5 Boroughs Partnership NHS Foundation Trust Annual ... - Monitor

5 Boroughs Partnership
NHS Foundation Trust
Annual Report and Accounts
1 April 2011 to 31 March 2012
Annual Report and Annual Accounts 2011-12 1

2
Annual Report and Annual Accounts 2011-12

5 Boroughs Partnership
NHS Foundation Trust
Annual Report and Accounts
1 April 2011 to 31 March 2012
Presented to Parliament pursuant to Schedule 7,
paragraph 25(4) of the National Health Service Act
2006
Annual Report and Annual Accounts 2011-12 3

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Annual Report and Annual Accounts 2011-12

Contents
Chairman and Chief Executive’s Statement Page 6
Our Profile and Our Vision Page 7
Our Services Page 8
Our Trust Board Page 10
Our Risk Management Page 21
Our Council of Members Page 24
Our Strategic Themes and Objectives 2011/2012 Page 35
Service Delivery and Patient Experience Page 36
Efficient and Effective Organisation Page 41
Clinical Leadership and Service Improvement Page 47
Engagement and Partnership Working Page 50
Well-Governed Page 55
Financial Viability Page 57
Organisational Development Page 60
Workforce Management and Experience Page 63
Financial Review of the Year Page 71
Remuneration Report Page 72
Annual Accounts; Accounting Policies; Going Concern Page 73
Your Comments and Contact Information Page 74
Speaking Your Language Page 75
Appendix 1 – Quality Report 2011-12 Page 77
Appendices Page 114
Appendix 2 Page 149
Statement of the Chief Executive’s responsibilities as
Accounting officer Page 150
Independent Auditor’s Report to the Council of Members Page 151
Annual Governance Statement 2011/12 Page 154
Annual Accounts 2011/12 Page 175
Annual Report and Annual Accounts 2011-12 5

Chairman and Chief Executive’s Statement
The conclusion of this reporting year marks the one-year anniversary of our
acquisition of community services in Knowsley.
We are delighted that Knowsley Clinical Commissioning Group (CCG) has
confirmed that Knowsley Integrated Provider Services (KIPS) will be
remaining with us after the initial two-year transfer period has ended. Our
current contract will continue until April 2014 when it will be replaced by one
with Knowsley CCG and other successor bodies with responsibility for
commissioning services provided by KIPS.
This excellent news is reflective of a year in which the Trust has continued to
seek and embrace new challenges – building upon its expertise in the fields of
mental health and learning disabilities with important work around physical
well-being. We are particularly proud that Sir David Nicholson officially
recognised the breadth of physical activities our people have taken part in –
presenting the Trust with a Gold NHS 2012 Challenge Award. We are also
proud of the Nursing Standard 2012 award-winning work our nursing staff
have undertaken as part of the State of Mind Programme – supporting Rugby
League players and their fan-bases to enjoy better mental well-being.
We have also continued with our important work around our Trust Values. The
development of Team Charters throughout our Trust demonstrates a clear
commitment by team members to live our Values consistently.
In this report you will see that our emphasis remains on the quality of our
patients’ experience. As such we have included an overview of the
consultation and pilot work we have undertaken to improve access to and
enhance the care we provide in our Adult; Later Life and Memory; and
Learning Disabilities services. Last year we announced that we are exploring
an opportunity to invest more than £20million into a new haven of recovery for
people with mental ill-health at Leigh Infirmary. We hope to finance a purposebuilt
facility influenced by ‘the best’ of current provision across England and
Wales.
With all this to look forward to 2012-13 looks to be another year of exciting
developments at the Trust.
Bernard Pilkington Simon Barber
Chairman of the Trust Chief Executive
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Annual Report and Annual Accounts 2011-12

Our Profile
Formed in 2002, 5 Boroughs Partnership NHS Trust achieved Foundation
Trust status on 1 March 2010 to become 5 Boroughs Partnership NHS
Foundation Trust. We are an NHS provider of specialist mental health and
learning disability services based in the North West of England. In addition
and as a result of the Government’s Transforming Community Services
Programme, we extended our existing partnership with NHS Knowsley to
enable the separation of their commissioner and provider arms. All of their
community services, which are delivered by multi-disciplinary integrated
Health and Social Care teams, and the employment of their provider staff
transferred to our Trust on 1 April 2011.
Our Vision
We work with many partners including primary care trusts, local authorities,
social services and the voluntary sector to help us turn our vision of
becoming:
“A leading provider of world-class mental
health, learning disability and community
services; with a reputation for quality,
innovation and excellence”
into a reality.
Annual Report and Annual Accounts 2011-12 7

Our Services
Children and Young People’s Services
We provide community-based child and adolescent mental health services in
each of our five boroughs for young people up to the age of 18. In addition we
see young people in schools and other premises to facilitate collaborative
working and care closer to home. We also provide both day patient and inpatient
services delivered from Fairhaven Young People’s Unit - our eight-bed
unit based in Warrington. We endeavour to include young people in all areas
of service development.
Adult Services
We provide acute community and in-patient assessment, treatment and
support services for adults who develop severe functional mental health
disorders such as Bipolar Disorder. We provide many community services in
partnership with local authorities and the voluntary sector. During 2012-13 we
plan to implement our new Acute Care Pathway for Community Services,
which has been developed in conjunction with senior clinicians to improve
access to assessment and enhance our ability to provide high-quality home
treatment and recovery-based services. We also operate one Psychiatric
Intensive Care Unit (PICU) at Leigh Infirmary. This is a highly specialised unit
which provides in-patient services to people requiring an intensive period of
support in a safe environment - typically for up to 28 days. Our services are
focused on providing support for people to recover from episodes of mental illhealth.
Later Life and Memory Services
We provide acute community and in-patient assessment and treatment
services for older people with mental ill-health. This includes specialist
services to people of all ages who develop memory problems or dementia.
We provide services for older people in a variety of community settings
including people’s own homes, acute psychiatric in-patient facilities and
through liaison at acute hospitals. Our Memory Services provide early
assessment, diagnosis and interventions to support people with memory
problems or dementia. A six-month pilot of a new model of care for older
people - ‘Building on Strengths’- began in Wigan in March 2012. This focuses
on earlier assessment, diagnosis and evidence-based intervention. The
proposed changes aim to meet the requirements of the National Dementia
Strategy and key priorities within the NHS Outcomes Framework.
Learning Disability Services
We provide specialist community and acute assessment and treatment inpatient
services for adults with a learning disability and additional mental
health issues. We offer people choice about their care and treatment, and
offer flexibility as to when and where they access services to fit in best with
their daily lives.
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Annual Report and Annual Accounts 2011-12

We are actively involved in Learning Disability Partnership Boards - working
with people who have a learning disability, their families and carers to ensure
that their health needs continue to be supported in community settings.
Commissioning bodies serving the population of Halton, St Helens,
Warrington and Knowsley (4 Boroughs Commissioning Alliance) presented
their commissioning intentions - a ‘New Model of Care’ for adults with
Learning Disabilities - to the Trust in November 2009. The proposal was to
redesign the services delivered by the Trust to enable those in the community
to be supported for as long as possible in their homes.
Forensic Services
We provide care and treatment in secure settings for those people who are
assessed as not being best cared for in an open environment. Such service
users often have multiple and complex care needs. We provide low-secure
services in two separate male and female units at Hollins Park, Warrington for
adults with mental ill-health, a low secure step-down unit for those ready to
move back into community settings and one unit for people with a learning
disability.
Knowsley Integrated Provider Services
Integrated Locality Services are provided across Knowsley and include
District Nurses, Social Care and Home Care. The teams work together to
support people with longer-term and complex conditions to enable selfmanagement
through to crisis intervention.
Targeted Services are delivered to people for a fixed period of
intervention and provide short-term, one-off support including crisis
intervention. They focus on curative care or co-ordinated support for
specific long-term conditions.
Acute and Rehab Services provide interventions for people who need
short-term support and rehabilitation. They aim to prevent unnecessary
hospital admissions; enhance recovery whilst in hospital and facilitate
timely discharge into the community. These services ensure people are
enabled to remain independent in their own home or as close to home
as possible and incorporate therapeutic interventions to improve a wide
range of health conditions such as musculo-skeletal and
rheumatological problems.
Children’s Services are delivered in two ways. Universal services
concentrate on improving children’s health from birth to 19 – taking a
preventative public health approach to tackle the causes of ill-health
and reduce inequalities. Children’s services are also delivered in a
targeted manner - providing a holistic approach to service delivery and
management of children with complex health needs by providing
support, advice and effective therapeutic interventions.
Annual Report and Annual Accounts 2011-12 9

Our Trust Board
Our Trust Board has a responsibility shared with our Council of Members for
strategic development, approving policy and monitoring performance. This
includes ensuring the delivery of effective financial stewardship, high
standards of clinical and corporate governance and promoting effective
relations with the local community we serve. Monthly Board Meetings took
place a total of eight times during this reporting period (there were no
meetings in August and December).
Individual attendance is disclosed in the following table. Where Executive
Directors and Non-Executive Directors were not eligible to attend due to their
start/leaving date, this is indicated with N/A (Not Applicable):
Trust Board 26/04/ 31/05/ 27/06/ 25/07/ 26/09/ 31/10/ 30/01/ 26/03/
Member
Bernard Pilkington -
11 11 11 11 11 11 12 12
Chairman x
Simon Barber - Chief
Executive
Nick Rowe –
Deputy Chief
Executive
10
N/A N/A N/A N/A x
Dr Louise Sell –
Medical Director N/A N/A N/A N/A N/A
Therese Patten –
Chief Operating
Officer
Dean Marsh –
Director of Finance
and Informatics
Nick Rowe –
Director of Human
Resources and
Organisational
Development
Tracy Hill – Director
of Human Resources
and Organisational
Development
Gail Briers – Director
of Nursing and
Governance
x
× x
N/A N/A N/A N/A N/A
N/A N/A N/A N/A
N/A N/A
Dr Fade Ibitoye -
Medical Director x N/A N/A N/A
John Kelly -
Director of
Partnerships and
Engagement
N/A N/A N/A N/A
Annual Report and Annual Accounts 2011-12

Trust Board
Member
Ray Walker –
Director of Nursing,
Governance and
Performance
Dr Colin Dale -
Non-Executive
Director
Brian Marshall -
Non-Executive
Director
Derek Taylor –
Non-Executive
Director
Allan Chan -
Non-Executive
Director
Rupert Nichols -
Non-Executive
Director
Philippa Tubb –
Non-Executive
Director
26/04/
11
31/05/
11
27/06/
11
25/07/
11
26/09/
11
31/10/
11
30/01/
12
26/03/
12
N/A N/A N/A N/A N/A N/A
x
x
N/A
The Board collectively considers that it is appropriately composed with a
balanced spread of expertise to fulfil its function and terms of authorisation.
The Chairman and Non-Executive Directors meet the independence criteria
laid down in the NHS Foundation Trust Code of Governance.
The Trust’s Executive Team provides organisational leadership and takes
appropriate action to ensure that the Trust delivers its strategic and
operational objectives.
It maintains arrangements for effective governance throughout the
organisation, monitors performance in the delivery of planned results and
ensures that corrective action is taken when necessary.
The Trust Board for the period 1 April 2011 to 31 March 2012 comprised:
Bernard Pilkington
Our Chairman, Bernard first became involved with the health service in 1984 -
serving as a Non-Executive Director of St Helens and Knowsley Health
Authority where he was Vice Chairman. He is currently Chair of St Helens
Mind - a voluntary organisation working with people who are isolated due to
mental health problems. He became Chairman of our Trust on 17 May 2007 -
later championing our successful bid for Foundation Trust status in 2010.
Simon Barber
Simon joined us as Chief Executive on 1 December 2007. He has extensive
commercial experience obtained from working as Finance Director and
Annual Report and Annual Accounts 2011-12 11

Commercial Director in a number of industries including utility supply,
advertising, retail, telecommunications and manufacturing. Simon came to the
NHS in 2006 to use his skills within the public sector. In March 2010 he was
selected as a member of the NHS Top Leaders Programme.
Our Executive Directors are:
Nick Rowe
Nick was appointed Deputy Chief Executive on 1 July 2011. From the period 1
June 2008 to 1 July 2012 he was the Trust’s Director of Human Resources
and Organisational Development. Nick joined the Trust from outside the NHS
(the utility sector).
Dr Louise Sell
On 1 October 2011 Louise was appointed as our Medical Director. Louise is
responsible for medical services within the Trust. Louise, who is a Consultant
Psychiatrist, joined us from Greater Manchester West Mental Health
Foundation Trust where she worked for 15 years.
Therese Patten
Therese was appointed as the Trust’s Chief Operating Officer on 1 April 2011.
She had previously been the Trust’s Commercial Director since 1 November
2008. Therese has more than 10 years senior management experience in the
NHS and the private sector. Since she joined, Therese has led on the
negotiation of the new Mental Health Contract, the acquisition of Knowsley
Integrated Provider Services and the development of our five-year service
strategy.
Dean Marsh
Dean is our Director of Finance and Informatics who started at the Trust in
April 2008 - taking on his current role on 14 January 2009. Dean is
responsible for advising our Trust Board on the best use of our resources by
keeping the Board updated on how we are performing against our financial
duties and how we are spending our money.
Tracy Hill
On 1 July 2011 Tracy was appointed as Director of Human Resources and
Organisational Development. Tracy is responsible for ensuring that our people
are able to continue to support the delivery of our services. She also leads on
developing our people and the organisation in order to meet the future needs
of the Trust. In December 2011 Tracy won the ‘Role Model/Contribution to the
Profession’ Award at the NHS North West 2011 Excellence in Human
Resources Awards.
Gail Briers
Gail was appointed Director of Nursing and Governance on 20 June 2011.
Gail started out at Winwick Hospital, Warrington as a Nursing Assistant 25
years ago. Since then she has worked in a variety of different services
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Annual Report and Annual Accounts 2011-12

including Adults, Learning Disabilities, Older People and Forensics. Since she
joined our Trust Board, the Trust has won both a Nursing Times 2011 Award
and a Nursing Standard 2012 Award.
Dr Fade Ibitoye
Fade was appointed as our Medical Director from 1 July 2008 to 30
September 2011. During this time Fade was responsible for medical services
within the Trust and is a Consultant Psychiatrist with a special interest in
Neuropsychiatry. Fade continues to work as a Consultant Psychiatrist within
our Trust and is designated as the Trust’s medical ‘Responsible Officer’.
John Kelly
John first joined the Trust on 1 November 2002 as Borough Director for
Knowsley. He took on the role of Director of Operations on 1 April 2009 and
was later appointed as Director of Partnerships and Engagement on 1 April
2011. He retired from the Trust on 31 August 2011.
Ray Walker
Ray started work in the NHS in 1978 and is a Registered Nurse. He joined the
Trust on 2 July 2006 and was the Trust’s Director of Nursing, Governance and
Performance until 17 June 2011 when he left the Trust.
Our Non-Executive Directors are:
Dr Colin Dale
Colin has been an Executive Director of Nursing in three mental health trusts.
He is the joint Violence Project Manager for the National Institute for Mental
Health and the National Patient Safety Strategy. Colin is Chair of the Clinical
Risk and Clinical Governance Committee. He was appointed in September
2008. Colin is also our Vice Chairman.
Brian Marshall
Brian is a qualified accountant with extensive experience in national and
international businesses at a senior level. He has a proven track record of
successfully leading financial turnaround programmes and has more than 20
years’ experience leading and managing in large complex industries.
In addition, he has NHS experience as an internal auditor for local health
authorities. Brian was appointed in December 2009. He is Chair of the Audit
Committee and sits on the Compliance with Authorisation Committee of the
Council of Members.
Derek Taylor
Derek has a broad range of commercial experience in the financial services
sector in the UK and Australia. Derek sits on both the Audit Committee and
the Clinical Risk and Clinical Governance Committee. He was appointed in
September 2008. Derek is also our Senior Independent Director and sits on
the Membership and Communications Committee of the Council of Members.
Annual Report and Annual Accounts 2011-12 13

