continually improving the quality of services we provide for you. We work with all of our providers to give you more information and choice about the services we offer. Quality boards have been formed with all our main providers so that we can be confident that we are commissioning and delivering safe and effective services for you. The boards are led by, for example, medical and nursing directors from each organisation and clinical representatives from primary care. The aims of the boards are to: o

identify quality priorities

o

make sure regional quality indicators are achieved

o

identify and monitor core quality standards

o

set priorities for continuous quality improvement;

o

monitor the delivery of national quality standards.

NHS Kirklees has made significant progress over the last 12 months to improve the quality of our commissioned services. Some of our achievements are as follows: Long term conditions (LTC) and intermediate care “The Department of Health strategy for long term conditions aims to put people with long term conditions at the centre of decision making about their own care. In this way, they will personalise the services they need so they are truly supported to live life as they want” Department of Health, 2010 We are committed to delivering high quality services for people with long term conditions. In the last year we have built upon our 2008/09 achievements and continue to improve services for the people of Kirklees. What we have achieved We have re-designed existing long term conditions services and further developed a number of these to provide care which is more suitable for people‟s individual needs. These include: a new discharge service for people with chronic obstructive pulmonary disease (COPD - that causes breathing problems) which lets people go home from hospital early has been introduced. This will provide people with specialist support at home for up to 14 days. family and carers support service for people and their carers following a stroke. round the clock staff who provide support for health or social care needs. Registered health or social care staff to help stop people having to go into hospital and, where they do, make sure they can come home as early as possible. assistive technology – this is new equipment that helps health care professionals and their patients share information. It monitors health to improve care and helps people

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care for themselves better. One hundred of these devices have been issued across Kirklees. the introduction of a tool which can predict the risk of future hospital admissions and provides data on the use of current services. This will help us to make valuable decisions about the services and support that local people need. improvement of service quality and safety for patients in Kirklees which will focus on the prevention of hospital admissions, enabling people to be cared for out of hospital, and the improvement of self care. make sure that the services we commission are what patients want and receive. We will provide individual care plans which help people to reach their full potential and meet their personal goals. Intermediate care services Intermediate care is what we call a range of integrated services that: Promote faster recovery from illness Prevent you from going in to hospital unnecessarily Support timely discharge when you do go into hospital Maximise independent living. These services are mostly, but not solely, used by older people. The idea behind them is that they bridge the gap between hospital and home so that you recover faster and can cope on your own more easily. What we have achieved A single point of contact has been established: one telephone number that clinicians can ring to gain access to support and advice about services available. There is a clinical lead who deals with all requests as well as delivering more individual assessments to make sure the correct package of care is delivered for each person. During the year, working in partnership with Kirklees Council, the South West Yorkshire Partnership Foundation Trust, Dementia UK and the Alzheimerâ€&#x;s Society has meant that Kirklees will have its first ever admiral nurses - specialist nurses who will support individuals with dementia and their carers. The development of the Kirklees Dementia Strategy and implementation plan to make sure that our health and social care services are ready for future challenges. This recognises the importance of carers and raising levels of awareness amongst the wider population of the major role carers play in the lives of their loved ones. Linked with carers and so many other areas of work across both health and social care is the developing End of Life Care Strategy. Most importantly, the strategy recognises the fact that we have only one chance to get things right at the end of life and this must be the ambition we strive to achieve.

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Mental health NHS Kirklees has worked with partner agencies to find ways of working together to achieve better outcomes for our patients. Existing partnerships such as those with Kirklees Council and specialist mental health providers have remained strong. We have also explored other forms of partnership working such as those involving the independent and not for profit sectors. What we have achieved During 2009/10 we have developed our mental health services to make sure they are appropriate for local people whatever their age. We have also commissioned a number of new service developments, including: community service for adults with attention deficit and hyperactivity disorder (ADHD) community eating disorder service primary care mental health service. More information about our future plans can be found in the Joint Mental Health Commissioning Strategy 2008-2011 www.kirklees.nhs.uk/fileadmin/documents/publications/Kirklees_Joint_Mental_Health_C ommissioning_Strategy_-_2008.pdf which is based on both national guidance and the local needs assessment. Learning disabilities We have worked with both our specialist health service, and social care providers to improve our learning disability services. What we have achieved During 2009/10 NHS Kirklees has commissioned new service developments, including: learning disability health action plans vulnerable In-Patient (VIP) cards specialist respite services enhanced primary care services new low secure service provision. We have also improved our learning disability low secure forensic services for local people by reviewing existing services, criteria, working practices, referral patterns, average lengths of stay and revised Department of Health forensic guidance.

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Listening to you As the local leader of the NHS we want to make sure that all NHS services used by you are of the best possible quality. By working together we make sure that everyone benefits from improved healthcare. It means putting patients at the centre of all we do in the health service. This includes involving patients and the public in: sharing your ideas and experiences identifying what you want from services making sure you understand our plans, and why services need to be changed, so that we make the best use of our resources. Public consultations During 2009/10 NHS Kirklees consulted on: The Mid Yorkshire Service Strategy Proposals for changes to services in Mid Yorkshire stemmed from the best clinical evidence, feedback and views previously gained from local people, new national guidelines and information from the national NHS review led by Lord Darzi. The changes proposed were to ensure that the three hospitals that make up The Mid Yorkshire Hospitalâ€&#x;s NHS Trust functioned in the best possible way, to provide the best possible care for patients and to help us respond to the changes that we expect to see in healthcare over the coming years. Following the outcome of the public consultation, the partnership board has supported the development of dedicated specialist centres for neonatal intensive care, childrenâ€&#x;s inpatient surgery and inpatient orthopaedic trauma. These will open at the new Pinderfields Hospital, when it fully opens in 2011.

Holme Valley Memorial Hospital (HVMH) Proposals to improve the facilities at HVMH are part of NHS Kirkleesâ€&#x; aim to provide patient centred care closer to home. Proposals to improve the facilities and range of services at HVMH include: a ward with 20 beds for patients who have to stay in hospital * facilities for minor surgical procedures physiotherapy podiatry outpatients appointments diagnostic tests and imaging including x-ray, ultrasound, electrocardiogram (ECG) and blood tests intravenous therapies such as chemotherapy specialist community dental services for clients who are unable to access regular dental services. * these services are already provided at Holme Valley Memorial Hospital.

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Consultation events took place over the summer months and we are developing the business case to secure funding to take this project forward. By making these changes we will get the best possible clinical outcomes for our patients.

Patient experience In 2009/10 NHS Kirklees looked at new ways to get information and work with local people to find out what they thought about us as an organisation and what they thought about health services in the area. The Comments Campervan is a mobile diary room where people can go to give their comments on the services provided by NHS Kirklees. The van attended several public events in 2009 so that we could get the opinions of Kirklees residents to improve your understanding of our role in improving local services. We also held a number of patient discussion groups with: People who had had a hip replacement in the previous three to six months. They had the opportunity to share experiences of their journey, including before surgery, the referral, surgery and recovery. People who experience persistent pain conditions i.e. lasting longer than three to six months and who are not responding to standard treatment. These activities have given us greater understanding of patientâ€&#x;s experiences of services. The information has been used to improve care services for patients suffering from long term pain. How we used what you told us Kirklees Drug and Alcohol Action Team You said Alcohol misuse and associated problems are a significant issue in Kirklees where over a third of Kirklees adults drink at levels that are placing their health at risk. Consultation with patients and the public identified that they want an alcohol treatment service that is easily accessible and separate from drug services. We did NHS Kirklees secured Neighbourhood Renewal Funding that went on to fund two specialist alcohol workers and an alcohol nurse. The funding also supported the Kirklees Partnership to develop the Kirklees Alcohol Strategy (2007 – 2010). Attention deficit hyperactivity disorders (ADHD) service You said Through consultation with parents, carers, children and young people we found out that they wanted well-timed and up-to-date information about ADHD, quick and easy access to services, parenting support, practical advice and coping strategies, an out of hours crisis contact number covering weekends and clarity about the roles and responsibilities of the different team members and agencies involved in ADHD service provision. Children and young people wanted to be listened to and their views about ADHD and the treatment options to be taken into account. They wanted school staff to have training on

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how to support pupils with ADHD, and to receive appointments via SMS text or email with reminders about appointments, follow up or contact sessions to be carried out over the phone where appropriate and a young persons support group where they could meet with other young people experiencing ADHD. Parents and carers requested coordinated and organised care plans for the child/young person which incorporated school and home based interventions, to be listened to, be encouraged for getting things right, and the service delivered in community locations closer to home. We did We have re-designed the ADHD service to include the things children, young people and families told us they wanted. We developed our service specification so that: • Services are delivered close to home in local children‟s centres • A range of parenting programmes will be offered to all parents and carers • A training programme will be rolled out so that schools and others will be more informed and able to manage children and young people with ADHD • A twice weekly drop-in session for families needing crisis support • Appointments are co-ordinated around the lives of children, young people and their families • All children and young people will receive a comprehensive assessment and treatment service.

Adult weight management service You said We consulted with health practitioners, adult service users and our adult target group about weight management and found the following: Health practitioners: • Men feel uncomfortable talking about the issue and taking action • Patients are more likely to use weight management programmes if they can afford to • Health care workers or peers may be better placed to motivate patients • People are not aware of all of the services that exist and different ways in which people can manage their weight Adult service users: • Most often use commercial weight management programmes such as Weight Watchers, Slimming World and other methods of self help • Their awareness of NHS services was low but there was a very high demand for programmes offered through the NHS • A lack of time and the cost of attending formal weight management activities are major barriers to attempting to lose weight. The adult target group:

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• Were put off services by the humiliation of the „weigh-in‟ and the people attending who were not seen as very overweight • Found cost was a barrier to them attending weight management programmes • Were turned off by attending hospital based weight management services as it felt impersonal • Men perceive weight management services as inappropriate and wanted materials targeted at them. We did We identified and approached key stakeholders to form an Expert Reference Group to shape the redesign of weight management provision. Throughout the process there was full clinical engagement. This group used the insight received from health practitioners, adult service users and our adult target group as a starting point for the review and redesign process. A „Healthy Weight 4 Kirklees‟ public website was introduced, providing the people of Kirklees with a one stop shop of information about the Kirklees Adult Weight Management Service, what‟s new, other local services, and where to get more information for themselves and their children.

Pilot diabetes expert patient programme A health needs assessment conducted in the Birkby and Fartown areas of the Huddersfield North locality identified a high prevalence of diabetes among the South Asian Community. Further consultation with community individuals and local health care professionals identified a lack of understanding about diabetes prevention, management and the services available to support self care. You said You wanted more support to increase your understanding of diabetes and what you can do to improve our health. We did We set up a project to increase awareness of diabetes and improve self care skills. Part of this project involved piloting a diabetes specific expert patient programme aimed at the South Asian community.

For further and more detailed information on public consultations and patient experience, please refer to the Patient and Public Involvement Annual Report 2009/10 at http://www.kirklees.nhs.uk/fileadmin/documents/PPI/Annual_Report_2010/2_ppi_Annual _Report.pdf?issuusl=ignore What happens when you have problems? NHS Kirklees welcomes and values any comments or suggestions on your healthcare services. We can learn from these and make improvements for you.

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We will respond to any complaints we may receive with the aim of making system or service changes to improve your experiences. We have a dedicated Patient Advice and Liaison Service (PALS) who help and advise on resolving any difficulties you may have. In 2009/10 NHS Kirklees handled 61 complaints. The following table shows a breakdown of these complaints: NHS Kirklees Antiviral collection service during the swine flu outbreak Commissioning Diabetic screening Freedom of information Exceptional case funding requests Health centre parking Immunisations Kirklees Community Health Services (KCHS) Contraception and sexual health Community dentistry District nursing Health visiting and school nursing Podiatry Phlebotomy Therapy services Walk in centre

1 6 3 2 2 1 1 5 14 5 6 2 2 8 3

We aim to learn from complaints and improve those services. When looking into complaints raised by individuals, NHS Kirklees is committed to following the „principles for good administration‟ and „principles for remedy‟. From 1 April 2009 there has been a single approach to dealing with complaints across health and social care. It also encourages a culture that seeks and then uses people‟s experiences to make services more effective, personal and safe. We always try to learn and improve as a result, so all comments, complaints and compliments give us useful feedback on services to change things for the future. Here are a few examples where we have done this: Kirklees Community Health Services have reviewed all baby assessment centres NHS Kirklees have reviewed parking policies with a view to increasing availability for patient parking at Cleckheaton Health Centre Continuing healthcare and care planning training is to be given to staff and service users Within community dental services, clinics must now to notify patients of cancellations both in writing and by telephone.

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Risk management This is the process that NHS Kirklees uses to make sure that it works efficiently and effectively. It means we try to anticipate problems that can happen and take action to prevent them. We aim to make sure that any problems have as little impact as possible on patients, staff and services. All staff have regular training in health and safety, fire, infection control and how to manage aggressive situations. We also have an incident reporting system in place which helps monitor any trends in accidents or incidents and take action to minimise the likelihood or prevent such things happening again. Our risk management team report incidents nationally to the national patient safety agency and to the counter fraud and security management service so that we can see how we perform compared with other similar organisations. An important area which we have been working on in 2009/10 is data security. We have reviewed all our policies that have an impact on data security and undertaken work to make sure all our computers and memory sticks are encrypted to protect any information that is held by NHS Kirklees. However we have had one data security incident this year which was reported as a serious untoward incident. This was investigated and successfully resolved with no adverse effect on patients. We have made sure that our new headquarters building has good security systems in place to protect staff and visitors. NHS Kirklees has maintained its Royal Society for the Prevention of Accidents bronze award and this year received the silver award. During 2009/10 we have developed our Patient Safety Strategy to make sure that patient safety is seen as everyoneâ€&#x;s responsibility. The Governance Committee is the board sub committee that oversees these key risk areas and reports to NHS Kirklees Board.

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Emergency planning In 2009 NHS Kirklees and its partner agencies were faced with the global swine flu pandemic and our experience gained from years of emergency planning, preparation and training, helped us to respond effectively to this emergency. We led a highly successful local multi-agency response to pandemic flu (H1N1) to lessen the local impact of this pandemic across Kirklees. This included managing a complex outbreak in Dewsbury involving different groups of people and settings. Having established effective control systems to address the initial impact of the pandemic, NHS Kirklees mobilised staff and resources to undertake a complex vaccination programme of people most at risk from swine flu. This included essential frontline staff from health and social care. NHS Kirklees achieved the highest uptake in healthcare workers for a primary care organisation regionally at 53.6%. This was due to visible senior leadership, effective communication and a dedicated core immunisation team that was flexible in timing and administering of the programme. NHS Kirklees is not complacent. Planning and testing of emergency preparedness will continue to make sure we respond effectively to future threats or other pandemic viruses. During the year NHS Kirklees took on as lead Primary Care Trust, responsibility for coordinating emergency planning across West Yorkshire, ensuring that the NHS works effectively with other key players, for example, the police, fire and rescue service, local authorities, through the West Yorkshire Resilience Forum.

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Primary care developments Nationally and locally, the NHS is changing to provide world class healthcare that‟s easy to access and meets the needs of each person, especially the most vulnerable and those in greatest need. Improving access to primary care is really important – so you can see a health professional at the time and place of your choice, knowing that you are receiving the best care for you and your family‟s needs. Improving access to GP services More than 83% of GP practices in Kirklees now offer extended hours in addition to their normal opening hours. Last year NHS Kirklees opened a new GP practice in Dewsbury Health Centre that anyone can use offering services from 8.00am to 8.00pm each day of the year. Access to dental services Access to emergency dental treatment out of normal working hours is available following assessment through the West Yorkshire Urgent Care Service. Patients without a dentist can access this service and receive in-hours emergency appointments at dental practices across Kirklees.

