Nhs westminster annual report web

NHS Westminster
Annual Report
www.westminster.nhs.uk

Foreword 4
About us 7
Our performance 8
Our strategic five-year plan 14
1. Reducing health inequalities 18
2. Adding years to life 20
3. Building a choice of quality healthcare 22
4. Adding life to years 23
5. Promoting healthy lifestyles 25
Directorate Reviews 28
1. Service Development 30
2. Public Health 36
3. Nursing and Quality 38
4. Finance and Performance Management 40
5. Human Resources and Corporate Affairs 44
Our Board 46
1. Members’ interests 50
Annual Accounts 54

Contents

NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk

section FOreWOrd Welcome to the 2008/09
one NhS WeStmiNSter ANNuAl report
This report outlines how the NHS in Westminster has been
working to improve the health and healthcare of Westminster
residents during the year.

A year of improvement
residents are waiting less time than ever for hospital appointments,
finding their doctors’ surgeries are open longer and being better
supported in leading healthier lives.

we lAuNCHeD A Five-yeAR We changed our name from Westminster Primary Care
£94M iNveStMeNt PRogRAMMe, Trust to NHS Westminster. This reflects our key role as
to CReAte New HeAltH commissioners, that is strategic buyers, of healthcare.
CeNtReS, PRoviDe MoRe Our aim is to focus local services as much on maintaining
DeNtiStS AND iNCReASe tHe healthy lifestyles and preventing ill health as they do on
NuMBeR oF NuRSeS. treating sickness.

Our community service providers (including more than 34 different types of
healthcare workers from physiotherapists to nurses) are separating from us and
forming a new organisation with their counterparts in Kensington and Chelsea
and Hammersmith and Fulham. This will be known as Central London Community
Healthcare and will have enhanced freedom to determine its own future.
This will allow us to focus on our commissioning role.

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5
Health services for our community
We spent over £390 million on health services for
our residents. They are able to be treated in some
of the country’s top performing hospitals. We’ve also
reduced treatment waiting times. Mental health
services have continued to expand with investment
in community care and psychological therapies,
as well as in hospitals.

Throughout the past year we have also been
working to bring more healthcare services closer to
Our programme of polysystems, across Westminster,
home, and to improve patient choice. Our investment
aims to provide a broad range of health and wellbeing
in community services ensures there are now more
services for local communities – they are likely to
nurses and therapists available locally. We have also
include district nurses and physiotherapists as well as
worked with local GPs to extend opening hours.
GP services. Improvements are also planned in dental
care, with two new practices expected in 2009.
we Met tHe New 18 week tARget
FRoM gP ReFeRRAl to tReAtMeNt. In the past year we have had great success with
78% oF PAtieNtS ARe Now BeiNg a proactive stop smoking campaign, which was
SeeN witHiN 12 weekS. targeted at areas with the highest numbers of
smokers. As a result there was a 60% increase
One of the highlights of the year was Health Minister in the uptake of smoking cessation advice at
Lord darzi launching our innovative community-based pharmacies where personal help is given.
cardiovascular disease prevention programme. Healthy
Hearts and Minds identifies residents with a more
than one-in-five chance of developing cardiovascular weStMiNSteR HAS MoRe
disease. Patients are then offered health advice from PHARMACieS tHAN ANywHeRe
a community team of cardiologists, nurses, dieticians elSe iN tHe CouNtRy.
and physiotherapists to help them reduce the risk of
having a heart attack or stroke. We listened
We are working alongside our partners to develop
health services that meet the needs of local people,
MoRe tHAN HAlF oF loCAl gPS and we encourage them to help us develop services
Now oFFeR APPoiNtMeNtS that are relevant, easy to access and that make
outSiDe NoRMAl woRkiNg HouRS. a real difference in maintaining health.

£94m £15.5m £390m 50%
will be spent over the next is what we’ve saved in was spent on healthcare More than 50% of
four years to create new 2008/09 to invest in our for Westminster residents Westminster GPs now
health centres, provide major health improvement in 2008/09 offer appointments outside
more dentists and increase programme normal working hours
the number of nurses

Contents


Health Minister Lord Darzi
with Chief Executive Michael
Scott, Chair Joe Hegarty and
Public Health Consultant
Dr Adrian Brown.

Looking ahead you will find more information on our plans and
NHS Westminster has developed a strategic plan strategic goals.
looking forward to 2013. This includes measures
Our financial performance has been strong and we
that will tell us if we’ve achieved our goals.
have ended the year with a surplus of £15.5 million
Most importantly we are working to reduce health – which means we can invest in a major health
inequalities in Westminster. Further on in this report improvement programme.

Our staff have again rated us as one of the top
we SPoke to MoRe tHAN 1,600 health employers in the country. We thank them for
PeoPle ABout tHeiR FutuRe their commitment and hard work that makes all our
viSioN oF HeAltHCARe. tHey achievements possible.
exPReSSeD CoNCeRN ABout
We look forward to the next year when we plan to
HeAltHCARe ASSoCiAteD
achieve real and lasting health benefits for everyone
iNFeCtioNS AND CANCeR
who uses the NHS in Westminster.
wAitiNg tiMeS. we ARe ACtiNg
oN tHoSe CoNCeRNS.

michael Scott Joe hegarty Dr Dennis Abadi
Chief Executive Chair CEC Chair

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7

AbOuT uS: WhAt iS NhS WeStmiNSter?
NHS Westminster is not a new organisation; it is the new
name for Westminster Primary Care Trust. The name reflects
our new focus as buyers of healthcare services rather than
providers of healthcare.
Where are we based? have the best of health and the best
We have been based in the heart of of healthcare.
Ab
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Westminster for the last six years and
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Planned changes across the NHS
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are responsible for funding all
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the health services across
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three priorities:
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the borough.
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• choice - we will provide quality
ate sv
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We share our boundaries
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with the City of Westminster,
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how and where you receive
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the north, Queens Park in the
ad

• care closer to home - we are
west and Covent Garden in the
Grosve
nor Road

providing care closer to your home
east. Our southern boundary follows
and linked to other services
the north bank of the river Thames.
• health - we all need to think about
What we do
healthier lifestyles and we want to
We spend over £433 million each year support you to achieve yours
making sure people in Westminster

90.07% £390m Commissioning of healthcare What we spend your money on:
£160m Maternity, general, Acute, A&e
• Family doctors
£72m Mental health
• Dentists, opticians and pharmacies
£43m Community health services
£40m gP services • Community services
£26m Prescribing costs • Hospital care
£14m Dental services • Promoting healthy living
£10m learning difficulties • Mental health
£25m other contractual services

9.93% £43m Property and other
corporate costs

Who we listen to and who we We ask for your feedback through
work for surveys, meetings, events and so on.
We exist to improve the health and Check www.westminster.nhs.uk for
wellbeing of our local residents. So we upcoming events, or call freephone
listen closely to what you have to say. 0800 587 8818.

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our performANce
This is a snapshot of our performance over the last year.

Jake Johnson with the Care Quality Commission Annual Health Check – at a glance
Fit Squad 3 Our rating improved from “Fair” to “Good” – this means we delivered
good quality services
3 We are in the top 20% of trusts in London
3 For the second year in a row we were rated “Good” for our
use of resources – which means we spend your money wisely
3 Our substance misuse service was rated as excellent
3 An in-depth review of urgent care put Westminster in the
best Performing category

We were found to have improved services in: mental health, particularly crisis
resolution services; helping pregnant women to give up smoking; improving
access to genito-urinary clinics within 48 hours; chronic disease management;
and helping people with long term conditions remain at home longer through
support from community matrons.

(The Care Quality Commission released its findings for 2007/08 in October
2008. Findings for 2008/09 were not released in time for this report.)

Top 20% 7 Top 5 excellent
We are in the top 20% We met the 18 week We are in the top 5 for Our substance misuse
of trusts in London, in target seven months urgent and emergency service was rated as
terms of performance ahead of schedule care in London excellent by the Annual
Health Check

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9
NHS Westminster – the local leader We are also speaking to private providers who can
World Class Commissioning is a new, ground-breaking meet NHS standards and prices – to provide more
approach to commissioning. It is designed to help choice for patients.
primary care trusts arrange for better services more
closely matched to local needs. This will result in Urgent and emergency care
better quality care, improved health and wellbeing, We were rated as one of the top five performers
and a reduction in health inequalities across in London for urgent and emergency care in the
the community. Care Quality Commission report published in
September 2008.
Like every primary care trust, we were assessed
for our commissioning skills in three areas: The Care Quality Commission released a major review
covering all urgent and emergency services. For the
• Health outcomes – our priorities for health
first time, this looked at how the whole system works.
improvements for local residents, including life
It included all the major aspects of care, including
expectancy and health inequalities
Accident & emergency, ambulance services, out-of-
• Organisational competencies – our knowledge, hours GP services, NHS direct, urgent care provided
skills, behaviours and characteristics that will by GPs, and urgent care centres including walk-in
make our organisation world class centres and minor injuries units.
• Governance – our arrangements for managing
The report gave us high scores for:
the organisation in the most effective way
possible. This includes developing areas such • public satisfaction with phone access
as strategic, financial and organisational planning, to GP surgeries
as well as the board’s controls and processes • the response time for GP out-of-hours services
to start telephone assessments of patients
NHS Westminster gained the top rating for our
strategy, vision and objectives. This included the • systems in place to ensure quality and safety
level of board ownership of our strategy, and the in GP out-of-hours services
consistency of our financial plan to deliver on it. • facilities for people with disabilities and systems
to protect vulnerable children and adults
Getting treated faster –
exceeding the 18 week target unfortunately, we received lower scores for:

We not only met but exceeded the national target • Accident & emergency attendance for conditions
for local patients to be treated within a maximum of that could be treated in other settings
18 weeks. Figures from the department of Health
• patient satisfaction with GP opening times
showed we met the target in May 2008, seven
months ahead of schedule. We have already improved our GP opening times
and are working on bringing care closer to home,
by March 2009, 98% of patients who did not
which will improve the opportunities for patients to
require admission to hospital received treatment
receive care faster and more conveniently.
within 18 weeks (ahead of the national target of
95%). 94% of patients who required a planned
admission to hospital were also treated within
18 weeks (ahead of the national target of 90%).

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meetiNg our tArgetS
Existing national targets
We were assessed against 17 existing national targets. We achieved 13, under achieved one and failed two.
One target was not assessed.

target rating

People with diabetes to be offered screening for the early detection of diabetic retinopathy Achieved

Maintain a maximum wait of 26 weeks for in-patients Achieved

Maintain a maximum wait of 13 weeks for an outpatient appointment Achieved

Maintain a maximum waiting time of two months from urgent referral to treatment for Achieved
all cancers

All ambulance trusts to respond to 75% of category A calls within eight minutes Achieved

All ambulance trusts to respond to 95% of category A calls within 19 minutes after Achieved
the request has been made for transport

All ambulance trusts to respond to 95% of category b calls within 19 minutes under achieved

Maintain delayed transfers of care at a minimal level Achieved

Maintain a maximum waiting time of one month from diagnosis to treatment for all cancers Achieved

every hospital appointment to be booked for the convenience of the patient, making it Failed
easier for patients and their GPs to choose a hospital and consultant that best meets their
needs. Patients should be able to choose from at least four health care providers for
planned hospital care

Guaranteed access to a primary care professional within 24 hours and to a primary care Failed
doctor within 48 hours

Improve life outcomes of adults and children with mental health problems by ensuring that Achieved
all patients who need them have access to crisis resolution services and a comprehensive
child and adolescent mental health service

update practice-based registers so that patients with coronary heart disease and diabetes, Achieved
and the majority of patients at high risk of coronary heart disease, continue to receive
appropriate advice and treatment in line with national service framework standards

Maintain a two week maximum wait from urgent GP referral to first outpatient appointment Achieved
for all urgent suspected cancer referrals

Maintain the four hour maximum wait in A&e from arrival to admission, transfer or discharge Achieved

Maintain a three month maximum wait for revascularisation Achieved

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11
New national targets
The government’s new national targets are goals for the entire NHS. These aim to improve the health of the
population of england.