Allan Chan
Allan has more than 19 years’ experience in the housing sector and has
worked in a wide variety of senior roles. Allan is a member of the UK
Association for Chinese Mental Health. He is a qualified accountant (FCCA).
He was appointed in July 2008.
Rupert Nichols
Rupert is a Solicitor and Chartered Secretary. He has a career spanning 40
years in corporate and commercial law and business affairs both in this
country and overseas. Rupert is a Parish Councillor in Rainford and a Fellow
and Trustee of the Chartered Institute of Logistics and Transport. He has been
Chairman of Cheshire Police Authority, an Officer in the Australian Army
Reserve and an LEA Governor of Rainford C of E Primary School. He was
appointed at the Trust in December 2009.
Philippa Tubb
Philippa Tubb commenced as a Non-Executive Director with our Trust on the
31 May 2011. Philippa has more than nine years experience in the NHS as
the Assistant Director of Clinical Governance at an acute NHS Foundation
Trust in Liverpool. She is also a Registered General Nurse with a clinical
background in tropical diseases and HIV. The terms of office for our Executive
Directors are outlined in the table below:
Trust Board Employment Status
Date
Executive Director appointed to
Trust Board
Tenure Notice period
Simon Barber
Chief Executive
1 December
2007
Permanent 6 months
Nick Rowe
Deputy Chief Executive
1 June 2008 Permanent 6 months
Dr Louise Sell
Medical Director
1 October
2011
Permanent 3 months
Therese Patten
Chief Operating Officer
1 November
2008
Permanent 6 months
Dean Marsh
Director of Finance and
Informatics
Tracy Hill
14 January
2009
Permanent 3 months
Director of Human Resources
and Organisational
Development
Gail Briers
1 July 2011 Permanent 3 months
Director of Nursing and
Governance
20 June 2011 Permanent 3 months
Dr Fade Ibitoye
Medical Director
1 July 2008
Permanent –
ended
3 months
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Annual Report and Annual Accounts 2011-12

Executive Director
John Kelly
Director of Partnerships and
Engagements
Ray Walker
Director of Nursing,
Governance and
Performance
Date
appointed to
Trust Board
1 April 2009
2 July 2006
Tenure Notice period
Permanent -
ended
Permanent -
ended
6 months
4 months
The performance of the Executive Directors is evaluated by the Chief
Executive. The performance of the Chief Executive and Non-Executive
Directors is evaluated by the Chairman on an annual basis. All senior
managers’ contracts are permanent and not subject to any unexpired term.
There is explicit provision for early or summary termination of employment
included in the contracts of employment for all senior managers as a
consequence of gross misconduct or other action which would lead or warrant
the person unable or ineligible to fulfil their contract as a Trust Board Director.
The terms of office for our Non-Executive Directors are outlined in the table
below:
Non-Executive Director Term commenced Term ends
Bernard Pilkington 17 May 2007 16 May 2014
Allan Chan 1 July 2008 30 June 2012
Dr Colin Dale 1 September 2008 31 August 2012
Derek Taylor 1 September 2008 31 August 2012
Brian Marshall 17 December 2009 16 December 2012
Rupert Nichols 17 December 2009 16 December 2012
Philippa Tubb 31 May 2011 30 May 2014
Non-Executive Directors’ appointments may be terminated on performance
grounds or for contravention of the qualification criteria set out in the
Constitution with the approval of three quarters of the Council of Members or
by mutual consent for other reasons.
There is no provision for compensation for early termination or liability on the
Trust’s part in the event of termination.
Register of Interests for the Board
To access the Register of Interests for the Board visit:
www.5boroughspartnership.nhs.uk/base-page.aspx?ID=5409
Our Chair has had no other significant commitments or any that have changed
during the reporting year.
Annual Report and Annual Accounts 2011-12 15

Board Committees
Members who are unable to attend committee meetings receive and review
the relevant papers. Normal practice is for the member to provide the
Chairman with detailed observations prior to the meeting.
Audit Committee
The Audit Committee is responsible for reviewing the establishment and
maintenance of an effective system of integrated governance, risk
management and internal control across the whole of the organisation’s
activities - both clinical and non-clinical - that supports the achievement of the
organisation’s objectives.
It achieves this by:
Reviewing the adequacy of all risk and control-related disclosure
statements, together with any accompanying Head of Internal Audit
statements, External Audit opinion or other appropriate independent
assurances, prior to endorsement by the Board
Ensuring that there is an effective Internal Audit function that provides
independent assurance to the Audit Committee, Chief Executive and the
Board
Reviewing the work and findings of the External Auditor
Reviewing the findings of other significant assurance functions both
internal and external to the organisation and considering the implications
to the governance of the organisation
Reviewing the work of other committees within the organisation whose
work can provide relevant assurance to the Audit Committee’s own scope
of work
Requesting and reviewing reports and positive assurances from Directors
and managers on the overall arrangements for integrated governance, risk
management and internal control
Reviewing the Annual Report and Financial Statements before submission
to the Board
Ensuring that the systems for financial reporting to the Board, including
those of budgetary control, are subject to review as to completeness and
accuracy of the information provided to the Board.
Brian Marshall is Chairman of the Audit Committee. Full membership and
details of attendance at meetings is disclosed in the table below. Where
committee members were not eligible to attend due to their start/leaving date,
this is indicated with N/A (Not Applicable):
Committee
Member
Dr Colin Dale –
Non-Executive
Director
16
17/05/
11
24/05/
11
19/07/
11
20/09/
11
Annual Report and Annual Accounts 2011-12
22/11/
11
21/02/
12
X

Committee
Member
Brian Marshall –
Non-Executive
Director
Derek Taylor –
Non-Executive
Director
Allan Chan –
Non-Executive
Director
Rupert Nichols –
Non-Executive
Director
17/05/
11
24/05/
11
19/07/
11
20/09/
11
22/11/
11
21/02/
12
X
X
Remuneration Committee
This Committee advises the Board on the appropriate remuneration and terms
of service for the Chief Executive and other Executive Directors. It is
concerned with all aspects of salary (including any performance-related
elements/bonuses) and provisions for other benefits including pensions and
cars as well as arrangements for termination of employment and other
contractual terms.
Its responsibilities are to:
Be advised of, monitor and evaluate the performance of the Executive and
Associate Directors
Advise on and oversee appropriate contractual arrangements for such
staff including proper calculation and scrutiny of termination payments -
taking account of employment law and national guidance as is appropriate
Be informed of disciplinary matters arising relating to Executive and
Associate Directors
Have responsibility for the ratification of appointments of Directors. This
requires that the Chief Executive is invited to attend the Committee for
those agenda items related to appointments of Directors
Ensure Executive and Associate Directors are fairly rewarded for their
individual contribution to the Trust. Proper regard must be given to the
Trust’s circumstances, size, difficulty of the job as benchmarked against
other organisations, individual performance and to the provision of any
national guidance and arrangements for such staff as appropriate.
In accordance with the NHS Foundation Trust Code of Governance the
Committee membership is comprised exclusively of Non-Executive Directors.
The Terms of Reference of the Committee stipulate the membership as the
Chairman plus three Non-Executive Directors.
Annual Report and Annual Accounts 2011-12 17

The Chief Executive is invited to attend the Committee except when his role is
an item on the agenda. The Chairman of the Trust, Bernard Pilkington, chairs
the Committee, which met on three occasions during the period 1 April 2011
to 31 March 2012.
Membership of the Remuneration Committee and details of attendance at
meetings is disclosed in the following table. Where committee members were
not eligible to attend due to their start/leaving date, this is indicated with N/A
(Not Applicable):
Committee Member 09/06/11 16/09/11 28/02/12
Bernard Pilkington – Chairman X
Colin Dale –
Vice Chairman
* N/A N/A
Brian Marshall –
Non-Executive Director
Derek Taylor –
Non-Executive Director
X X
Rupert Nichols –
Non-Executive Director
* Colin Dale attended in his capacity as Vice Chairman of the Trust
Clinical Risk and Clinical Governance Committee
Linking closely with the Audit Committee, the Clinical Risk and Clinical
Governance Committee assures the Board that appropriate structures,
systems and processes are embedded in the organisation to manage patient
safety and clinical risk and ensure that services are continuously improving.
This includes ensuring appropriate actions are taken to address any deviation
from accepted standards and informing the Board of any significant lapses. It
also ensures that learning occurs as a result of risk analysis and feedback to
services.
The Committee provides assurance that:
The Trust has effective systems to monitor the level of compliance with
relevant safety legislation, policy and national implementation guidance. It
will ensure that processes are in place for managing and responding to the
recommendations arising from external agency visits, inspections and
accreditations
Ensure that regular, ongoing internal analysis of Serious and Untoward
Incidents (SUIs), complaints, compliments and claims occurs and that the
Trust can demonstrate lessons learned from these through service
improvement
Provide a forum for service users’ and carers’ representatives, Chair of the
Staffside committee and Executive and Non-Executive Directors to seek
evidence of clear lines of accountability and management of the risks
associated with meeting the requirements of the Annual Health Check and
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Annual Report and Annual Accounts 2011-12

key safety recommendations in respect of service users, carers, staff and
clinical governance and clinical risk
Oversee the Trust’s annual clinical audit programme and ensure that
outcomes result in service improvement
Formally ratify Trust policies with the exception of accounting policies,
which are ratified by the Audit Committee
Receive reports by exception - as well as relevant action plans and annual
reports as agreed in the annual work plan - from the groups that have a
statutory requirement to report directly to the Committee.
Dr Colin Dale, Non-Executive Director, chairs the committee, which met on
five occasions from 1 April 2011 to 31 March 2012. In addition to Executive
and Non-Executive Directors, the Committee membership includes clinicians
and senior managers from the Trust, service users, carers and the Staffside
Chairman. Details of meeting attendance is disclosed in the following table.
Where committee members were not eligible to attend due to their
start/leaving date, this is indicated with N/A (Not Applicable):
Committee
Member
Dr Colin Dale –
17/05/11 19/07/11 20/09/11 22/11/11 21/02/12
Non-Executive
Director
Derek Taylor –
Non-Executive
Director
Philippa Tubb
Non-Executive
Director
Dr Louise Sell
N/A
Medical Director N/A N/A N/A
Therese Patten –
Chief Operating
Officer
Tracy Hill
Human Resources
and Organisational
Development
Gail Briers
Director of Nursing
and Governance
Steve Hull – Asst
Director of Nursing
and Safeguarding
Nick Rowe –
Director of Human
Resources and
Organisational
Development
N/A
N/A x
N/A N/A N/A
N/A N/A N/A N/A
Dr Fade Ibitoye –
Medical Director x N/A N/A
Annual Report and Annual Accounts 2011-12 19

Committee
Member
Sue Hooton –
Assistant Director
of Nursing,
Governance and
Performance
Ray Walker –
Director of
Nursing,
Governance and
Performance
Christine
Molyneux -
Public Member
Councillor
Sandra Banawich -
Public Member
Councillor
Brian Morris -
Staffside
Chairman
* Replaced by
20
17/05/11 19/07/11 20/09/11 22/11/11 21/02/12
Sue
Cronin,
Head of
Risk
Management
and
Patient
Safety
N/A N/A
N/A N/A N/A N/A
x x x x
Annual Report and Annual Accounts 2011-12
* Alan
Griffiths -
Public
Member
Councillor
x