GP and dental training practices NHS Kirklees, NHS Yorkshire and the Humber, the Strategic Health Authority and the Yorkshire Deanery have invested a total of £800,000 to support nine GP practices and five dental practices in extending their premises to allow them to accommodate additional vocational trainees. These GPs and dental vocational trainees will work with established and qualified GPs and dentists as part of their training programme. From experience it is known that many trainees when qualified remain in the area and this will help us retain newly qualified practitioners. Quality and Outcome Framework (QOF) The Quality and Outcome Framework (QOF) was introduced in April 2004 to improve patient care by rewarding GPs for quality rather than quantity of work. Since 2004 achievements in QOF points have increased and in 2008/09 the average QOF points for GP practices in Kirklees are 954.5 points with four practices achieving the full 1000 points available.

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Valuing our staff As at 31 March 2010, NHS Kirklees employed 1574 staff, of which 1201 worked for Kirklees Community Health Care Services (KCHS). NHS Kirklees has now successfully met the criteria for Investors in People, the UKâ€&#x;s leading people management standard, which was awarded on 13 January 2010. Around 150 staff from across NHS Kirklees and KCHS took part in the assessment process, which included both in-depth one-to-one and group interviews. The evidence gathered was used to establish whether the aims and ambitions of senior managers are understood and being implemented by those throughout the organisation. Following the last NHS staff survey for NHS Kirklees, greater emphasis has been placed on people development through new initiatives and strengthening those already in place. This includes revising the mandatory training programme and personal development reviews. A leadership framework is also being put in place to make sure every member of staff knows what is expected of them and has the skills and support to deliver objectives. Equality and diversity As a public sector body, NHS Kirklees has a duty to monitor its workforce on key employment indicators by ethnicity, disability status, age and gender to make sure that there is no discrimination against any of these groups. NHS Kirklees has decided to extend this to include data on sexual orientation and religion or belief. NHS Kirkleesâ€&#x; Diversity and Equal Opportunities in Employment Policy/Procedure, which includes information about our disability policy can be found at http://www.kirklees.nhs.uk/public-information/policies-and-procedures/employment-policies/ The equality data for employed staff as at 31 March 2010 is outlined as follows:

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Gender Male Female

Count % 138 8.8% 1436 91.2%

Disability Yes No Not declared Undefined

Count

Religion/ Belief Atheism Buddism Christianity Hinduism Islam Judaism Sikhism Other Not Declared Undefined

52 1291 228 3

% 3.3% 82% 14.5% 0.2%

Count % 108 6.86% 2 0.13% 831 52.8% 10 0.64% 57 3.62% 1 0.06% 8 0.51% 58 3.68% 498 31.64% 1 0.06%

Age: Under 25 25-34 35-44 45-54 55-64 65+

Count % 52 3.3% 307 19.5% 480 30.5% 525 33.35% 198 12.58% 12 0.76%

Ethnicity: White Mixed Asian/Asian British Black/ Black British Chinese or other ethnic group Undefined

Count % 1428 90.7% 15 0.95% 95 6% 24 1.5%

Sexual Orientation Bisexual Heterosexual Gay Lesbian Not declared Undefined

Count

7 5

0.45% 0.3%

1 1027 2 5 538 1

% 0.06% 65.25% 0.13% 0.32% 34.18% 0.06%

N.B: Not declared means people would not say. Undefined means that people did not answer the question. Sickness information From 1 April 2009 to 31 March 2010 the sickness rate for NHS Kirklees was 3.98%. This is below our target rate of 4.9% and the national NHS average of 4.4%. The Human Resources/Organisational Development shared service works with managers to manage sickness and submit regular workforce scorecard reports to the Governance Committee. The total cost of sickness absence for 2009/10 was £1.7m. Annual staff awards 2009 The annual NHS Kirklees staff awards took place in October 2009. Over 300 staff attended the event to celebrate the long service, achievements and dedication of our colleagues across NHS Kirklees. For the first time separate awards were presented to both the commissioning and provider parts of the organisation as well as 27 members of staff who were presented with long service awards and vouchers in recognition of 25 years service to the NHS. Queen’s garden party Two lucky members of staff enjoyed a visit to Buckingham Palace after being invited to attend one of this summers royal garden parties.

24


Sheila Dilks, Director of Patient Care and Professions, was nominated to attend the garden party in recognition of her long service to the NHS. Her career, which began in nursing has spanned 35 years during which she has worked as a midwife and health visitor as well as a national role with the Department of Health. Barbara Cruddas, Receptionist at Broad Lea House, was nominated by her line manager Pat Patrice in recognition of her commitment to the organisation. Pat explained, „Barbara always goes beyond what she has to do – she is helpful and I don‟t think people realise the hard work that she does.‟

25


Our new headquarters – a positive impact on the environment In February 2010 NHS Kirklees moved into a new headquarters. This is a key change for staff at NHS Kirklees and has enabled all commissioning staff to move into one building at Bradley Business Park. This was prompted by the planned closure of the St Luke‟s site. Advice was sought from the District Valuer to confirm that the plans represented value for money. There will be an annual saving of a minimum of £98,000 on headquarters running costs so nearly £1million over 10 years. This change was intended not only to provide an improved working environment for our staff but to have a positive impact on our carbon footprint. NHS Kirklees has approved an environmental strategy http://www.kirklees.nhs.uk/fileadmin/documents/publications/Kirklees_PCT_Environmental_s trategy_V5_13.05.10.pdf in line with the overall NHS strategy „Saving Carbon, Improving Health‟ and to show how we are working to meet our vision and values for Kirklees. It sets out how we aim to minimise the environmental impact of our services and explains our sustainability objectives. The aim of it is to make sure that environmentally responsible practices and procedures are used to reduce the overall impact on your health. The landscaping on the new site has seen planting of trees which is supporting the natural environment and wildlife in the surrounding area. The building was designed by low carbon consulting engineers incorporating measures such as high efficiency glazing and better building insulation. The lighting used is high efficiency throughout and the building incorporates an automatic reading system to determine where energy is being expended to allow us to review our energy use within the building and make changes to reduce energy consumption. The building has been registered under the Building Research Establishment‟s Environmental Assessment Method (BREEAM) at a rating of very good. This represents an energy efficient design through the careful selection of sustainable materials and environmentally friendly mechanical and electrical installations. This change also means that staff travel between sites will be reduced which also enables us to reduce our CO2 emissions. As well as the building change we have also introduced other initiatives such as home working and a cycle to work scheme. These not only have a positive impact on the environment but also on staff wellbeing. We are also planning to pilot a recycling scheme at Broad Lea House to see how we can maximise what we recycle and reduce overall waste and waste disposal costs.

26


Our directorates and the Board Rob Napier  Chairman*

Valerie Aguirregoicoa  Non-executive   director*

Tony Gerrard  Non-executive director*

Mehboob Khan  Non-executive director*

Rob Millington  Non-executive director*

Imran Patel  Non-executive director*

Vanessa Stirum  Non-executive director*

Sheila Dilks  Executive Director of Patient Care and Professions*

* Voting members of the Board

Dr Peter Flynn  Director of   Performance and Information

Dr Judith Hooper  Executive Director   of Public Health*

Sarah Brackwell  Health Visitor

PEC representatives

Mike Potts  Chief Executive*

Helena Corder  Director of Corporate Services

Dr David   Anderson  GP/PEC Chair*

Bryan Machin  Executive Director   of Finance*

Carol McKenna  Executive Director of Commissioning and Strategic Development*

Sue Ellis  Director of Human Resources and Organisational Development

N.B. Sarah Brackwell was a PEC representative until August 2009.


Director of Finance’s report I am pleased to report that NHS Kirklees has once again achieved all the financial duties set for it by the Government. 2009/10 Performance NHS Kirklees received two separate allocations of money from the Department of Health. For 2009/10, our allocation is split two ways and includes: a revenue allocation of £645 million which we use to commission and provide health services for the population of Kirklees, many of which you can read about elsewhere in this Annual Report a capital allocation of £4.4 million which we used for improvements to buildings, equipment, and information technology. This report summarises how we have invested this money to deliver and improve health care and services for Kirklees residents. It also highlights some of the key challenges that we have addressed during 2009/10 and those that face us in the coming years. Revenue Allocation We delivered the planned surplus of £2.9 million (0.4%) against our revenue allocation. This will be carried forward to support investments in services in 2010/11. We received a 5.6% recurrent increase in our revenue allocation for 2009/10 of £31 million. After meeting the costs of inflation we were able to make significant investments in improving access to health services, improving the quality of services, improving the environment and safety in doctors’ and dentists’ surgeries and improving community services. For example we have invested: £5.0 million in hospital services to meet increased demand and ensure that the local population is able to access services in a timely manner for inpatient, outpatient, A&E and cancer services £0.8 million in extending services to treat age related macular degeneration £5.8 million in specialist regional services such as cancer treatments and drugs £4.0 million in continuing care to meet increased demand due to the ageing population and changes in regulations clarifying when people are eligible for free health care £1.2 million in services for people with long term conditions such as stroke and breathing difficulties £0.2 million in intermediate care services to promote faster recovery from illness and prevent people going in to hospital £1.5 million in services provided by Kirklees Community Health Services £0.6 million in services to help prevent people becoming ill such as making vitamin supplements available to those who most need them and to help people improve their lifestyles by changing damaging habits relating to alcohol, drugs, and obesity. We spend our money with a range of organisations. These include NHS and non-NHS hospitals, community organisations, GPs (including prescription costs), dentists, optometrists, and pharmacists. We also spend our money helping people to improve their health and well-being, such as helping people to stop smoking, promoting healthy lifestyles and encouraging access to screening services. We provide a range of community services

28


ourselves, including district and school nursing services through our provider arm, Kirklees Community Health Services. The following chart provides a summary of how we spend your money:

Spend £ms Community Health Serv ices, 55

Prescribing, 70 Other, 1

GPs, 57

A&E, 33

Dentists, 25 Opticians, 4 Learning Difficulties, 12

General and

Mental Illness, 62

Acute, 276

Maternity, 25

During the year we managed our money flexibly to meet changing circumstances. In particular, we faced higher in costs due to rises in the number and costs of people receiving treatment in hospital. We were able to fund this from our available resources by working closely with local NHS trusts and NHS foundation trusts, identifying efficiencies from within the organisations own expenditure and the fact that some new investments took longer to implement than anticipated. We have also had the benefit of money we placed in a Strategic Investment Fund held on our behalf by the Yorkshire and the Humber Strategic Health Authority (SHA). Over the course of the year we have withdrawn and used £11 million. This leaves £4 million in the fund which we are planning to spend in 2010/11. Capital Allocation During the year we have invested £4.6 million in improving infrastructure, equipment and information technology. The main areas where we have invested are: £900k in completing the upgrade of the Hawthorne Ward at the Home Valley Memorial Hospital. This was a scheme which started in the previous year, and in total we have now invested nearly £3 million on improving facilities at the ward £275k on portable ‘tough book’ computers for district nurses to improve the quality and efficiency of services they deliver £250k on a number of small schemes to improve GP premises

29


£2 million on a new head quarters building for the organisation, enabling it to bring all of its commissioning functions and staff together on one site for the first time since it was formed in 2006. This move was necessary after the owners of our previous headquarters at St Luke’s Hospital advised us of their intention to sell the site. The move will have important benefits and improve our efficiency and effectiveness. It was funded from additional capital funds made available by the SHA £600k on improving information technology and equipment for NHS Kirklees and for GP practices. We have also made grants of around £1.5 million to a number of GPs and dentists to help them improve their premises mainly to support vocational training of new clinicians and to improve infection control arrangements. Looking forward NHS Kirklees will again see its revenue allocations increase by 5.6% in 2010/11. After this, increases are anticipated to be much lower at around 1%. We recently published our five year Strategic Plan, Realising our ambition, and this explains how we will continue to work to improve the quality of health and healthcare services for the people of Kirklees in this more difficult economic climate. Although things will be more financially challenging, our history of strong financial performance means that we are in a good position to deal with this effectively. We are planning to improve our efficiency by reducing management and agency costs, joint working with other primary care trusts, and focusing on those things which help us to make the biggest improvements to the health services available to people locally. We are also working with hospitals, GPs, dentists, and other partners to make sure they continue to provide services that are good quality, effective and efficient. We take our responsibilities for safeguarding public money and achieving value for money very seriously. On behalf of the Board, the Audit Committee considers financial governance. The members of the Committee receive regular reports from our external auditors, the Audit Commission, and from our internal auditors. In addition to their statutory audit of the organisation’s accounts, the Audit Commission also provide a number of other reports that help us achieve value for money. Summary Financial Statements The Summary Financial Statements that accompany this report are taken from the Annual Accounts for 2009/10. These accounts are the first that we have produced under International Financial Reporting Standards (IFRS). These are the set of rules which we are required to follow by the Treasury and they mean that some additional information is now disclosed in the accounts. The main implication if IFRS for NHS Kirklees has been in the accounting treatment of five health centres constructed under a Private Finance Initiative around five years ago. Under the previous accounting rules these were not included as assets within our accounts. They are now included as assets in and shown in the Statement of Financial Position (previously called the Balance Sheet). The previous year’s comparative figures in the Summary Financial Statements below have been restated on an IFRS basis to allow meaningful comparisons to be drawn between years.

30


The Summary Financial Statements are intended to highlight and summarise the key financial information contained in the Annual Accounts. If you would like to receive a full set of the accounts or a copy of our Statement on Internal Control (SIC) please contact:

Director of Finance NHS Kirklees Broad Lea House Bradley Park Dyson Wood Way Bradley Huddersfield HD2 1GZ Telephone: 01484 464031 e-mail: financepa@kirklees.nhs.uk

31


Data entered below will be used throughout the workbook: 1998/99 Trust Accounts pro-forma PCT name: This year Last year This year ended Last year ended This year commencing:

NHS Kirklees 2009/10 2008/09 31 March 2010 31 March 2009 1 April 2009

Intro


NHS Kirklees Annual Accounts 2009/10


NHS Kirklees - Annual Accounts 2009/10

FOREWORD TO THE ACCOUNTS

These accounts for the year ended 31 March 2010 have been prepared by the Kirklees Primary Care Trust under the National Health Service Act 2006 in the form which the Secretary of State has, with the approval of the Treasury, directed.

Page 1


NHS Kirklees - Annual Accounts 2009/10 OPERATING COST STATEMENT FOR THE PERIOD ENDED 31 March 2010 NOTE

2009/10 ÂŁ000

2008/09 ÂŁ000

Employee benefits *1

7.1

15,083

13,904

Other costs *2

5.1

600,044

651,285

4

(12,200) 602,927

(120,057) 545,132

7.1

31,916

28,353

5.1

15,372

15,430

4

(4,906) 42,382

(4,770) 39,013

645,309

584,145

0 (7) 1,176 646,478

0 633 1,225 586,003

Commissioning

Income *3 Commissioning Net Operating Costs Provider Employee benefits *1 Other costs

*2

*3

Income Provider Net Operating costs PCT net operating costs before interest Investment income Other (Gains)/Losses Finance costs Net operating costs for the financial year

9 10 11 42.2

The notes on pages 6 to 47 form part of these accounts. *1

Note 7.1 analyses the total of commissioning and provider employee benefits.

*2

Note 5.1 analyses the total of commissioning and provider costs including employee benefits. *3

Note 4 analyses the total of commissioning and provider income.