We were assessed against 13 targets. We achieved eight and under achieved five.

target rating

Achieve year on year reductions in MrSA levels, expanding to cover other healthcare Achieved
associated infections as data from mandatory surveillance becomes available

Improve the quality of life and independence of vulnerable older people by increasing Achieved
the proportion being supported to live in their own home by 2008

Increase the participation of problem drug users in drug treatment programmes by 2008; Achieved
and increase year on year the proportion of users successfully sustaining or completing
treatment programmes

reduce health inequalities by 2010 Achieved

Secure sustained national improvements in NHS patient experience by 2008 Achieved

Halt the rise in obesity among children by 2010, as part of a broader strategy to tackle Achieved
obesity in the population as a whole

ensure that by 2008 nobody waits more than 18 weeks from GP referral to Achieved
hospital treatment

Improve health outcomes for people with long term conditions by offering a personalised Achieved
care plan for vulnerable people most at risk; and reduce emergency bed days by 2008
through improved care in primary care and community settings for people with long
term conditions

reduce adult smoking rates by 2010 under
achieved

reduce the under-18 conception rate by 2010, as part of a broader strategy to improve under
sexual health achieved

Substantially reduce mortality rates from suicide and undetermined injury by 2010 under
achieved

Substantially reduce mortality rates from cancer by 2010 under
achieved

Substantially reduce mortality rates from heart disease, stroke and related diseases under
by 2010 achieved

Contents


NHS WeSTMINSTer –
iNVeStiNg iN better heAlth
A five-year investment programme of £94 million is already
changing healthcare in Westminster for the better. We spent
more than £23 million on this programme in 2008/09.
For NHS Westminster to achieve its ambitious goals and see a measurable
improvement in health there must be a change in how we work and how
we deliver care.

In 2008/09 our major investments included:

• £2.5 million to reduce health inequalities – including £400,000 on
transforming community nursing in Westminster
• £1.4 million to add years to life – including £700,000 on cardiovascular
disease prevention and cardiac rehabilitation
• £6.6 million to build a choice of quality healthcare – including £1 million to
ensure a maximum waiting time for patients of 12 weeks for planned care;
£1.4 million to increase the number of staff working at the Gordon and
St Charles Hospitals for Westminster residents receiving in-patient mental
health care; £1 million to ensure GP premises for Westminster residents are
of the standards required; and investments of up to half a million pounds in
individual practice-based GP commissioning clusters
• £2.7 million to add life to years – including £770,000 invested in a community
cardiac team
• £1.2 million to promote healthy lifestyles – including more than £400,000 in
addressing obesity in children and adults and more than £200,000 in our stop
smoking service

ASk youR PAtieNtS week 2008 SuRvey ReSultS

92% 92%
rated their overall experience of using said they were seen on time or within
Westminster’s community health services a given time frame
as excellent or good

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13
Looking forward The extra GP services at Queens Park will make it
Our investment programme for 2009/10 includes easier to see a GP in Westminster. The new family
£3.8 million in mental health services, £3.6 million in doctor drop-in services will be open for everyone
primary care facilities and more than £6 million in who lives, works or visits Westminster from 8am to
developing Westminster’s first community health 8pm, seven days a week. The new services will be in
hubs or ‘polysystems’. addition to existing GP services and will make it
easier for everyone to see a doctor or nurse quickly,
A new GP-led health centre will bring care closer at a convenient time. Patients can book an
to home and to make it easier to see a GP appointment or simply turn up – without having
in Westminster. to face long, and sometimes worrying, waits.

You told us… we listened
A team from NHS Westminster beat 50 others paper questionnaires, and encouraged teenagers
to win in the Primary Care category, at the to take part by using video booths. We spoke to
Involvement to Impact Awards 2008. during more than 2,200 people and turned their feedback
Ask Your Patients week, we used online and into action.

Why polysystems? What is a polysystem?
residents said that they want to be able to see A polysystem is a health system that provides
a GP and access more health services more easily a wide range of health and wellbeing services to
– especially during weekends and evenings and a local community, closer to home. Our polysystems
without having to take time off work. will have a central services “hub” and a network of
linked GP practices. The “hub” will be in a building
similar to a large health centre but will offer a far
wider range of services. In addition to GP services,
there will be services such as district nursing, health
visiting and physiotherapy. There will also be
specialist services such as outpatient clinics and
associated diagnostics services (like X-ray), and
Emily Savin and Simon Hope from NHS Westminster with health and wellbeing services such as managing
Westminster residents at a polysystem consultation.
weight and how to stop smoking.

66% 83% 98%
said they had seen the healthcare said they felt confident with had high satisfaction (‘excellent’
professional’s Id hygiene standards or ‘Good’) with a pilot community
blood-clotting prevention service
to bring care closer to home

Contents

www.westminster.nhs.uk

Contents

OUR
STRATEgiC
FivE-YEAR
plAN

Contents


section Our STrATeGIC PLAN SeTS OuT
two our ViSioN from NoW to 2013
In partnership with our practice-based commissioning clusters,
over the next five years we will work with Westminster City
Council, a range of healthcare providers and other local
partners, to lead local healthcare improvements.

Five years – five strategic objectives
To achieve our vision, we have set five strategic goals:

1. 0 reducing health inequalities
2. 0 Adding years to life
3. 0 building a choice of quality healthcare
4. 0 Adding life to years
5. 0 Promoting healthy lifestyles

10 health outcomes

NHS Westminster has put in place 10 health outcomes that will show if our
strategy has succeeded. These are to:

1. 0 reduce overall health inequalities, including reducing the size of the gap in
life expectancy between the most affluent and those on the lowest incomes.
We intend to reduce this by 10% by 2012 measured according to the
nationally recognised Index of Multiple deprivation (IMd) score.

2. 0 Increase the overall average number of years people in Westminster are
expected to live.

3. 0 Achieve 98% coverage of children under five who complete both doses
of the mumps, measles and rubella (MMr) vaccine by 2013. Westminster
and London are below the national target of 95% (required for herd
immunity which protects those unable to be vaccinated due to medical
contraindications). The capital therefore is at risk of a measles epidemic.

4. 0 Increase the proportion of women aged 53 to 64 who are screened every
three years for breast cancer. The proportion of Westminster women who
take these regular tests is substantially below the national average.

5. 0 reduce the number of people who die from heart disease. This is the single
biggest cause of premature death in Westminster and the main reason why
people on lower incomes die younger than more affluent people.

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17
6. 0 reduce the number of people who die from 10. Increase the numbers of people with mental
diseases related to breathing and circulation, health problems who receive psychological
such as bronchitis, emphysema and other therapies. The proportion of Westminster’s
diseases of the lungs. This is the second population with mental health problems is
biggest contributor to why people on lower relatively high and not everybody is getting
incomes die younger. The biggest cause of the help and treatment they need.
these diseases is smoking and we aim to
reduce the level of smoking in young people Who we work with
and adults to 10% of the population by 2013. Our key partners include Westminster City Council,
Imperial College Healthcare NHS Trust, Chelsea and
7. 0 Cut the rate of Clostridium difficile (known as
Westminster Hospitals NHS Foundation Trust,
C-diff) in patients who go into hospital. C-diff
university College London Hospital NHS Foundation
is a healthcare acquired infection to which older
Trust, Central and North West London NHS Foundation
people are particularly susceptible. Hospital
Trust, Central London Community Healthcare,
infection control is a key priority both for us and
neighbouring primary care trusts, i.e. Kensington and
Westminster residents.
Chelsea, Hammersmith and Fulham, brent and
8. 0 reduce the numbers of people who are Camden, NHS London, London Ambulance Service,
admitted to hospital because of harm caused Metropolitan Police, Voluntary Action Westminster,
by alcohol. There is growing concern about how black and Minority ethnic Health Forum, the Carers
many people need hospital care because of the Network, Westminster Local Involvement Network
effects of alcohol consumption. (LINk) and other organisations in the voluntary sector.

9.0 reduce the proportion of primary school-aged
children who are recorded as being obese. There
is growing concern about the rates of childhood
obesity, which rises sharply between starting
primary school and secondary school.

Our local targets
We set these four targets after consultation and within 31 days. by 2013 we want all patients who
engagement with local residents: have a full diagnosis of cancer to have begun their
treatment within nine days or less.
• reduce the proportion of our population that
smokes from around a quarter where it is now,
to one adult in ten or less.
• Measure the experience that patients and users
actually have of the NHS, so we know how
patients really feel about NHS services. We will
involve patients and their families, who will help
us make real and tangible improvements.
• reduce the level of MrSA infection in hospital.
• everyone who is diagnosed by their GP as
A Westminster resident at the Westminster Health Debate.
potentially having cancer beginning their treatment

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Our STrATeGIC FIVe-YeAr PLAN
1. reDuciNg heAlth iNequAlitieS
Overall the health of people living in Westminster is good.
However, people on different incomes and from different
backgrounds have very different levels of health. We are
working to narrow these gaps, including gaps between the
wealthiest and those on the lowest incomes, between men
and women and between different ethnic groups.

Above left: Lord Darzi and NHS Westminster, with City Partnership colleagues, has developed
Dr Adrian Brown, Consultant a five-year strategy to address health inequalities. It includes tackling
in Public Health at the launch
of Healthy Hearts and Minds
the causes, reducing the impact, and improving the health of all
Westminster residents.
Above right: Marina, who
attended our Understanding
Health Improvement course, Healthy Futures
part of our Health Trainers
This project takes an innovative approach to breaking the cycle of declining
programme.
health among residents who find it hard to access mainstream services and
opportunities. The project includes:

healthy people: Health MOTs are available at community centres.
These support residents in choosing healthy lifestyles, including stopping
smoking, increasing physical activity and healthy eating.

DiFFeReNCeS iN HeAltH

12.7 yrs x2 x6
There are significant differences People living in the most deprived Type 2 diabetes is up to six times
in life expectancy between areas of Westminster experience more common in people of South
Westminster’s wards with a gap twice the rate of coronary heart Asian descent and up to three times
of up to 12.7 years for men and disease and death from stroke, more common in those of African
12.6 years for women as those living in the least and Caribbean descent than in the
deprived areas general population

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19
healthy homes: environmental health officers Improving access to psychological therapies
carry out home health improvement in people’s We have expanded our cognitive behavioural therapy
homes. They identify people who can get help workers from 5 to 11 (funding we won through the
with home adaptations, fuel poverty and winter department of Health).
warmth payments.
We will also support people with mental health
health trainers: This is an accredited scheme that problems to return to work or stay in their jobs.
trains local people to provide key health messages These new services will help reduce health
within their community. This includes giving information inequalities and regenerate Westminster by:
and advice on the services available locally. • ensuring that people who need access to primary
care mental health services for anxiety and
Healthy Hearts and Minds depression receive them rapidly
In January 2009 Health Minister Lord darzi launched • helping people to stay in work or return to work
an innovative community-based cardiovascular and supporting those who have recently been
disease prevention programme in Westminster – made redundant
Healthy Hearts and Minds. This is designed to tackle
• creating jobs for local people in both the NHS
the biggest killers and causes of premature death,
and the voluntary sector, through investment in
heart disease and stroke.
the local economy
Healthy Hearts and Minds identifies the residents
with a more than one in five chance of developing
cardiovascular disease. It will help them to make
lifestyle changes to reduce their chances of having
a heart attack or stroke.

Patients recruited to the programme are offered BY 2013 WE Will
one-to-one assessments and health advice from • educe overall health inequalities
R
a team of cardiologists, nurses, dieticians and • ncrease average number of years people in
I
physiotherapists. In regular sessions at community Westminster are expected to live
venues they will be able take part in supervised
• ncrease proportion of children under five who
I
exercise classes, workshops on healthy eating,
get both doses of the MMr vaccine
diabetes, blood pressure management and how
to stop smoking.

Measles, Mumps and Rubella (MMR) catch-up campaign
Local GP practices and NHS Westminster took part We are nearing the 95% recommended by the
in the national catch-up programme for all children World Health Organization (WHO) to ensure
aged 13 months to 18 years. It was successful, with protection for the whole community (including those
the number taking the first dose of the MMr unable to have the vaccine for medical reasons).
vaccination increasing by 10% to 89%. The number of children getting the second dose of
MMr more than doubled during the programme.
67% of children have now had the vaccine.