Our Risk Management
Our Risk Management Policy sets out the overall aims and objectives for risk
management across the Trust. These are delivered through an annual work
plan set against each of the objectives. The Risk Management Policy
describes a clear structured and systematic approach to the management of
risk across organisational, financial and clinical activities.
Our Risk Management Policy sets out both the collective responsibilities of the
Trust Board and its Committees, and the individual responsibilities of the Chief
Executive, Directors and all levels of staff across the Trust. The Trust Audit
Committee seeks assurance that the risk management process is
comprehensive, effective, complies with regulatory requirements and is fit for
purpose by taking independent objective advice through the appointment of
internal auditors. It also approves the Annual Governance Statement.
Risk Management Policy
The overall aim of the Risk Management Policy is to ensure that high-quality
healthcare services are delivered with the safety, health and well-being of
services users, carers and staff at the forefront of everything we do and to
provide assurance through clear reporting structures that the Risk
Management System across the Trust is embedded and effective.
The Trust is committed to ensuring the safety of service users, staff and the
public through an integrated approach to managing risk - whether financial,
organisational or clinical - within systems that are open and transparent, and
demonstrate sound governance.
The Risk Management Work Plan is approved by the Trust Executive Team
annually and is supported by the Risk Management Policy and Incident
Management Policy, which set out the framework and methodology for
effective risk and incident management across the Trust.
Risk Management Process
In pursuit of implementing effective risk management the Trust Risk
Management Policy has adopted the overarching process for managing all
risk within a single framework. The Risk Management Policy details the
framework for identification, evaluation, analysis, treatment, control,
monitoring and review of risks within a single Trust-wide Risk Register.
The risk management process begins with the identification of risks
throughout the Trust. Risks are identified through a number of sources
including risk assessment, audit, incidents, complaints, safety alerts, external
reviews and inspection, emerging financial and environmental risks and
compliance with statutory and regulatory requirements.
Risks are evaluated and prioritised using a qualitative approach where the risk
levels (Consequence and Likelihood) are estimated. This provides an
estimate of where the most serious overall risks lie and assists both the
Annual Report and Annual Accounts 2011-12 21

evaluation and prioritisation of risks within the management decision-making
process.
The Risk Management Policy clearly describes the process for authority to
manage risk within the Trust - with low-level risk being managed locally and
high-level risk escalated to the Trust Executive Team and reported to the
Trust Board. The Trust Board receives bi-monthly reports on the current
status and management of all risks within the Trust. Directors attending the
Trust Operational Performance Team meetings review high-level risks
monthly and in further detail at the Clinical Governance and Clinical Risk
Committee, which is a sub-committee of the Trust Board.
Risk movement and control is monitored monthly at the Trust Operational
Performance Management meetings where accountabilities for risk control
and risk movement are discussed. The operational groups for managing risk
are the Business Stream Risk and Performance meetings (that receive a
monthly Business Stream Risk Report) and the Corporate Quality,
Performance and Risk Forum, which receives a monthly Safety and Quality
Metrics Report.
Overview of the arrangements in place to govern service quality
This year the Trust has produced its third annual Quality Report. Our Quality
Report is published alongside our Annual Report, which we will continue to
produce each year and make available as a public statement of our
commitment to improving quality and safety in the Trust.
Improving on 2011-12 Quality Measures
The Trust’s quality priorities for 2011-12 have been monitored by the Trust for
the past year. Although the Trust achieved these priorities, they will continue
to be reported on for the following year. Details of our 2011-12 priorities are
included in the annual Quality Report – see page 93.
Trust Quality Improvement Plan
The Trust has developed a Quality Improvement Plan for 2012-13 which
includes:
Quality and Safety Priority Indicators 2012-13 (as above)
Actions arising from the National Patient Survey results
Actions arising from the Trust Patient Experience Survey results
Safety and quality actions from external regulator’s visits/reports
Actions relating to data quality in the Monitor External Assurance
review.
The Quality Improvement Plan will be published on the Trust’s internet site
following publication of the Quality Accounts.
22
Annual Report and Annual Accounts 2011-12

Statements of Assurance Provided by the Trust Board
As part of our Quality Report, we are required to present a series of
statements which have been agreed by the Trust Board that relate to the
quality of our services – see page 86.
These statements serve to offer assurance to our members and the general
public that we are:
Performing to national essential standards for safety and quality (CQC
Registration standards)
Measuring and improving our clinical performance in audit and research
activity
Engaging in innovative projects (CQUIN framework)
Maintaining compliance with our Monitor targets.
System of Internal Control
Risks to the Trust’s Strategic Objectives are managed by a 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.
The System of Internal Control is based on an ongoing process designed to:
Identify and prioritise the risks to the achievement of the organisation’s
policies, aims and objectives (via the Assurance Framework)
Evaluate the likelihood of those risks being realised and the impact should
they be realised and manage them efficiently, effectively and
economically.
Maintaining and reviewing Systems of Internal Control throughout the Trust is
monitored through the Trust Board, its sub-committees and through an
effective governance structure.
The Assurance Framework
The Trust regards the Assurance Framework as an essential element of the
management of risk within the Trust. The Assurance Framework is integrated
into the overarching risk management framework. The Assurance Framework
provides key evidence to support the Annual Governance Statement.
The Trust Board approves the Assurance Framework and receives bi-monthly
reports detailing progress against risk control and assurance for the delivery
of objectives. The Trust’s Leadership Forum is the accountable and
responsible group for monitoring and critical review of the Assurance
Framework. Progress against key targets is discussed at each meeting.
Internal Audit Assurance Framework
An Internal Assurance Framework has been established, which is designed
and operating to meet the requirements of the Annual Governance Statement
and provide reasonable assurance that there is an effective System of Internal
Control to manage the principal risks identified by the organisation.
Annual Report and Annual Accounts 2011-12 23

Our Council of Members
The Trust has a Council of Members which consists of both elected and
appointed governors known as Member Councillors. These work with the
Trust Board to make decisions about our services and future priorities.
Member Councillors have a duty to talk to and speak up for the needs, wants
and ideas of our Foundation Trust members and to pass on feedback from the
Council of Members and the Trust Board.
The Chair of the Trust Board is also the Chair of the Council of Members.
During the regular meetings Member Councillors are updated on the
performance of the Trust. Members of the public can attend and information
about these meetings is available on the ‘Membership’ section of our website.
The Quality Accounts and the Business Planning Cycle of the Trust Board is
supported by and involves the Council of Members.
The Trust has six constituencies – ‘Warrington’, ‘St Helens’, ‘Halton’,
‘Knowsley’, ‘Wigan’ and ‘Other’ (for members who live outside the Trust
footprint).
Member Councillors' responsibilities include:
Appointing the Chairman
Appointing the Non-Executive Directors
Approving the appointment of the Chief Executive
Removing the Chairman and Non-Executive Directors
Agreeing Non-Executive Directors' terms and conditions
Appointing and removing auditors
Receiving the annual report and accounts
Approving changes to the Constitution
Consulting on proposed changes and providing guidance on the future
direction of the NHS Foundation Trust
Member Councillors - other than Appointed Member Councillors which are
appointed by the Trust’s partner organisations - are chosen by election by
their constituency or, where there are classes within a constituency, by their
class within that constituency. Elections are conducted in accordance with the
Model Election Rules on the first-past-the-post basis. If contested elections
take place, these are conducted by secret ballot in accordance with the Model
Election Rules contained within the Trust Constitution.
Member Councillors must be at least 16 years of age at the date they are
nominated for election or appointment.
An elected or an appointed Member Councillor may hold office for a period of
up to three years. They are eligible for re-election at the end of their term, but
cannot serve more than three consecutive Terms of Office.
24
Annual Report and Annual Accounts 2011-12

During the reporting year the Trust held two elections. For the 2011 elections
we invited nominations for Public Member Councillors in the Constituencies of
Wigan (2 seats), Halton (1 seat) and Other (1 seat). We also invited
nominations for Staff: Supporting Services (1 seat).
Nominations closed on 19 September 2011. Elections were uncontested in
the Wigan Constituency and Staff, Supporting Services and therefore no
elections took place. Contested Elections were held in the Constituencies of
Halton and Other. Voting closed on 3 November 2011.
The Trust also invited nominations in 2012 as a result of the expiry of the
Terms of Office for some Member Councillors. Vacancies arose in the
Constituencies of Knowsley (2 seats); Halton (1 seat); St Helens (2 seats);
Wigan (2 seats) and Warrington (4 seats).
We also invited nominations for the Staff Classifications of Supporting
Services (1 seat); Managers above Band 8B (1 seat); Nursing Staff (2 seats);
Allied Health Professionals (1 seat) and Medical Staff (1 seat). Nominations
closed on 4 January 2012.
Elections were uncontested in the Halton and Wigan Constituencies and the
Staff Classifications of Managers above Band 8; Nursing Staff; Supporting
Services and Medical Staff.
Contested Elections were held in the Constituencies of Knowsley, St Helens
and Warrington. Voting closed on 13 February 2012. This process was
independently carried out by the Electoral Reform Services.
We have 26 Public Member Councillors, 11 Staff Member Councillors and 11
Appointed Member Councillors from our partner organisations:
Warrington Constituency
Alfred Clemo - finished 23 January 2012
Christine Molyneux
Irene Ann Harris – finished 24 August 2012
James Leicester – commenced 1 March 2012
Michael Mackenzie – commenced 1 March 2012
Peter Ashley
Sarah Hall
St Helens Constituency
Alan Griffiths
Jeffrey Hext
Patricia Robinson – commenced 1 March 2012
Sandra Banawich – finished 14 February 2012
William Bradbury
Annual Report and Annual Accounts 2011-12 25

Halton Constituency
Bill Jackson – commenced 1 March 2012
Jacqueline McGloin
John Paul Chiocchi
Michael Tiernan – finished 29 February 2012
Susan Bradfield-Smith – commenced 4 November 2011
Knowsley Constituency
Christopher Whittle – commenced 1 March 2012
David Manley – finished 29 February 2012
Dorothy Hadley
Iain Yates
Ronald Rotherham
Wigan Constituency
Derek McMahon – finished February 2012
Frank Jones – commenced 4 October 2011
Gillian Fairhurst – 1 May 2011
James Armstrong – commenced 1 March 2012
Jean Garlick
Nick Pym
Norman Bradbury
Steven Darbyshire – commenced 4 October 2011
Vincent Jackson
Yvonne Halliwell
Other Constituency
Pat Clarke – commenced 4 November 2011
Staff Member Councillors
Allied Professions
Cecelia Barber
Managers (above Band 8)
John Evans
Nursing Staff
Joanne McDonnell
Michael Kenny – finished 29 February 2012
Neil Callan
Neil Powell – commenced 1 March 2012
Supporting Services
Ann Cunliffe
Angela Fearnley – finished 29 February 2012
26
Annual Report and Annual Accounts 2011-12

Christopher Ashman
Diane French – commenced 4 October 2012
Donna Hargreaves – commenced 1 March 2012
Yvonne Morris
Medical Staff
Dr Sandeep Ranote
Appointed Member Councillors
NHS Warrington
Bruce Rigby – commenced 8 April
Warrington Borough Council
Councillor Roy Smith – finished 1 September 2011
Councillor Pat Wright – commenced 19 December 2011
NHS Halton and St Helens
Seamus McGirr (Executive Nurse, Director of Clinical Quality and
Standards) – 1 June 2011
Current vacancy
St Helens Council
Councillor Joe Pearson
Halton Borough Council
Councillor Ann Gerrard – finished 14 November 2011
Current Vacancy
NHS Knowsley
Janice Coulter (Director of Health and Social Care)
Knowsley Council
Councillor Jayne Aston – finished 4 December 2011
Councillor Bob Swann – commenced 5 December 2011
NHS Ashton, Leigh and Wigan
Dr David Valentine (Executive Director of Primary Care and Medical
Director)– finished 18 August 2011
Current Vacancy
Wigan Council
Councillor Keith Cunliffe
Police Representative
Current vacancy
Annual Report and Annual Accounts 2011-12 27

Staffside Chairman
Brian Morris
Register of Member Councillor Interests
To access the Register of Interests for the Council of Members visit
www.5boroughspartnership.nhs.uk/members-area/
Our Council of Members met five times during the period 1 April 2011 to 31
March 2012. Our Chief Executive was in attendance at the meetings.
Attendance of our Member Councillors is detailed in the table below. Where
Member Councillors were not eligible to attend due to their start/leaving date,
this is indicated with N/A (Not Applicable):
Chairman
18/05/
11
11/07/
11
08/11/
11
19/01/
12
14/03/
12
Bernard Pilkington
Public Member Councillor
18/05/
11
11/07/
11
08/11/
11
19/01/
12
14/03/
12
Alfred Clemo – Warrington X X N/A
Christine Molyneux – Warrington X
Irene Harris – Warrington X N/A N/A N/A
James Leicester – Warrington N/A N/A N/A N/A
Michael Mackenzie – Warrington N/A N/A N/A N/A
Peter Ashley – Warrington X
Sarah Hall – Warrington X
Alan Griffiths – St Helens X X
Jeffrey Hext – St Helens X
Patricia Robinson – St Helens N/A N/A N/A N/A
Sandra Banawich – St Helens X X X N/A
William Bradbury – St Helens
Bill Jackson – Halton N/A N/A N/A N/A
Jacqui McGloin – Halton X X X
John Chiocchi – Halton X X
Michael Tiernan – Halton X X N/A
Susan Bradfield-Smith N/A N/A N/A X
Christopher Whittle - Knowsley N/A N/A N/A N/A
David Manley – Knowsley X X X N/A
Dorothy Hadley – Knowsley
Iain Yates – Knowsley X X
Ronald Rotheram – Knowsley X
Derek McMahon – Wigan X X X
Frank Jones – Wigan N/A N/A
Gillian Fairhurst – Wigan X X N/A N/A N/A
James Armstrong – Wigan N/A N/A N/A N/A
Jean Garlick – Wigan
Nick Pym – Wigan X X X
Norman Bradbury – Wigan X X X X
28
Annual Report and Annual Accounts 2011-12

Public Member Councillor
18/05/
11
11/07/
11
08/11/
11
19/01/
12
14/03/
12
Steven Darbyshire – Wigan N/A N/A X
Vincent Jackson – Wigan
Yvonne Halliwell – Wigan X X X X
Pat Clarke - Other N/A N/A N/A
Staff Member Councillor 18/05/ 11/07/ 08/11/ 19/01/ 14/03/
11 11 11 11 11
Cecelia Barber – Staff – Allied
X X
Professionals
John Evans – Staff – Managers X
Joanne McDonnell – Staff – Nursing X X X X
Michael Kenny – Staff – Nursing X N/A
Neil Callan – Staff – Nursing X
Neil Powell – Staff – Nursing N/A N/A N/A N/A X
Ann Cunliffe – Staff – Supporting X
Angela Fearnley – Staff – Supporting X X N/A
Christopher Ashman – Staff –
Supporting
X
Diane French – Staff – Supporting N/A N/A X
Donna Hargreaves – Staff –
Supporting
N/A N/A N/A N/A
Yvonne Morris – Staff – Supporting X
Dr Sandeep Ranote – Staff – Medical X X X X
Appointed Member Councillor 18/05/ 11/07/ 08/11/ 19/01/ 14/03/
11 11 11 12 12
Bruce Rigby – NHS Warrington X X
Cllr Roy Smith – Warrington Borough
Council
X X N/A N/A N/A
Cllr Pat Wright – Warrington Borough
Council
N/A N/A N/A N/A X
Seamus McGirr – NHS Halton and
St Helens
X X N/A N/A N/A
Cllr Joe Pearson – St Helens Council X X X X
Cllr Ann Gerrard – Halton Borough
Council
X X X N/A N/A
Janice Coulter – NHS Knowsley X X X
Cllr Jayne Aston – Knowsley Council X X N/A N/A
Cllr Bob Swann – Knowsley Council N/A N/A N/A
Dr David Valentine – NHS Ashton,
Leigh and Wigan
X X N/A N/A N/A
Cllr Keith Cunliffe – Wigan Council X X X X
Brian Morris – Staffside Chairman X X
There is an open invitation from the Council of Members to Board Members -
both Executive and Non-Executive Directors - to attend Council Meetings.
This is regularly taken up.
Annual Report and Annual Accounts 2011-12 29