Page 2


NHS Kirklees - Annual Accounts 2009/10 STATEMENT OF FINANCIAL POSITION AS AT 31 March 2010 31 March 2010 £000

31 March 2009 £000

1 April 2008 £000

12 13 30 17.1

32,744 41 0 0 32,785

44,626 91 0 0 44,717

47,397 107 0 0 47,504

16.1 17.1 30 31 32

270 5,687 0 0 98 6,055 0

566 6,207 0 0 90 6,863 243

361 4,712 0 0 559 5,632 0

6,055

7,106

5,632

38,840

51,823

53,136

NOTE Non-current assets: Property, plant and equipment Intangible assets Other financial assets Trade and other receivables Total non-current assets Current assets: Inventories Trade and other receivables Other financial assets Other current assets Cash and cash equivalents Non-current assets classified "Held for Sale"

15

Total current assets Total assets Current liabilities Trade and other payables

18

(44,152)

(39,887)

(34,041)

Other liabilities

20

0

0

0

Provisions

21

(588)

(334)

(547)

Borrowings

19

(712)

(696)

0

Other financial liabilities

24

0

0

0

(45,452)

(40,917)

(34,588)

(6,612)

10,906

18,548

(13) (1,414) (26,305) 0 0

(3,620) (1,642) (27,017) 0 0

(142) (1,791) (28,389) 0 0

Total non-current liabilities Total Assets Employed:

(27,732) (34,344)

(32,279) (21,373)

(30,322) (11,774)

FINANCED BY: TAXPAYERS' EQUITY General fund Revaluation reserve Donated asset reserve Government grant reserve Other reserves Total Taxpayers' Equity:

(36,086) 1,742 0 0 0 (34,344)

(25,649) 4,276 0 0 0 (21,373)

(18,737) 6,963 0 0 0 (11,774)

Total current liabilities Non-current assets plus/less net current assets/liabilities Non-current liabilities Trade and other payables Provisions Borrowings Other financial liabilities Other liabilities

18 21 19 24 20

The notes on pages 6 to 47 form part of this account. The financial statements on pages 2 to 47 were approved by the Board on 10th June 2010 and signed on its behalf by

Chief Executive:

Date:

Page 3


NHS Kirklees - Annual Accounts 2009/10 STATEMENT OF CHANGES IN TAXPAYERS' EQUITY For the year ended 31 March 2010 General fund

Revaluation reserve

Donated asset reserve

Govt. grant reserve

Other reserves

Total reserves

£000 (18,737) 0 (18,737)

£000 6,963 0 6,963

£000 0 0 0

£000 0 0 0

£000 0 0 0

£000 (11,774) 0 (11,774)

(586,003) 0 0 0 0 0 0 0 0 (591) 97 0 (586,497) 579,585 (25,649)

0 39 0 0 0 0 0 (2,629) 0 0 (97) 0 (2,687) 0 4,276

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

(586,003) 39 0 0 0 0 0 (2,629) 0 (591) 0 0 (589,184) 579,585 (21,373)

General Fund

Revaluation Reserve

Govt. Grant Reserve

Other Reserves

Total Reserves

Changes in taxpayers’ equity for 2009/10 Balance at 1 April 2009 Net operating cost for the year Net gain on revaluation of property, plant, equipment Net gain on revaluation of intangible assets Net gain on revaluation of financial assets Net gain on revaluation of assets held for sale Receipt of donated or government granted assets Movements in other reserves Impairments and reversals Release of reserves to OCS Non-cash charges – cost of capital Transfers between reserves Transfers to/(from) other bodies within the Resource Account Boundary

£000 (25,649) (646,478) 0 0 0 0 0 0 0 0 (975) 111 0

£000 4,276 0 871 0 0 0 0 0 (3,294) 0 0 (111) 0

Donated Asset Reserve £000 0 0 0 0 0 0 0 0 0 0 0 0 0

£000 0 0 0 0 0 0 0 0 0 0 0 0 0

£000 0 0 0 0 0 0 0 0 0 0 0 0 0

£000 (21,373) (646,478) 871 0 0 0 0 0 (3,294) 0 (975) 0 0

Total recognised income and expense for 2009/10 Net Parliamentary funding Balance at 31 March 2010

(647,342) 636,905 (36,086)

(2,534)

0

0

0

1,742

0

0

0

(649,876) 636,905 (34,344)

Balance at 31 March 2008 Changes in accounting policy Restated balance at 1 April 2008 Changes in taxpayers’ equity for 2008/09 Net operating cost for the year Net gain on revaluation of property, plant, equipment Net gain on revaluation of intangible assets Net gain on revaluation of financial assets Net gain on revaluation of assets held for sale Receipt of donated or government granted assets Movements in other reserves Impairments and reversals Release of reserves to OCS Non-cash charges – cost of capital Transfers between reserves Transfers to/(from) other bodies within the Resource Account Boundary Total recognised income and expense for 2008/09 Net Parliamentary funding Balance at 31 March 2009

STATEMENT OF CHANGES IN TAXPAYERS' EQUITY For the year ended 31 March 2010

Page 4


NHS Kirklees - Annual Accounts 2009/10 STATEMENT OF CASH FLOWS FOR THE YEAR ENDED 31 March 2010 2009/10 ÂŁ000

2008/09 ÂŁ000

(645,309) 13,306 1,522 (238) (1,137) (631,856)

(584,145) 1,958 7,288 (350) (1,182) (576,431)

(4,568) (27) 250 0 0 0 0 0 0 0 0 (4,345) (636,201)

(2,928) (19) 0 0 0 0 0 0 0 0 0 (2,947) (579,378)

636,905 0 0 (696) 0 636,209

579,585 0 0 (676) 0 578,909

Cash (and) cash equivalents (and bank overdrafts) at the beginning of the Net increase/(decrease) in cash and cash equivalents financial year Effect of exchange rate changes on the balance of cash held in foreign

8 90 0

(469) 559 0

Cash (and) cash equivalents (and bank overdrafts) at the end of the financial year

98

90

NOTE Cash flow from operating activities Net operating cost before interest Other cash flow adjustments Movements in Working Capital Provisions utilised Interest paid Net cash outflow from operating activities

39 38 21

Cash flows from investing activities Payments to purchase property, plant and equipment Payments to purchase intangible assets Proceeds of disposal PPE & intangible assets Purchase of financial investments (LIFT) Sale of financial investments (LIFT) Loans made in respect of LIFT Loans repaid in respect of LIFT Payments for other financial assets Proceeds from disposal of other financial assets Interest received Rental Income Net cash inflow/(outflow) from investing activities Net cash inflow/(outflow) before financing Cash flows from financing activities Net Parliamentary Funding Other capital receipts surrendered Capital grants received Capital element of payments in respect of finance leases, on-SoFP PFI and LIFT Cash transfers (to)/from other NHS bodies Net cash inflow/(outflow) from financing

Page 5


NHS Kirklees - Annual Accounts 2009/10 1. Accounting policies The Secretary of State for Health has directed that the financial statements of PCTs shall meet the accounting requirements of the PCT Manual for Accounts, which shall be agreed with HM Treasury. Consequently, the following financial statements have been prepared in accordance with the 2009/10 PCTs Manual for Accounts issued by the Department of Health. From the current year, the accounting policies contained in that manual follow International Financial Reporting Standards (IFRS) 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 appropriate the prior year comparator figures have been re-stated to an IFRS basis. There are some exceptions where prior year figures have not been re-stated as this would make comparisons between years difficult. Where this is the case, this is clearly stated in the notes. Where the PCT 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 PCT for the purpose of giving a true and fair view has been selected. The particular policies adopted by the PCT are described below. They have been applied consistently in dealing with items considered material in relation to the accounts. The PCT is within the Government Resource Accounting Boundary and therefore has only consolidated interests in other entities where the other entity is also within the resource accounting boundary and the PCT exercise in-year budgetary control over the other entity. For 2009/10, in accordance with the directed accounting policy from the Secretary of State, the PCT does not consolidate the NHS charitable funds for which it is the corporate trustee.

1.1

Accounting Conventions

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 Acquisitions and Discontinued Operations Activities are considered to be 'acquired' only if they are acquired 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 NHS body to another. Critical accounting judgements and key sources of estimation uncertainty In the application of the PCT‟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. 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. 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 entity‟s accounting policies and that have the most significant effect on the amounts recognised in the financial statements. HM Treasury has determined that government bodies shall account for infrastructure PFI schemes where the government body controls the use of the infrastructure and the residual interest in the infrastructure at the end of the arrangement as service concession arrangements, following the principles of the requirements of IFRIC 12. The PCT therefore recognises the PFI asset as an item of property, plant and equipment together with a liability to pay for it. The services received under the contract are recorded as operating expenses. In coming to the decision to account for the PFI scheme in this way, the PCT assessed the facts of the PFI scheme against the DoH Guidance 'Accounting for PFI under IFRS' and concluded that the scheme is a service concession and therefore has accounted for it under IFRIC 12 and this is covered by Note 27 in the accounts. The PCT also has a number of legal charges on residential care properties against the requirements of IFRIC 12 to see if they constituted service concessions, and also against IFRIC4 to see if they constitute leases. The conclusion was that they are neither service concessions nor leases, and the PCT has accounted for them as contingent assets in note 22. Key sources of estimation uncertainty The following are the key assumptions concerning the future, and other key sources of estimation uncertainty at the Statement of Financial Position date, that have a significant risk of causing a material adjustment to the carrying amounts of assets and liabilities within the next financial year. The PCT includes land and buildings in its accounts at values which are based on their fair values. In arriving at these fair values the PCT uses the services of the District Valuation Service. The assets were valued at the end of the financial year to ensure that the carrying amounts reflect current market conditions. Buildings make up £24.4m, and land £3.9m of the total non-current assets value of £32.7m. The asset lives of the buildings are based on the standard District Valuer lives . Of the total provisions included in the Statement of Financial Position of £1.7m, £1m relates to back to back provisions with NHS Trusts and are supported by information received from these Trusts. £0.7m relates to early retirement provisions and are supported by information from the NHS Pensions Agency.

Page 6


NHS Kirklees - Annual Accounts 2009/10 1. Accounting policies (continued) 1.2

Revenue and Funding

The main source of funding for the Primary Care Trust is allocations (Parliamentary Funding) from the Department of Health within an approved cash limit, which is credited to the General Fund of the Primary Care Trust. Parliamentary funding is recognised in the financial period in which the cash is received. Miscellaneous revenue is income which relates directly to the operating activities of the Primary Care Trust. It principally comprises fees and charges for services provided on a full cost basis to external customers, as well as public repayment work. It includes both income appropriated-in-aid of the Vote and income to the Consolidated Fund which HM Treasury has agreed should be treated as operating income. 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. Where income has been received for a specific activity to be delivered in the following financial year, that income will be deferred.

1.3

Care Trust Designation

NHS Kirklees is not a Care Trust under Section 45 of the Health and Social Care Act 2001.

1.4

Pooled budgets

The PCT has entered into a pooled budget arrangement with Kirklees Metropolitan Council. Under the arrangement funds are pooled under s31 of the Heath Act 1999 for the purchase of community equipment and a memorandum note (Note 41.1) to the accounts provides details of the joint income and expenditure. The pool (Kirklees Integrated Equipment Store) is hosted by Kirklees Metropolitan Council. As a commissioner of healthcare services the PCT has made contributions to the pool, which are then used to purchase healthcare services. The PCT accounts for its share of the assets, liabilities, income and expenditure of the pool as determined by the pooled budget arrangement. The Learning Disabilities Development Fund (LDDF) ceased to be managed as a pooled budget at the end of 2007/08 and is now operated solely by Kirklees Council. Balances remaining in the fund when it was disbanded were ring-fenced to be used for the original purposes of the pooled budget. A note (Note 41.2) is included in the accounts to show that this remaining balance has now been fully spent.

1.5 Taxation The PCT is not liable to pay corporation tax. Expenditure is shown net of recoverable VAT. Irrecoverable VAT is charged to the most appropriate expenditure heading in Note 5, or capitalised in the Statement of Financial Position if it relates to a non-current asset.

1.6

Capital Charges

A charge, reflecting the cost of capital utilised by the PCT is included in the operating costs. The capital charge is 3.5% (2008-09 3.5%) of the net average assets less liabilities except for donated assets and cash balances with the Office of the Paymaster General (OPG) or Government Banking Services (GBS) which are excluded from the calculation.

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NHS Kirklees - Annual Accounts 2009/10 1. Accounting policies (continued) 1.7 Property, Plant & 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 PCT; ● 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 a 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 PCT's services or for administrative purposes are stated in the statement of financial position at their re-valued 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 (MEA) and, where it would meet the location requirements of the service being provided, an alternative site can be valued. The PCT has moved to the modern equivalent asset method of valuation from 1 April 2009. Note 12 summarises the impact of the adoption of the HM Treasury standard approach. 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 re-valued 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 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. Gains and losses recognised in the revaluation reserve are reported in the Statement of Changes in Taxpayers' Equity. 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 written-out and charged to operating expenses.

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NHS Kirklees - Annual Accounts 2009/10 1. Accounting policies (continued) 1.8 Intangible Assets Recognition Intangible assets are non-monetary assets without physical substance, which are capable of sale separately from the rest of the PCT‟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 PCT, where the cost of the asset can be measured reliably, and where the cost is at least £5,000. 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 amortized historic cost to reflect the opposing effects of increases in development costs and technological advances.

1.9 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 PCT expects to obtain economic benefits or service potential from the asset. This is specific to the PCT 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, or where shorter, the lease term.

At each reporting period end, the PCT checks whether there is any indication that any of its tangible or intangible noncurrent 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. If there has been an impairment loss, the asset is written down to its recoverable amount, with the loss charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, 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. Page 9


NHS Kirklees - Annual Accounts 2009/10 1. Accounting policies (continued) 1.10 Donated assets Donated non-current assets are capitalised at their fair value on receipt, with a matching credit to the donated asset reserve. They are valued, depreciated and impaired as described above for purchased assets. Gains and losses on revaluations and impairments are taken to the donated asset reserve and, each year, an amount equal to the depreciation charge on the asset is released from the donated asset reserve to offset the expenditure. On sale of donated assets, the net book value is transferred from the donated asset reserve to retained earnings. The PCT does not have any donated assets.

1.11 Government grants Government grants are grants from government bodies other than revenue from NHS bodies for the provision of services. Revenue grants are treated as deferred income initially and credited to income to match the expenditure to which they relate. Capital grants are credited to the government grant reserve and released to operating revenue over the life of the asset in a manner consistent with the depreciation and impairment charges for that asset. Assets purchased from government grants are valued, depreciated and impaired as described above for purchased assets. Gains and losses on revaluations and impairments are taken to the government grant reserve and, each year, an amount equal to the depreciation charge on the asset is released from the government grant reserve to offset the expenditure.

1.12 Non-current assets held for sale Non-current assets are classified as held for sale if their carrying amount will be recovered principally through a sale transaction rather than through continuing use. This condition is regarded as met when the sale is highly probable, the asset is available for immediate sale in its present condition and management is committed to the sale, which is expected to qualify for recognition as a completed sale within one year from the date of classification. Non-current assets held for sale are measured at the lower of their previous carrying amount and fair value less costs to sell. Fair value is open market value including alternative uses. The profit or loss arising on disposal of an asset is the difference between the sale proceeds and the carrying amount and is recognised in the Operating Cost Statement. On disposal, the balance for the asset on the revaluation reserve is transferred to retained earnings. For donated and government-granted assets, a transfer is made to or from the relevant reserve to the profit/loss on disposal account so that no profit or loss is recognised in income or expenses. The remaining surplus or deficit in the donated asset or government grant reserve is then transferred to retained earnings. Property, plant and equipment that is to be scrapped or demolished does not qualify for recognition as held for sale. Instead, it is retained as an operational asset and its economic life is adjusted. The asset is de-recognised when it is scrapped or demolished. The PCT does not have any non-current assets held for sale.

