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NHS Westminster Annual Report

NHS Westminster is the organization that plans and buys healthcare services for residents of Westminster, London. In the past year, they have worked to improve access to healthcare and reduce wait times. They launched a £94M investment program over 5 years to create new health centers, provide more dentists, and increase nurses. Their financial performance was strong, with a £15.5M surplus that will be reinvested in health services. Looking ahead, their strategic plan focuses on reducing health inequalities in the community.

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NHS Westminster Annual Report www.westminster.nhs.uk
CONTENTS Contents
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. Contents
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
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk 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 Contents
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 be yR W oa ell d ing to REGENT’S n Westminster for the last six years and M Ro aid ad PARK a Va Planned changes across the NHS le Pa rk Lis are responsible for funding all Ro so ad nG ro ve e Ro ad in Westminster reflect our big the health services across ebon Maryl Bake Reg three priorities: Ed r St en gw t Stre are reet G Ro Street lo ad Oxford et the borough. uc es te d Street rT Oxfor err ac e St reet r Road enor • choice - we will provide quality ate sv Baysw Gro d an Str Pa rk La HYDE PARK We share our boundaries ne d illy information so you can choose ca ia Pic Victor all eM Th ge with the City of Westminster, tsbrid Kensington Road Knigh Walk Birdcage Sloan how and where you receive e et Stre ad Str oria Ro Vict ee extending to regent’s Park in t ace Pal your healthcare Va ham u xh all ng Bri dg cki e Bu Ro 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. Contents
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk 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 Contents
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%). Contents
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk 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 Contents
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 ANNuAl report 08/09 www.westminster.nhs.uk 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 Contents
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
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk 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. Contents
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 Contents
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk 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 Contents
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. Contents
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk Our STrATeGIC FIVe-YeAr PLAN 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 Contents
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
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk Our STrATeGIC FIVe-YeAr PLAN 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. Contents
23 Our STrATeGIC FIVe-YeAr PLAN 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
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk 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 Contents
25 Our STrATeGIC FIVe-YeAr PLAN 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
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk 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 Contents
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
www.westminster.nhs.uk Contents
DiRECTORATE REviEWS Contents
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk 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 Contents
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
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk • 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. Contents
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
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk 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 Contents
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
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk 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. Key achievements in 2008/09 • 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 Contents
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
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk 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. Key achievements in 2008/09 • 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 Contents
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
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk 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 Key achievements in 2008/09 • 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 Contents
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. Contents
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk 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 Contents
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NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk 5. humAN reSourceS AND corporAte AffAirS Key achievements in 2008/09 • 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. Contents
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
Contents
OUR BOARD Contents
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk 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) Contents
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 Contents
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk 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 Contents
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, Senior Management Team, 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 Senior Management Team, Member PEC*, CEC** Contents
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk 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, Senior Management Team, 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 Senior Management Team, 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
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ANNUAl ACCOUNTS Contents
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk 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 Contents
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
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk 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. Contents
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
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk 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 Contents
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
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk 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; Contents
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
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk 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 Contents
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 Contents
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk 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 Contents
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. Contents
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk 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. Contents
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) Contents
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk • 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). Contents
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. Contents
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk 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. Contents
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 Contents
NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk 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 Contents
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. Contents
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 Contents
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 Contents
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NHS Westminster Annual Report