Sub-committees
The sub-committees of the Council of Members are supported by Directors or
Senior Managers from the Trust.
Membership and Communications Committee
The Council of Members established a sub-committee known as the
Membership and Communications Committee. The remit of the committee is
to oversee the delivery of the Membership Strategy and to ensure effective
communication with the membership of the Trust. The committee met four
times during the period 1 April 2011 to 31 March 2012.
Attendance is detailed in the table below. Where Committee members were
not eligible to attend due to their start/leaving date, this is indicated with N/A
(Not Applicable):
30
Members 27/07/11 28/09/11 11/01/12 22/02/12
Christine Molyneux –
Warrington – Public
Member Councillor
Irene Ann Harris –
Warrington – Public
Member Councillor
X
X X X X
Sarah Hall – Warrington –
Public Member Councillor X
Jacqueline McGloin –
Halton – Public Member
Councillor
Michael Tiernan – Halton
– Public Member
Councillor
Dorothy Hadley –
Knowsley – Public
Member Councillor
X X X
X X X X
X X X
Iain Yates – Knowsley –
Public Member Councillor X X
Ronald Rotheram –
Knowsley – Public
Member Councillor
Vincent Jackson – Wigan
– Public Member
Councillor
Yvonne Halliwell – Wigan
– Public Member
Councillor
X X
X
X
Annual Report and Annual Accounts 2011-12

Members 27/07/11 28/09/11 11/01/12 22/02/12
Cecelia Barber – Allied
Professionals – Staff
Member Councillor
John Evans – Managers
Above Band 8 – Staff
Member Councillor
X X X
X
Neil Callan – Nursing –
Staff Member Councillor X X X
Nominations and Remuneration Committee
The Council of Members has established a sub-committee known as the
Nominations and Remuneration Committee. The committee met once during
the period 1 April 2011 to 31 March 2012. The membership is made up of the
Council Chairman, Bernard Pilkington, plus three members of the Council of
Members. The Committee is supported by the Director of Human Resources
and Organisational Development. Attendance is outlined in the table below.
Where Committee members were not eligible to attend due to their
start/leaving date, this is indicated with N/A (Not Applicable):
Member 27/02/12
Bernard Pilkington – Chair
John Chiocchi – Halton – Public Member Councillor
William Bradbury – St Helens – Public Member
Councillor
Jean Garlick – Wigan - Public Member Councillor
(from 01/03/12)
Councillor Jayne Aston – Knowsley Council – Appointed
Member Councillor (up to 29/02/12)
N/A
In addition, Non-Executive Director Derek Taylor also attends and chairs the
meeting for matters relating to the appointment, performance and
remuneration of the Chairman. The remit of the committee is to:
a) Nominations
Regularly review the composition of Non-Executive Directors on the Board
to ensure that they reflect the required expertise and experience and to
make recommendations to the Council of Members. This includes periodic
consideration of information prepared for the Board and reviewing the
independence, skills and experience required for Non-Executive Directors
to ensure the appropriate balance of experience and expertise
Evaluate the balance of skills, knowledge and experience on the Board
To prepare a job description and person specification for the role and
capabilities required for a particular appointment of a Non-Executive
Director (including the Chairman)
Annual Report and Annual Accounts 2011-12 31

To identify suitable candidates to fill Non-Executive Directors posts
through a process of open competition
To make recommendations to the Council of Members as to the
appointment of Non-Executive Directors (including the Chairman)
To evaluate and report to the Council of Members on the performance of
the Chairman and Non-Executive Directors - including their retention or
removal as appropriate.
b) Remuneration
To consider and make recommendations to the Council of Members as to
the remuneration, allowances and other terms and conditions of office of
the Chairman and Non-Executive Directors.
Compliance with Authorisation Committee
The Council of Members has established a sub-committee known as the
Compliance with Authorisation Committee, which meets five times a year.
Attendance is detailed in the table below. Where Committee members were
not eligible to attend due to their start/leaving date, this is indicated with N/A
(Not Applicable):
Member 03/05/11 06/09/11 01/11/11 10/01/12 06/03/12
Chris Molyneux –
Warrington - Public X X X X X
Member Councillor
Ronald Rotheram –
Knowsley – Public
Member Councillor
Alan Griffiths – St Helens
– Public Member
Councillor
Jeffrey Hext – St Helens
– Public Member
Councillor
Frank Jones – Wigan –
Public Member
Councillor
Jean Garlick – Wigan –
Public Member
Councillor
Nick Pym – Wigan –
Public Member
Councillor
Michael Kenny – Staff
Member Councillor –
Nursing
Christopher Asham –
Supporting Services –
Staff Member Councillor
32
X
X X
X X X
X
X X
X
X X X X
Annual Report and Annual Accounts 2011-12

The remit of the Committee is to be responsible for:
Involvement in the preparation of the Annual Plan to ensure that the
interests of members are considered when strategic developments are
proposed
Receiving reports on the performance of the Trust
Receiving the annual accounts and any report of the auditor on them for
onward presentation to the Council of Members
Receiving a report from the Audit Committee identifying any matters where
it considers that action or improvement is needed
Receiving a report for approval from the Audit Committee on the
appointment of the Trust’s external auditors
Receiving an annual report on the effectiveness of the Trust’s System of
Internal Control
Involvement in the Quality Accounts process throughout their annual cycle.
Membership of our Foundation Trust
As a Foundation Trust we have a membership to give local people a say in
how we respond to the specific needs of the population we serve. Our
membership is made up of both staff and the public.
Members of our Trust can:
Receive information about the Trust and be consulted on plans for future
development of the Trust and its services
Elect representatives to serve on the Council of Members
Stand for election to the Council of Members.
It has been one of the Trust’s aims to develop a membership that enables
varying levels of participation according to the needs and degree of
involvement of individual members. Accordingly the membership of this Trust
provides for three levels of public membership:
Bronze - To receive information only from the Trust
Silver - To receive information but also to provide feedback
Gold - Has an extra dimension of having an influence
Anyone who is a member of the public can become a member of the Trust
providing they are aged 14 or over. Members of the public constituency must
complete a membership form and submit it to the Membership Office.
On 31 March 2012, there were 5,555 public members – 811 from Halton; 671
from Knowsley; 839 from St Helens; 1,292 from Warrington; 1,094 from
Wigan and 848 from ‘Other’.
Trust staff are automatically members but may opt out if they wish. On 31
March 2012 there were 3,823 staff members. The staff constituency is subdivided
into the following classes:
Allied Health Professions (qualified)
Managers (Band 8 or above)
Annual Report and Annual Accounts 2011-12 33

Medical staff
Nursing staff (qualified)
Supporting services (including nursing assistants, healthcare workers and
administrators).
With the addition of staff from Knowsley Integrated Provider Services – who
joined the Trust on 1 April 2011 - we reached our target of 9,000 members.
Our focus has therefore changed from proactive membership recruitment to
meaningful communication and engagement with those current members of
our Foundation Trust.
Maintenance of the membership numbers will be managed by attending
external events – as well as establishing links with our partners in the
voluntary sector – to ensure representation of minority and vulnerable groups.
As part of a Communications meeting held in September 2011, the Member
Councillors identified the third sector organisations that operated within each
of their Constituencies and looked at ways they could understand the views of
our members by engaging with these groups.
We communicate with our members through ‘Insight’ - a newsletter which has
been designed specifically for them. We also produce a quarterly Council of
Members Update in e-format. The content is appropriate to our members and
as with all our communications, we ask for feedback on each edition. To
complement this, we have also redesigned our website to include an area that
is full of up-to-date information for our members including details of upcoming
meetings. Council Members are linked in with the third sector organisations
within their Boroughs as a way of meeting members who are also part of
these groups. Member Councillors and Non-Executive Directors also attend
regular Service User and Carer Forums meetings as well as local
constituency events such as the Disability Awareness Day - an annual event
held in Warrington.
Gold members are also encouraged to get involved in Trust activities. We
invited our Gold members to join ‘Expert by Experience’ groups and be
consulted over proposed redesigns of our care pathways.
Any member who wishes to contact their Member Councillor must, in the first
instance, telephone the Membership Office on 01925 664801. Alternatively,
they can send an email to ft.membership@5bp.nhs.uk – marking it for the
attention of their Member Councillor.
34
Annual Report and Annual Accounts 2011-12

Our Strategic Themes and Objectives
2011/2012
Our eight strategic themes inform what we hope to achieve and deliver over
the coming years. These themes are in place to improve our services, the
lives of our service users and their carers, our people and to make sure we
can provide the best care and treatment we possibly can. Our Strategic
Themes and Objectives cover the period 1 April 2011 to 31 March 2012. More
details about our in-year achievements against each theme can be found
throughout this annual report. The information provided has been presented
by the relevant Director with responsibility for each Strategic Theme. The
table below summarises our progress against each theme this year:
Theme Director High-Level Objective 2011/12 Progress
Service Gail By March 2012 we will be able to Fully met
Delivery and
Patient
Experience
Briers demonstrate that we have improved the
effectiveness, experience and safety of
our services
Efficient and Dean During 2011-12 we will ensure services Partially
Effective
Organisation
Marsh are provided in the most economic,
efficient, effective and equitable manner
met
Clinical Therese In 2011-12 we will support our clinical Partially
Leadership and
Service
Improvement
Patten leaders to deliver service improvement
across the organisation ensuring we
deliver high-quality services
met
Engagement Simon In 2011-12 the Trust will contribute to Fully met
and
Partnership
Working
Barber and support partnership arrangements
with all stakeholders to ensure the
delivery of key agreed priorities and to
improve the health and well-being of
local communities
Well-Governed Simon In 2011-12 we will maintain sound Fully met
Barber governance arrangements that will
ensure we continue to hold our CQC
registration status and FT authorisation
Financial Dean In 2011-12 we will meet our statutory Fully met
Viability Marsh financial duties and maintain a robust
five-year financial plan
Organisational Tracy Throughout 2011-12 we will deliver Partially
Development Hill organisational improvement through our
key themes of:
met
Employee and Organisational
Health and Well-being
Employee engagement
Trust Values/Organisational Culture
Workforce Tracy Throughout 2011-12 we will continue to Partially
Management
and experience
Hill plan for, attract and develop our people
so that they are able to deliver a highquality
service
met
Annual Report and Annual Accounts 2011-12 35

Service Delivery and Patient Experience
This theme relates to how we deliver our services and the quality of our
patients’ experiences. It is about what people think of us and the quality of the
services we deliver. We have fully met the objectives agreed with the Trust
Board for this year, for this strategic theme.
What have we done against this Strategic Objective in 2011/12?
Capturing Patient Experience
This objective has been met. We consulted widely on how best to capture
patient experience in addition to recording key measures on patient
satisfaction. We have established key ‘touch points’ in our clinical pathways
where we can now measure and track improvements to our patients’
experience. In addition we are working with our Intranet and Internet
developers around the creation of an innovative and potentially marketing -
leading approach to eliciting service user feedback.
We have been listening to our service users and carers about the quality of
their patient experience in a variety of ways including:
National Patient Survey Results
This year’s results were presented in a new format know as a ‘Summary
Report’, with marks given out of 10, and published on the Care Quality
Commission website. The Trust was rated “better” than other Trusts in the
overall category.
In-patient and Community Patient Surveys
The Trust has continued to obtain real-time feedback from service users
regarding their satisfaction with our mental health and learning disability
services.
Knowsley Integrated Provider Services Generic Satisfaction Survey
Generic Satisfaction Surveys were carried out in December 2011 and March
2012. On both occasions 42 services took part with approximately half of all
people surveyed responding.
Patient Opinion
The Trust continues to support the national Patient Opinion website and
during the reporting year Patient Opinion was rolled out to Knowsley
Integrated Provider Services.
‘Big Brother’ Booth
Having previously piloted the use of our portable ‘Big Brother’ Booth within our
community settings, during the reporting year we gave our in-patients at our
hospital at Hollins Park, Warrington the opportunity to feed back on the quality
of our services on camera. This included traditionally hard-to-reach audiences
including people in our learning disability settings.
36
Annual Report and Annual Accounts 2011-12

Joint Service User and Carer Forum
This monthly forum enables our service users and carers to discuss issues
regarding the services we provide with our senior management team including
the Chief Executive and Chairman.
During 2011 separate forums were established for service users and carers
from our Learning Disability, Forensics and Later Life and Memory Services.
Practical changes have been made to service delivery as a result of feedback.
Preventing Avoidable Harm
This objective has been met. We have monitored the percentage of no harm
incidents based on the NPSA definitions throughout the year across all our
services. The Trusts ratio of no harm incidents has significantly exceeded the
NPSA target of greater than 67 per cent.
The targeted areas within each business stream have shown improvement.
Absconsions in the adult business stream have reduced by a further 20 per
cent from the already improved position in 2010/11.
The number of falls across Later Life and Memory Services reduced from 710
in 2010/11 to 508 by the end of March 2012.
Improving the physical health of our service users
This objective has been met. There has been a 43 per cent increase of
service users within the Community Mental Health Teams with physical health
incorporated in their care plans.
During the year we have also achieved a 100 per cent compliance in
consistently carrying out health screening and examination in line with NICE
guidance for all service users who were newly commenced on depot injection
medication.
What else have we achieved against this Strategic Theme during the
reporting year?
Service User Safety
Throughout the reporting period we have continued to develop our Patient
Safety Framework, which ensures patient safety learning is co-ordinated
across all parts of the Trust. The Trust Patient Safety Framework consists of:
Patient Safety Panel (challenge meetings around Serious Untoward
Incident (SUI) reports)
Patient Safety and Quality Metrics (all safety incident reporting in one
report)
Executive-level walkabouts to visit clinical services
Thematic review using the Safer Mental Health Checklist
Clinical Quality Dashboard to feed back key data to frontline staff
Annual Report and Annual Accounts 2011-12 37