1.13 Inventories Inventories are valued at the lower of cost and net realisable value using the weighted average cost formula.

1.14 Cash and cash equivalents Cash is cash in hand and deposits with any financial institution repayable without penalty on notice of not more than 24 hours. Cash equivalents are investments that mature in 3 months or less from the date of acquisition and that are readily convertible to known amounts of cash with insignificant risk of change in value. In the Statement of Cash Flows, cash and cash equivalents are shown net of bank overdrafts that are repayable on demand and that form an integral part of the PCTâ€&#x;s cash management.

1.15 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 each individual case is handled. Losses and special payments are charged to the relevant functional headings including losses which would have been made good through insurance cover had PCTs not been bearing their own risks (with insurance premiums then being included as normal revenue expenditure).

1.16 Clinical Negligence Costs From 1 April 2000, the NHS Litigation Authority (NHSLA) took over the full financial responsibility for all Existing Liabilities Scheme (ELS) cases unsettled at that date and from 1 April 2002 all Clinical Negligence Scheme for Trusts (CNST) cases. Provisions for these are included in the accounts of the NHSLA. The NHSLA operates a risk pooling scheme under which the PCT pays an annual contribution to the NHSLA which in return settles all clinical negligence claims. The contribution is charged to expenditure in the year that it is due. Although the NHSLA is administratively responsible for all clinical negligence cases the legal liability remains with the PCT. The total value of clinical negligence provisions carried by the NHSLA on behalf of the PCT is disclosed at Note 21.

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NHS Kirklees - Annual Accounts 2009/10 1. Accounting policies (continued) 1.17 Employee benefits Short-term employee benefits Salaries, wages and employment-related payments are recognised in the period in which the service is received from employees, except for leave earned but not yet taken which is not accrued for at the year end, on the grounds of immateriality. 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 PCT commits itself to the retirement, regardless of the method of payment.

1.18 Research and Development Research and development expenditure is charged against income in the year in which it is incurred, except insofar as development expenditure relates to a clearly defined project and the benefits of it can reasonably be regarded as assured. Expenditure so deferred is limited to the value of future benefits expected and is amortised through the Operating Cost Statement on a systematic basis over the period expected to benefit from the project. It should be re-valued on the basis of current cost. The amortisation is calculated on the same basis as depreciation, on a quarterly basis.

1.19 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.

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NHS Kirklees - Annual Accounts 2009/10 1. Accounting policies (continued) 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 PCT, or a present obligation that is not recognised because it is not probable that a payment will be required to settle the obligation or the amount of the obligation cannot be measured sufficiently reliably. A contingent liability is disclosed unless the possibility of a payment is remote. A contingent asset is a possible asset that arises from past events and whose existence will be confirmed by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control of the trust. A contingent asset is disclosed where an inflow of economic benefits is probable. Where the time value of money is material, contingencies are disclosed at their present value.

1.21 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 PCT as lessee Property, plant and equipment held under finance leases are initially recognised, at the inception of the lease, at fair value or, if lower, at the present value of the minimum lease payments, with a matching liability for the lease obligation to the lessor. Lease payments are apportioned between finance charges and reduction of the lease obligation so as to achieve a constant rate on interest on the remaining balance of the liability. Finance charges are recognised in calculating the PCT‟s net operating cost. 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. Contingent rentals are recognised as an expense in the period in which they are incurred. Where a lease is for land and buildings, the land and building components are separated. Leased land is treated as an operating lease. Leased buildings are assessed as to whether they are operating or finance leases.

The PCT as lessor Amounts due from lessees under finance leases are recorded as receivables at the amount of the PCT‟s net investment in the leases. Finance lease income is allocated to accounting periods so as to reflect a constant periodic rate of return on the PCT‟s net investment outstanding in respect of the leases. Rental income from operating leases is recognised on a straight-line basis over the term of the lease. Initial direct costs incurred in negotiating and arranging an operating lease are added to the carrying amount of the leased asset and recognised on a straight-line basis over the lease term.

1.22 Foreign exchange Transactions which are denominated in a foreign currency are translated into sterling at the exchange rate ruling on the date of each transaction, except where rates do not fluctuate significantly, in which case an average rate for a period is used. Resulting exchange gains and losses are taken to the Operating Cost Statement.

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

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NHS Kirklees - Annual Accounts 2009/10 1. Accounting policies (continued) 1.24 Financial Instruments

Financial assets Financial assets are recognised when the PCT 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. Financial assets at fair value through profit and loss Embedded derivatives that have different risks and characteristics to their host contracts, and contracts with embedded derivatives whose separate value cannot be ascertained, are treated as financial assets at fair value through profit and loss. They are held at fair value, with any resultant gain or loss recognised in the operating cost statement. The net gain or loss incorporates any interest earned on the financial asset. The PCT has no such assets. Held to maturity investments Held to maturity investments are non-derivative financial assets with fixed or determinable payments and fixed maturity, and there is a positive intention and ability to hold to maturity. After initial recognition, they are held at amortised cost using the effective interest method, less any impairment. Interest is recognised using the effective interest method. Available for sale financial assets Available for sale financial assets are non-derivative financial assets that are designated as available for sale or that do not fall within any of the other three financial asset classifications. They are measured at fair value with changes in value taken to the revaluation reserve, with the exception of impairment losses. Accumulated gains or losses are recycled to the operating cost statement on de-recognition. Loans and receivables Loans and receivables are non-derivative financial assets with fixed or determinable payments which are not quoted in an active market. After initial recognition, they are measured at amortised cost using the effective interest method, less any 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. At the Statement of Financial Position date, the PCT 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 the Operating Cost Statement 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 the Operating Cost Statement 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.

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NHS Kirklees - Annual Accounts 2009/10 1. Accounting policies (continued) Financial liabilities Financial liabilities are recognised on the Statement of Financial Position when the PCT 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 derecognised when the liability has been discharged, that is, the liability has been paid or has expired. Financial liabilities are initially recognised at fair value. Financial liabilities are classified as either financial liabilities „at fair value through profit and loss‟ or other financial liabilities. Other financial liabilities After initial recognition, all other financial liabilities are measured at amortised cost using the effective interest method. 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.

1.25 Private Finance Initiative (PFI) transactions In 2005/06 North Kirklees PCT entered into a PFI scheme to build and operate 5 new health centres. In 2006/07, North Kirklees PCT merged with Huddersfield Central PCT and South Huddersfield to form Kirklees PCT. The PFI scheme transferred to Kirklees PCT as part of this merger. The 5 health centres are in Cleckheaton, Dewsbury, Batley, Ravensthorpe, and Eddercliffe. HM Treasury has determined that government bodies shall account for infrastructure PFI schemes where the government body controls the use of the infrastructure and the residual interest in the infrastructure at the end of the arrangement as service concessions, as required by IFRIC 12. The PCT recognises the PFI asset as an item of property, plant and equipment together with a liability to pay for it. The services received under the contract are recorded as operating expenses. NHS Kirklees makes an annual unitary payment to the PFI company. The annual unitary payment is separated into the following component parts, using appropriate estimation techniques where necessary: ● Payment for the fair value of services received, which include services such as estates, utilities, domestic services, grounds maintenance; ● Payment for the PFI asset, including finance costs; and ● Payment for the replacement of components of the asset during the contract „lifecycle replacement‟. Service received The fair value of services received in the year is recorded under the relevant expenditure headings within „operating expenses‟. PFI assets, liabilities, and finance costs The PFI assets are recognised as property, plant and equipment, when they come into use. The assets are measured initially at fair value in accordance with the principles of IAS 17. Subsequently, the assets are measured at fair value, which is kept up to date in accordance with the PCT‟s approach for each relevant class of asset in accordance with the principles of IAS 16. A PFI liability is recognised at the same time as the PFI assets are recognised. It is measured initially at the same amount as the fair value of the PFI assets and is subsequently measured as a finance lease liability in accordance with IAS 17.

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NHS Kirklees - Annual Accounts 2009/10 1. Accounting policies (continued) An annual finance cost is calculated by applying the implicit interest rate in the lease to the opening lease liability for the period, and is charged to „Finance Costs‟ within the Operating Cost Statement. The element of the annual unitary payment that is allocated as a finance lease rental is applied to meet the annual finance cost and to repay the lease liability over the contract term. An element of the annual unitary payment increase due to cumulative indexation is allocated to the finance lease. In accordance with IAS 17, this amount is not included in the minimum lease payments, but is instead treated as contingent rent and is expensed as incurred. In substance, this amount is a finance cost in respect of the liability and the expense is presented as a contingent finance cost in the Operating Cost Statement. Lifecycle replacement Components of the assets will be replaced by the operator from time to time during the contract („lifecycle replacement‟) as and when this is required. NHS Kirklees pays for these replacements through the annual unitary charge. NHS Kirklees charges all of the unitary payment to the Operating Cost Statement, and does not separately identify the lifecycle replacement costs as capital expenditure. This means that the element of the unitary payment attributed to finance costs is increased by a non-material amount. Modelling undertaken by NHS Kirklees shows that, in any one year of the contract, the maximum likely impact of this is £135k and in most years is less than this. Assets contributed by the PCT to the operator for use in the scheme Assets contributed for use in the scheme continue to be recognised as items of property, plant and equipment in the PCT‟s Operating Cost Statement.

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NHS Kirklees - Annual Accounts 2009/10 1. Accounting policies (continued) 1.26 Accounting standards that have been issued but have not yet been adopted The following standards and interpretations have been adopted by the European Union but are not required to be followed until 2010/11. None of them are expected to impact upon the PCT financial statements. IAS 27 (Revised) Consolidated and separate financial statements Amendment to IAS 32 Financial instruments: Presentation on classification or rights issues Amendment to IAS 39 Eligible hedged items IFRS 3 (Revised) Business combinations IFRIC 17 Distributions of Non-cash Assets to Owners IFRIC 18 Transfer of assets from customers

1.27 Accounting standards issued that have been adopted early The amendment to IFRS 8 Operating segments that was included in the April 2009 Improvements to IFRS has been adopted early. As a result, total assets are not reported by operating segment.

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NHS Kirklees - Annual Accounts 2009/10 2. Operating segments This section provides information on the income received by the PCT both by the types of services for which the income was earned and by major customers. It also summarises the financial performance of the PCT by operating segments. The Chief Operating Decision Maker is the PCT's Board. It receives information on the financial performance of each of the segments in the routine monthly financial information presented at each Board Meeting. This information covers the income and expenditure of each of the segments, but does not analyse the Statement of Financial Position between the segments. 1. Income by Type of Service The purpose of this disclosure is to provide information on income received from external customers by the types of services for which it was received. The income shown in Note 3: Miscellaneous Income, is analysed by type of service in the table below. 2009/10 £000

2008/09 £000

0

108,925

Dental Services

6,120

6,048

This is a combination of dental charge income from dentists and income from other PCTs for community dental services.

Management and Admin Services

3,523

1,924

This is income for management and administrative services provided by Kirklees PCT to other PCTs. It includes Human Resources and Organisational Development, Yorkshire and Humber PCT collaborative, and Health Property Management Services. The increased income mainly relates to the PCT collaborative.

Drugs Treatment Services Community Loan store Therapies Property Related Income Continuing Care & Mental Health

1,767 1,714 1,144 690 531

1,586 1,923 1,091 689 1,322

Other Health Care

425

349

This is income to support the provision of drugs treatment services. This is local authority income for the jointly operated community equipment service. This is income for therapy services provided to the local authority and NHS Trusts. This is income from third parties occupying premises owned by the PCT. This represents contributions to the care of patients in care homes from both the local authority and neighbouring PCTs. The income varies from year to year depending on the number of these patients. This is income mainly for provision of Chlamydia screening and minor day case surgery provided to other PCTs.

Education and Training Public health

451 182

230 362

This is income to support education and training of medical staff. This is primarily income from the local authority in relation to joint initiatives to improve the health of the local population.

559 17,106

379 124,828

Type of Service Hosted Specialist Commissioning Arrangements

Other Total Miscellaneous income

Description of Service The collaborative approach to commissioning specialist services on a regional basis was hosted by Kirklees PCT in 2008/09. It is now hosted by Barnsley PCT. The income is the other Yorkshire and Humber PCTs' contributions to these arrangements.

Other smaller items of income.

2. Income from Major Customers The purpose of this disclosure is to provide information on income from major external customers, where an a major customer is defined as being more than 10% of the PCT's total miscellaneous income. There are three major customers to disclose and details of the income from each of these are shown in the tables below. Income From Other PCTs Type of Service Hosted Specialist Commissioning Arrangements Management and Admin Services Continuing Care & Mental Health Dental Services Other Health Care Other Total Income From Dental Charges Type of Service Dental Services Total Income From Local Authorities Type of Service Community Loan Store Continuing Care & Mental Health Drugs Treatment Services Management and Admin Services Other Health Care Public health Therapies Other Total

Kirklees Commissioning 2009/10 2008/09 £000 £000 0 0 3,343 1,539 307 737 0 96 0 0 75 39 3,725 2,411

Provision of Services 2009/10 2008/09 £000 £000 0 0 0 0 0 0 604 639 325 255 5 0 934 894

Hosting of StHA Wide Commissioning 2009/10 2008/09 £000 £000 0 108,925 0 0 0 0 0 0 0 0 0 0 0 108,925

Total 2009/10 £000 0 3,343 307 604 325 80 4,659

2008/09 £000 108,925 1,539 737 735 255 39 112,230

Kirklees Commissioning 2009/10 2008/09 £000 £000 5,402 5,313 5,402 5,313

Provision of Services 2009/10 2008/09 £000 £000 0 0 0 0

Hosting of StHA Wide Commissioning 2009/10 2008/09 £000 £000 0 0 0 0

Total 2009/10 £000 5,402 5,402

2008/09 £000 5,313 5,313

Kirklees Commissioning 2009/10 2008/09 £000 £000 0 0 223 584 513 347 0 21 0 0 153 170 0 0 12 7 901 1,129

Provision of Services 2009/10 2008/09 £000 £000 1,633 1,923 0 0 0 0 52 49 96 94 29 191 125 110 134 5 2,069 2,372

Hosting of StHA Wide Commissioning 2009/10 2008/09 £000 £000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Total 2009/10 £000 1,633 223 513 52 96 182 125 146 2,970

2008/09 £000 1,923 584 347 70 94 361 110 12 3,501

3. Financial Performance by Segment The purpose of this note is to provide information on the financial performance of each of the PCT's segments and how these contribute to the overall performance of the PCT. During 2008/09 the PCT had three distinct segments. These are: the commissioning of services for the population of Kirklees; the direct provision of services for the population of Kirklees; and the hosting of Yorkshire and Humber wide commissioning arrangements which commission services for the wider population of the StHA area. In 2009/10 the PCT no longer hosted the Yorkshire and Humber wide commissioning arrangements. The table below summarises the financial performance of these segments.