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2. ADDiNg yeArS to life
Preventable ill health and disease is one of the major causes
of premature death in Westminster.

We will change this by working to prevent ill health, diagnosing disease
much earlier and giving people more rapid access to specialist centres
of excellence. This will give many more Westminster residents a better
chance of living longer.

Cancer
In Westminster, cancer accounts for 33% of premature deaths in men and 41%
of those in women. The main causes of premature cancer death in men are lung
and bowel cancer. In women they are
eARly CHeCk uP iS tHe MoSt breast, bowel and lung cancer.
iMPoRtANt tHiNg, BeCAuSe
We are working to ensure that people
PReveNtioN iS BetteR tHAN CuRe!
Mr Kasim, Harrow Road use cancer screening programmes
(cervical, breast and bowel), promoting
healthy lifestyles, and we are improving access to cancer treatment services. This
means that people who develop cancer receive treatment as early as possible.

After talking with local residents, we have set ourselves local cancer targets:

• everyone who is diagnosed by their GP as potentially having cancer should
begin their treatment within 31 days
• by 2012 we want all patients who have cancer to have begun their treatment
within nine days or less of their diagnosis

3 days 1 in 8 90% 170,000
One woman in Westminster For every eight women 90 per cent of care ”NHS Westminster sets
is diagnosed with cancer diagnosed with breast currently delivered at a gold standard for the
every three days. cancer, one will be spared hospital outpatient prevention of heart attack
a mastectomy. departments will be and stroke, which kills
delivered by the new 170,000 people every year
community cardiac team. in the uK.” Health Minister
Lord darzi

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21

MyAction
MyAction is a new and rapidly growing programme
in heart disease prevention. It integrates the care
of patients with cardiovascular disease (and their
families) and those at high risk of developing
atherosclerotic disease, within a convenient local
community setting.

In Westminster, we will provide the programme
to around 1,500 families each year, in seven
community centres.

Community Cardiac Team
This year we commissioned a new service to move
the care of patients with cardiovascular disease into
the community. We plan to integrate it with MyAction
and our new polysystems.

The services will be consultant-led with a range of
new specialist nurse posts. It will be a one-stop shop
for diagnostics and patient clinical management
plans. It will also move patients out of hospitals and HeARt DiSeASe AND StRoke
into the community. because they are run by clinical ARe tHe BiggeSt CoNtRiButiNg
specialists, patients will have world class expertise FACtoRS to tHe HeAltH
closer to home.
iNeQuAlitieS tHAt exiSt BetweeN
RiCH AND PooR, Not oNly iN
weStMiNSteR witH itS DiveRSe
PoPulAtioN, But ACRoSS tHe uk.

BY 2013 WE Will
• ncrease the proportion of 54- to 64-year-
I
old women who are screened every three
years for breast cancer
• educe the number of people who die
R
from heart disease – the single biggest
cause of premature death in Westminster
and the main reason poorer people die
younger than wealthier people

Contents


3. builDiNg A choice of
quAlity heAlthcAre
The NHS now allows all patients to be treated at any hospital
of their choice. We’re working to ensure residents are aware
of their right to choose the care that is best for them.

Since december 2008, more than half the GP practices in Westminster
gp-led offer patients longer opening times. This includes before 8.00am, after
heath centres 6.30pm in the evening and on Saturday mornings. We are now planning
• pen 8am to 8pm,
o extra GP services which will open from 8.00am to 8.00pm, seven days
7 days a week a week.
• GP appointments We’ve commissioned a GP-led health centre which should help patients
• walk-in services see GPs and get primary care services when they need them – patients
• or registered and
f had told us that they found it difficult to see a GP at a convenient time.
non-registered
The launch of our practice nursing scheme funds more nursing hours – giving
patients
more appointment choices for patients wanting to see a practice nurse.

Local residents also told us that more dental surgeries were needed to give
them easy access to NHS dental care. We are making major improvements
to dental care with two new practices opening in 2009.

both new surgeries will be offering
we StARteD oFFeRiNg A lAte longer opening hours and services for
NigHt weDNeSDAy SuRgeRy patients with disabilities and phobias.
uNtil 8PM AND A SAtuRDAy It is planned that the new surgeries
MoRNiNg oPeNiNg. ouR FiRSt will cover 3,000 new patients by 2010
week wAS Fully BookeD! ouR and that this will increase to 5,000 by
PAtieNtS HAve welCoMeD tHe March 2011.
New, CoNveNieNt tiMeS.
We have enough dentists for all
Mandy Walsh, Practice Manager at Bayswater
Westminster residents to register and
Medical Centre in Craven Road, W2
receive NHS dental care.

For a list of dentists accepting new patients and clear guidance on charges
visit www.westminster.nhs.uk, call freephone 0800 587 8818 or email
pals@westminster-pct.nhs.uk.

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23

4. ADDiNg life to yeArS
Many people live with illness for a significant part of their lives.
We are working to improve the quality of their life, as well
as their lifespan, by tailoring care to their particular needs,
preferences and expectations. Where possible, we also aim
to keep patients out of hospital.

Care pathways
In 2008/09, we redesigned care pathways for clinical areas including
musculoskeletal services, dermatology, gynaecology and ear nose and throat.
The new pathways mean more services will be available in the community, as
most of these services are currently provided in hospital. We are working to have
care closer to home wherever possible.

A wide range of local clinicians have been involved in developing the new pathways,
including GPs, hospital consultants, nurses and physiotherapists. Local people were
also asked their opinions and provided ideas and feedback into the project.

The new pathways will be commissioned during 2009 and patients will be able
to have specialist care at a clinic close to their home.

Closer to home
More health services are being provided at or near the home than ever before
and people in Westminster have better access to high quality care. This particularly
helps people with long-term conditions such as asthma and diabetes to stay
healthy and independent for as long as possible.

NHS Westminster will also be funding more staff to work in the community with
increased community nursing, therapists and services to support people with
mental health problems.

Audrey Lewis, Clinical Lead for Healthy Choices/Obesity

Contents


i HAve A HeAltH ACtioN PlAN. People with learning disabilities now get to see
it’S ABout HeAltHy eAtiNg AND their GP at least once a year for a health check –
which includes everything from diet to sexual health
exeRCiSe. HeAltH ACtioN PlANS
and foot care. They then develop an individual
ARe veRy iMPoRtANt iF you HAve
health action plan, with their GP.
A HeAltH PRoBleM.
Patricia, Learning Disability Partnership Since the new service started, blood pressure
Board member recordings have doubled from 41% to 82.5%.

A new team has been formed to help patients These health checks have also given us vital public
who have suffered a stroke to leave hospital earlier. health information that we use to improve other
When they return home, they are supported by an services such as dentistry, sexual health and weight
expert team taking hospital level care into management for people with learning disabilities.
the community. Since the health checks started, referrals have
increased almost tenfold.
Patients have welcomed a new community blood
clotting prevention service which gives them the
opportunity to be treated locally – or at home if they
are unable to make it to the local clinics.

Learning disabilities
NHS Westminster was praised by a national
independent inquiry for good practice in providing
health services for people with learning disabilities.
(The Independent Inquiry into Access to Healthcare
Matthew Morris and Dr Tom Mtandabar at a Health Check
for People with Learning disabilities cited the Trust’s
work in their report released on 29 July 2008.)
Expert patients programme
NHS Westminster has developed a unique service in
This is a free, six week course giving you the
conjunction with local GPs. This was developed after
confidence, skills and knowledge to manage
listening to local people with learning disabilities and
your condition better, and reduce its impact on
their carers, who said that better access to health
your daily life. Courses are led by tutors living
services was needed.
with long term conditions themselves.
we HAve DouBleD tHe tAke-uP Call our Patient Advice and Liaison Service
oF RoutiNe HeAltH teStS (PALS) Freephone 0800 587 8818 or check
FoR PeoPle witH leARNiNg our website www.westminster.nhs.uk for
DiSABilitieS. more information.

£3.6m £260,000 £540,000
£3.6m will be spent over three years £260,000 in a new community- £540,000 in a community-based
in community nursing services based assessment and treatment podiatry service which will start in
service for elderly patients 2009. More than 2,000 Westminster
residents told us what they wanted
from their local podiatry service

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25

5. promotiNg heAlthy lifeStyleS
London welcomes the world to its Olympic Games in three
years time, and we see our preparations for the Olympics as
a major opportunity to promote the need for us all to make
lifestyle changes that will improve our health and wellbeing.

Preventing illness is one of our major priorities. It includes raising awareness of,
as well as supporting, healthy lifestyles. There are six lifestyle areas we are
concentrating on:

1. Healthy eating
2. Physical activity
3. Smoking
4. Sexual health
5. Substance misuse
6. Mental health and wellbeing

KickStart – from strength to strength
kiCkStARt HAS BeeN
Kickstart helps children and families in Westminster adopt a healthier
gReAt Not juSt FoR
lifestyle. It’s a free 12-week after-school programme for children
My SoN, But FoR tHe
above their ideal weight, who are aged 7-12, and their families.
wHole FAMily.
Family-focused and hands on, the sessions are interactive and packed
Westminster Dad, Moifak Dib
with exciting activities including street dance, football and cooking.

The programme, which has been running since 2006, has helped over 60
children and their parents lead healthier lives. It uses behavioural change
strategies, healthy eating education and physical activity to help children and
families get healthier.

Drop in to Weigh In
In Westminster local schemes give support to residents to make healthy lifestyle and
food choices. Over 500 people have joined our ‘drop in to Weigh In’ scheme and lost
hundreds of kilos.

Our dieticians set up the free weight management service, to help people lose
weight and increase their knowledge and understanding of healthy eating principles
and a healthy lifestyle.

Supporting people to stop smoking
kiDS ARe HeAltHieR
wHeN tHeiR HoMeS The Westminster Stop Smoking Service has helped just over
10,000 people quit smoking from 1 April 2003 – 31 March 2009.
ARe SMokeFRee.

Contents


This year we focussed on the areas with the heaviest
it iS vAluABle to See tHe
smokers: Westbourne Park, Queens Park, Church
DietiCiANS eACH week AND i eNjoy
Street, Harrow road, Warwick, Tachbrook, Churchill
MeetiNg otHeR PeoPle At tHe and Vincent Square. Local pharmacies saw a
SeSSioN FoR eNCouRAgeMeNt 60% increase in referrals where one-on-one help
AND SuPPoRt AND AM FeeliNg was available.
HeAltHieR AS A ReSult. Now i Feel
We have also been working to keep Westminster
gooD ABout MySelF AND AM
homes “Smokefree”. We know second hand smoke
lookiNg FoRwARD to loSiNg
can cause cancer. So, we want to give families
MoRe iN 2009.
in Westminster a reason to stop smoking around
David Fearn
their children. Our Smokefree project includes
a community-led programme of education, a social
marketing campaign, health promotion and a referral
to a stop smoking service if required.

Promoting Sexual Health
We aim to reduce the levels of HIV and other
sexually transmitted diseases, particularly in those
people under 25. We are adding to our sexual health
services and commissioning more community projects
to engage with young people around sexual health.
A significant element of this programme is our
chlamydia screening programme.

BY 2013 WE Will
• ave less primary school-aged children
H
recorded as being obese – obesity levels for
children rise sharply between starting primary
school and beginning secondary school
• ave less people admitted to hospital
H
because of harm caused by alcohol. There
is growing concern about how many people
need hospital care because of the effects
of alcohol consumption

4 24% 500
Smokers are four times more likely of under-25s would not tell their More than 500 people have joined
to quit with NHS support previous sexual partners that they our drop in to Weigh in scheme
had chlamydia

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27

i HAve FouND it AN exCelleNt
wAy oF loSiNg weigHt AS it
iS RelAxiNg AND tHeRe iS No
PReSSuRe. i tHiNk oF it AS HeAltHy
eAtiNg, Not DietiNg. i MADe
CHANgeS to My eAtiNg wHiCH
HAS MADe A ReAl DiFFeReNCe AND
i Now Feel BetteR, i go tHe gyM
AND CAN RuN to tHe BuS. tHe FACt
it’S FRee iS AN ADDeD iNCeNtive.
Brenda Smith, Drop in to Weigh In participant

A Queens Park resident signing up to Smokefree Homes.