A series of briefings, alerts and newsletters that aim to ensure changes are
made and patient safety improved are distributed throughout the Trust
regularly. This includes MHRA alerts within the CAS system. Learning is
further shared in the form of annual conferences such as the Service User
and Carer Involvement Conference, Service User Physical Health and Well-
Being Conference and the Trust’s Patient Safety Conference.
Health and Safety Performance
During the reporting year the Health and Safety Advisor reported a total of 43
incidents to the Health and Safety Executive under RIDDOR.
Good working relations within the Health and Safety Executive continues to
remain effective, with no enforcement action taken for the Trust as a whole for
the last financial year.
Infection Prevention and Control
Infection Prevention and Control is high on the Trust’s agenda and is a key
indicator of quality. The Trust continues to achieve full compliance with the
Care Quality Commission and the Health Act 2008 Code of Practice for the
Prevention and Control of Healthcare-Associated Infections.
Overall, there has been an improvement in all the results from the Trust’s
Infection Prevention and Control audit programme. Audits undertaken across
all our business streams scored 90 per cent and above. The audit process
involves ensuring compliance with Infection Prevention and Control
procedures, cleanliness of environment, patient care equipment and hand
hygiene.
We won first poster prize at the North West Audit Conference ‘Bridging the
Gap’ for our audit of ‘MRSA in a mental health trust’. We have been asked to
look at leading on a national audit of such infections.
Healthcare-Associated Infections
Infection Prevention and Control of Healthcare-Associated Infections (HCAI)
are monitored nationally via the Care Quality Commission (CQC) with
standards based on The Health and Social Care Act 2008 (updated 2010).
The Trust has declared compliance with the standards.
Compliments and Complaints
We are committed to doing everything possible to resolve concerns and
complaints raised with us. The Complaints team and Patient Advice and
Liaison Service (PALS) work closely together to ensure that concerns and
complaint issues are captured and resolved at the earliest opportunity and
that the complainant’s views are sought at all stages as part of the resolution
process.
All complaints we receive are dealt with through our Complaints and Concerns
Policy and in line with current NHS complaint regulations.
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Annual Report and Annual Accounts 2011-12

For the period 1 April 2011 to 31 March 2012 we received 1,013 compliments
and 242 complaints. We closed 237 complaints - some of which relate
historically to the previous reporting period.
Of the 237 closed complaints 155 (65.4 percent of all complaints closed) were
not upheld; 82 (34.6 percent of all complaints closed) had some or all of the
issues upheld.
During the period 1 April 2011 to 31 March 2012 there have been no Serious
Untoward Incident reviews (SUIs) relating to data loss. We were informed of
eight complaints that were referred to the Parliamentary and Health Service
Ombudsman.
Emergency Preparedness
The Trust has a Major Incident Plan that was revised in January 2012 to
reflect the NHS changes. This is to be audited by NHS Merseyside in the
second quarter of 2012. This is complemented by incident-specific plans, such
as fuel shortage, flooding, heatwave and winter pressures. There is also a
specific Business Continuity plan, which was subject to formal audit by NHS
Merseyside in February 2012.
The Trust falls into three Local Resilience Forum (LRF) areas. An agreement
has been reached with the Strategic Health Authority (SHA) that NHS
Merseyside will act as lead primary care trust with regard to emergency
planning and performance management. As such, the Trust falls under the
Merseyside Lead Primary Care Trust Function Activation Plan for major
incidents requiring co-ordination and mutual aid between NHS organisations
and key partners (October 2008, revised January 2012).
NHS Merseyside monitors the development of plans and report assurance to
the Strategic Health Authority (SHA). They also host training and exercises
such as the three-monthly ‘Exercise First Call’, which tests the ability of the
command and control network to establish contact with on-call Directors.
In the 12-month period inclusive of January 2012, 104 Trust staff have been
involved in internal or external training and exercise events. In addition, the
Major Incident Room was opened on the day of industrial action on 30
November 2011 and the full command and control process put in place. The
incident was managed effectively and the core business of the Trust was not
compromised.
Annual Report and Annual Accounts 2011-12 39

Our Future Plans and Objectives for Service Delivery and Patient
Experience in 2012/3
During 2012/13 we will be able to demonstrate that we have improved
the effectiveness, experience, quality and safety of our services.
To achieve this, our high-level objectives are:
During 2012/13 we will have developed and implemented a minimum of
five methods of capturing, reporting on and responding to service user and
carer experience which can be learned from and utilised across all our
services
By October 2012 we will have rolled out the falls strategy across the
organisation and by March 2013 have reduced the number of falls by 10
per cent. The March 2012 baseline will be used
By October 2012 we will have established methods of collating, reporting
and acting upon issues of concern and compliments expressed by our
service users and carers
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Annual Report and Annual Accounts 2011-12

Effective and Efficient Organisation
This theme relates to how we deliver improvement, value for money and
improved outcomes for service users. We have partially met objectives agreed
with the Trust Board for this year, for this strategic theme.
What have we done against this Strategic Objective in 2011/12?
Improvement in Patient Contact Time
A significant element of our improvement work has been to look at how much
time our frontline staff spend in delivering care face-to-face with our service
users and changing the way in which we do things so that as much time as
possible is spent in delivering care. A number of initiatives have begun this
year and will continue next year to make sure that this is achieved. Freeing up
this time means that our clinicians are able to see more service users and to
spend more time individually with them to improve the quality of, and access
to, our services.
The initiatives that have been started in 2011/12 have focused on a number of
particular wards and community teams to demonstrate how by making small
changes to how the ward is run can release this ‘time to care’. This
improvement approach has not yet been applied to all wards and all teams
across the Trust, which is why the objective has only been partially met.
Implementation of New Best Practice Pathways of Care
This objective has been partially met. We have been successful in producing
and delivering plans that have improved value for money. This has meant that
we have been able to save money while at the same time improving the
overall quality of service and patient experience. This has been achieved by
embarking on a planned programme of change which has helped our services
operate more efficiently.
Adult Services
A new community model of adult mental health has been developed that
focuses on improving access to assessment, diagnosis and evidence-based
treatment. The changes, which are clinically-supported, were proposed in
response to stakeholder feedback from GPs/clinical colleagues and service
users and carers about difficulties in accessing services. This new pathway of
care will start to be implemented in June 2012.
Later Life and Memory Services
A proposed new model of care for older people ‘Building on Strengths’ has
also been developed that focuses on earlier assessment, diagnosis and
evidence-based intervention. The proposed changes aim to meet the
requirements of the National Dementia Strategy and key priorities within the
NHS Outcomes Framework. They will support the development of services to
meet the predicted increases in dementia within the population and has
Annual Report and Annual Accounts 2011-12 41

esulted from discussions with our local commissioners and GPs around the
development of early intervention and support for people experiencing
dementia.
The Later Life and Memory services new pathway of care began being piloted
in Wigan in March 2012. This is been robustly evaluated by the Trust and its
key partners to demonstrate that the new pathway will deliver on the service
improvements.
Learning Disabilities Services
Following public consultation during 2011/12 a new pathway of care to
support the delivery of service users with learning disabilities was approved.
The agreed approach is to redesign the services delivered by the Trust in the
following way:
To enhance the Specialist Intensive Community Support Team to enable
those in the community to be supported for as long as possible in their
homes
As a result of the enhanced support available, to reduce the number of
Assessment and Treatment beds serving the 4 Boroughs (Warrington,
Halton, St Helens and Knowsley)
To deliver the Assessment and Treatment beds from the best and clinically
most appropriate venue.
Having now agreed this approach, the implementation of the new pathway
commenced in April 2012.
Implementation of Service Line Reporting
Service Line Reporting and Service Line Management is a different way of
looking at the way in which services use resources. It is intended to help
services think about the value they get from the resources they use - not just
whether they have over or under-spent against their budget. In 2011/12 the
Trust Board has regularly received information at a business stream level, but
the aim is to provide a tool to senior managers in the Trust to improve the
efficiency of the services they provide.
Service Line Reporting has been used in children’s services within the Trust
and training provided to other senior managers to help them get the most out
of this particular approach to looking at efficiency and effectiveness. The Trust
will continue to roll out the use of this across the organisation over the next 12
months.
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What else have we achieved against this Strategic Theme during the
reporting year?
Reference Costs
The Department of Health published the national Reference Costs data in
November 2011. This is a mandatory data collection exercise conducted each
year and compares the average unit prices of NHS organisations that provide
services. These averages are summarised at organisational level and
compared to similar types of organisation (e.g. a mental health provider).
The averages are then turned into an index with 100 representing the
‘average’ trust. A Reference Cost Index of less than 100 therefore means that
an organisation is more ‘cost effective’ than the average Trust in its category.
For 2009/10 5 Boroughs had a reference cost of 95; for the latest (2010/11)
data, published in 2011/12 this index has improved to 88, which means that 5
Boroughs unit costs are 12 per cent lower than the national average. This also
compares favourably with other mental health trusts in the North West as
demonstrated in the table below:
North West mental health provider 2010/11 Reference Cost Index
5 Boroughs Partnership NHS FT 88
Cheshire and Wirral Partnership NHS FT 109
Cumbria Partnership NHS FT 114
Greater Manchester West NHS FT 97
Lancashire Care NHS FT 115
Manchester Mental Health 101
Mersey Care NHS FT 103
Pennine Care NHS FT 86
‘Fiver a Fortnight’ Campaign
Our ‘FAF’ or ‘Fiver a Fortnight’ campaign was successful at encouraging our
people to think about ways to save the Trust a ‘fiver a fortnight’ and to achieve
a common awareness of the economic factors affecting the performance of
the Trust. A section on the intranet was created to showcase ideas that were
submitted - grouping under themes such as ‘Estates’ and ‘Procurement’. The
most imaginative ideas were awarded ‘FAF of the Month’. This interactive and
fun way of thinking about money-saving activities has resulted in staff
changing the way they work in some areas.
Environment and Sustainability
The Trust continues to recognise its responsibility towards protecting the
environment. The Climate Change Act 2008 contains provisions that set a
legally-binding target for reducing UK carbon dioxide emission by at least 26
per cent by 2020, with a target to cut emissions by 80 per cent by 2050
(compared to 1990 levels). The major impact of this legislation for the NHS
has been the requirement to join an emissions trading scheme knows as the
Annual Report and Annual Accounts 2011-12 43

Carbon Reduction Commitment Energy Efficiency scheme (CRC). This will
require the current level of growth of emissions to not only be curbed, but the
trend to be reversed and absolute emissions reduced. The Trust falls below
the threshold for inclusion within the CRC scheme, but has continued to seek
to demonstrate a reduction in carbon emissions in accordance with NHS
requirements.
Last year the Trust Board recognised a Sustainable Development
Management Plan; the signing up to the Good Corporate Citizenship
Assessment Model; the monitoring and review of carbon and the need to raise
awareness of carbon at every level of the organisation. The Sustainable
Development Management Plan sets out how the Trust will initiate a low
carbon management programme to both lower carbon emissions and improve
the health of staff, patients and the wider population we serve.
In addition terms of reference have now been established for a Sustainability
Working Group with representation from staff, service users and the Council
of Members. The objective of this group is to co-ordinate the implementation
of the Sustainable Development Management Plan and the group will:
44
Review what good practice already exists within the organisation and
document this
Identify a suite of new initiatives that build and add to what already
exists for Board-level discussion
Establish a management and performance monitoring structure and
identify the Trust’s carbon footprint across all activity
Implement proposals from the Green Transport Plan.
Resource has been identified in the Estates and Facilities budget to support
this.
During the reporting year the Trust has made several key achievements:
Carbon Reduction Schemes
Our Estates and Facilities function continue to improve efficiency and reduce
energy consumption. During 2011/2012 this included:
New boilers and controls fitted across a further two sites (Manchester
Road, Ince and Thorn Road, Runcorn) resulting in increased boiler
efficiency, centralised control settings and a reduction of set-points across
the Trust of one degree centigrade.
When undertaking refurbishment work we continue to source and use new
sustainable technologies and materials including:
Sun pipes and mono-draught units which give natural light and ventilation
to internal corridors - reducing the need for artificial lighting
PIR lighting controls in all toilets/bathroom and storage areas which turn
lights off when no movement is detected
Annual Report and Annual Accounts 2011-12

Increased roof and wall insulation
Double-glazed windows with K glass coating – reflecting heat back into
the room whilst also letting in free heat from the sun known as “passive
solar gain”
Smaller toilet cisterns to reduce water usage
Further rollout of the installation of LED lighting to external garden areas
replacing high-energy halogen fittings, which will reduce consumption by
as much as 80 per cent.
Carbon Emissions
The basis of measurement of a sound carbon management programme is the
carbon footprint of its activities. One of the responsibilities of the Sustainability
Working Group will be to set up audit procedures to monitor the impact on the
environment across all sectors of the Trust.
Our carbon emissions from electricity and gas (excluding KIPS) for the
reporting year is 4,112 tonnes. This does not include travel, procurement,
waste and water. Further work is required to calculate the Trust’s total carbon
footprint, which will be based on all agreed activity. This will be included in the
Sustainability Working Group’s objectives.
Waste Recycling Schemes
Waste recycling schemes that encourage increased recycling are in existence
throughout the Trust. These include:
On average 85 per cent of all Trust domestic waste is recycled - firstly by
sorting and secondly by Refuse Derived Fuel (RDF)
Approximately 40 per cent of the Trust’s healthcare waste currently goes
to the incinerator at Hope Hospital in Salford where it is used to generate
steam, which in turn helps provide power to Hope Hospital
All non-electrical metal is recycled by the Trust. Approximately 4.5 tonnes
of metal waste per year has been averted from landfill and is now sent off
dedicated metal recycling
Approximately 1200 ink cartridges are recycled through a company that
breaks down the components and reuses them
All confidential waste is 100 per cent recycled through shredding consoles.
Cooking oil is collected and processed into bio-fuel
Large wood waste is collected and pre-sorted. The wood is then
distributed to a dedicated wood recycler
All items of furniture, before condemning as waste, follow the waste
hierarchy and are recovered, reused and recycled throughout the Trust
where possible.
Future Plans
Following the completion of a renewable energy feasibility study carried out at
the Hollins Park site, further detailed work now needs to be completed on the
favoured energy solution of photovoltaic, solar thermal and wind turbines.
The Trust Board will make a decision on taking this forward in 2012-13.
Annual Report and Annual Accounts 2011-12 45