  • 1.
  • 3.
  • 4.
    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
  • 5.
    NhS WeStmiNSter ANNuAlreport 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. Contents
  • 6.
    5 Health services forour 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
  • 7.
    NhS WeStmiNSter ANNuAlreport 08/09 www.westminster.nhs.uk 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 Contents
  • 8.
    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 be yR W oa ell d ing to REGENT’S n Westminster for the last six years and M Ro aid ad PARK a Va Planned changes across the NHS le Pa rk Lis are responsible for funding all Ro so ad nG ro ve e Ro ad in Westminster reflect our big the health services across ebon Maryl Bake Reg three priorities: Ed r St en gw t Stre are reet G Ro Street lo ad Oxford et the borough. uc es te d Street rT Oxfor err ac e St reet r Road enor • choice - we will provide quality ate sv Baysw Gro d an Str Pa rk La HYDE PARK We share our boundaries ne d illy information so you can choose ca ia Pic Victor all eM Th ge with the City of Westminster, tsbrid Kensington Road Knigh Walk Birdcage Sloan how and where you receive e et Stre ad Str oria Ro Vict ee extending to regent’s Park in t ace Pal your healthcare Va ham u xh all ng Bri dg cki e Bu Ro 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. Contents
  • 9.
    NhS WeStmiNSter ANNuAlreport 08/09 www.westminster.nhs.uk 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 Contents
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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%). Contents
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    NhS WeStmiNSter ANNuAlreport 08/09 www.westminster.nhs.uk 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 Contents
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    11 New national targets Thegovernment’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
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    NhS WeStmiNSter ANNuAlreport 08/09 www.westminster.nhs.uk 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 Contents
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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
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    NhS WeStmiNSter ANNuAlreport 08/09 www.westminster.nhs.uk 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. Contents
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    17 6. 0 reducethe 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 Contents
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    NhS WeStmiNSter ANNuAlreport 08/09 www.westminster.nhs.uk 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 Contents
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    19 healthy homes: environmentalhealth 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. Contents
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    NhS WeStmiNSter ANNuAlreport 08/09 www.westminster.nhs.uk Our STrATeGIC FIVe-YeAr PLAN 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 Contents
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    21 MyAction MyAction is anew 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
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    NhS WeStmiNSter ANNuAlreport 08/09 www.westminster.nhs.uk Our STrATeGIC FIVe-YeAr PLAN 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. Contents
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    23 Our STrATeGIC FIVe-YeArPLAN 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
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    NhS WeStmiNSter ANNuAlreport 08/09 www.westminster.nhs.uk 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 Contents
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    25 Our STrATeGIC FIVe-YeAr PLAN 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
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    NhS WeStmiNSter ANNuAlreport 08/09 www.westminster.nhs.uk 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 Contents
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    27 i HAveFouND 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
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    NhS WeStmiNSter ANNuAlreport 08/09 www.westminster.nhs.uk 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 Contents
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    31 • We arereviewing 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
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    NhS WeStmiNSter ANNuAlreport 08/09 www.westminster.nhs.uk • 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. Contents
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    33 adementia 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
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    NhS WeStmiNSter ANNuAlreport 08/09 www.westminster.nhs.uk 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 Contents
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    35 Eye Care On 1August, 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
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    NhS WeStmiNSter ANNuAlreport 08/09 www.westminster.nhs.uk 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. Key achievements in 2008/09 • 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 Contents
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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
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    NhS WeStmiNSter ANNuAlreport 08/09 www.westminster.nhs.uk 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. Key achievements in 2008/09 • 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 Contents
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    39 Our investment incommunity 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
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    NhS WeStmiNSter ANNuAlreport 08/09 www.westminster.nhs.uk 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 Key achievements in 2008/09 • 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 Contents
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    41 Looking to thefuture 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. Contents
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    NhS WeStmiNSter ANNuAlreport 08/09 www.westminster.nhs.uk 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 Contents
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    NhS WeStmiNSter ANNuAlreport 08/09 www.westminster.nhs.uk 5. humAN reSourceS AND corporAte AffAirS Key achievements in 2008/09 • 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. Contents
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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
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    OUR BOARD Contents
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    NhS WeStmiNSter ANNuAlreport 08/09 www.westminster.nhs.uk 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) Contents
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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 Contents
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    NhS WeStmiNSter ANNuAlreport 08/09 www.westminster.nhs.uk 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 Contents
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    51 during 2008-09 thefollowing 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, Senior Management Team, 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 Senior Management Team, Member PEC*, CEC** Contents
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    NhS WeStmiNSter ANNuAlreport 08/09 www.westminster.nhs.uk 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, Senior Management Team, 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 Senior Management Team, 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
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    NhS WeStmiNSter ANNuAlreport 08/09 www.westminster.nhs.uk 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 Contents
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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
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    NhS WeStmiNSter ANNuAlreport 08/09 www.westminster.nhs.uk 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. Contents
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    59 The Risk andControl 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
  • 61.
    NhS WeStmiNSter ANNuAlreport 08/09 www.westminster.nhs.uk 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 Contents
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    61 INdePeNdeNT AudITOr’S rePOrT tothe 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
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    NhS WeStmiNSter ANNuAlreport 08/09 www.westminster.nhs.uk 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; Contents
  • 64.
    63 • in allmaterial 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
  • 65.
    NhS WeStmiNSter ANNuAlreport 08/09 www.westminster.nhs.uk 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 Contents
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    65 bAlANce Sheet ASAt 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 Contents
  • 67.
    NhS WeStmiNSter ANNuAlreport 08/09 www.westminster.nhs.uk 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 Contents
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    67 Note 2. financialperformance 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. Contents
  • 69.
    NhS WeStmiNSter ANNuAlreport 08/09 www.westminster.nhs.uk 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. Contents
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    69 Note 20. RelatedParty 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) Contents
  • 71.
    NhS WeStmiNSter ANNuAlreport 08/09 www.westminster.nhs.uk • 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). Contents
  • 72.
    71 remuNerAtioN report 2008/09 Thisreport 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. Contents
  • 73.
    NhS WeStmiNSter ANNuAlreport 08/09 www.westminster.nhs.uk 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. Contents
  • 74.
    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 Contents
  • 75.
    NhS WeStmiNSter ANNuAlreport 08/09 www.westminster.nhs.uk 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 Contents
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    75 Pension entitlements Nameand 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. Contents
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    Cash Equivalent TransferValues 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 Contents
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    If you wouldlike 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 Contents
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