Direct Operating Costs Common Operating Costs Gross Operating Costs Less Misc income from external customers Income and Expenditure with internal customers Net Operating Costs Less Non-discretionary Net Operating costs less non-discretionary Revenue Resource Limit Under/(over) spend against Revenue Resource Limit

Kirklees Commissioning 2009/10 2008/09 £000 £000 596,287 526,150 20,009 20,157 616,296 546,307 (12,200) (10,399) 42,451 50,452 646,547 586,360 (3,999) (3,575) 642,548 582,785 645,407 584,315 2,859

Provision of Services 2009/10 2008/09 £000 £000 39,893 36,166 7,395 7,617 47,288 43,783 (4,906) (4,770) (42,451) (39,233) (69) (220) 0 0 (69) (220) 0 0

1,530

69

220

Hosting of StHA Wide Commissioning 2009/10 2008/09 £000 £000 0 119,840 0 0 0 119,840 0 (109,658) 0 (11,219) 0 (1,037) 0 0 0 (1,037) 0 0 0

1,037

Note that these figures for 2008/09 comparators are based on UK GAAP in order to show performance against the Revenue Resource Limit consistent with Note 3.1

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Total 2009/10 £000 636,180 27,404 663,584 (17,106) 0 646,478 (3,999) 642,479 645,407 2,928

2008/09 £000 682,156 27,774 709,930 (124,827) 0 585,103 (3,575) 581,528 584,315 2,787


NHS Kirklees - Annual Accounts 2009/10 3. Financial Performance Targets 3.1 Revenue Resource Limit The PCTs' performance for the year ended 31 March 2010 is as follows: Total Net Operating Cost for the Financial Year Non-Discretionary Expenditure Net Operating Cost less Non Discretionary Expenditure Revenue Resource Limit Under/(Over)spend Against Revenue Resource Limit (RRL)

2009/10 £000

2008/09 £000

646,478 3,999 642,479 645,407 2,928

585,103 3,575 581,528 584,315 2,787

Included in the Revenue Resource limit above is £11,350k of resource limit drawn down from the Strategic Investment Fund held on behalf of PCTs by the Yorkshire and Humber Strategic Health Authority. The PCT has a remaining balance of £4m in this Fund at the end of 2009/10 which we plan to draw down in future years to support spending and investment plans. The under spend against the Revenue Resource Limit of £2,928k means that the PCT has achieved its planned under spend for the year. The figures given for periods prior to 2009/10 are on a UK GAAP basis as that is the basis on which the targets were set for those years.

3.2 Capital Resource Limit The PCT is required to keep within its Capital Resource Limit. Total Gross Capital Expenditure Loss in Respect of Disposals of Donated Assets less: Net Book Value of Non-Current Assets Disposed of to NHS Bodies less: Net Book Value of Non-Current Assets Disposed of to non-NHS Bodies less: Net Book Value of Financial Instruments (Investments) Disposed Of to NHS bodies less: Net Book Value of Financial Instruments (Investments) Disposed Of to Non-NHS less: Capital Grants Received less: Donations Charge Against the Capital Resource Limit (CRL) Capital Resource Limit (CRL) (Over)/Under spend Against CRL

3.3 Provider full cost recovery duty The PCT is required to recover full costs in relation to its provider functions. The performance for 2009/10 is as follows: Provider gross operating costs Provider Operating Revenue Net Provider Operating Costs Costs Met Within PCTs Own Allocation Under/(Over) Recovery of Costs

2009/10 £000 4,547 0 0 (243) 0 0 0 0 4,304 4,409 105

2008/09 £000 3,283 0 0 (341) 0 0 0 0 2,942 4,063 1,121

2009/10 £000

2008/09 £000

47,288 (4,906) 42,382 (42,451) (69)

43,783 (4,770) 39,013 (39,233) (220)

The performance in the above tables in respect of financial year 2008/09 have not been restated to IFRS and remain on a UK GAAP basis.

Page 18


NHS Kirklees - Annual Accounts 2009/10 4. Miscellaneous Revenue

Fees and Charges Dental Charge income from Contractor-Led GDS & PDS Dental Charge income from Trust-Led GDS & PDS Prescription Charge income Strategic Health Authorities NHS Trusts NHS Foundation Trusts Primary Care Trusts Contributions to DATs Primary Care Trusts - Other Primary Care Trusts - Lead Commissioning *1 English RAB Special Health Authorities Other English Special Health Authorities Department of Health - SMPTB Department of Health - Other Local Authorities Patient Transport Services Education, Training and Research Non-NHS: Private Patients Non-NHS: Overseas Patients (Non-Reciprocal) NHS Injury Costs Recovery Other Non-NHS Patient Care Services Charitable and Other Contributions to Expenditure Transfers from the Donated Asset Reserve Transfers from the Government Grant Reserve Contingent Rental Income from Finance Leases Rental Income from Operating Leases Other Income *2 Total miscellaneous income

2009/10

2009/10 Not Appropriated- AppropriatedIn-Aid In-Aid £000 £000

2009/10

2008/09

Total £000

Total £000

28 5,402 37 0 0 0 0 0 0

0 0 0 0 195 806 169 0 4,659

28 5,402 37 0 195 806 169 0 4,659

31 5,313 41 0 222 981 79 0 3,306

0 0 0 0 0 2,970 0 16 0 0 0 0 0 0 0 0 0

0 0 0 0 41 0 0 436 0 0 0 0 0 0 0 0 0

0 0 0 0 41 2,970 0 452 0 0 0 0 0 0 0 0 0

108,925 0 0 0 1 3,501 0 230 0 0 0 0 0 0 0 0 0

2,347 10,800

0 6,306

2,347 17,106

2,197 124,827

*1

Primary Care Trust - Lead Commissioning Income for 2008/09 included income relating to the PCT's lead commissioning role in relation to the Specialist Commissioning Group (North) within the Yorkshire and Humber region. This role ceased at the end of 2008/09. Income and expenditure relating to the role are disclosed in Note 2. *2

Other income includes Home Office funding for Drugs Intervention of £1.25m (2008/09 £1.3m)

Page 19


NHS Kirklees - Annual Accounts 2009/10 5. Operating Costs 5.1 Analysis of operating costs: Goods and Services from Other PCTs Healthcare Non-Healthcare Total Goods and Services from Other NHS Bodies other than FTs Healthcare *1 Non-Healthcare Total Goods and Services from Foundation Trusts *1 Purchase of Healthcare from Non-NHS bodies Social Care from Independent Providers Expenditure on Drugs Action Teams Non-GMS Services from GPs Contractor Led GDS & PDS (excluding employee benefits) Salaried Trust-Led PDS & PCT DS (excluding employee benefits) Chair, Non-executive Directors & PEC remuneration Consultancy Services Prescribing Costs G/PMS, APMS and PCTMS (excluding employee benefits) Pharmaceutical Services Local Pharmaceutical Services Pilots New Pharmacy Contract General Ophthalmic Services Supplies and Services - Clinical Supplies and Services - General Establishment Transport Premises Impairments & Reversals of Property, plant and equipment *2 Impairments and Reversals of non-current assets held for sale Depreciation Amortisation Impairment & Reversals Intangible non-current assets Cost of Capital Charge Impairment and Reversals of Financial Assets Impairment of Receivables Inventory write offs Research and Development Expenditure Audit Fees Other Auditors Remuneration Clinical Negligence Costs Education and Training Other *3 Total Operating costs charged to OCS (excluding employee benefits) Employee Benefits Employee Benefits (excluding staff associated with PCTMS) Employee Benefits associated with PCTMS PCT Officer Board Members Total Employee Benefits charged to OCS Total Operating Costs

2009/10 £000

2008/09 £000

36,050 1,022 37,072

13,698 137 13,835

141,412 393 141,805

291,412 948 292,360

193,302 47,987 0 6,149 1,796 25,101 0 237 362 63,736 55,041 0 0 6,354 3,999 5,084 775 2,551 1,679 5,560

145,479 41,514 0 5,392 996 24,887 0 208 740 61,593 51,838 0 0 5,459 3,575 4,094 565 2,741 1,574 5,571

12,049 0 1,934 73 0 (975) 0 0 156 6 298 0 0 710

461 0 2,108 35 0 (591) 0 0 0 0 296 0 0 598

2,575 615,416

1,387 666,715

44,481 1,462 1,056 46,999 662,415

39,667 1,433 1,157 42,257 708,972

PCT Officer Board Member Costs include £nil for early retirements prior to 6th March 1995 (2008/09 £nil). Employee benefits include £nil for early retirements prior to 6th March 1995 (2008/09 £nil). *1

Goods and Services from NHS bodies in 2008/09 included expenditure relating to the PCT's lead commissioning role in relation to the Specialist Commissioning Group (North) within the Yorkshire and Humber region. This role ceased at the end of 2008/09. Income and expenditure relating to the role are disclosed in Note 2. *2

See note 14.1 for an explanation of the impairments.

*3

Other Costs in 2009/10 include £1,504k grants to GPs and dentists Other costs in 2008/9 include a £553k grant to Northorpe Hall. Page 20


NHS Kirklees - Annual Accounts 2009/10 5.2 Analysis of operating expenditure by expenditure classification

2009/10

2008/09

ÂŁ000

ÂŁ000

Purchase of Primary Health Care GMS / PMS/ APMS / PCTMS Prescribing costs Contractor led GDS & PDS Trust led GDS & PDS General Ophthalmic Services Department of Health Initiative Funding Pharmaceutical services Local Pharmaceutical Services Pilots New Pharmacy Contract Non-GMS Services from GPs Other Total Primary Healthcare purchased

55,041 63,736 25,101 0 3,999 0 0 0 6,354 1,796 0 156,027

51,838 61,593 24,887 0 3,575 0 0 0 5,459 996 0 148,348

Purchase of Secondary Healthcare Learning Difficulties Mental Illness Maternity General and Acute Accident and emergency Community Health Services Other Contractual Total Secondary Healthcare Purchased

12,246 61,746 25,131 275,091 33,379 54,988 1,315 463,896

10,719 60,371 21,180 256,644 30,847 48,811 2,333 430,905

Grant Funding Grants (revenue) to fund Capital Projects - GMS Grants (revenue) to LAs to fund Capital Projects Grants (revenue) to private sector to fund Capital Projects Grants (revenue) to fund Capital Projects - Dental Grants (revenue) to fund Capital Projects - other Total Healthcare Purchased by PCT

0 0 497 1,007 0 621,427

0 0 588 177 0 580,018

42,451

39,233

PCT self-provided secondary healthcare included above

Page 21


NHS Kirklees - Annual Accounts 2009/10 6. Operating Leases 6.1 PCT as lessee

Payments recognised as an expense Minimum lease payments Contingent rents Sub-lease payments Total Payable: No later than one year Between one and five years After five years Total

GP Premises £000

2009/10 Land & Buildings £000

Other £000

Total £000

GP Premises £000

2008/09 Land & Buildings £000

Other £000

Total £000

2,229 0 0 2,229

318 0 0 318

276 0 0 276

2,823 0 0 2,823

2,176 0 0 2,176

261 0 0 261

259 0 0 259

2,696 0 0 2,696

2,229 8,918 0 11,147

850 3,292 3,472 7,614

223 272 0 495

3,302 12,482 3,472 19,256

2,176 8,706 0 10,882

209 685 0 894

337 259 0 596

2,722 9,650 0 12,372

NHS Kirklees has entered into contracts for services with GPs. These contracts involve the use of GP premises. We have reviewed these arrangements under IAS17 Leases, and IFRIC4 Determining Whether an Arrangement Contains a Lease. We have determined that these arrangements contain a lease where the PCT reimburses the GP for the rental of GP premises. We have disclosed the value of these reimbursements in note 6.1 above. It is not possible to calculate the amounts payable after five years as the nature of the arrangements with GPs are open ended. These leases do not involve the legal form of a lease. We have re-stated the 2008/09 figures to include comparable figures. Total future sublease payments expected to be received: £0 (2008/09 £0)

6.2 PCT as lessor Recognised as income Rents Contingent rents Total Receivable: No later than one year Between one and five years After five years Total

Page 22

2009/10 £000

2008/09 £000

0 0 0

0 0 0

0 0 0 0

0 0 0 0


NHS Kirklees - Annual Accounts 2009/10 7. Employee benefits and staff numbers 7.1 Employee benefits Total £000

2009/10 Permanently Employed £000

Other £000

Salaries and wages Social security costs Employer contributions to NHS Pensions scheme Other pension costs Other post-employment benefits Other employment benefits Termination benefits Total employee benefits

38,873 3,005 4,944 99 0 0 78 46,999

35,795 2,956 4,863 99 0 0 49 43,762

3,078 49 81 0 0 0 29 3,237

Recognised as: Commissioning employee benefits Provider employee benefits Employee benefits capitalised as part of assets

15,083 31,916 0

13,904 28,353 0

Total

46,999

42,257

7.2 Staff Numbers

Total £000

2008/09 Permanently Employed £000

Other £000

35,137 2,680 4,440 0 0 0 0 42,257

32,090 2,631 4,359 0 0 0 0 39,080

3,047 49 81 0 0 0 0 3,177

Other Number 0 0 24 0 3 0 2 0 0 29

Total Number

2009/10 Permanently Employed Number

Other Number

Total Number

2008/09 Permanently Employed Number

27 0 526 145 475 0 129 0 1 1,303

26 0 495 140 474 0 128 0 0 1,263

1 0 31 5 1 0 1 0 1 40

23 0 465 132 430 0 124 0 0 1,174

23 0 441 132 427 0 122 0 0 1,145

Medical and dental Ambulance staff Administration and estates Healthcare assistants & other support staff Nursing, midwifery & health visiting staff Nursing, midwifery & health visiting learners Scientific, therapeutic and technical staff Social Care staff Other Total staff numbers

Numbers of staff above (wte) whose costs have been capitalised: £0

7.3 Staff Sickness absence Total Days Lost to Long and Short Term Sickness Total Staff Years Average working Days Lost Total Staff Employed In Period (Headcount)

2009/10 Number 10,486 1,245 8.42 1,574

Note: The sickness figures are based on the calendar year 1-Jan-2009 to 31-Dec-2009 to reflect cabinet office requirements. Note: No prior-year figure available as this note is a new requirement for 2009/10

7.4 Retirements due to ill-health 3 persons (2008/09: 8 persons) retired early on ill-health grounds. The total additional accrued pension liabilities in the year amounted to £161k (2008/09: £388k). The cost of ill health retirements is borne by the NHS Business Services Authority, which administers the NHS Pension Scheme.