Efficient and Effective Organisation: Our Future Plans and Objectives for
2012/13
During 2012/13 we will work to ensure services are provided in the most
economic, efficient, effective and equitable manner
The Trust plans to continue the work it has already begun on implementing
the new pathways of care across its services and ensure that it is maximising
the amount of time clinicians are able to spend with service users. It is also
important that the Trust is able to measure the impact of these changes to
demonstrate to its key stakeholders that these initiatives are delivering the
expected benefits.
To achieve this, our high-level objectives are:
By December 2012 we will have implemented tools to measure direct
patient contact time across all in-patient and community teams. By March
2013 we will begin rolling out a programme to increase patient contact time
in all our teams by improving and streamlining processes. We will
evidence this initially by an increase in patient contact time with our
qualified nurses on our productive ward pilot sites by 10 percentage points.
By December 2012 we will have implemented the community aspects of
the new service models in Adult service and Later Life and Memory
services and will have collated a set of performance measures to evidence
the change.
During 2012/13 we will have improved our care delivery - ensuring that
service users share in decision-making using tools such as the Recovery
Star and Triangle of Care so that plans focus on and support recovery.
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Annual Report and Annual Accounts 2011-12

Clinical Leadership and Service Improvement
This theme aims to create an environment that encourages and supports the
development of ideas, proactively seeks new business opportunities, focuses
on our expertise and strengths and actively involves service users and carers.
To our stakeholders, this means the provision of innovative, effective and
efficient services. We have partially met the objectives agreed with the Trust
Board for this year contained within this strategic theme.
What have we done against this Strategic Objective in 2011/12?
Working with Commissioners to maintain our Contracted Services
This objective has been met. We have maintained 99 per cent of our
contracted services and generated £3million of new business.
Effective Clinical Networking leading to Service Improvement
This objective has been met. We have developed more robust methods of
networking externally and of bringing back development opportunities into the
organisation.
Planned Trust-wide Approach to Service Improvement
This objective has been partially met. We have developed a service
improvement plan in outline and this will be further developed and
implemented in 2012/13.
What else have we achieved against this Strategic Theme during the
reporting year?
New Business
During the reporting year the Trust generated an additional £3million of new
business across four of our six business streams. These include
Psychological Therapies Service, Adult ADHD Service, Healthy Lifestyle
Service, Early Supported Discharge, Children’s Services and Musculoskeletal
(MSK) Services.
Psychological Therapies: Red House
The Red House Service is a psychological therapy service offering
assessment, consultation, individual therapy and group therapy to patients.
The service was commissioned in September 2011 by NHS Ashton, Leigh
and Wigan. The service particularly helps clients with moderate to severe
personality disorders by offering an intensive psychosocial and psychoeducational
therapy.
Adult Attention Deficit and Hyperactivity Disorder (ADHD)
In 2011 we were commissioned to provide the ADHD Community Assessment
and Treatment service for NHS Ashton, Leigh and Wigan. The service
provides an assessment, treatment and review function for adults aged over
Annual Report and Annual Accounts 2011-12 47

18 years of age who are exhibiting signs and symptoms of ADHD, including
transitional arrangements for people in CAMHS who already have a diagnosis
of ADHD and wish to continue on prescribed medication.
Healthy Lifestyle Services
2011 saw the expansion of community services into the Wirral area with the
provision of adult weight management services. The service was launched
successfully in June.
Early Supported Discharge
NHS Halton and St Helens commissioners acknowledged the importance of
achieving optimum outcomes for patients suffering from a stroke with
investment in a targeted service within the community. The service was
implemented in late Autumn 2011.
Children’s Services
Additional investment in Knowsley children’s services has seen our Health
Visiting compliment expanded. In addition to this our school nursing provision
has been further enhanced with a specialist asthma pathway. In addition our
Breast Feeding Peer-Support service has been enhanced and extended
beyond the original contract period.
Musculoskeletal (MSK) Services for NHS Halton and St Helens
This year a tendering exercise gave us the opportunity to redesign existing
MSK. The new service was launched in June and includes a Chronic Pain
Management Service for patients with complex and enduring needs.
Effective Clinical Networking
We have been working throughout the year to support our clinical colleagues
to develop relationships to enable us to maintain or win new business for the
Trust. We have been particularly successful within the children’s business
stream and our Fairhaven Unit now provides services to organisations outside
our usual footprint.
During the year we introduced the role of Medical Ambassador to enable us to
build up relationships between our consultants and GP colleagues. The model
has been further built upon by our new Medical Director, who is developing a
revised clinical engagement model for the organisation.
Clinical Research
Participation in clinical research demonstrates the Trust’s commitment to
improving the quality of care we offer and to making our contribution to wider
health improvement. It helps us ensure that our clinical staff stay abreast of
the latest treatment possibilities and value active participation in research as it
leads to successful patient outcomes.
The number of patients receiving NHS services (provided or sub-contracted
by the Trust in 2011-2012 that were recruited during that period to participate
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Annual Report and Annual Accounts 2011-12

in research approved by a Research Ethics Committee) was 300. The total
number of participants taking part in studies was 759 - a significant increase
from the baseline figure of less than 80 in 2009-10 and 350 last year.
In order to promote frontline clinical engagement in research the Trust has
launched a Research Grant Application Scheme. The first scheme ran in
September 2012 for which we received seven applications. Following the
success of our inaugural Research Awareness Day, a second day is planned
in June 2012.
Clinical Leadership and Service Improvement: Our Future Plans and
objectives for 2012/13
During 2012/13 we will support our clinical leaders to deliver service
improvement across the organisation ensuring we deliver high-quality
services.
To achieve this, our high-level objectives are:
By March 2013 we will have a system to evaluate the impact of the service
development ideas brought back to the organisation through clinical
networking and will understand which bring sustainable service
improvement, transferable skills or experience, or new business to 5BP.
By October 2012 we will have reviewed the form and function of the
Clinical Advisory Group (CAG) to ensure that by March 2013 we will be
able to demonstrate that service developments and relevant business
decisions have been considered at the CAG and remain clinically
focussed.
During 2012/13 we will develop a strategic plan to enhance clinical
leadership and engagement from all the clinical professions represented in
our workforce - leading to improved organisational safety and quality of
provision.
Annual Report and Annual Accounts 2011-12 49

Engagement and Partnership Working
This theme relates to our proactive work with stakeholders for maximum,
mutual benefit. It is about our commitment to work in partnership and engage
with our service users, our carers and our other stakeholders. We fully met the
objectives agreed with the Trust Board for this year, for this strategic theme.
What have we done against this Strategic Objective in 2011/12?
Involving Service Users and Carers
This objective has been fully met. The Trust’s Involvement Scheme provides
structured support to more than 320 service users, carers and volunteers
involved in Trust business. Involvement Scheme members are supported
through the application process, induction, independent welfare benefits and
tax checks, and are offered payments, personal development training and
practical assistance. During the past year the number of involvement
opportunities increased by 61 per cent to 1,184 - including attending corporate
meetings and developing and delivering staff training as well as membership
of recruitment panels, investigation and audit teams, and task and finish
groups.
Highlights of involvement include:
Experts by Experience (service users and carers) play an active part in the
Personality Disorder Hub - co-delivering training alongside Experts by
Occupation (staff) and playing a full role in the team’s business meetings.
The Personality Disorder Hub achieved finalist status in the 2011 HSJ
Awards
Service users from No Secrets - an independent voluntary organisation led
by people with experience of self-harming and their carers - deliver training
to mental health professionals
Essence of Care Scrutiny Group: A panel of service users and carers
scrutinise evidence from audits undertaken in all operational teams
including wards. Recommendations from the group are used to influence
service improvements.
Establishing Constructive and Effective Relationships with GPs
This objective has been fully met. The Trust executive team, led by the Chief
Executive and supported by our consultants, have worked throughout the year
to meet and engage with GPs - particularly in emergent Clinical
Commissioning Groups. We worked especially closely in finalising our new
models of care for Adult and Later Life and Memory services through the
establishment of both Clinical Forums and a Technical Appraisal Group.
Establishing Constructive and Effective Relationships with Local
Authorities and Health and Well-Being Boards
This objective has been fully met. We have engaged with Local Authorities
through their scrutiny committees to finalise our new models of care.
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Annual Report and Annual Accounts 2011-12

In addition we have representation on Health and Well-being Boards or their
sub-committees across all of our five boroughs.
What else have we achieved against this Strategic Theme during the
reporting year?
Communication with our Service Users
We have encouraged volunteers to participate in the production of our service
user and carers’ newsletter ‘Outlook’. Volunteers sit on the editorial panel so
that their ideas shape the content. In May 2011 members of the Trust’s
Involvement Scheme were asked to comment on the design and content of
‘Outlook’. A short questionnaire was sent to all 320 members of the scheme.
The qualitative feedback was universal in its call for a fresher design, more
light-hearted, non-mental health-related content and an ongoing focus on reallife
accounts from our service users. The data has already informed significant
positive changes.
‘Sticks and Stones’ Campaign
Our ‘Sticks and Stones’ campaign to challenge mental health and learning
disability-related stigma received two commendations in 2011, from the
Association of Healthcare Communications and Marketing and ChaMPS
Public Health Network.
During the reporting year we succeeded in achieving a very specific
behavioural goal designed to improve the mental well-being of our service
users - achieving 106,577 pledges on our online petition not to use words like
‘nutter’ to describe people with mental ill-health and learning disabilities.
We created 2.3 million opportunities for people to read stories about mental
health and learning disabilities in the media – helping to reduce stigma by
promoting greater public awareness and understanding of conditions such as
Personality Disorder.
Specially-designed educational packs produced with the input of teacher
volunteers are currently being delivered in schools across our footprint. The
packs include lesson plans and activities for children aged four to 16 –
supporting teachers to improve the quality of education young people receive
around mental health and learning disabilities.
We have increased our Corporate Partnership membership to more than 30
employers – working with them to embed the campaign values within their
workplaces and improve the quality of support they provide to employees with
mental ill-health.
2011 Annual Involvement Conference
More than 180 service users, carers and representatives from local support
groups and services attended the Trust’s Annual Involvement Conference.
Annual Report and Annual Accounts 2011-12 51

Speakers included service users, carers, the Chief Executive, Chairman,
national mental health-lead officers and staff who led on involvement
activities. Feature presentations focused on the national mental health
strategy and the Trust’s ‘Sticks and Stones’ anti-stigma campaign.
Patient and Public Involvement Advisory Group
Attended by representatives from all six business streams, service users,
carers, Member Councillors and representatives from Local Involvement
Networks (LINks) the group monitors Trust-wide service user and carer
involvement activity. It also promotes the involvement agenda both internally
and externally with our partners.
Knowsley Community Health Development Team Forums
Health forums that are chaired by the Community Health Development team
and are held in Kirkby, Prescot, Huyton and Halewood, meet on a monthly
basis to discuss current health issues in the community. Public Health are
invited along and the forums are advertised in the local media so that
community members can attend.
The Knowsley Health and Well-being patient experience ‘Best Practice’
celebratory event was held in the Huyton Suite in October 2011.
Knowsley won an award this year from the national Patient Experience
Network (PEN) in the category ‘Environment of Care’ for its integrated
strategy for improving service user involvement and experience. The
Community Health Development Team won recognition awards for each of its
four health forums, which went some way to help them win the national award.
Engagement Activities at Knowsley Integrated Provider Services
Plans are under way to roll out the feedback card currently used in our Breastfeeding
service across all Children’s Services. The card will be produced in
different formats/languages, such as Polish, following consultation with locallybased
groups.
The development of Syringe Driver literature for use by patients and carers
was undertaken in consultation with Knowsley Older People’s Voices and
Knowsley LINk. A review of dietetics service evaluation documentation for
‘readability’, followed by a focus group, was undertaken with Knowsley LINk.
In negotiation with locality-based Health Forums, a schedule of ‘Take it to the
Top’ sessions has been agreed. Members of KIPS Senior Management Team
will meet with the forums that are made up of residents to answer questions
pertaining to health provision.
With the robust relationships that exist within Knowsley between KIPS and
groups that represent community members, we will look to support services to
embed patient feedback in their service improvement methodology.
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Annual Report and Annual Accounts 2011-12

One of the ways we will do this in 2012-13 is to develop a schedule for
services to hold engagement events that will be facilitated/hosted by
Knowsley LINk. These events will take place monthly and provide services
with an opportunity to talk to the public.
Investing in Children
All five of our locality teams have regular meetings with service users at
convenient times for them in which updates are provided and feedback is
sought. Over the past 12 months - as requested - we have progressed from
locality meetings and held pan borough-wide events where young people from
across the Trust have met to consider issues such as the use of social media
to highlight mental health concerns and how to access CAMHS. Many young
people have now signed up to the Trust’s Service User Involvement Scheme
where their opinions can be sought on strategic issues such as service
provision and delivery. We have maintained our certification with Investing in
Children (IiC) in recognition of our continued dialogue with young people.
Valuing Carers Steering Group/Carers’ Champions
The group provides a forum to exchange information and develop support
systems. Attendees include carers of our service users and representatives
from carers’ support groups and carers’ centres. Members have helped to
design a Carers’ Booklet and a Carers’ Champions scheme. During the year
staff and volunteers from Princess Royal Trust Warrington Carers’ Centre
delivered four training sessions to Trust staff. Members of the forum have
been involved in regional developments for the national Triangle of Care
report.
Service User Art Scheme
The scheme aims to co-ordinate and showcase art produced by local service
users and promote the value of all creative arts as a self-help tool for mental
well-being. Highlights have included the publication of artwork and poetry in
‘Reflections’ – a national magazine. During the year artwork produced by
Trust service users was displayed at the House of Commons and also the
Sheffield and Bury Football Club grounds. A project in partnership with the
Northern School of Music saw musicians working with our Later Life service
users.
Leading the Way in Privacy and Dignity
The Trust continues to be fully compliant with the Government’s
recommendations on eliminating mixed-sex accommodation. We were
involved in a partnership project in the Halton Dignity Network. Lessons
learned have been used across the Trust.
Annual Report and Annual Accounts 2011-12 53

Engagement and Partnership Working: Our Future Plans and Objectives
for 2012/13
During 2012/13 we will become better at working in partnerships. We will
explore opportunities for partnering in order to develop innovative
solutions for improving health outcomes for the people we serve.
To achieve this, our high-level objectives are:
During 2012/13 we will maintain close and effective relationships with our
CCGs by enhancing our relationship manager role with clinical support in
order to maximise our opportunities to deliver improved health outcomes
for the people we serve.
By June 2012 we will develop a partnering strategy making clear how we
will select and work with partners to deliver improved health outcomes for
the people we serve.
During 2012/13 we will maintain close and effective relationships with our
local authority partners through involvement with inter alia the Health and
Well-being Boards in order to maintain the profile of mental health within
the local health and social care priorities.
54
Annual Report and Annual Accounts 2011-12