Contents

DiRECTORATE
REviEWS

Contents


section dIreCTOrATe reVIeWS
three 1. SerVice DeVelopmeNt
Key achievements in 2008/09

Strategic and Joint Commissioning
• We invested £1 million to reduce waiting times for planned care – and since
July 2008, 95% of patients are now seen within 18 weeks
• We redesigned care pathways to move more clinical services away from
hospitals into the community to give patients care closer to home
• We helped GP Practices review the services they offer to make them more
accessible and convenient – with quicker and more proactive care.
• We developed an electrocardiogram reporting service, a falls prevention clinic
and an anticoagulation service
• based on an assessment of health needs in Westminster,
we ARe CReAtiNg joBS
we developed new, three year commissioning strategies, that
FoR loCAl PeoPle By
bear in mind the needs of users, carers and the wider community
eNCouRAgiNg ouR
ReSiDeNtS to tRAiN • We received “beacon” status for our joint strategic
commissioning, which means we have been recognised as
AS PSyCHologiCAl
delivering best practice, from the IdeA programme on behalf
tHeRAPy woRkeRS.
of the department for Communities and Local Government.
We plan to share our experiences in 2009/10
• We developed a procurement policy and a procurement competition dispute
resolution procedure for dealing with issues raised around individual tenders
• Major re-commissioning programmes have been implemented or are in
progress and include: the integration of drug and alcohol services; access to
psychological therapies; new supported housing for people with learning
disabilities; improved access to wheelchair services; and an overhaul of the
chlamydia screening programme

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31
• We are reviewing our contract portfolio to make
services more personalised and to give new
guidance on community health service and mental
health contracting

Mental Health
• We invested an extra £1.4 million to improve the
quality of care at the mental health in-patient
wards at Gordon Hospital and the St Charles’
Mental Health unit, including putting more staff
on the wards
• We secured additional investment to improve
access to psychological therapies by employing
14 low and high intensity, locally based, cognitive
behavioural therapy workers. This means that
more people get help for depression and anxiety
when they need it
• We commissioned a user-led website,
Go4mentalhealth.com which was conceived,
implemented, led and maintained by service users,
employs a website manager and a trained
volunteer team. More than 200 people have
visited the site each month since April 2008
• Westminster Forum, our local mental health user
group, organised three Open Forum events and
a user-led conference

Learning Disabilities
• We increased investment in learning disability
services to support young people moving from
children’s to adult’s services, and the resettlement
of people from NHS campuses

tHe Big PlAN outliNeS tHe
joiNt CoMMiSSioNiNg StRAtegy
FoR PeoPle witH leARNiNg
DiSABilitieS oveR tHe Next
tHRee yeARS. it CAN Be
DowNloADeD FRoM tHe
weStMiNSteR City CouNCil
weBSite At: www.weStMiNSteR.
gov.uk/wlDP/tHeBigPlAN

Contents


• As part of the local housing strategy for people Older People and Physical Disabilities
with learning disabilities, seven new flats with on • A pilot scheme to support early discharge of
site support have been opened. We are working stroke patients from hospital has been set up.
with Westminster City Council to develop more This involves providing specialist multidisciplinary
• Our locally enhanced service, to ensure people stroke rehabilitation and care in the home setting.
with learning disabilities receive an annual health The team includes home support, physiotherapy
assessment and health action plan, has been and voluntary sector services, providing return to
acknowledged by the department of Health work support, re-training, vocational rehabilitation
as an example of best practice and so on

• We have invested in oral hygiene, healthy living, • Two hub projects, strategically attached to older
health and fitness projects – and a liaison post peoples’ housing units, provide drop-in centres for
at St Mary’s Hospital patients over 50 years of age – allowing them
access to a range of services that help them stay
• The Learning disability Partnership board
well and independent at home
had elections for positions that included video
campaign addresses on the website. Over 100 • A new memory assessment service has been
people voted commissioned as part of the development of

New sexual health centre at 56 Dean Street
Chelsea and Westminster Hospital NHS provides a full range of HIV and sexual health
Foundation Trust opened a new state-of-the-art services and is even open during the evenings and
HIV and sexual health centre in the heart of Soho on Saturdays. It has proved popular with patients
in March 2009. 56 dean Street, which replaced - 23% more people used services at 56 dean
the Trust’s Victoria Clinic at the South Westminster Street in the 4 months from 2 March - 31 July
Centre, has been designed to be welcoming and compared with the same period last year at the
friendly, with a social, rather than clinical, feel. It Victoria Clinic.

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33
a dementia strategy. This service will ensure good or have children; and continue to have services in
quality diagnosis and intervention for all, with easy, place to meet people’s needs around housing,
direct access to services welfare benefits and debt advice
• A survey was introduced to obtain patient
Substance Misuse
feedback on their experience of using major
home adaptations and community equipment. It is • We are on target to increase by 3% the numbers
influencing the way local services are developed of drug users receiving treatment

• At the Physical disabilities and Sensory Needs • An additional three hostels offering services were
Strategy stakeholder event, the aims and priorities established in 2008/09
of the strategy for the next three years were agreed • We have commissioned two new services to
by service users, carers and group members improve the general health and well being of
substance misusers
HIV and Sexual Health
• A joint pilot project to develop a comprehensive
• We commissioned a range of services to screen
package of testing and support in Westminster to
15-24 year olds in Westminster for chlamydia
offer dry blood spot testing was successful. It will
which included screening in sexual health centres,
be mainstreamed in 2009/2010 and focus on
GP and pharmacy services, outreach in community
improving pathways into secondary care for
and social services, the www.check-kit.org.uk
substance mis-users who test positive for
website and marketing campaigns
hepatitis C and HIV

16 to 24-yeAR-olDS iN weSt • We increased the provision and availability of
loNDoN CAN get A FRee alcohol services in Accident and emergency
CHlAMyDiA teSt FRoM (A&e), which increased the number of referrals
www.CHeCk-kit.oRg.uk from 848 in 2007/08 to 956 in 2008/09

Blood Borne Viruses
• We currently have the third largest HIV positive
population in London. So, in partnership with • From just two testing sessions in 2007/08 the
Westminster City Council, we carried out an HIV service has expanded to coverage across the city
needs assessment to ensure we have the right five days a week in 2008/09. Over 500 patients
services in place by April 2010. We’re aiming to have been tested for blood borne viruses
make HIV testing more accessible – in primary • The project has been endorsed by the National
care, out-patient services, and community and Treatment Agency as an example of best practice
social venues; provide support to people at times in terms of harm reduction
of need, such as when they are first diagnosed,
start treatment, are entering a new relationship

Contents


Alcohol and Accident & Emergency Community Pharmacy
• We commission two posts based in Accident With the Community Pharmacy Advisor, we have
& emergency who offer brief interventions and commissioned a range of new services to be
referrals into specialist alcohol services in their delivered through local pharmacies. These include:
borough of residence. The service is embedded as
• stop smoking services
part of the core staff team which is part of the
reason it has been successful • flu vaccinations
• chlamydia screenings
Dentistry
• medicine usage reviews
• We have designed a new, quality focused, service
specification to procure two new dental practices • emergency hormonal contraception

• Working with our current practices, we’ve • minor ailments
increased provision and improved access to • supervised consumption and needle exchange
already established practices
Following the 2007/08 pilot, this year we
• We have implemented a communication strategy
implemented the flu vaccination service in pharmacies
to give local people information about good oral
and increased the numbers of patients vaccinated
health and where to find services
there from 412 to 946 – an increase of over 100%.
• We’ve also funded digital signage in 11 local
practices to inform patients about their
entitlement to care, costs and to promote oral
health. The digital screens will also display other
healthcare messages and we aim to install the
same equipment in further practices

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35
Eye Care
On 1 August, we rolled out the national contract
across 70 NHS practices. As part of this, 19 opticians
now provide home-based services. We are developing
a needs assessment to inform future commissioning
decisions for eye care services for local people.

General Practice
We have been working with GPs to improve access
to services, both in primary care and for specialist
referrals. We recently awarded a contract for a new
GP-led health centres. Our aim is to increase the
range of services that patients can receive from their
GPs. So we have funded practices to:

• implement Choose and book, which allows
patients real choice in where they obtain
secondary care (most practices have now
implemented this system)
• open longer – over 50% now have more sessions
at the weekend or open later for at least some
evenings during the week
• offer chlamydia screening
• increase coverage of flu vaccination
• provide a greater range of minor surgery
• develop anticoagulation services

NHS Westminster has introduced a system to measure
practice performance, including the range of services
available at each GP surgery. The results will be shared
with the public through NHS Westminster’s website.
This will give patients information on practices in their
area, and to help them choose where they would like to
register. A similar scheme will be introduced for dentists.

91 2,283,360 50%
We have 91 pharmacists working In 2008/09 we filled over More than 50% of
in Westminster 2.2 million prescriptions Westminster GPs now
offer appointments outside
normal working hours

Contents


2. public heAlth
We aim to lead the development and implementation of
programmes to improve the health and wellbeing of the
local population and to reduce health inequalities.

• The Westminster Health debate, where 1,600 local people contributed to the
development of our strategic plan
• The 2006/07 Public Health report, which identified the health inequalities
that exist in Westminster, and the development on behalf of the Westminster
City Partnership of a joint strategy to tackle these health inequalities
• Our joint strategic needs assessment, developed in partnership with Westminster
City Council, which aims to build a shared view of Westminster and ensure that
our services meet the needs of our population, now and in the future
• The Westminster Smoke Free Homes Project, which encourages local people
to keep their homes smoke free, reduces exposure of children to second hand
smoke, and supports people to quit smoking
• The launch of the Healthy Hearts and Minds Programme, a community-based
cardiovascular disease prevention and treatment programme
• The implementation of our new diabetes service,
Key findings from the Westminster which has enabled more people to receive high
Health Debate quality care closer to where they live (our model is
now recommended by Healthcare for London for
Health care services in Westminster generally
how to improve diabetes services across the capital)
have a good quality but there was felt to be
“room for improvement”. A need for increased • Our Health Trainer Programme, which supports
dental and mental health services was identified people living in Westminster’s most deprived
as well as more flexibility from GP surgeries. areas to choose healthier lifestyles and to access
There is also a call to reduce waiting times. health and social care services

Westminster residents are aware of core health • The black, Minority and ethnic (bMe) Health
services. but, there is much less known about Forum’s Good Practices for Access and Wellbeing
specialist services. programme for GPs and dental practices

General lifestyle was seen to be the main • National recognition for our Ask Your Patients Week
barrier to healthy living. Programme, which won the Primary Care Category
of the Involvement to Impact Awards 2008
There was broad agreement that people need
to take responsibility for their own actions, • Safer management of controlled drugs in
however NHS Westminster can help by Westminster resulting from the sharing of
promoting healthy lifestyle services. intelligence with external agencies

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37

Health training
“I work for a charity that deals with the older Asian
community. Health is something that we deal with and
health and nutrition is of particular importance. I will
use what I have learnt of this course to inform people
of the impact of food on health.” Adbul Kalum
“I am interested in anything that is designed to keep
you fit and well. I will use this information to talk to the
children that I work with and hopefully take the next
level of this course.” Mary Amayo

Stephen, who attended our Understanding Health Improvement course.

Contents


3. NurSiNg AND quAlity
We aim to provide nursing advice to the Board, ensure that
vulnerable adults and children are protected, and that our
nurses are fit to practice.

• Continued to implement the community nursing programme with an
investment of £3.6 million over the next two years
• Strengthened clinical practice by employing nurses with teaching skills
• Created clinical leads for end of life care, long term conditions, urgent care,
access and medical technology, self care and health inequalities
• Took part in the productive ward scheme in Garside Nursing Home and the
rehabilitation unit at Athlone House with real improvements for patients and staff
• Worked with children’s services on the integration agenda including the family
recovery project
• delivered the national cervical cancer immunisation programme for young girls
• recruited two GPs to provide four sessions a week on safeguarding children
to support General Practices in Westminster
• Continued to raise the safeguarding agenda, making it everyone’s responsibility
• Achieved compliance for all 24 core standards for better Health, as both
a commissioner and provider of healthcare services
• delivered a research governance audit and we now submit all projects for
monitoring and onto national research registers
• data quality send from NHS Westminster to the National Patient Safety
Agency met 100% accuracy
• Actions to prevent incidents occurring and minimising actions had greater
data quality
• Greater number of incidents with ‘no harm’ outcomes reported
• 13% increase in numbers of incidents reported on 2005/06
• All incidents involving patients reported effectively via the National Patient
Safety Agency reporting and learning mechanism
• Improvement in staff skills to de-escalate conflict situations

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39

Our investment in community nursing
We are recruiting over 80 extra staff, ranging
from health care support workers, assistant
administrators to district nurses. This will
increase the quality of patient care and the
ability to look after more patients in the
community to deliver care closer to people’s
homes within Westminster.