Page 23


NHS Kirklees - Annual Accounts 2009/10 7.5 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, General Practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the scheme is accounted for as if it were a defined contribution scheme: the cost to the NHS Body of participating in the scheme is taken as equal to the contributions payable to the scheme for the accounting period. The scheme is subject to a full actuarial valuation every four years (until 2004, every five years) and an accounting valuation every year. An outline of these follows:

a) Full actuarial (funding) valuation The purpose of this valuation is to assess the level of liability in respect of the benefits due under the scheme (taking into account its recent demographic experience), and to recommend the contribution rates to be paid by employers and scheme members. The last such valuation, which determined current contribution rates was undertaken as at 31 March 2004 and covered the period from 1 April 1999 to that date. The conclusion from the 2004 valuation was that the scheme had accumulated a notional deficit of £3.3 billion against the notional assets as at 31 March 2004. In order to defray the costs of benefits, employers pay contributions at 14% of pensionable pay and most employees had up to April 2008 paid 6%, with manual staff paying 5%. Following the full actuarial review by the Government Actuary undertaken as at 31 March 2004, and after consideration of changes to the NHS Pension Scheme taking effect from 1 April 2008, his Valuation report recommended that employer contributions could continue at the existing rate of 14% of pensionable pay, from 1 April 2008, following the introduction of employee contributions on a tiered scale from 5% up to 8.5% of their pensionable pay depending on total earnings. On advice from the scheme actuary, scheme contributions may be varied from time to time to reflect changes in the scheme‟s liabilities.

b) Accounting valuation A valuation of the scheme liability is carried out annually by the scheme actuary as at the end of the reporting period by updating the results of the full actuarial valuation. Between the full actuarial valuations at a two-year midpoint, a full and detailed member data-set is provided to the scheme actuary. At this point the assumptions regarding the composition of the scheme membership are updated to allow the scheme liability to be valued. The valuation of the scheme liability as at 31 March 2010, is based on detailed membership data as at 31 March 2008 (the latest midpoint) updated to 31 March 2010 with summary global member and accounting data. The latest assessment of the liabilities of the scheme is contained in the scheme actuary report, which forms part of the annual NHS Pension Scheme (England and Wales) Resource Account, published annually. These accounts can be viewed on the NHS Pensions website. Copies can also be obtained from The Stationery Office.

c) Scheme provisions In 2008-09 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: Annual Pensions 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”. Pensions Indexation 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. Lump Sum Allowance A lump sum is payable on retirement which is normally three times the annual pension payment. Ill-Health Retirement Early payment of a pension, with enhancement in certain circumstances, is available to members of the Scheme who are permanently incapable of fulfilling their duties or regular employment effectively through illness or infirmity. Death Benefits A death gratuity of twice their final year‟s pensionable pay for death in service, and five times their annual pension for death after retirement is payable. Additional Voluntary Contributions (AVCs) 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. Transfer between Funds Scheme members have the option to transfer their pension between the NHS Pension Scheme and another scheme when they move into or out of NHS employment. Preserved Benefits Where a scheme member ceases NHS employment with more than two years service they can preserve their accrued NHS pension for payment when they reach retirement age. Compensation for Early Retirement Where a member of the Scheme is made redundant they may be entitled to early receipt of their pension plus enhancement, at the employer‟s cost.

Page 24


NHS Kirklees - Annual Accounts 2009/10 7.6 Management Costs

2009/10

2008/09

Management costs (£000s) Weighted population (number in units) Management Cost per weighted head of population (£ per head)

10,801 398,534 27.10

9,594 378,145 25.37

7.6.2 PCT Commissioning Services Management Costs

2009/10

2008/09

7,839

6,944

398,534

378,145

19.67

18.36

2009/10

2008/09

2,962

2,650

Provider Services Income

47,357

44,003

Management Costs as a percentage of income

6.25%

6.02%

Management costs (£000s) Weighted population (number in units) Management Cost per weighted head of population (£ per head)

7.6.3 PCT Provider Services Management Costs Management costs (£000s)

8. Better Payment Practice Code 8.1 Measure of compliance Non-NHS Payables Total Non-NHS Trade Invoices Paid in the Year Total Non-NHS Trade Invoices Paid Within Target Percentage of Non-NHS Trade Invoices Paid Within Target 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

2009/10 Number

2009/10 £000

2008/09 Number

2008/09 £000

32,309 30,752

85,085 79,127

30,995 28,827

74,136 69,664

95%

93%

93%

94%

3,344 3,024 90%

380,234 362,490 95%

2,750 2,503 91%

450,756 446,553 99%

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

8.2 The Late Payment of Commercial Debts (Interest) Act 1998

2009/10 £000

2008/09 £000

Amounts included in finance costs from claims made under this legislation Compensation paid to cover debt recovery costs under this legislation Total

0 0 0

0 0 0

Page 25


NHS Kirklees - Annual Accounts 2009/10 9. Investment Income

Rental Income

PFI finance lease income planned contingent Other finance lease revenue Interest Income LIFT: equity dividends receivable LIFT: loan interest receivable Bank interest Other loans and receivables Impaired financial assets Other financial assets Total investment income

10. Other Gains and Losses Gain/(loss) on disposal of property, plant and equipment Gain/(loss) on disposal of intangible assets Gain/(loss) on disposal of financial assets Gain/(loss) on foreign exchange Change in fair value of financial assets carried at fair value through the OCS Change in fair value of financial liabilities carried at fair value through the OCS Recycling of gain/(loss) from equity on disposal of financial assets held for sale Total

11. Finance Costs Interest Interest on obligations under finance leases Interest on obligations under PFI contracts: - main finance cost - contingent finance cost Interest on obligations under LIFT contracts: - main finance cost - contingent finance cost Provisions - unwinding of discount Interest on late payment of commercial debt Other interest expense Other finance costs Total

Page 26

2009/10 £000

2008/09 £000

0 0 0

0 0 0

0 0 0 0 0 0 0

0 0 0 0 0 0 0

2009/10 £000

2008/09 £000

7 0 0 0 0 0 0 7

(633) 0 0 0 0 0 0 (633)

2009/10 £000

2008/09 £000

0

0

828 309

848 334

0 0 39 0 0 0 1,176

0 0 43 0 0 0 1,225


NHS Kirklees - Annual Accounts 2009/10 12.1 Property, plant and equipment Land

Buildings excluding dwellings

Dwellings

Plant & machinery

Transport equipment

Information technology

Furniture & fittings

Total

£000

£000

£000

£000

£000

£000

£000

£000

Assets under construction and payments on account £000

Cost or valuation: At 1 April 2009 Additions Purchased Additions Donated Additions Government Granted Reclassifications Reclassifications as Held for Sale Disposals other than for sale Upward revaluation/positive indexation Impairments/negative indexation Reversal of Impairments Transfers (to)/from NHS Bodies At 31 March 2010

3,119 0 0 0 0 0 0 793 0 0 0 3,912

38,135 2,369 0 0 0 0 0 78 (3,294) 0 0 37,288

0 0 0 0 0 0 0 0 0 0 0 0

0 159 0 0 0 0 0 0 0 0 0 159

1,782 495 0 0 0 0 0 0 0 0 0 2,277

0 0 0 0 0 0 0 0 0 0 0 0

3,792 988 0 0 0 0 0 0 0 0 0 4,780

915 513 0 0 0 0 0 0 0 0 0 1,428

47,743 4,524 0 0 0 0 0 871 (3,294) 0 0 49,844

Depreciation At 1 April 2009 Reclassifications Reclassifications as Held for Sale Disposals other than for sale Upward revaluation/positive indexation Impairments Reversal of Impairments Charged During the Year Transfers to NHS Bodies At 31 March 2010 Net book value at 31 March 2010

0 0 0 0 0 13 0 0 0 13 3,899

0 0 0 0 0 12,036 0 849 0 12,885 24,403

0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 159

723 0 0 0 0 0 0 212 0 935 1,342

0 0 0 0 0 0 0 0 0 0 0

1,841 0 0 0 0 0 0 712 0 2,553 2,227

553 0 0 0 0 0 0 161 0 714 714

3,117 0 0 0 0 12,049 0 1,934 0 17,100 32,744

Purchased Donated Government Granted Total at 31 March 2010

3,899 0 0 3,899

24,403 0 0 24,403

0 0 0 0

159 0 0 159

1,342 0 0 1,342

0 0 0 0

2,227 0 0 2,227

714 0 0 714

32,744 0 0 32,744

12.2 Asset financing: Owned Held on finance lease On-SOFP PFI contracts PFI residual: interests Total

3,899 0 0 0 3,899

7,435 0 16,968 0 24,403

0 0 0 0 0

159 0 0 0 159

1,342 0 0 0 1,342

0 0 0 0 0

2,227 0 0 0 2,227

714 0 0 0 714

15,776 0 16,968 0 32,744

Buildings £000's 4,010 (3,274) 736

Equipment £000's 65 (30) 35

Other £000's 0 0 0

Total £000's 4,276 (2,534) 1,742

2009/10

12.2 Revaluation Reserve Balance for Property, Plant & Equipment At 1 April 2009 Movements as a result of the District Valuers Revaluation At 31 March 2010

Land £000's 201 770 971

Page 27


NHS Kirklees - Annual Accounts 2009/10 12.3 Property, plant and equipment Plant & machinery

Transport equipment

Information technology

Furniture & fittings

Total

£000

Assets under construction and payments on account £000

£000

£000

£000

£000

£000

39,872 1,627 0 0 0 (160) (416) 0 (1,743) 0 0 39,180

0 0 0 0 0 0 0 0 0 0 0 0

0 330 0 0 0 0 (292) 0 (38) 0 0 0

1,540 216 0 0 0 0 0 26 0 0 0 1,782

0 0 0 0 0 0 0 0 0 0 0 0

2,703 1,089 0 0 0 0 0 0 0 0 0 3,792

900 2 0 0 0 0 0 13 0 0 0 915

49,524 3,264 0 0 0 (243) (708) 39 (2,629) 0 0 49,247

0 0 0 0 0 459 0 0 0 459 3,119

0 0 0 (75) 0 2 0 1,118 0 1,045 38,135

0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0

534 0 0 0 0 0 0 189 0 723 1,059

0 0 0 0 0 0 0 0 0 0 0

1,200 0 0 0 0 0 0 641 0 1,841 1,951

393 0 0 0 0 0 0 160 0 553 362

2,127 0 0 (75) 0 461 0 2,108 0 4,621 44,626

3,119 0 0 3,119

38,135 0 0 38,135

0 0 0 0

0 0 0 0

1,059 0 0 1,059

0 0 0 0

1,951 0 0 1,951

362 0 0 362

44,626 0 0 44,626

3,119 0 0 0 3,119

10,018 0 28,117 0 38,135

0 0 0 0 0

0 0 0 0 0

1,059 0 0 0 1,059

0 0 0 0 0

1,951 0 0 0 1,951

362 0 0 0 362

16,509 0 28,117 0 44,626

Land

Buildings excluding dwellings

Dwellings

£000

£000

Revaluation & indexation gains Impairments Reversals of impairments In-year transfers to/from NHS bodies At 31 March 2009

4,509 0 0 0 0 (83) 0 0 (848) 0 0 3,578

Depreciation At 1 April 2008 Reclassifications Reclassifications as Held for Sale Disposals other than for sale Upward revaluation/positive indexation Impairments Reversal of Impairments Charged During the Year Transfers to NHS Bodies At 31 March 2009 Net book value Purchased Donated Government Granted Total at 31 March 2009

2008/09 Cost or valuation: At 1 April 2008 Additions - purchased Additions - donated Additions - government granted Reclassifications Reclassified as held for sale Disposals other than by sale

12.4 Asset financing: Owned Held on finance lease On-SOFP PFI contracts PFI residual: interests

Page 28


NHS Kirklees - Annual Accounts 2009/10 12 (cont). Property, plant and equipment The PCT has revalued all of its land an buildings during the financial year for two reasons: - moving to using MEA as the basis of valuation which was done on 1 April 2009. - updating these valuations on 31 March 2010 to reflect changes in value during the financial year. In both cases the valuations were undertaken by independent valuers employed by the District Valuation Service. The valuations were undertaken in accordance with the terms of the Royal Institution of Chartered Surveyors' Calculation Standards, 6th Edition, insofar as these terms are consistent with the requirements of the HM Treasury, the National Health Service and the Department of Health. The impact of these revaluations was to reduce the value of the land and buildings in the Statement of Financial Position. Notes 14.1 and 14.2 provide more details on this impairment and shows how has been charged to the Operating Cost Statement and the Impairment Reserve. Estimated remaining economic lives of assets at 31 March 2010 range from:

Minimum (years) Maximum (years)

Buildings excluding dwellings

Plant & machinery

Information technology

Furniture & fittings

5 98

4 10

2 5

2 10

Page 29


NHS Kirklees - Annual Accounts 2009/10 13.1 Intangible non-current assets 2009/10 Cost or valuation: At 1 April 2009 Additions - purchased Additions - internally generated Additions - donated Additions - government granted Reclassifications Reclassified as held for sale Disposals other than by sale

Revaluation & indexation gains Impairments Reversal of impairments In-year transfers to/from NHS bodies At 31 March 2010 Amortisation At 1 April 2009 Charged in-year Reclassifications Reclassified as held for sale Disposals other than by sale

Revaluation & indexation gains Impairments Reversal of Impairments In-year transfers to NHS bodies At 31 March 2010 NBV at 31 March 2010 Net book value at 31 March 2010 comprises: Purchased Donated Government Granted Total at 31 March 2010

Software purchased

Licences & trademarks

Patents

Development expenditure

Total

£000

Software internally generated £000

£000

£000

£000

£000

140 23 0 0 0 0 0 0 0 0 0 0 163

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 0

140 23 0 0 0 0 0 0 0 0 0 0 163

49 73 0 0 0 0 0 0 0 122 41

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

49 73 0 0 0 0 0 0 0 122 41

41 0 0 41

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

41 0 0 41

Page 30


NHS Kirklees - Annual Accounts 2009/10 13.2 Intangible non-current assets 2008/09 Cost or valuation: At 1 April 2008 Additions - purchased Additions - internally generated Additions - donated Additions - government granted Reclassifications Reclassified as held for sale Disposals other than by sale

Revaluation & indexation gains Impairments Reversal of impairments In-year transfers to/from NHS bodies At 31 March 2009 Amortisation At 1 April 2008 Charged During the Year Impairments Reversal of Impairments Reclassifications Revaluation/Indexation gains Reclassified as Held for Sale Disposals other than for sale In-year transfers to NHS bodies At 31 March 2009 Net book value at 31 March 2009 Net book value at 31 March 2009 comprises: Purchased Donated Government Granted Total at 31 March 2009

Software purchased

Licences & trademarks

Patents

Development expenditure

Total

£000

Software internally generated £000

£000

£000

£000

£000

121 19 0 0 0 0 0 0 0 0 0 0 140

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 0

121 19 0 0 0 0 0 0 0 0 0 0 140

14 35 0 0 0 0 0 0 0 49 91

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

14 35 0 0 0 0 0 0 0 49 91

91 0 0 91

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

91 0 0 91

Page 31


NHS Kirklees - Annual Accounts 2009/10 13.3 Intangible non-current assets Estimated remaining economic lives of assets at 31 March 2010 range from: Software purchased 1 4

Minimum (years) Maximum (years)

Software Licences purchased prior to the 1st April 2008 are written down over a 5 year life. New software licences purchased after 1st April 2008 are written down over 1 year.

13.4 Revaluation reserve balance for intangible assets At 1 April Changes At 31 March

Page 32

2009/10 ÂŁ000

2008/09 ÂŁ000

0 0 0

0 0 0


NHS Kirklees - Annual Accounts 2009/10 14. Impairments 14.1 Impairments charged in the year to the Operating Cost Statement

Impairments arose from: Loss or damage from normal operations Loss as a result of catastrophe Abandonment in the course of construction Unforeseen obsolescence Over-specification of assets Changes in market price Write down to depreciated replacement cost on bringing a new asset into use Total

Property, plant and equipment £000 0 0 0 0 0 11,613

2009/10 Intangible assets

Financial assets

£000 0 0 0 0 0 0

£000 0 0 0 0 0 0

Property, plant and equipment £000 0 0 0 0 0 461

0 0

0 0

0 461

436 12,049

2008/09 Intangible assets

Financial assets

£000 0 0 0 0 0 0

£000 0 0 0 0 0 0

0 0

0 0

The impairments result from a reduction in the value of land and property and the implementation of a Modern Equivalent Asset valuation.