Well-Governed
In order for any organisation to be successful, it needs to be well-governed.
This theme is about our aim to be transparent, open and fully accountable and
how we demonstrate strong leadership. We have fully met the objectives
agreed with the Trust Board for this year, for this strategic theme.
What have we done against this Strategic Objective in 2011/12?
Integrating KIPS within the Trust’s Governance Processes
This objective has been fully achieved and the Trust governance processes
now fully embrace the KIPS organisation. We have Improved the KIPS
performance management framework during 2011-12 to ensure full alignment
with the year’s monitoring processes, including monthly Business Stream
reports. In addition the KIPS Leadership Team review and action on reports
each month on contract activity, performance, quality and safety reports, cost
improvement and business plan performance. All KIPS governance functions
are included within the revised Trust-wide governance structure. A full clinical
audit plan has been developed and CQC framework reports are now
completed and monitored in line with the Trust standard.
Evaluating the Performance of the Trust Board and the Council of
Members
This objective has been fully achieved. We have undertaken a review of the
effectiveness of the Trusts Board utilising an evaluation tool provided by
Deloitte. The outcome was subsequently reviewed by the Trust Board and a
number of improvement initiatives were implemented. Our internal auditors,
KPMG, also undertook a Corporate Governance Audit during January and
February 2012 and confirmed an overall outcome of Significant Assurance.
The Company Secretary has also undertaken a self-assessment review of the
Council of Members and its sub committees and subsequent improvements
have been put in place.
Maintaining Our Monitor Target Risk Ratings
As outlined in our annual plan, we aimed to achieve a Financial Risk Rating of
4 and a Governance Risk Rating of Green and maintain these ratings
throughout the reporting period.
Annual
Plan
2011/12
Quarter 1
2011/12
Quarter 2
2011/12
Quarter 3
2011/12
Quarter 4
2011/12
Financial
risk rating
4 4 4 4 4
Governance Green Green Green Green Green
Annual Report and Annual Accounts 2011-12 55

isk rating
The table below demonstrates that we have successfully achieved this
financial risk rating throughout the reporting period:
The Trust is required to register with the Care Quality Commission and its
current registration status is ‘registered without conditions’. The Care Quality
Commission has not taken enforcement action against 5 Boroughs
Partnership NHS Foundation Trust during 2011/2012.
During 2011/12 the Trust was inspected by the Care Quality Commission as
part of their targeted inspection programme to review services for people with
learning disabilities. The review was to establish if in-patients experience
effective, safe and appropriate care and treatment and support that meets
their needs and protects their rights and whether they are protected from
abuse. The Trust has maintained registration without conditions.
What else have we achieved against this Strategic Theme during the
reporting year?
Annual Members’ Meeting
In September 2011 we held a successful and well-attended Annual Members’
Meeting and formally presented our previous Annual Report and Accounts.
Our Chairman, staff, service users, carers and visitors from our partner
organisations were all in attendance.
Well-Governed: Our future plans and Objectives for 2012/13
During 2012/13 we will maintain sound governance arrangements that
will ensure we continue to hold our CQC registration status and FT
authorisation.
To achieve this, our high-level objectives are:
By 31 May 2012 we will have in place an effective Trust Assurance
Framework that actively tracks achievement of high-level objectives and
the elimination or control of associated risks leading to the Trust Board
being assured of the delivery of the Trust's Strategic Objectives.
During 2012/13 we will continue with a structured programme of
development for the Trust Board and the Council of Members so that they
can continue to demonstrate carrying out their respective functions
effectively.
During 2012/13 we will take the necessary steps to ensure that we
become compliant with the CQC essential standard over Safeguarding and
that by March 2013 we are compliant with all CQC essential standards.
56
Annual Report and Annual Accounts 2011-12

Financial Viability
This theme relates to our ability to operate within our financial targets and
budgets. It is about how we manage our resources in the most effective way
we can. We have fully met objectives agreed with the Trust Board for this
year, for this strategic theme.
What have we done against this Strategic Objective in 2011/12?
Meeting our Statutory Financial Duties and Financial Targets in addition
to Meeting our Terms of Authorisation
In 2011-12 we have posted an underlying surplus of £4.4m and paid over 95
percent of our invoices within 30 days for the third consecutive year. We have
£12.5m of cash in the bank to make sure that we can continue to meet our
payment obligations. This has meant that overall our regulator Monitor has
given us a Financial Risk Rating of 4, which is good and shows that we
remain financially healthy and viable as a Foundation Trust.
Budget-Holder Management and Ownership
Overall the Trust has exceeded the surplus target of £4 million it set itself at
the start of the financial year, which means that overall the budgetary control
in the Trust has been very good. This has been borne out by an independent
assessment of our budgetary control systems by our auditors, which has
provided the Board with significant assurance that the way in which we
manage our budgets is effective.
Whilst this continues to be good news for the Trust, not every budget holder in
the organisation is able to manage to their original planned budget. This is
almost always as a consequence of factors outside of their control, such as
higher-than-expected sickness rates or maternity leave or particularly complex
service users who require additional clinical support. In these instances the
costs are met by individual budget holders, but the senior managers overall
find a way of funding these costs so that even if an individual budget
overspends the Trust stays within plan.
What else have we achieved against this Strategic Theme during the
reporting year?
During the reporting period we have continued to maintain a strong financial
position and have increased our surplus a little when compared with last year.
We acquired Knowsley Integrated Provider Services - the community services
provider arm from NHS Knowsley – on 1 April 2011. This brought in an extra
£45million of income in 2011-12 and has improved our overall financial
standing.
We have developed and delivered on a range of cost improvement initiatives
that have helped to underpin our strong financial performance and still
maintain the quality of our service.
Annual Report and Annual Accounts 2011-12 57

Investments
In 2011-12 we have invested £2.7million in improving the environment in
which our service users are cared for and our staff work in. In particular we
have spent:
£800,000 improving the Chesterton and Marlowe low secure units at
Hollins Park, Warrington, to improve the environment for patients and staff
More than £1million across the Trust to provide a safer and more secure
environment for service users and to reduce the risk of harm coming to
them
More than £500,000 on improving the quality of our buildings across the
whole of the Trust to help improve the service users’ experience of our
services.
In addition to improving our buildings we also spent money on improving the
experience of our service users by investing in activity co-ordinators on our
wards and improving access to psychological therapies for service users on
our wards. These initiatives will carry on in the future and represent a further
investment in care of nearly £500,000 in a full year.
What does it really mean for our service users?
Sound financial management is hugely important in the delivery of patient
care. If our money is managed well and our use of it is well planned, we are
not faced with the problem of having to take difficult short-term decisions that
might have a detrimental effect on service delivery. This helps to maintain and
improve our already high-quality services.
In addition, as we have already seen, good financial management means that
we have the resources to be able to continue to improve the environment that
our services are delivered in.
Accounts Team of the Year
Our people were crowned ‘Accounts Team of the Year’ in the Healthcare
Financial Management Association Awards 2011. This is the second year in
succession that Trust has been shortlisted in this category, which aims to
recognise the most effective, innovative and efficient accounts team looking
both at the processes carried out throughout the year and those undertaken at
year end.
Our Future Plans and Objectives for 2012/13
During 2012/13 we will meet our statutory financial duties and maintain a
robust five year financial plan.
2012-13 will be a challenging year for the NHS in the current economic
environment, but the Trust has put robust plans in place to make sure it
58
Annual Report and Annual Accounts 2011-12

continues to perform well and improve quality. This will be achieved through a
strong process of improving efficiency. The Trust has plans to:
Spend less on its ‘back office’ functions
Increase the staff on some of its wards
Continue to improve the quality of our buildings
Help frontline staff to spend more time with patients
Improve our use of technology to support frontline staff
We believe that by doing this we will have a more efficient effective service
that improves the quality of service whilst maintaining our strong financial
performance.
The Board has agreed a financial plan for 2012/13 to maintain an underlying
surplus of £4.4m and to invest up to £7.9m in improving safety and the
environment for both staff and service users. Through sound financial
management the Trust is also investing £1.6m in new initiatives to improve
further the quality of the services we provide and the experience of our service
users.
This strong financial performance is then what enables the Trust to invest its
money in improving services and the environment.
Leigh Infirmary
As part of the Trust’s long-term strategic aim to provide the best-quality
environment for staff and service users it has produced its five-year capital
programme. A major component of this strategy is a £20million-plus
investment in a new mental health development on the existing Leigh
Infirmary site.
For 2012/13, our high-level objectives are:
During 2012/13 we will achieve our statutory financial duties and meet all
other financial targets and obligations within our Terms of Authorisation -
leading to the achievement of a Financial Risk Rating of at least a 3.
During 2012/13 budget holders will operate within financial limits and
produce and own forecasts that look forward 12 months - leading to the
identification and acting upon of appropriate actions to deliver the longterm
financial plans of the Trust.
During 2012/13 we will ensure that the appropriate clinical practices and
operational systems are in place to allow cluster data to be captured in a
timely and appropriate fashion leading to the successful transition to PbR.
This will be measured by the shadow monitoring of cluster information
through our commissioning contracts.
Annual Report and Annual Accounts 2011-12 59

Organisational Development
This theme relates to how we deliver organisational improvement through our
key themes of Employee and Organisational Health and Well-being;
Employee Engagement and Trust Values, and Organisational Culture.
Furthermore it addresses how we plan, attract, manage, develop and engage
our people to deliver our services. We have partially met the objectives
agreed with the Trust Board for this year, for these strategic themes.
What have we done against this Strategic Objective in 2011/12?
Bringing our Values to Life
This objective was fully met through the implementation of a year-long Values
Implementation Programme. Commencing in March 2011 with the launch of
our Values, the programme involved a range of initiatives that would enable
our Values to become fully embedded throughout the Trust. These initiatives
included the development of a Values intranet page where our staff can post
comments and feedback on our Values.
Teams have developed their own Team Charters identifying how they will live
our Values. Our Values are a key part of our Performance and Development
Review experience.
Our Values are now part of our recruitment and selection process and are
central to our Corporate Induction programme and our Management and
Leadership Development framework. In addition, the Trust’s Recognition
Scheme has been further enhanced to integrate our Values. This includes the
development of a range of electronic message cards the launch of two new
awards – ‘Team of the Month’ and ‘Work-Based Learner of the Year’ - and a
Messages of Appreciation webpage.
Coaching Culture Programme
At our original Values Development workshops, people identified a number of
key themes which they believed should characterise and enhance the culture
of our Trust. They included: respect, professionalism, a ‘can do’ attitude,
openness and honesty. In particular, points were made regarding the
development of a culture that supported a problem-solving approach whereby
individuals felt empowered to make decisions and think creatively. In
response to these points we have put together a programme to support a
culture of coaching and coaching conversations throughout the Trust. The
purpose is not to develop every senior leader as an internal coach; it is to
facilitate the development of a coaching culture throughout the Trust.
The Coaching Culture Programme was launched in September 2011 with 40
of our most senior leaders undertaking a programme of development to
enhance their skills and knowledge of the coaching principles and style that
will support our coaching culture. Phase two of the programme, which will be
rolled out to our wider management and leadership community, commences
60
Annual Report and Annual Accounts 2011-12

in April 2012. By April 2013 more than 200 managers and leaders will have
completed the programme. This will be complemented by a cohort of our
leaders undertaking a more intensive coaching programme leading to Post
Graduate Certificate in Business and Executive Coaching.
Implementing the Health and Well-Being Strategy for our People
This objective was partially met. The last 12 months have been a successful
year for our Trust with regards to developing the health and well-being of our
people. In recognition of this our Trust was awarded a Gold Certificate from
Sir David Nicholson and was one of only eight NHS Trusts in England to
receive this award. Our health and well-being campaign has included free
weekly fitness classes; monthly challenges focusing on diet and exercise;
access to a free online website which provided fitness videos and a rounders
and rugby tournament.
The Trust provides Occupational Health services through an NHS Plus
Occupational Health unit. These are available to all staff via either their
manager or self referral.
In addition to supporting the physical well-being of our people, the Trust also
launched its mental well-being intranet pages. As part of our Health, Wellbeing
and Engagement Strategy the mental well-being intranet pages offer
support, information, tips, guidance, exercises, models and links to further
information for enhancing mental well-being.
As a result of a number of management actions and our health and well-being
initiatives, our sickness and absence figures have continued to decrease and
remain just above our target of 5 per cent at 5.16 per cent.
Details of the Trust’s employee sickness absence throughout the reporting
year are shown in the table below:
Rolling 12-month average
Quarter 2011 - 2012
One 4.09%
Two 5.18%
Three 6.02%
Four 5.27%
What else have we achieved against this Strategic Theme during the
reporting year?
Our Communications with Our People
We believe that good communications help us to engage effectively with our
people. Our communications are two-way. We listen to our people and their
views. We communicate with our people via a range of different media
including a face-to-face monthly core brief, a weekly e-bulletin, a regular
Annual Report and Annual Accounts 2011-12 61

newsletter which includes input from our staff, a monthly events calendar and
our intranet site.
As part of our ‘Let’s Talk’ initiative we have held four ‘Afternoon with the Chief
Executive’ sessions during the reporting period - offering our people the
opportunity to submit online questions on any work-related subject to Simon
Barber via our intranet for an immediate response. The response to these
sessions has been very positive with a wide variety of questions being asked
from all areas of the organisation. Some of the issues raised during this
session have ignited high-level discussions which have resulted in further
communications to our people to clarify the issues.
Organisational Development: Our Future Plans and Objectives for
2012/13
During 2012/13 we will deliver organisational improvement through our
key themes of Employee and Organisational Health and Well-Being,
Employee Engagement and our Values and Organisational Culture.
To achieve this, our high-level objectives are:
During 2012/13 as part of our Health, Well-Being and Engagement
Strategy we will continue to implement a range of targeted health and wellbeing
activities which will contribute to a sickness absence rate of below
five per cent.
During 2012/13 we will continue to develop our organisational culture with
the embedding of our Values and our Coaching Culture Programme. This
will lead to enhanced behaviours that consistently demonstrate how we
value and listen to one another, engaging and involving others in decisionmaking
and measured by the Staff Opinion Survey.
62
Annual Report and Annual Accounts 2011-12