“community nursing will be transformed
under this programme to bring the most
specialised hospital level care out to
patients in their own homes. We will aim
to recruit a number of the new staff from
the Westminster area to build up community
links and knowledge. this investment
supports the theme of bringing care out
of hospital and closer to people’s home
which is a major aim of NhS Westminster
and healthcare for london”
Chief executive Michael Scott

Contents


4. fiNANce AND
performANce mANAgemeNt
This year, we spent over £390 million on services for
our residents.

We also had a revenue surplus of £15.5m for 2008/09, achieving financial
balance for the seventh consecutive year. The surplus is £3.0m above the
planned £12.5m and remains within the local surplus target range of £14.7m
to £15.9m set by NHS London.

Funding our goals
during 2008/09 NHS Westminster has invested an extra £10m in support of
the five strategic goals which best reflect the health needs of our population.
This includes:

• funding 115 individual schemes ranging in value from £0.02m to £1.42m
• a further £20m has been set aside for strategic goals in 2009/10
• an action plan is being developed to prioritise investment schemes and ensure
they deliver the intended health and quality improvements whilst achieving
value for money

• Supporting provider services to separate from NHS Westminster
• Continuing to support and develop our practice-based commissioning clusters
• Preparing the organisation and systems to operate under International
Financial reporting Standards (IFrS) from 2009/10
• Providing significant financial and informatics support to the world class
commissioning submission and associated strategic plan
• delivering annual accounts within the national faster closure timetable
• developing a new information strategy for 2009-14
• Significant progress on information governance agenda
• Implementing GP referrals information service
• Continuing to roll out IT network improvements across NHS Westminster
and primary care services in Westminster

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41
Looking to the future Use of Resources
The financial prospects for NHS Westminster show The Annual Health Check looked for evidence of
a continuing surplus. This allows us to support both positive outcomes from our use of resources and
our five-year Commissioning Strategy Plan and the processes in terms of economy, efficiency and
Healthcare for London programme. We have reported effectiveness. It covered the following themes:
to our board that the biggest risk to our plans during
• Managing finances – How effectively does NHS
this period is our capacity to deliver on our ambitious
Westminster manage its finances to deliver value
investment programme. The final two years are likely
for money?
to be much more financially challenging and a savings
programme of at least £5m is being developed to • Governing the business – How well does NHS
ensure NHS Westminster has the funds required to Westminster govern itself; ensure value for money
invest in the future. in the services it delivers and commissions; and
delivers better outcomes for local people?
Annual Health Check • Managing resources – How well does NHS
The Care Quality Commission’s (previously the Westminster achieve value for money in relation
Healthcare Commission) Annual Health Check seeks to a wider definition of resources, including
to establish whether an organisation is getting the natural resources, people and assets
basics right and is making and sustaining progress.
The Annual Health Check interim review for use of
Trusts are assessed in five areas and an overall
resources in 2008/9 classed us as good. The final
rating determined for:
rating will be confirmed in October 2009.
• use of resources (focussing on how well finances
are managed) Declaration of Core Standards

• quality of services (which includes whether we are One of the five components of the Care Quality
meeting standards and targets set by Government) Commission’s, Annual Health Check is the
“Core Standards for better Health”.
ratings are excellent, Good, Fair or Weak.
This sets out 24 standards as a minimum level of
The Care Quality Commission released its findings for service NHS Westminster should provide to ensure
2007/08 in October 2008. Findings for 2008/09 our services are safe and of an acceptable quality.
were not released in time for inclusion in this report.
We assessed and rated our performance against the
For 2007/08, NHS Westminster again scored core standards and declared compliance as both
“Good” for use of resources, and we also scored a buyer and provider of healthcare.
“Good” for quality of services – an improvement
on “Fair” in previous years.

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Meeting our targets
NHS Westminster is required to meet five financial and administrative duties to ensure that public funds are
used appropriately.

Duties our performance in 2008/09 Duty
met?

1 Meet revenue resources limit NHS Westminster has a surplus of £15.53 million Yes
against a revenue resource limit of £428.51 million
2 Meet capital resource limit We underspent by £0.04 million on a capital Yes
resource limit of £1.43 million
3 Meet cash limit (revenue and capital) with No variance against the cash limit Yes
no unplanned borrowing at year end
4 Full cost recovery of directly provided services £0.91 million underspend Yes
5 To meet the better Practice Code by NHS Westminster achieved 91.7% (on volume) and No
paying 95% of non-NHS creditors within 93.1% (on value) which are lower than 2007/08 due
30 days of the invoice date to the impact of operating two financial systems for
commissioning/provider split. An action plan is in
place to improve performance in 2009/10

Information Governance
Information governance risks are management actions and are included in the corporate objectives
document that incorporates the board Assurance Framework, and our risk register.

There were no breaches of information governance which met the criteria outlined for serious untoward
incidents. All incidents are shown below.

Summary of other personal data incidents 2008-09

Dh category Nature of incident total

I Loss of inadequately protected electronic equipment devices 0
or paper documents from secured NHS premises

II Loss of inadequately protected electronic equipment devices 5
or paper documents from outside secured NHS premises

III Insecure disposal of inadequately protected electronic equipment, 0
devices or paper documents

IV unauthorised disclosure 7

V Other – Patient notes not available for consultation 13

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5. humAN reSourceS AND
corporAte AffAirS

• Supporting and preparing our provider services and commissioning services
to be fit for their future including the Strengthening Commissioning
programme and World Class Commissioning audit process
• engaging and supporting staff through the processes of significant
organisational change
• Keeping our sickness absence rate at 3.26% which is well below our
target of 5%
• Keeping our staff turnover rate at a reasonable level of 19.65% full time
employed at a time of significant organisational change
• Assisting in the recruitment of a significant number of key new nursing
positions – an example of our extra investment in district nursing
• relocating the Occupational Health Service to a new site with a view to
providing increased services for the wellbeing of staff
• Supporting staff through sickness to improve their health and wellbeing
through our Occupational Health department
• Increasing the number of cases handled by our Patient Advice and Liaison
Service (PALS) by 21%

StAFF RAteD uS iN tHe toP 20% oF PRiMARy CARe
tRuStS iN 15 AReAS oF woRk iN tHe 2008 NAtioNAl
NHS StAFF SuRvey.

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45
Annual Staff Survey Challenges and opportunities of the year ahead
For the fifth year running, our staff told us that NHS To support our staff in facing the challenges
Westminster is well-run, well-managed and a good of working in a new and more market-oriented
place to work. environment, we are developing:

We were particularly pleased to be rated second • a board development programme
of all trusts in the country for having a high majority • a Talent Management Strategy to develop NHS
of staff who would recommend the organisation as Westminster’s ability to identify and manage
a great place to work. talented staff rising through the ranks
Key areas in which NHS Westminster is in the top • project management and leadership skills
20% of primary care trusts nationally; • a range of commissioning capabilities including
• staff feeling satisfied with the quality of care they database management and monitoring skills,
are able to deliver procurement, risk analysis, predictive modelling
and contract management
• staff agreeing that their role makes a difference
to patients • effective induction and appraisal systems

• quality of job design We are also developing a range of skills such as
management, leadership, IT and business planning,
• perceptions of effective action from employer
as well as looking at new approaches of working
towards violence and harassment
with patients to improve their experience of using
• fairness and effectiveness of procedures for our services.
reporting errors, near misses or incidents
NHS Westminster also scored a higher than our
average percentage for staff receiving job relevant
training, learning or development. This maintains our Staff group Total
strong performance from last year’s survey.
Administration and estates 392

Healthcare assistants and
other support staff 106

Medical and dental 43

Nursing, midwifery and health
visiting learners 5

Nursing, midwifery and health
visiting staff 343

Other 7

Scientific, therapeutic and
technical staff (including allied
health professionals) 220

grand Total 1116

Contents


section our boArD
four

Joe Hegarty Catherine longworth Michael Scott
Chair Vice Chair Chief Executive

Dr Dennis Abadi Jeff Deane Dr Margaret guy
PEC/CEC Chair Executive Director Executive Director

Ann Duncan Dr Sheila D’Souza Andrew Whitley
Executive Director Non-Executive Director Non-Executive Director

Nicholas Woolf Marek Stepniak Councillor Ed Argar*
Non-Executive Director Non-Executive Director Co-Opted Board Member

Marian Harrington* Brigitta lock** David Hawker*
Co-Opted Board Member Co-Opted Board Member Co-Opted Board Member

* Co-opted member (Westminster City Council)
** Co-opted member (Patient Public Involvement Forum)

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49
Professional Executive Jeff deane Tera Younger
Committee Members Margaret Guy Paul Jenkins
dr Maher Shakarchi*** Ann duncan Marian Harrington*
Sangita Patel Michael Scott dr dennis Abadi (Chair)
Meredith Gamble Karen broughton
dr derek Chase *** Commissioning Executive Jeff deane
dr Mike Cornell *** Committee Members Margaret Guy
dr Nazeer Ahmed *** dr derek Chase *** Ann duncan
Tera Younger dr Nazeer Ahmed *** Michael Scott
Paul Jenkins dr Matthew Johnson***
Marian Harrington* dr Jonathan Fluxman***
dr dennis Abadi (Chair) dr Jonathan Munday***

Board membership 2008/09 Changes in our Commissioning
NHS Westminster non-executive directors Catherine Executive Committee
Longworth, Sheila d’Souza and Andrew Whitley have The Professional executive Committee (PeC)
been re-appointed in the past year. was dissolved on 31 december 2008 and the
Commissioning executive Committee (CeC) began
Catherine Longworth is Vice-Chair of the board
on 1 January 2009.
and has been a non-executive director at NHS
Westminster since 2002, Sheila d’Souza since The change in membership of the Commissioning
2005 and Andrew Whitley since 2002. executive Committee reflects the need for a more
formal commissioning relationship between NHS
In the last year david Hawker and brigitta Lock left
Westminster and the practice-based commissioning
the board and we thank them for all their hard work
consortia.
and commitment.
The chairs of each practice-based commissioning
We have been joined by Councillor ed Argar and
cluster/consortium will be full members of the
Marian Harrington (Co-Opted Members, Westminster
Commissioning executive Committee. They will be
City Council). Councillor Argar is the Cabinet Member
tasked with leading, or at least contributing to, the
for Health and Adult Social Care. Marian is currently
strategic commissioning decisions of NHS Westminster.
responsible for the care management service and
They will also bring their local commissioning plans
commissioning and developing services for older
to the Commissioning executive Committee for
and disabled people in Westminster.
discussion and endorsement.
Throughout the year our board members have taken
The practice-based commissioning chairs will be
part in a wide range of seminars and training.
making healthcare commissioning decisions on
behalf of their clusters/consortia, as well as the
populations they serve. They will therefore be
mandated to disseminate these decisions back
to their constituent practices. Practice-based
commissioning cluster chairs will also be mandated
to make decisions on behalf of their practice-based
commissioning clusters/consortia.
* Co-opted member (Westminster City Council)
*** Practice-based commissioning cluster representative

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memberS’ iNtereStS
All board, Professional executive Committee and Commissioning executive
Committee members of NHS Westminster are required, on appointment,
to subscribe to a Code of Conduct. As part of this, they should declare any
conflict of interest that arises in the course of conducting NHS business.
They are required to declare:

• directorships
• Ownerships or part ownerships of private businesses or consultancies likely
to or seeking to do business with the NHS
• Significant shareholdings in organisations likely or possibly seeking to do
business with the NHS
• details of any position of authority in any body, including a charity or voluntary
body, in the field of health and social care
• details of any connection with a voluntary or other body contracting
for NHS services
• details of fees received from public bodies or other organisations

Westminster local involvement Network (liNk)
Westminster LINk is your chance to have a say westminsterlink@vawcvs.org
on how health and social care services are 020 7535 0492
provided in Westminster. The LINk is independent, Westminster LINk, c/o VAW, 37 Chapel St,
run by local volunteers and open to everyone: London, NW1 5dP
you can take part whether you’re an individual www.westminsterlink.org.uk
or part of a group.