14.2 Impairments charged in the year to the revaluation reserve

Impairments arose from: Loss or damage from normal operations Loss as a result of catastrophe Abandonment in the course of construction Unforeseen obsolescence Over-specification of assets Changes in market price Write down to depreciated replacement cost on bringing a new asset into use Total

Property, plant and equipment £000 0 0 0 0 0 3,294

2009/10 Intangible assets

Financial assets

£000 0 0 0 0 0 0

£000 0 0 0 0 0 0

Property, plant and equipment £000 0 0 0 0 0 2,629

0 0

0 0

0 2,629

0 3,294

2008/09 Intangible assets

Financial assets

£000 0 0 0 0 0 0

£000 0 0 0 0 0 0

0 0

0 0

The impairments due to changes in market price are as a result of the economic downturn resulting in a fall in the value of land and property.

15. Non-current assets held for sale

Land

Buildings, excl. dwellings

Dwellings

Other property, plant and equipment

Intangible assets

Total

£000

£000

£000

£000

£000

£000

Balance brought forward 1 April 2009 Plus assets classified as held for sale in the year Less assets sold in the year Less impairment of assets held for sale Plus reversal of impairment of assets held for sale Less assets no longer classified as held for sale, for reasons other than disposal by sale Balance carried forward 31 March 2010

83 0 (83) 0 0

160 0 (160) 0 0

0 0 0 0 0

0 0 0 0 0

0 0 0 0 0

243 0 (243) 0 0

0 0

0 0

0 0

0 0

0 0

0 0

Balance brought forward 1 April 2008 Plus assets classified as held for sale in the year Less assets sold in the year Less impairment of assets held for sale Plus reversal of impairment of assets held for sale Less assets no longer classified as held for sale, for reasons other than disposal by sale Balance carried forward 31 March 2009

0 83 0 0 0

0 160 0 0 0

0 0 0 0 0

0 0 0 0 0

0 0 0 0 0

0 243 0 0 0

0 83

0 160

0 0

0 0

0 0

0 243

Page 33


NHS Kirklees - Annual Accounts 2009/10 16.1 Inventories

31 March 2010 31 March 2009 £000 £000

Drugs Consumables Loan equipment Other Total

0 107 163 0 270

0 169 397 0 566

2009/10

2008/09

£000

£000

Inventories recognised as an expense in the period Write-down of expenses (including losses) Reversal of write-down previously taken to OCS Total

140 156 0 296

(205) 0 0 (205)

17.1 Trade and other receivables

Current

Non-current

31 March 2010 31 March 2009 £000 £000

31 March 2010 31 March 2009 £000 £000

16.2 Inventories recognised in expenses

NHS receivables - revenue NHS receivables - Capital Non-NHS receivables - revenue Non-NHS receivables - capital Provision for the impairment of receivables VAT Prepayments & other accrued income Finance Lease Receivables Operating Lease Receivables Other Receivables Total

819 0 720 0 0 0 4,146 0 0 2 5,687

17.2 Receivables past their due date but not impaired

2,233 0 889 0 0 0 2,765 0 0 320 6,207

0 0 0 0 0 0 0 0 0 0 0

31 March 2010 31 March 2009 £000 £000 260 11 262 533

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

17.3 Provision for impairment of receivables

0 0 0 0 0 0 0 0 0 0 0

194 39 223 456

31 March 2010 31 March 2009 £000 £000

Balance at 1 April Amount written off during the year Amount recovered during the year (Increase)/decrease in receivables impaired Balance at 31 March

0 0 0 0 0

Page 34

0 0 0 0 0


NHS Kirklees - Annual Accounts 2009/10 18. Trade and other payables

Interest payable Payments received on account NHS payables - revenue NHS Payables - capital FHS Payables Non-NHS trade payables - revenue Non-NHS trade payables - capital Tax and Social Security Costs VAT Other Payables Accruals & Deferred Income Total

Current 31 March 2010 31 March 2009 £000 £000 0 0 12,147 0 13,728 4,327 84 526 19 1,049 12,272 44,152

0 0 10,320 0 13,604 3,246 132 897 0 634 11,054 39,887

Non-current 31 March 2010 31 March 2009 £000 £000 0 0 0 0 0 13 0 0 0 0 0 13

0 0 3,620 0 0 0 0 0 0 0 0 3,620

NHS payables - revenue, includes £3.6m in relation to the PCT's agreement with Mid Yorkshire Hospitals NHS Trust to provide a solution to the historical financial problems and to secure the financial base for the Trust's new hospital implementation plan. All of this is shown under current payables. In 2008/09 £7.4m was included, with £3.8m shown as current and £3.6m as non-current. Other payables include £0 (2008/09: £0) in respect of payments due in future years under arrangements to buy out the liability for early retirements over 5 instalments; and £621k in respect of outstanding pensions contributions at 31 March 2010 (31 March 2009: £601k).

19. Borrowings

Bank overdraft - Office of HM Paymaster General / Government Banking Service Bank overdraft - Commercial banks Finance lease liabilities PFI liabilities: Main liability Lifecycle replacement received in advance LIFT liabilities: Main liability Lifecycle replacement received in advance Other (describe) Total

Current 31 March 2010 31 March 2009 £000 £000

Non-current 31 March 2010 31 March 2009 £000 £000

0 0 0

0 0 0

0 0 0

0 0 0

712 0

696 0

26,305 0

27,017 0

0 0 0 712

0 0 0 696

0 0 0 26,305

0 0 0 27,017

All of the borrowings relate to on Statement of Financial Position PFI schemes. Note 25 Finance Lease Obligations show how the borrowings relate to finance leases. Note 27 provides more information on the PFI scheme which make up the finance lease.

20. Other liabilities

Current 31 March 2010 31 March 2009 £000 £000 0 0 0 0

PFI/LIFT deferred credit Lease incentives Other [specify] Total

Page 35

0 0 0 0

Non-current 31 March 2010 31 March 2009 £000 £000 0 0 0 0

0 0 0 0


NHS Kirklees - Annual Accounts 2009/10 21. Provisions

Pensions relating to former directors Pensions relating to other staff Legal claims Restructurings Continuing Care Agenda for Change Equal Pay Other Total

Current 31 March 2010 31 March 2009 £000 £000

Non-current 31 March 2010 31 March 2009 £000 £000

0 198 66 0 0 0 0 324 588

0 191 116 0 0 0 0 27 334

0 860 554 0 0 0 0 0 1,414

0 1,040 602 0 0 0 0 0 1,642

Pensions relating to former directors £000

Pensions relating to other staff

Legal claims

Restructurings

Other

Total

£000

£000

£000

£000

£000

At 1 April 2009 Arising during the year *1 Utilised during the year Reversed unused Unwinding of discount Transferred in-year At 31 March 2010

0 0 0 0 0 0 0

1,231 0 (198) 0 25 0 1,058

718 9 (40) (81) 14 0 620

0 0 0 0 0 0 0

27 324 0 (27) 0 0 324

1,976 333 (238) (108) 39 0 2,002

Expected timing of cash flows: In the remainder of the spending review period 31 March 2011 Between 1 April 2011 and 31 March 2016 Between 1 April 2016 and 31 March 2021 Thereafter Total

0 0 0 0 0

198 850 10 0 1,058

66 152 158 244 620

0 0 0 0 0

324 0 0 0 324

588 1,002 168 244 2,002

*1

Provisions relating to the PCT's own provider function are shown gross with the expected reimbursement from the NHSLA included in debtors.

£27k is included in the provisions of the NHS Litigation Authority at 31/3/2010 in respect of clinical negligence liabilities of the PCT (31/03/2009 £24k). Of the total £1.7m (2008/09 £1.9m) of provisions held by the PCT, £1.0m (2008/09 £1.1m) are back to back provisions held on behalf of other NHS Trusts and £0.7m (2008/09 £0.8m) relate to provisions for premature retirements.

Page 36


NHS Kirklees - Annual Accounts 2009/10 22. Contingencies Contingent liabilities Claims managed by the NHSLA on behalf of the PCT Contingent assets Legal charges on properties

31 March 2010 £000

31 March 2009 £000

(13)

(9)

8,217

8,217

The contingent assets relate to 22 properties used to provide residential care for patients with mental health or learning disability needs. The purchase of these properties was funded in part or whole by grants from NHS bodies which were predecessor bodies of NHS Kirklees. The PCT has a legal charge on these properties which was placed on them at the time the grants were made. The PCT also has a contract with St Annes Community Services for the provision of residential care services from these properties. We have reviewed the legal charges and our contract for services in the light of IFRIC 12 to determine if it constitues a service concession, and IFRIC 4 to determine if it constitues a lease. We have concluded that the arrangements do not constitue either a service concession or a lease as the PCT does not exclusively determine who uses the service or control the price for the services. However, the arrangements do create contingent assets whose existence will be confirmed by the occurrence or nonoccurrence of one or more uncertain future events which are not wholly with the control of the PCT. The uncertain events are that the properties cease to be used to provide the care services specified in the legal charges. In these circumstances the PCT is entitled to receive a sum of money which is specified by reference to the market value of the properties at that time. The aggregate value of these are shown above. They are based on current market values of the properties as assessed by the District Valuer. There is no material difference in these values between 2008/09 and 2009/10. Note that legal fees and estate agent fees would be deducted from the contingent asset values. Since these are variable and are unlikely to be material the values above have not been adjusted for these.

23. Capital Commitments Contracted capital commitments at 31 March not otherwise included in these financial statements:

Property, plant and equipment Intangible assets Total Capital Other commitments Total

31 March 2010 £000 100 0 100 0 100

31 March 2009 £000 843 0 843 0 843

The property, plant and equipment commitments for 2009/10 relate to Skelmanthorpe £50K and Holme Valley Hawthorn Ward retention £50K. The property Plant and equipment commitments for 2008/09 related to slippage on the Holme Valley Memorial Hospital Capital Scheme.

24. Other financial liabilities Financial liabilities carried at fair value through profit and loss: Current 31 March 2010 31 March 2009 £000 £000 Embedded Derivatives at Fair Value through OCS 0 0 Other Financial Liabilities at Fair Value through Profit and Loss 0 0 Amortised Cost 0 0 Total 0 0

Page 37

Non-current 31 March 2010 31 March 2009 £000 £000 0

0

0 0 0

0 0 0


NHS Kirklees - Annual Accounts 2009/10 25. Finance lease obligations The PCT does not have any finance lease obligations other than on Statement of Financial Position Private Finance Initiatives, and these are detailed in note 27.

26. Finance lease receivables (i.e. as lessor)

Amounts receivable under finance leases

Gross investments in leases 31 March 2010 31 March 2009 £000 £000

Present value of minimum lease payments 31 March 2010 31 March 2009 £000 £000

Within one year Between one and five years After five years Less future finance charges Present value of minimum lease payments

0 0 0 0 0

0 0 0 0 0

0 0 0 0

0 0 0 0

Less allowance for uncollectable lease payments: Total finance lease receivable recognised in the statement of financial position

0

0

0

0

0

0

0

0

0 0 0

0 0 0

0 0 0

0 0 0

Included in: Current finance lease receivables Non-current finance lease receivables

The unguaranteed residual value accruing to the PCT is £0 (prior year £0) Accumulated allowance for uncollectable lease payments receivable £0 (prior year £0) Rental Income

2009/10 £000

2008/09 £000

0 0 0

0 0 0

Contingent rent Other Total rental income

Page 38


NHS Kirklees - Annual Accounts 2009/10 27. Private Finance Initiatives (PFI) 27.1 PFI off-Statement of Financial Position None. 27.2 PFI schemes on-Statement of Financial Position In 2005/06 North Kirklees PCT entered into a PFI scheme to build and operate 5 new health centres. In 2006/07, North Kirklees PCT merged with Huddersfield Central PCT and South Huddersfield to form Kirklees PCT. The PFI scheme transferred to Kirklees PCT as part of this merger. The 5 health centres are in Ravensthorpe, Dewsbury, Batley, Cleckheaton, and Eddercliffe. The PFI runs until 2036. The unitary payment is revised at the start of each financial year in line with the retail price index movement between February and February. The PFI provider is required to maintain the assets in good working order as specified within the Project Agreement To do this it is obliged to provide a range of services which include estates, utilities, domestic services, grounds maintenance. The standards to which these are delivered are covered in the Project Agreement. At the end of the PFI in 2036 the assets transfer to the PCT for no further payment. Under IFRIC 12, the asset is treated as an asset of the PCT. The substance of the contract is that the trust has a finance lease and payments comprise two elements – imputed finance lease charges and service charges – details of the imputed finance lease charges are shown in the table below. Total obligations for on-Statement of Financial Position PFI contracts due:

Not later than one year Later than one year, not later than five years Later than five years Sub total Less: interest element Total

Page 39

31 March 2010 £000

31 March 2009 £000

1,524 6,096 31,439 39,059 (12,042) 27,017

1,524 6,096 32,004 39,624 (11,912) 27,712


NHS Kirklees - Annual Accounts 2009/10 27.3 Charges to expenditure The total charged in the year to expenditure in respect of the service element of onstatement of financial position PFI contracts was £536k (prior year £536k). The PCT does not have any off statement PFI contracts. The PCT is committed to the following annual charges PFI scheme expiry date: Not later than one year Later than one year, not later than five years Later than five years Total

31 March 2010

31 March 2009

£000

£000

0 0 13,636 13,636

0 0 14,172 14,172

28. Financial Instruments 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. As the cash requirements of the PCT are met through Parliamentary Funding, financial instruments play a more limited role in creating risk that would apply to a nonpublic sector body of a similar size. The majority of financial instruments relate to contracts for non-financial items in line with the PCT‟s expected purchase and usage requirements and the PCT is therefore exposed to little credit, liquidity or market risk. Currency risk The PCT is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK and Sterling based. The PCT has no overseas operations. The PCT therefore has low exposure to currency rate fluctuations. Interest rate risk PCTs are not permitted to borrow. The PCT therefore has low exposure to interest- rate fluctuations Credit Risk Because the majority of the PCT‟s income comes from funds voted by Parliament the PCT has low exposure to credit risk.

Liquidity Risk The PCT is required to operate within limits set by the Secretary of State for the financial year and draws down funds from the Department of Health as the requirement arises. The PCT is not, therefore, exposed to significant liquidity risks.

Page 40


NHS Kirklees - Annual Accounts 2009/10 28.1 Financial Assets

At ‘fair value through profit and loss’

Loans and receivables

Available for sale

Total

£000

£000

£000

£000

Embedded derivatives Receivables - NHS Receivables - non-NHS Cash at bank and in hand Other financial assets Total at 31 March 2010

0 0 0 0 0 0

0 819 1,793 98 0 2,710

0 0 0 0 0 0

0 819 1,793 98 0 2,710

Embedded derivatives Receivables - NHS Receivables - non-NHS Cash at bank and in hand Other financial assets Total at 31 March 2009

0 0 0 0 0 0

0 2,233 2,885 90 0 5,208

0 0 0 0 243 243

0 2,233 2,885 90 243 5,451

At ‘fair value through profit and loss’

Other

Total

£000

£000

£000

Embedded derivatives NHS payables Non-NHS payables Other borrowings PFI & finance lease obligations Other financial liabilities Total at 31 March 2010

0 0 0 0 0 0 0

0 12,767 29,518 0 27,017 0 69,302

0 12,767 29,518 0 27,017 0 69,302

Embedded derivatives NHS payables Non-NHS payables Other borrowings PFI & finance lease obligations Other financial liabilities Total at 31 March 2009

0 0 0 0 0 0 0

0 14,658 27,947 0 27,713 0 70,318

0 14,658 27,947 0 27,713 0 70,318

28.2 Financial Liabilities

Page 41


NHS Kirklees - Annual Accounts 2009/10 29. NHS LIFT Investments The PCT does not have any NHS LIFT Investments.