Catherine Longworth at
The Rainbow Centre

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51
during 2008-09 the following interests were declared:

dr dennis Chair PEC*, CEC** GP Principal St John’s Wood Medical Practice under
Abadi contract with NHS Westminster. director/Shareholder
General Healthcare provision, a company set up in 2006
to provide health services in the community. Fees from
GMS GP Contract, additional enhanced services, rent and
rates reimbursement from NHS Westminster
dr Nazeer Member PEC*, CEC** No outside interests declared
Ahmed
Councillor Co-opted Board Member Cabinet Member, Health and Adult Social Care,
edward Argar Westminster City Council. Vice-Chair London Councils
Health and Social Care Forum. employed by Mouchel
Contracting with various NHS bodies. Allowance paid by
Westminster City Council and also by London Councils
Karen Director of Human No outside interests declared
broughton Resources and Corporate
Affairs,
Senior Management Team
dr derek Member PEC*, director, Central London Healthcare Ltd. director/
Chase Member CEC** part-owner/shareholder, Central Healthcare Provider Ltd.
Chairman, Central London Healthcare Ltd. Fees from
Central London Healthcare Ltd and Central Healthcare
Provider Limited
Jeff deane Director of Finance director Allington Healthcare Ltd. A company providing
and Performance, residential care to elderly people
Senior Management Team,
Member PEC*, CEC**
dr Sheila Non-Executive No outside interests declared
d’Souza
Ann duncan Director of Nursing No outside interests declared
and Quality,
Member PEC*, CEC**
dr Jonathan Member CEC** delegated representative on CeC to dr Nazeer Ahmed
Fluxman
Meredith Member PEC* No outside interests declared
Gamble
dr Margaret Guy Director of Public Health / General board Member, Faculty of Public Health. Member
Medical Director, of Healthcare delivery Working Group, diabetes uK
Member PEC*, CEC**

Contents


Marian Member PEC*, CEC**, Strategic director, Adult & Community Services
Harrington Co-opted Board Member Westminster City Council. Salary Westminster
City Council
Joe Hegarty Chair, Non-Executive director Manor House (Marylebone) Ltd, a company
established to purchase the freehold of Mr Hegarty’s
home. Chair of Governors, St Vincent’s Catholic
Primary School
Paul Jenkins Director of Service Chair, rugby House
Development,
Member PEC*, CEC**
dr Matthew Member CEC** Owner, small private medical practice providing treatment
Johnson and testing for persons with drug related problems.
No NHS work planned
brigitta Lock Co-opted Board Member Co-owner and Trustee of a family charity trust,
Member of LINk
Catherine Vice Chair, Non-Executive Trustee, dolphin Square Charitable Foundation,
Longworth Francis Holland School Trust
dr Jonathan Member CEC** Chairman Victoria GPs LLP. President, Hammersmith
Munday division St John’s Ambulance. GMS Locum Fees PCT
Sangita Patel Member PEC* No outside interests declared
Michael Scott* Chief Executive, Governor, Quintin Kynaston School
Member PEC*, CEC**
dr Maher Member PEC* PeC Practice-based commissioning Cluster representative,
Sharkachi board Member, Victoria Commissioning Consortium
Marek Stepniak Non-Executive director, Stepniak & Partners, Governor North West
London NHS Foundation Trust, Non executive director
CWL Community Services. Advisor and consultant to
Perot Systems Corporation
Andrew Whitley Non-Executive Interim Chair, City West Homes (paid role). retainer,
richmond Fellowship
Nicholas Woolf Non-Executive director, derby Homes Limited, Concilian Group. Trustee,
Princess Alice Hospice, beating bowel Cancer and barts
& The London Charity
Tera Younger Member PEC*, CEC** Owner, TY Consultancy

* The PeC was dissolved on 31 december 2008.
**The Commissioning executive Committee superseded PeC on 1 January 2009.

Contents

ANNUAl
ACCOUNTS

Contents


section FINANCIAL STATeMeNTS 2008/09
five Foreword to the Accounts
These accounts for the year ended 31 March 2009 have been prepared by
Westminster PCT under section 98 (2) of the National Health Service Act
1977 (as amended by section 24 (2), schedule 2 of the National Health
Service and Community Care Act 1990) in the form which the Secretary
of State has, with the approval of the Treasury, directed.

Westminster PCT was established with effect from 1 April 2002.

dIreCTOr’S STATeMeNT
Statement of the Chief Executive’s responsibilities as the
Accountable Officer of the Primary Care Trust
The Secretary of State has directed 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 authority;
• the expenditure and income of the authority has been applied to the purpose
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.

Chief executive

date 09.06.09

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57

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 organisation 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 organisation 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 health
authority and hence for taking reasonable steps for the prevention 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 financial statements.

by order of the board.

Chief executive

date 09.06.09

director of Finance

date 09.06.09

Contents


STATeMeNT OF INTerNAL CONTrOL
Scope of Responsibility
The board is accountable for internal control. As Accountable Officer, and Chief executive of
this board, I have responsibility for maintaining a sound system of internal control that supports
the achievement of the organisation’s policies, aims and objectives. I also have responsibility
for safeguarding the public funds and the organisation’s assets for which I am personally
responsible as set out in the Accountable Officer Memorandum.

I am accountable to the Chair of the Trust and to the Chief executive of the Strategic Health
Authority. The Chief executive is regularly performance managed through twice yearly
performance appraisals undertaken by the Trust Chair and, at the year end, the Chief executive
of the Strategic Health Authority formally records his/her comments on NHS Westminster
Chief executive’s performance. Westminster Primary Care Trust also undergoes a quarterly
performance review process with the Strategic Health Authority, involving NHS Westminster
Chief executive and other PCT executive directors.

I have constructed systems and processes to ensure effective working with partner organisations.

The Purpose of the System of Internal Control
The system of internal control is designed to manage risk to a reasonable level rather than to
eliminate all risk of failure to achieve policies, aims and objectives; it can therefore only provide
reasonable and not absolute assurance of effectiveness. The system of internal control is
based on an ongoing process designed to:

i. identify and prioritise the risks to the achievement of the organisation’s policies,
aims and objectives

ii. evaluate the likelihood of those risks being realised and the impact should they be realised
and to manage them efficiently, effectively and economically.

The system of internal control has been in place in Westminster Primary Care Trust for the year
ended 31 March 2009 and up to the date of approval of the annual report and accounts.

Capacity to Handle Risk
NHS Westminster has in place a risk management strategy that is reviewed annually.
The director of Nursing and Quality has delegated responsibility for managing the strategic
development and implementation of organisational risk management and controls assurance.
The director of Nursing and Quality has overall responsibility for clinical risk management and
this includes being the Lead director, in 2008/09, for the work on risk Assessment.

The risk management agenda is led at directorate level by clinical governance facilitators who
are provided with training. The Trust learns from good practice through clinical supervision and
reflective practice, individual and peer reviews, performance management, continuing professional
development programmes, clinical audit and application of evidence-based practice.

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59
The Risk and Control Framework
The system of internal control is based on an ongoing risk management process
which combines the following elements:
• the identification and treatment of principal risks to the achievement of the
organisation’s objectives;
• the identification of risks through the comparison of Trust practice against external
standards such as Standards for better Health, Clinical Negligence Scheme for Trusts,
risk Pooling Scheme for Trusts and National Frameworks; and
• the analysis, recording and learning from untoward occurrences or near misses.
The Trust’s risk Assessment Tool ensures a consistent approach is taken to the evaluation
and monitoring of risk, in terms of the assessment of likelihood and consequence. The board,
Audit Committee and the Clinical Governance Assurance Committee are responsible for
reviewing action plans, providing scrutiny and monitoring their implementation for risks with
a significant and high rating.

The risk Management Strategy clearly states that risk management is the responsibility of all
employees. All staff are provided with risk management training at induction. Clinical governance
facilitators act as local risk management leads. All staff are able to identify risks through
incident reports and risk assessments.

The board Assurance Framework is based on the four corporate and 37 principal objectives
underpinning them for 2008/09 as identified in the Westminster Primary Care Trust’s
business Plan. The risks to achieving these objectives have been identified and there are
action plans and improvements underway accordingly.

The Framework identifies the effectiveness of the operation of the key controls to manage
the risks identified and the assurance provider for those controls. Gaps in control and gaps in
assurance have been identified and prioritised and include major incident and flu pandemic
planning, the achievement of breast cancer screening targets, chlamydia screening, targets
to reduce healthcare-associated infections in acute hospital activity, meeting the 18 week
referral to treatment target (including the robust scrutiny of patient data), the monitoring of
independent contractor performance and meeting the decontamination standard requirements.
The board requires the development and implementation of action plans for gaps identified but
not presently being addressed, and monitors the development of these action plans.

The partnership mechanisms described previously are used to explore potential risks which
may impact upon other organisations and public stakeholders. Additionally, there are also many
cross organisation fora which exist to support this approach.

As an employer with staff entitled to membership of the NHS Pension Scheme, control measures
are in place to ensure all employer obligations contained within the Scheme regulations are complied
with. This includes ensuring that deductions from salary, employer’s contributions and payments in to
the Scheme are in accordance with the Scheme rules, and that member Pension Scheme records are
accurately updated in accordance with the timescales detailed in the regulations.

Control measures are in place to ensure that all the organisation’s obligations under equality,
diversity and human rights legislation are complied with.

Contents


Review of Effectiveness
As Accountable Officer, I have responsibility for reviewing the effectiveness of the system
of internal control.

My review is informed in a number of ways. The Head of Internal Audit provides me with an
opinion on the overall arrangements for gaining assurance through the board Assurance
Framework and on the controls reviewed as part of the internal audit work. executive
managers within the organisation who have responsibility for the development and
maintenance of the system of internal control provide me with assurance.

The Assurance Framework itself provides me with evidence that the effectiveness of controls
that manage the risks to the organisation achieving its principal objectives have been reviewed.

My review is also informed by a regular performance reporting on targets and objectives to the
Trust board, internal and external audits including the use of resources, Healthcare Commission
Annual Healthcheck and other reviews, the Commissioning Strategy Plan, Operating Plan and
Local delivery Plans, Health and Safety executive inspections, and Patient and Staff Surveys.
The performance improvement plan is driven by both the Healthcare Commission Annual
Healthcheck and NHS London’s quality and outcome framework.

The Trust is fully compliant with the core standards for better health.

The Head of Internal Audit Opinion’s review awarded overall significant assurance for the sound
system of internal control, with 3 out of 10 objectives achieving limited assurances. These relate
to occupational health, dental contracts and practice-based commissioning. It must be noted
that action plans are in place to improve these risks identified in the review.

I have been advised on the implications of the result of my review of the effectiveness of the
system of internal control by the board, the Professional executive Committee, the Audit
Committee and the Clinical Governance Assurance Committee. A plan to address weaknesses
and ensure continuous improvement of the system is in place and includes:
• the implementation of action plans arising from Corporate Objectives/board Assurance Framework;
• increasing the number of significant principal risks monitored by the Audit and Clinical
Governance Assurance Committees.
The Audit Committee provides the board with an independent and objective view of arrangements
for internal financial control within the PCT, ensuring the Internal Audit service complies with
mandatory auditing standards including the review of all fundamental financial systems.

executive directors have managed and reviewed their principal risks through the business
Planning process, the Performance Improvement Plan and their contribution to development
of the board Assurance Framework.

Signed on behalf of the board

Chief executive
date: 09.06.09

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61

INdePeNdeNT AudITOr’S rePOrT
to the Director’S of the boArD of
WeStmiNSter primAry cAre truSt
Opinion on the financial statements
I have audited the financial statements of Westminster PCT for the year ended 31 March 2009
under the Audit Commission Act 1998. The financial statements comprise the Operating Cost
Statement, the balance Sheet, the Cashflow Statement, the Statement of Total recognised
Gains and Losses and the related notes. These financial statements have been prepared in
accordance with the accounting policies directed by the Secretary of State with the consent of
the Treasury as relevant to the National Health Service set out within them. I have also audited
the information in the remuneration report that is described as having been audited.

This report is made solely to the board of directors of Westminster PCT in accordance with Part II
of the Audit Commission Act 1998 and for no other purpose, as set out in paragraph 36 of the
Statement of responsibilities of Auditors and of Audited bodies prepared by the Audit Commission.

Respective responsibilities of Directors and auditor
The directors’ responsibilities for preparing the financial statements in accordance with
directions made by the Secretary of State are set out in the Statement of directors’ responsibilities.
The Chief executive’s responsibility, as Accountable Officer, for ensuring the regularity of financial
transactions is set out in the Statement of the Chief executive’s responsibilities.

My responsibility is to audit the financial statements in accordance with relevant legal and
regulatory requirements and International Standards on Auditing (uK and Ireland).

I report to you my opinion as to whether the financial statements give a true and fair view in
accordance with the accounting policies directed by the Secretary of State as being relevant to
the National Health Service in england. I report whether the financial statements and the part
of the remuneration report to be audited have been properly prepared in accordance with the
accounting policies directed by the Secretary of State as being relevant to the National Health
Service in england. I report to you whether, in my opinion, the information which comprises the
‘General Introduction’, ‘Annual Health Check’, ‘use of resources’ and ‘Meeting our Targets’
sections in the commentary on ‘Financial and Performance Management’ in the Annual report
is consistent with the financial statements. I also report whether in all material respects the
expenditure and income have been applied to the purposes intended by Parliament and the
financial transactions conform to the authorities which govern them.

I review whether the directors’ Statement on Internal Control reflects compliance with the
department of Health’s requirements, set out in ‘Guidance on Completing the Statement
on Internal Control 2008/09’, issued on 25 February 2009. I report if it does not meet the
requirements specified by the department of Health or if the statement is misleading or
inconsistent with other information I am aware of from my audit of the financial statements.
I am not required to consider, nor have I considered, whether the directors’ Statement on

Contents


Internal Control covers all risks and controls. Neither am I required to form an opinion on the
effectiveness of the PCT’s corporate governance procedures or its risk and control procedures.

I read the other information contained in the Annual report and consider whether it is consistent
with the audited financial statements. This other information comprises the Annual report,
except for the ‘General Introduction’, ‘Annual Health Check’, ‘use of resources’ and ‘Meeting
our Targets’ sections of the commentary on ‘Financial and Performance Management’, and the
unaudited part of the remuneration report. I consider the implications for my report if I become
aware of any apparent misstatements or material inconsistencies with the financial statements.
My responsibilities do not extend to any other information.

Basis of audit opinion
I conducted my audit in accordance with the Audit Commission Act 1998, the Code of Audit
Practice issued by the Audit Commission and International Standards on Auditing (uK and
Ireland) issued by the Auditing Practices board. An audit includes examination, on a test basis,
of evidence relevant to the amounts and disclosures in the financial statements and the part
of the remuneration report to be audited. It also includes an assessment of the significant
estimates and judgments made by the directors in the preparation of the financial statements,
and of whether the accounting policies are appropriate to the PCT’s circumstances,
consistently applied and adequately disclosed.

I planned and performed my audit so as to obtain all the information and explanations which
I considered necessary in order to provide me with sufficient evidence to give reasonable
assurance that:

• the financial statements are free from material misstatement, whether caused by fraud
or other irregularity or error;
• the financial statements and the part of the remuneration report to be audited have been
properly prepared; and
• in all material respects the expenditure and income have been applied to the purposes
intended by Parliament and the financial transactions conform to the authorities which
govern them.
In forming my opinion I also evaluated the overall adequacy of the presentation of information
in the financial statements and the part of the remuneration report to be audited.

Opinion
In my opinion:

• the financial statements give a true and fair view, in accordance with the accounting policies
directed by the Secretary of State as being relevant to the National Health Service in england,
of the state of the Westminster PCT’s affairs as at 31 March 2009 and of its net operating
costs for the year then ended;
• the part of the remuneration report to be audited has been properly prepared in accordance
with the accounting policies directed by the Secretary of State as being relevant to the
National Health Service in england;

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63
• in all material respects the expenditure and income have been applied to the purposes
intended by Parliament and the financial transactions conform to the authorities which
govern them; and
• information which comprises the ‘General Introduction’, ‘Annual Health Check’,
‘use of resources’ and ‘Meeting our Targets’ sections of the commentary on ‘Financial and
Performance Management’ in the Annual report is consistent with the financial statements.

Conclusion on arrangements for securing economy, efficiency and effectiveness
in the use of resources

Directors’ responsibilities
The directors are responsible for putting in place proper arrangements to secure economy,
efficiency and effectiveness in the PCT’s use of resources, to ensure proper stewardship and
governance and regularly to review the adequacy and effectiveness of these arrangements.

Auditor’s responsibilities
I am required by the Audit Commission Act 1998 to be satisfied that proper arrangements
have been made by the PCT for securing economy, efficiency and effectiveness in its use of
resources. The Code of Audit Practice issued by the Audit Commission requires me to report
to you my conclusion in relation to proper arrangements, having regard to the use of resources
Guidance issued by the Audit Commission. I report if significant matters have come to my
attention which prevent me from concluding that the PCT has made such proper arrangements.
I am not required to consider, nor have I considered, whether all aspects of the PCT’s arrangements
for securing economy, efficiency and effectiveness in its use of resources are operating effectively.

Conclusion
I have undertaken my audit in accordance with the Code of Audit Practice and having regard
to the use of resources Guidance published by the Audit Commission in May 2008 and
updated in February 2009, I am satisfied that, in all significant respects, Westminster PCT
made proper arrangements to secure economy, efficiency and effectiveness in its use of
resources for the year ended 31 March 2009.

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

Michael Haworth-Maden
district Auditor
Audit Commission
1st Floor, Millbank Tower
Millbank , London SW1P 4HQ
June 2009

Contents


operAtiNg coSt StAtemeNt
FOr THe YeAr eNded 31 MArCH 2009
commissioning
2008/09 2007/08
£000 £000
Gross operating costs 397,632 374,306
Less: Miscellaneous income (10,284) (7,712)
Commissioning net operating costs 387,348 366,594

provider
Gross operating costs 36,320 30,326
Less: Miscellaneous income (9,352) (5,910)
Provider Net operating costs 26,968 24,416
Net operating costs before interest 414,316 391,010
Interest receivable 0 0
Interest payable 147 23
Net operating cost for the financial year 414,463 391,033

StAtemeNt of recogNiSeD gAiNS
AND loSSeS FOr THe YeAr eNded
31 MArCH 2009
2008/09 2007/08
£000 £000
Fixed asset impairment losses 0 0
unrealised surplus / (deficit) on fixed asset
revaluations/indexation (7,740) 3,991
Increase in the donated asset reserve and government
grant reserve due to receipt of donated and government
granted assets 0 0
Additions / (reductions) in the General Fund due to the
transfer of assets from/(to) NHS bodies and the
department of Health 0 0
Additions / (reductions) in “other reserves” 0 0
recognised gains and losses for the financial year (7,740) 3,991
Prior period adjustment – other 0 0
gains and losses recognised in the financial year (7,740) 3,991

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65

bAlANce Sheet AS At 31 MArCH 2009
31 march 2009 31 March 2008
£000 £000
fixed assets
Intangible assets 150 81
Tangible assets 54,095 61,278
Investments 0 0
Financial assets 0 –
54,245 61,359

current assets
Stocks and work in progress 0 75
debtors 6,790 5,582
Other financial assets 0 –
Cash at bank and in hand 10 38
total current assets 6,800 5,695
Creditors: Amounts falling due within one year (26,049) (26,784)
Other financial liabilities falling due within one year 0 –
Net current assets / (liabilities) (19,249) (21,089)
total assets less current liabilities 34,996 40,270
Creditors: Amounts falling due after more than one year (2,570) (255)
Other financial liabilities falling due after more than one year 0 –
Provisions for liabilities and charges (14,979) (16,225)
total assets employed 17,447 23,790

financed by: taxpayers equity
General fund 0 0
revaluation reserve 2,961 1,485
Other reserves 0 0
total taxpayers equity 17,447 23,790

The financial statements were approved by the board
on 9th June 2009 and signed on its behalf by:

Chief executive

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cASh floW StAtemeNt FOr THe YeAr
eNded 31 MArCH 2009
2008/09 2007/08
£000 £000
operating activities
Net cash outflow from operating activities (415,092) (391,566)

Servicing of finance and returns on investment:
Interest paid 0 0
Interest received 0 0
Interest element of finance leases (147) 0
Net cash inflow/(outflow) from servicing of finance
and returns on investment (147) 0

capital expenditure
Payments to acquire intangible assets (90) (24)
receipts from sale of intangible assets 0 0
Payments to acquire tangible fixed assets (2,071) (1,150)
receipts from sale of tangible fixed assets 0 0
Payments to acquire fixed asset investments – 0
receipts from sale of fixed asset investments – 0
Payments to acquire financial instruments 0 0
receipts from sale of financial instruments 0 0
Net cash inflow/(outflow) from capital expenditure (2,161) (1,174)
Net cash inflow/(outflow) before financing and
management of liquid resources (417,400) (392,740)

management of liquid resources
(Purchase) of other current asset investments – 0
Sale of other current asset investments – 0
Net cash inflow/(outflow) from management
of liquid resources 0 0
Net cash inflow/(outflow) before financing (417,400) (392,740)

financing
Net Parliamentary Funding 417,372 392,795
Other capital receipts surrendered 0 0
Capital grants received 0 0
Capital element of finance lease rental payments 0 (23)
Cash transfers (to)/from other NHS bodies 0 0
Net cash inflow/(outflow) from financing 417,372 392,772
increase/(decrease) in cash (28) 32

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67
Note 2. financial performance targets
Note 2.1 revenue resource limit

The PCTs’ performance for 2008/09 is as follows:
2008/09 2007/08
£000 £000
Total net operating cost for the financial year 414,463 391,033
Less: Non-discretionary expenditure 1,488 1,107
operating costs less non-discretionary expenditure 412,975 389,926
Final revenue resource Limit for year 428,509 401,801
under/(over) spend against revenue resource limit 15,534 11,875

Note 2.2. capital resource limit
The PCT is required to keep within its Capital resource Limit
Gross Capital expenditure 1,389 1,960
Add: Loss in respect of disposals of donated assets 0 0
Less: Net book value of assets disposed of 0 0
Less: Capital grants 0 0
Less: donations 0 0
charge Against the capital resource limit 1,389 1,960
capital resource limit 1,429 3,151
(over) / under spend against capital resource limit 40 1,191

Note 2.3. provider full cost recovery duty
The PCT is required to recover full costs in relation to its provider functions.
The performance for 2008/09 is as follows:
Provider gross operating cost* 36,320 30,326
Less: Miscellaneous income relating to provider functions (9,352) (5,910)
Net operating cost 26,968 24,416
Less: Costs met from PCT’s own allocation (27,879) (24,802)
under / (over) recovery of costs (911) (386)

*Costs do not include an allocation for corporate overheads.

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2008/09 2007/08
£000 £000
employee benefits 0 0
0 0

retirements due to ill-health
during 2008/09 there was one early retirement from the PCT agreed on the grounds of
ill-health (2007/08: 2). The estimated additional pension liabilities of this ill-health retirement
(calculated on an average basis and borne by the NHS Pension Scheme) will be £2k
(2007/08: £32k).

management costs
Management costs (£000s) 9,081 8,206
Weighted population (Number) 256,602 256,602
management cost per head of
weighted population (£) 35.39 31.98

the pct measures its management costs according to the definitions provided
by the Department of health

better payment practice code
better Payment Practice Code – measure of compliance

2008/09 2008/09 2007/08 2007/08
number £000 number £000
Non-NhS creditors
Total bills paid in the year 24,284 77,407 21,152 47,494
Total bills paid within target 22,273 72,089 19,973 45,936
Percentage of bills paid within target 91.72% 93.13% 94.43% 96.72%

NhS creditors
Total bills paid in the year 3,019 294,419 2,808 247,406
Total bills paid within target 2,776 287,206 2,680 246,161
Percentage of bills paid within target 91.95% 97.55% 95.44% 99.50%

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.