30. Other financial assets Current 31 March 2010 31 March 2009 £000 £000 Embedded Derivatives at Fair Value through OCS Financial assets carried at fair value through OCS Held to maturity investments at amortised cost Available for sale financial assets carried at fair value Loans carried at amortised cost Total

0 0 0 0 0 0

Non-current 31 March 2010 31 March 2009 £000 £000

0 0 0 0 0 0

0 0 0 0 0 0

31 March 2010 £000

31 March 2009 £000

0 0 0

0 0 0

31 March 2010 £000

31 March 2009 £000

Balance at 1 April Net change in year Balance at 31 March

90 8 98

559 (469) 90

Made up of Cash with Office of HM Paymaster General/GBS Commercial banks and cash in hand Current investments Cash and cash equivalents as in statement of financial position Bank overdraft - Office of HM Paymaster General/GBS Bank overdraft - Commercial banks Cash and cash equivalents as in statement of cash flows

96 2 0 98 0 0 98

88 2 0 90 0 0 90

0

0

31. Other current assets EU Emissions Trading Scheme Allowance Other Assets Total

32. Cash and Cash Equivalents

Patients' money held by the PCT, not included above

Page 42

0 0 0 0 0 0


NHS Kirklees - Annual Accounts 2009/10 33. Related party transactions Kirklees Primary Care Trust is a body corporate established by order of the Secretary of State for Health. During the year none of the Department of Health Ministers, Board Members or members of the key management staff or parties related to them has undertaken any material transactions with Kirklees Primary Care Trust. The following General Medical Practitioners and Dentists receive personal remuneration as Board and PEC members, their practices received remuneration in accordance with GMS/PMS and dental contracts for 2009/10 as below: Practice Payments to Related Party £000

Receipts from Related Party £000

Amounts owed to Related Party £000

Amounts due from Related Party £000

1,828 325 1,318 909

0 0 0 0

121 20 82 0

0 0 0 0

Practice Payments to Related Party £000

Receipts from Related Party £000

Amounts owed to Related Party £000

Amounts due from Related Party £000

1,626 310 1,047 732

0 0 0 0

132 21 94 0

0 0 0 0

Dr D Anderson Dr AP Mehrotra Dr A Aggarwal DE Wood Prior year comparators for 2008/09 are as below:

Dr D Anderson Dr AP Mehrotra Dr A Aggarwal DE Wood

The Department of Health is regarded as a related party. During the year Kirklees Primary Care Trust has had a significant number of material transactions with the Department, and with other entities for which the Department is regarded as the parent Department. These entities are listed below:

*1

Mid Yorkshire Hospital NHS Trust Calderdale and Huddersfield NHS Foundation Trust Leeds Teaching Hospitals NHS Trust *1 South West Yorkshire Partnerships NHS Foundation Trust Hull and East Yorkshire NHS Trust

*2

*1 *1

Bradford Hospitals NHS Teaching Trust Yorkshire Ambulance Service NHS Trust Prescription Pricing Authority Barnsley PCT

2009/10 £000

2008/09 £000

99,259 138,095

108,585 124,116

25,942

90,807

43,401

39,159

94

38,022

5,397 13,590 70,114 33,489

19,289 12,952 66,998 9,481

*1

In 2008/09 the PCT hosted the North Specialist Commissioning Group (SCG) which it does not host in 2009/10. For these Trusts, the 2008/09 figures include significant elements of hosted SCG spend in 2008/09. *2

This organisation was previosuly called South West Yorkshire Mental Health NHS Trust

In addition, the Primary Care Trust has had a significant number of material transactions with other Government Departments and other central and local Government bodies. Most of these transactions have been with Kirklees Council.

Page 43


NHS Kirklees - Annual Accounts 2009/10 34. Third party assets The PCT held £0 cash and cash equivalents at 31 March 2010 on behalf of patients (£0 at 31 March 2009).

35. Intra-Government Balances

Current receivables £000s

Non-current receivables £000s

Current payables £000s

Non-current payables £000s

Balances with other Central Government Bodies Balances with Local Authorities Balances with NHS Trusts and Foundation Trusts Balances with Public Corporations and Trading Funds Total Intra-Government balances Balances with bodies external to government At 31 March 2010

53 696 766 0 1,515 4,172 5,687

0 0 0 0 0 0 0

1,436 209 11,877 0 13,522 30,630 44,152

0 0 0 0 0 13 13

Balances with other Central Government Bodies

1,718 644 833 0 3,195 3,012 6,207

0 0 0 0 0 0 0

4,469 599 7,349 0 12,417 27,470 39,887

0 0 3,620 0 3,620 0 3,620

Balances with Local Authorities Balances with NHS Trusts and Foundation Trusts Balances with Public Corporations and Trading Funds Total Intra-Government balances Balances with bodies external to government At 31 March 2009

36. Losses and Special Payments The total number of losses cases in 2009/10 was 11, involving a total loss of £1,645 (2008/09 3 cases and £49). The total number of special payments in 2009/10 was 3, involving a total of £14,111 (2008/09 1 case and £3,462). Details of cases individually over £250,000 31 March 2010 Losses category: Cash losses Claims abandoned Administrative write-offs Fruitless cases Store losses Total Special payments Special payments Total

31 March 2009

£000s

£000s

0 0 0 0 0 0

0 0 0 0 0 0

0 0

0 0

37. Events after the reporting period The Board of the PCT is aware of a matter that may be regarded as an event after the reporting period: in line with national policy that requires most PCTs to divest themselves of their provider arm, NHS Kirklees is considering the future of its provider arm, Kirklees Community Health Services. The Board has agreed to pursue an integrated care model of provision in the future but no decision has yet been taken as to the future organisation form.

Page 44


NHS Kirklees - Annual Accounts 2009/10 38. Movements in working capital (Increase)/decrease in trade and other receivables (Increase)/decrease in inventories Increase/(decrease) in trade and other payables (Increase)/decrease in other current assets Increase/(decrease) in other current liabilities Total

39. Other cash flow adjustments Depreciation Amortisation Impairments and reversals Cost of Capital Charge Transfer from donated asset reserve Transfer from government grant reserve Non-cash movements in provisions Release of PFI deferred credits Net foreign exchange gain/(losses) Total

40. Cash flow relating to exceptional items There are no cash flows relating to exceptional items.

Page 45

2009/10 £000

2008/09 £000

520 296 706 0 0 1,522

(1,699) (205) 9,192 0 0 7,288

2009/10 £000

2008/09 £000

1,934 73 12,049 (975) 0 0 225 0 0 13,306

2,108 35 461 (591) 0 0 (55) 0 0 1,958


NHS Kirklees - Annual Accounts 2009/10 41. Pooled Budgets 41.1 Kirklees Integrated Community Equipment Services Pooled Budget Kirklees PCT has a pooled budget arrangement hosted by Kirklees Council, the Kirklees Integrated Community Equipment Service. The draft memorandum account for the pooled budget is included below: 2009/10 £000

2008/09 £000

Add Balance b/f from previous year Total Funding

357 1,419 1,776 226 2,002

300 1,544 1,844 437 2,281

Expenditure Equipment and Overheads Management Overheads Total Expenditure

1,913 102 2,015

1,913 141 2,054

13

(227)

Gross Funding Kirklees PCT Kirklees Council

Net (Surplus)/Deficit

41.2 Learning Disabilities Development Fund (LDDF) The LDDF ceased to be managed as a pooled budget at the end of 2007/08 and is now operated solely by Kirklees Council. Balances remaining in the fund when it was disbanded were ring-fenced to be used for the original purposes of the pooled budget. £80k remained at the end of 2008/09 and this has been fully spent in 2009/10. The deficit of £8k shown below has been funded by Kirklees Council. The draft memorandum for the remaining balance is included below: 2009/10 £000

2008/09 £000

Add Balance b/f from previous year Total Funding

0 0 0 0 460 460

0 0 6 6 484 490

Expenditure Pay Non Pay Total Expenditure

322 146 468

302 108 410

8

(80)

Gross Funding Kirklees PCT Kirklees Council Other Income

Net (Surplus)/Deficit

Page 46


NHS Kirklees - Annual Accounts 2009/10 42. Transition to IFRS General fund

42.1 Impact on Taxpayers Equity Taxpayers’ equity at 31 March 2009 under UK GAAP: Adjustments for IFRS changes: Private finance initiative Elimination Of Negative Revaluation Reserves Additional Depreciation in 08-09 on PFI / Indexation in 08-09 of PFI Assets Loss On Sale Of Asset Under Construction Re Introduction Of PFI Write Back Capital Element of Rental Payment Against L.T. Loan Taxpayers’ equity at 1 April 2009 under IFRS:

42.2 Impact on Operating Costs Net Operating Cost for 2008/09 under UK GAAP Adjustments for: Elimination of negative revaluation reserves Additional 2008/09 depreciation on PFI Loss On Sale Of Asset Under Construction Re Introduction Of PFI Write Back Capital Element of Rental Payment Against L.T. Loan Reduction in Capital Charges as a result of Balance Sheet restatement Net Operating Cost for 2008/09 under IFRS

Revaluation Donated asset reserve reserve

Government grant reserve

Other reserves

Total

£000

£000

£000

£000

£000

£000

(23,031)

2,343

0

0

0

(2,282) (461) (259) (292) 676 (25,649)

3,311 461 (1,839) 0 0 4,276

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

(20,688) 0 1,029 0 (2,098) (292) 676 (21,373)

£000 585,103 461 817 292 (676) 6 586,003

42.3 Impact on Cash Flow The UK GAAP 2008/09 cash flow statement and the 2008/09 IFRS cash flow statement both included net movements in liquid resources of £(469)k.

42.4 Revenue costs of IFRS: PFIs newly brought on to SoFP under IFRIC12 2009/10 £000 Depreciation charges Interest Expense Impairment charge - AME Impairment charge - DEL Other Expenditure Revenue Receivable from subleasing Cost of Capital Charge Total IFRS Expenditure (IFRIC12) Revenue consequences of LIFT/PFI schemes under UK GAAP / ESA95 (net of any sublease income) Net IFRS change (IFRIC12) Net Resource Limit cover provided for Revenue consequences identified above Total

817 1,137 8,761 0 536 0 0 11,251 (2,039) 9,212 8,882 330

Page 47


Declarations of interest

Name Position Held Type of Interest None

Mike Potts Chief Executive Detail

Name Position Held Type of Interest None

Helena Corder Director of Corporate Services Detail

Name Position Held Type of Interest Programme Advisor External Assessor Health Foundation Registered Charity

Sheila Dilks Director of Patient Care and Professions Detail Advise on programmes Review, assess and advise on funding allocation for special project.

Name Position Held

Carol McKenna Director of Development Detail

Type of Interest None

Commissioning

Name Position Held Type of Interest None

Bryan Machin Director of Finance Detail

Name Position Held Type of Interest

Dr. Judith Hooper Director of Public Health Detail

and

Strategic


Related parties

Partner, clinical Lead for NHS Kirklees and provides self care training and musculoskeletal services

Name Robert Flack Position Held Director of Kirklees Community Healthcare Services Type of Interest Detail Membership of Sports York Cricket Club - Captain Club Committee Membership of Sports Member of MCC area representative with endorsing rights Club Committee Related Parties Spouse works for North Yorkshire and York Primary Care Trust as Physiotherapist and Manager

Name Position Held

Susan M Ellis Director of Human Resources and Organisational Development Type of Interest Detail Shared post with NHS Post at Board level shared with Calderdale Calderdale

Name Position Held Type of Interest None

Peter Flynn Director of Performance & Information Detail

Name Position Held Type of Interest Related parties

Rob Napier Chairman Detail Spouse is a NED on Barnsley F T

Name Position Held Type of Interest School Governor Trustee NED & Chair

Vanessa Stirum Non Executive Director Detail King James School, Almondbury, Huddersfield King James Foundation Kirklees Community Healthcare Services

Name Position Held Type of Interest Non Executive Director

Rob Millington Non Executive Director Detail Kirklees Community Healthcare Services


LPSB – Regeneration and Sustainability Astra Zeneca & Various

Board Member Share Holdings

Name Position Held Type of Interest Independent Member Company Secretary Executive Director Related parties

Valerie Aguirregoicoa Non Executive Director Detail West Yorkshire Police Authority / Aguirregoicoa Ltd Sister is employee at the Mid Yorkshire Hospitals NHS Trust

Name Position Held Type of Interest Commercial Interest

Tony Gerrard Non Executive Director Detail Director of Tony Gerrard Associates Ltd

Name Position Held Type of Interest Political Schools Public Bodies

Mehboob Khan Non Executive Director Detail Councillor of Kirklees Governor of Greenhead Member of West Yorkshire Fire Authority Board member of the Standards Board of England Board member of Local Government Association Council of Europe

Private Company

Shareholder in Excol Consulting Ltd

Name Position Held Type of Interest Parent Governor Local Authority Officer

Imran M Patel Non executive Director Detail Park Road Junior, Infant and Nursery School Batley City Of Bradford Metropolitan Borough Council

Name Position Held Type of Interest PCT Sub Contractor Other Trusts

David Wood PEC member Detail Proprietor of Woods Dental Practice, Mirfield. Honorary Contracts with Mid Yorks Hospital Trust and Leeds Teaching Hospitals Trust Member of the Local Dental Committee

Local Dental Committee


Clinical Tutor

Clinical Tutor at the University of Leeds

Name Position Held Type of Interest None

Dawn Gordon District Nurse Team Leader Detail

Name Position Held Type of Interest Partner

Secretary

Dr. A. K. Aggarwal GP (PEC member) Detail Partner at Meltham Road Surgery, Lockwood, Huddersfield Executive Member of the Three Valleys Commissioning Consortium Secretary Huddersfield Friends Group of Martin House

Name Position Held Type of Interest GP Principal Related parties

Dr. David Anderson PEC Chairman Detail GP Principal at Grange Group Practice Spouse works for KCHS as a Health Visitor

Name Position Held Type of Interest Company Secretary

Sarah Brackwell Health Visitor Team Leader (PEC Member) Detail Brackwell Consultancy Services (self employment vehicle for husband) Termsol Ltd (Partners Company)

Executive Member

Director

Name Position Held Type of Interest None

Angela Ladocha PEC Member/ Clinical Lead Detail

Name Position Held Type of Interest Registered PMS GP

Dr A P Mehrotra GP PEC Member, Urgent Care Lead Detail Windsor Medical Centre, 2 William Street, Leeds Road, Dewsbury Forrest Burlinson Accountants, Owl Lane, Shaw Cross, Dewsbury.

Chairman Kirklees LMC


2009-10 Annual Accounts of Kirklees Primary Care Trust STATEMENT OF THE CHIEF EXECUTIVE’S RESPONSIBILITIES AS THE ACCOUNTABLE OFFICER OF THE PRIMARY CARE TRUST The Chief Executive of the NHS has designated that the Chief Executive should be the Accountable Officer to the primary care 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 primary care trust; the expenditure and income of the primary care 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 net operating cost, 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.

Mike Potts, Chief Executive Date: 9 June 2010


2009-10 Annual Accounts of Kirklees Primary Care Trust 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 primary care trust and the net operating cost, recognised gains and losses and cash flows for the year. In preparing these 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 at any time the financial position of the primary care trust and to enable them to ensure that the accounts comply with requirements outlined in the above mentioned direction of the Secretary of State. They are also responsible for safeguarding the assets of the primary care 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. Mike Potts, Chief Executive Date: 9 June 2010

Bryan Machin, Director of Finance Date: 9 June 2010


http://www.kirklees.nhs.uk/fileadmin/documents/publications/Audit_Reports/2009-10/TEXT_ONLY_FINAL_An