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69
Note 20. Related Party Transactions
Westminster Primary Care Trust is a body corporate established by order of the Secretary of
State for Health.

related party transactions between the PCT and board Members and members of key
management were:

payments to payments to
related party related party
08/09 07/08
£ £

dr Chase (Cavendish Health Centre 1,871,658 1,801,911
and Kings College*)

dr N Ahmed (Queens Park Health Centre) 249,367 216,402

dr Abadi (dr S Charkin & Partners – 1,267,873 1,065,121
St John’s Wood Medical Centre)

dr M Cornell (dr M Cornell & Partners) 192,836 918,534

dr M Shakarchi (dr V Muir & Partner – 444,478 785,336
belgrave Medical Centre)

Other senior manager related party interests are:

*£924,848 relates to Kings College and £946,810 relates to Cavendish Health Centre.

London Central & West unscheduled Care Collaborative (dr M Cornell is a director)
£1,790,763 - Payment for unscheduled GP cover for Westminster practices and accident
& emergency. dr. Cornell also received £16,302 for the completion of GP appraisals.

Westminster City Council (d Hawker – deputy Chief executive & director of Children Services
(to July 2008), M Harrington Head of Care Management Service) £41,865k for the provision
of social services and payments in respect of joint working in 2008/09 (2007/08 £24,839k).

The department of Health is regarded as a related party. during the year Westminster 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. The entities
with transactions greater than 1% of Westminster Primary Care Trust’s net operating cost for
the financial year are listed below:

• Imperial College Healthcare NHS Trust, provision of acute healthcare services, £98,704k,
formerly St Mary’s NHS Trust, provision of acute healthcare services (2006/07 £107,857k)
• Hammersmith Hospitals NHS Trust, provision of acute healthcare services (2006/07 £9,752k)
• Central & North West London Mental Health NHS Foundation Trust, provision of mental
healthcare services £53,389k (2007/08 £49,166k)

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• Chelsea & Westminster NHS Foundation Trust, provision of acute healthcare services
£16,284k (2007/08 £15,068k)
• university College London Hospital NHS Foundation Trust, provision of acute healthcare
services £16,102k (2007/08 £12,508K)
• Hillingdon PCT, provision of acute and community healthcare services through shared
commissioning £12,080k (2007/08 £12,055k)
• London Ambulance Service NHS Trust, provision of acute healthcare services £10,415k
(2007/08 £7,271k)
• royal Free Hampstead NHS Trust, provision of acute healthcare services £5,089k
(07/08 £3,935k)
• Guy’s and St Thomas’ NHS Foundation Trust, provision of acute healthcare services
£8,775k (2007/08 £7,260k)

The PCT has not received revenue or capital payments from any charitable funds, apart from
the charitable funds hosted by North West London Hospitals Trust. Net receipts for 2008/09
were £32k. (In 2007/08 there were net receipts of £3k).

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71

remuNerAtioN report 2008/09
This report has been prepared in accordance with the directors’ remuneration regulations 2002.

Membership of the remuneration and Terms of Services Committee:

Nicholas Woolf Non executive director (Chair)
marek Stepniak Non executive director
Sheila D’Souza Non executive director
catherine longworth Non executive director
Joe hegarty (in an advisory capacity)
Andrew Whitley (receives papers)
Karen broughton director of Human resources – Secretary

Role of the Remuneration and Terms of Services Committee and Statement of Policy on the
Remuneration of Senior Managers
The Committee advises the board on appropriate remuneration and terms of service for the Chief executive
and Trust directors. The Committee monitors and evaluates the performance of the Chief executive,
directors and individual officer members of the Professional executive Committee – having proper regard
to the PCT’s circumstances and performance and to the provisions of any national arrangements for such
members and staff where appropriate.

The Committee reports the basis for its recommendations to the board which uses the Committee’s report
as the basis for its decisions on remuneration. However, the board remains accountable for taking final
decisions on the remuneration and terms of service for the Chief executive and Trust directors.

For directors’ pay increases, the following factors are considered:

• current national market rates of comparable director posts;
• the individual performance of directors;
• internal comparators;
• changes to director portfolios;
• NHS pay awards for other staff groups;
• any national guidance relating to maximum pay bill increases;
• significant recruitment and/or retention issues; and
• financial position of the PCT.

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Performance measurement
directors’ performance is appraised on an annual basis by the Chief executive. The Chief executive’s
performance is appraised on an annual basis by the Chief executive of the Strategic Health Authority,
now called NHS London.

Summary and explanation of policy on duration of contracts, and notice periods and
termination payments
Senior managers are permanent employees of the PCT, and in the event of redundancy, they are subject
to standard NHS severance packages.

CEC and Non-Executive unexpired contract dates
contract end date contract end date
Non-executive cec (commissioning executive committee,
Joe Hegarty – (Chair) 31 January 2011 superseded pec on 1/01/2009)
Catherine Longworth – 31 March 2013 dr dennis Abadi – 01 January 2011
(Vice Chair) (CeC Chair)
Sheila d’Souza 31 March 2013 Karen broughton*
Marek Stepniak 31 March 2010 dr derek Chase 31 March 2009
Andrew Whitley 31 March 2013 Jeff deane*
Nicholas Woolf 31 March 2010 Ann duncan *
pec members Margaret Guy*
(the pec was dissolved on 31 Dec 08) Marian Harrington *
dr dennis Abadi – 31 december 2008 dr Nazeer Ahmed
(PeC Chair) Paul Jenkins *
dr Nazeer Ahmed 31 december 2008 dr Matthew Johnson 01 January 2011
dr derek Chase 31 december 2008 dr Jonathan Fluxman 31 March 2009
dr Mike Cornell 30 September 2008 dr Jonathan Munday 01 January 2011
Jeff deane* Michael Scott* 01 January 2011
Ann duncan * Tera Younger 13 January 2011
Meredith Gamble 31 december 2008
* These people retain tenure in the CeC as long as
Margaret Guy*
they remain in post.
Marian Harrington *
Paul Jenkins *
Sangita Patel 31 december 2008
Michael Scott*
dr Maher Sharkachi 31 december 2008
Tera Younger 31 december 2008

* These people retain tenure in the PeC as long as
they remain in post.

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73
Senior Managers’ remuneration
2008-09 2007-08
Name and title Salary other benefits Salary Other benefits
(bands of remuneration in kind (bands of remuneration in kind
£5,000) (bands of (bands of £5,000) (bands of (bands of
£5,000) £100) £5,000) £100)
£000 £000 £00 £000 £000 £00
d Abadi – 35-40 0 0 30-35 0 0
PeC/CeC Chair
K broughton – director 70-75 0 0 65-70 0 0
of Human resources
J deane – 95-100 0 0 95-100 0 0
director of Finance
& Performance Mgmt
A duncan – director 70-75 0 0 60-65 0 0
of Nursing and Quality
M Gamble – Clinical 5-10 60-65 0 5-10 60-65 0
PeC Member1
J Gannon – director 0 50-55 0 85-90 0 0
of Primary Care2
M Guy – director of 155-160 0 0 160-165 0 0
Public Health/
Medical director
L Hamlyn – 0 0 0 105-110 0 0
Chief executive3
J Hegarty – 30-35 0 0 30-35 0 0
Chair – Non executive
P Jenkins – director of 100-105 0 0 95-100 0 0
Service development
C Longworth – 5-10 0 0 5-10 0 0
Non executive
T Mali – Clinical 0 0 0 5-10 40-45 0
PeC Member4
S Patel – 0-5 35-40 0 0-5 20-25 0
Clinical PeC Member5
M Scott – 130-135 0 0 0 0 0
Chief executive6
S d’Souza – 5-10 0 0 5-10 0 0
Non executive
1. up to 31/12/2008
2. left 1/09/2008
3. left 11/01/2008
4. left 30/03/08
5. from 31/12/2008
6. from 28/03/2008

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2008-09 2007-08
Name and title Salary other benefits Salary Other benefits
(bands of remuneration in kind (bands of remuneration in kind
£5,000) (bands of (bands of £5,000) (bands of (bands of
£5,000) £100) £5,000) £100)
£000 £000 £00 £000 £000 £00
M Stepniak – 5-10 0 0 5-10 0 0
Non executive
A Whitley – 5-10 0 0 5-10 0 0
Non executive
N Woolf – Audit 10-15 0 0 10-15 0 0
Committee Chair
& Non-executive
T Younger – 0-5 0 0 0 0 0
Lay CeC Member

• Marian Harrington – CeC Member for Westminster City Council – her remuneration is a recharge
therefore excluded
• Tera Younger – Lay CeC Member – received a nominal amount of £16.05 per meeting up to
december 2008
• dr N Ahmed, dr derek Chase, dr Michael Cornell and dr Maher Sharkachi are practice-based
commissioning cluster representatives who receive locum cover only
• Councillor ed Argar, Marian Harrington and brigitta Lock are co-opted board members who are unpaid

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75
Pension entitlements
Name and title real lump sum total cash Cash real
increase at age 60 accrued equivalent equivalent increase in
in pension related to pension at transfer Transfer in Cash
at age 60 real age 60 at Value at Value at equivalent
(bands of increase in 31 march 31 march 31 March Transfer
£2,500) pension 2009 2009 2008 Value
(bands of (bands of
£2,500) £5,000)
2007/08 £000 £000 £000 £000 £000
d Abadi – CeC Chair 0-2.5 5-7.5 40-45 686 506 168
K broughton – director 5-7.5 17.5-20 15-20 221 130 88
of Human resources
J deane – 0-2.5 5-7.5 40-45 860 637 207
director of Finance
& Performance Mgmt
A duncan – 2.5-5 12.5-15 20-25 421 284 130
Chief Nurse
J Gannon – director 2.5-5 7.5-10 20-25 344 231 36
of Primary Care
L Hamlyn – 0 0 0 0 963 215
Chief executive
M Gamble – 0-2.5 0-2.5 5-10 113 83 28
Clinical PeC Member
M Guy – director 10-12.5 32.5-35 50-55 1,173 1,085 61
of Public Health/
Medical director
P Jenkins – director of 0-2.5 0-2.5 20-25 395 312 76
Service development
T Mali – 0 0 0 0 103 n/a
Clinical PeC Member
S Patel – Clinical 0-2.5 0-2.5 10-15 216 163 49
PeC Member
M Scott – 0-2.5 2.5-5 0-5 33 0 33
Chief executive
real increase in Cash equivalent Transfer Value is the comparison of the inflated values at 31 March 2008 with the actual values
at 31 March 2009.

As Non-executive members have elected not to receive pensionable remuneration, there are no entries in respect of pensions
for Non-executive members.

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Cash Equivalent Transfer Values
A Cash equivalent Transfer Value (CeTV) is the actuarially assessed capital value of the pension scheme benefits
accrued by a member at a particular point in time. The benefits valued are the member’s accrued benefits and any
contingent spouse’s pension payable from the scheme.

A CeTV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension
scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their
former scheme.

The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total
membership of the pension scheme, not just their service in a senior capacity to which disclosure applies.

The CeTV figures and the other pension details include the value of any pension benefits in another scheme
or arrangement which the individual has transferred to the NHS pension scheme.

They also include any additional pension benefit accrued to the member as a result of their purchasing additional
years of pension service in the scheme at their own cost.

CeTVs are calculated within the guidelines and framework prescribed by the Institute of Faculty of Actuaries.

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

What do you think?
NHS Westminster wants to hear from you.
If you have any questions, ideas or feedback about health or healthcare in Westminster, get in touch.
Call freephone 0800 587 8818
email pals@westminster-pct.nhs.uk
If you would like to comment on this report, please email communications@westminster-pct.nhs.uk.

Photography by:
Piers Allardyce, Adam Scott, Peter Whyte, darrell Fields, Hayley davis

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If you would like this document in large print or another format,
please email communications@westminster-pct.nhs.uk or call
freephone 0800 587 8818.
View this report online at www.westminster.nhs.uk

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