Workforce Management and Experience
This theme relates to how we to plan to attract and develop our people so that
they are able to deliver a high-quality service.
What have we done against this Strategic Objective in 2011/12?
Developing Future Workforce Resourcing and Development Plans
This objective has been fully met. During the reporting year the Trust
continued to work closely with all operational business streams to develop
workforce and resourcing plans. These plans facilitate the accurate prediction
of workforce requirements, ensuring that the Trust recruits, utilises, manages
and develops staff in the most effective way.
The Trust has successfully rolled out Electronic Self-Serve for the use of
inputting sickness absence and enrolling on training courses. Self-serve has
allowed managers to take greater control of managing sickness absence -
inputting real-time data in a timelier manner and having access to more up-todate
information. It has also greatly improved the ease with which staff can
manage their training requirements by having the ability to directly enrol on to
training courses.
Additionally, the Trust continues to utilise the North West Strategic Health
Authority’s Workforce Information Portal - electronic Workforce Information
Network (eWIN). This workforce portal for NHS North West healthcare
organisations has been developed to support North West organisations to
deliver high-quality healthcare and to continue to develop a world-class
workforce. It gives access to a wide range of intelligence including
benchmarking data, innovative case studies and research reports - helping to
demonstrate the wealth of workforce developments taking place across the
North West.
The Trust was shortlisted for an award for its use of e-WIN at the North West
Human Resources Development Conference annual Human Resources
Awards.
Ensuring our people are up-to-date with Mandatory Training
This objective has been partially met. In 2011-12 we introduced CAST (Core
And Statutory Training) a new way of delivering mandatory training. This
week-long programme has been designed following feedback from clinical
staff to make our training more flexible and therefore easier to attend and
complete. In addition to attending all the face-to-face core and statutory
training during the CAST week, staff are able to complete e-learning
programmes on-site. During the CAST week our colleagues from
Occupational Health provide health and well-being briefings and interventions
including drop-in flu vaccinations, weight management and general health
advice.
Annual Report and Annual Accounts 2011-12 63

As of 31 March 2012 82 per cent of staff were in date with their statutory
training. Long-term sickness, maternity leave and career breaks would on
average account for 10 per cent of all staff.
What else have we achieved against this Strategic Theme during the
reporting year?
Care Quality Commission Staff Opinion Survey Results 2011
The Staff Opinion Survey is designed to establish the effectiveness of agreed
national Human Resources policies across the NHS and in our Trust
specifically to gauge the mood, opinions and views of our people who work for
us. All NHS Trusts in England are required to take part and the results are coordinated
and analysed by the Care Quality Commission. The Trust’s results
were published by the Care Quality Commission/Department of Health in
March 2012. They have been compared with 72 mental health trusts in
England.
In order to satisfy the Care Quality Commission’s requirements, a random
sample of 800 staff was selected to complete the questionnaire. From that
sample, 373 completed the questionnaire. This is a response rate of 45 per
cent, which is below the 48 per cent average for Mental Health Trusts and
compares with a response rate of 54 per cent in the 2010 survey. The data
collated from this sample has been used to inform the Care Quality
Commission Staff Opinion Survey Report for our Trust.
The key messages from the 2011 survey include:
The majority of our staff are aware of our Trust values, believe that the
Trust is committed to our Values and understand how to challenge
behaviour that does not reflect our Values
The number of completed Performance and Development Reviews has
once again risen and is significantly higher than the national average
The vast majority of staff agree that the statutory and core training
requirements for their role are clear
In relation to engagement the majority of staff ‘agreed’ or ‘strongly agreed’
that they feel engaged with their team’s objectives, the objectives of the
Business Stream and the Trust
This year our Trust scored higher than the national average for
commitment to work-life balance.
Response
rate
64
Trust
2010 2011
National
Average
Trust
National
Average
Annual Report and Annual Accounts 2011-12
Trust
improvement/
deterioration
52% 54% 45% 48% 7% decrease

Top Four Rankings Progress 2010 to 2011
Top Four
Ranking Scores
Percentage of
staff receiving
health and safety
training in last 12
months
Percentage of
staff believing
the Trust
provides equal
opportunities for
career
progression or
promotion
Percentage of
staff
experiencing
discrimination at
work in the last
12 months
Percentage of
staff (who feel
comfortable)
reporting errors,
near-misses or
incidents
witnessed in the
last month
2010 2011
Trust National
Average
Trust National
Average
Trust
Improvement/
Deterioration
95% 80% 87% 83% 8% decrease
96% 89% 92% 90% 4% decrease
8% 14% 10% 14% 2% decrease
100% 100% 98% 97% 2% decrease
Annual Report and Annual Accounts 2011-12 65

Bottom Four Rankings Progress for 2010 to 2011
Bottom Four
Ranking Scores
Percentage of
staff using
flexible working
options
Percentage of
staff agreeing
that their role
makes a
difference to
patients
Percentage of
staff
experiencing
physical violence
from staff in the
last 12 months
Impact of health
and well-being
on ability to
perform work or
daily activities
66
2010 2011
Trust National
Average
Trust National
Average
Annual Report and Annual Accounts 2011-12
Trust
improvement/
deterioration
56% 67% 61% 67% 5% improvement
90% 90% 93% 74% 3% improvement
1% 1% 2% 1% 1% deterioration
2% 2% 2% 2% No change
New Top Four Rankings for 2011
Top Four Ranking Scores
Percentage of staff appraised with a
Trust National Average
personal development plan in the last 84% 73%
12 months
Percentage of staff receiving jobrelevant
training, learning or
development in the last 12 months
Percentage of staff agreeing that their
role makes a difference to patients
Percentage of staff
experiencing harassment, bullying or
abuse from staff in the last 12 months
83% 82%
93%
90%
11% 13%

New Bottom Four Rankings 2011
Bottom Four Ranking Scores Trust National Average
Percentage of staff using flexible
working options 61% 67%
Percentage of staff feeling pressure in
the last three months to attend work
when feeling unwell
22% 20%
Percentage of staff experiencing
physical violence from staff in the last
12 months
2% 1%
Staff intention to leave jobs 3% 3%
The Trust plans to work with Assistant Directors to develop localised action
plans for each business stream and directorate to address areas in which we
can make further improvements.
Staff Recognition Awards
In July 2011 we once again celebrated our achievements at our annual Staff
Recognition Awards. The awards recognised and celebrated the contribution
that individuals and teams have made to our Trust in providing high-quality
care and support to our service users and carers. This year we were delighted
with the number and quality of nominations from both our clinical and support
services. What was particularly pleasing was the range of winners and
runners-up who represented a wide section of the Trust. It is anticipated that
as our colleagues from Integrated Community Services will be able to
nominate this year, our nominations will increase significantly making 2012 an
exciting year for our recognition awards.
Our People Benefits
We provide a wide range of facilities and schemes to improve the working
lives of our people including a range of childcare facilities, flexible working
options, support during maternity leave, paternity leave and information about
carers’ and statutory rights.
Equality, Diversity and Inclusion
Recognising that there are shared principles associated to equality and
diversity, patient and public involvement and social inclusion, we have
developed a joint approach to these work streams under the title ‘Equality,
Diversity and Inclusion’.
Values relating to Equality, Diversity and Inclusion are central to our policymaking,
service delivery, employment practices and community involvement.
We acknowledge that the main key to measuring the success of our actions is
to ensure that service users, carers, staff, the public and other stakeholders
have opportunities to share their experience with us and that we use these
shared experiences to inform the design of future services. In particular we
Annual Report and Annual Accounts 2011-12 67

understand that only by recognising the value of service user, carer and staff
experiences can we have due regard for human rights, dignity and respect.
In response to Race, Disability and Gender Equality Duties the Trust
produced a Single Equality Scheme and Action Plan 2009-12. The Scheme
and Action Plan is monitored by members of our Equality, Diversity and
Inclusion Steering Group. Chaired by the Deputy Chief Executive,
membership includes representatives from the Equality, Diversity and
Inclusion Unit; Human Resources; Education and Training; Estates and
Facilities; Operational Services; the Assurance Unit and service users. The
group provided strategic direction that ensured all of the actions identified in
the 2011-12 Action Plan were completed within the past year.
Workforce and Recruitment Diversity Reporting
During 2011-12 reports have been produced which provided a breakdown of
the diversity of the Trust’s current workforce and of job applicants. Information
is taken from the Trust’s Electronic Staff Record (ESR) system and the NHS
Jobs website, which is used to administer and monitor all job applications.
Analysis provided in the reports aims to identify significant differences in
various diversity classifications and influence policy development. The scope
of the report covers race, disability, gender, age, sexual orientation, religion
and beliefs.
Employment and Mental Health Service Users
As part of our Social Inclusion work stream we monitor the employment status
of service users and the information provided to them. Our Social Inclusion
Co-ordinator provides information, advice and support to staff and service
users on a range of employment issues including recruitment and retention.
Partnership working with local and regional employment support agencies
continues to be an important focus of this work - building on existing
relationships and exploring potential new opportunities for future services to
increase employment opportunities for Trust service users. During the past
year the Trust supported two Individual Placement and Support (IPS) pilots
funded by NHS North West.
Carers
Our Equality, Diversity and Inclusion Unit successfully influenced the NHS
Employers’ decision to adopt ‘carers’ as an additional strand of their Equality
and Diversity work streams. This resulted in the development of a carers’
section on their website and links with the national Employers for Carers’
scheme.
Recruitment and Retention of Disabled People
As a Trust we use the ‘Two Ticks’ Positive About Disabled People symbol on
all adverts through NHS Jobs. This shows applicants that we actively support
disabled people.
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Annual Report and Annual Accounts 2011-12

Jobcentre Plus has awarded the symbol to the Trust and ensure that as a
Trust we meet the following five commitments:
To interview all disabled applicants who meet the minimum criteria for a
job vacancy and to consider them on their abilities
To discuss with disabled employees, at any time but at least once a year,
what both parties can do to make sure disabled employees can develop
and use their abilities
To make every effort when employees become disabled to make sure they
stay in employment
To take action to ensure that all employees develop the appropriate level
of disability awareness needed to make these commitments work
To review these commitments each year and assess what has been
achieved, plan ways to improve on them and let employees and Jobcentre
Plus know about progress and future plans.
During the year staff from the Equality, Diversity and Inclusion unit,
Occupational Health and Human Resources departments have worked
together with managers and disabled staff to make reasonable adjustments to
their roles and working environment, which has enabled them wherever
possible to remain in employment with the Trust.
Disability Access and Facilities
Our Estates Department has undertaken a £50,000 programme of work aimed
at improving access and facilities at Trust premises. This includes new
accessible toilets, electric door-opening devices, refurbishing lift carriages,
fitting anti-ligature emergency pull cords in disabled toilets, surface marking
and improved signage for Blue Badge car parking spaces.
Our Disability Access and Facilities Minimum Standards Guidelines have
been applied in all refurbishment schemes. Representatives from local
disability access groups worked with the Trust to review priorities identified in
the access audits and to review our guidelines document.
Annual Report and Annual Accounts 2011-12 69

Workforce Management and Experience: Our Future Plans and
Objectives for 2012/13
During 2012/13 we will continue to plan for, attract and develop our
people so that they are able to deliver a high-quality service.
To achieve this, our high-level objectives are:
By 30th June 2012, 90 per cent of staff will have participated in a quality PDR
leading to an agreed personal development plan which supports personal and
professional development. This will be measured by our Staff Opinion
Survey.
Throughout 2012/13 we will, month on month, demonstrably improve our
staff’s compliance with Mandatory Training requirements leading to overall
compliance being greater than 90 per cent by 31 March 2013.
By December 2012 all business streams will have reviewed their workforce
resourcing and development plans-leading to the identification of how new
roles and new ways of working will enhance their service delivery.
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Annual Report and Annual Accounts 2011-12

Financial Review of the Year
We have had another successful year (our second full year as a Foundation
Trust) in terms of our financial performance. Readers of the accounts will see
an underlying surplus of £4.4m. This surplus enables the Trust to continue to
invest in improving its buildings and environment for the benefit of staff and
service users.
This surplus compares favourably with the £2.8million surplus we made in
2010-11 and shows that the Trust goes from strength to strength - particularly
when set against our improvements in the quality of the services we provide.
We have met all of our financial duties through creating an underlying surplus
- keeping enough cash in the bank during the year to cover our outgoings and
paid more than 95 per cent of our invoices within 30 days in accordance with
the Better Payment Practice Code.
Our Monitor Risk Rating at the year end was 4, which represents an excellent
achievement and stands us in good stead for the years to come.
Our income comes almost exclusively from our primary care trust contracts,
with no private patient income or endowment income. This means that we do
not have any problems arising from cost allocation or subsidisation of our
services from different income sources.
Like all organisations we have faced, and continue to face, financial and
business risks - in particular the difficult financial position of some our main
commissioners, the reduction in our NHS contracts and the need to drive out
significant efficiency savings in the future.
However, as our financial performance for last year demonstrates, the Trust
has the right skills and staff to ensure that these risks are managed
successfully in the future.
Dean Marsh
Director of Finance and Informatics
Annual Report and Annual Accounts 2011-12 71

Remuneration Report
The Remuneration Committee comprises the Chairman, Bernard Pilkington
and three designated Non-Executive Directors – Brian Marshall, Derek Taylor
and Rupert Nichols. The committee met on three occasions during the period
1 April 2011 to 31 March 2012 and was quorate. For full details of attendance,
please turn to page 14.
The committee is supported by the Director of Human Resources and
Organisational Development, who is able to provide market movement and
benchmark data to the committee. In addition, the committee receives
independent data on executive salaries and employment benefits. The Chief
Executive will also attend the committee in an advisory capacity except when
discussing his own remuneration or other terms of service.
The main function of the committee is to make recommendations to the Trust
Board on the remuneration, allowances and terms of office of the Executive
Directors (including the Chief Executive) to ensure that they are fairly
rewarded for their individual contribution to the organisation; having regard to
the organisations’ circumstances and performance. The committee also
advises and oversees the contractual arrangements including the calculation
and scrutiny of termination payments of Executive Directors - taking account
of national guidance as appropriate.
All senior managers employed by the Trust below Executive Director level are
covered by the nationally agreed and negotiated ‘Agenda for Change’ pay
system and the associated terms and conditions of employment.
The Chairman and Non-Executive Directors’ remuneration is determined by
the Nominations and Remuneration Committee of the Council of Members. In
determining pay levels, the Committee takes into account market data
provided by the Foundation Trust Network in addition to remuneration reports
provided by the Appointments Commission.
All appointments to the posts of Chief Executive and Executive Director have
been made on merit and on the basis of fair and open competition. The Chief
Executive and Executive Directors covered by this report are all subject to
open-ended contracts.
Basic pay for Executive Directors and Non-Executive Directors is not subject
to any specific performance-related element (e.g. bonus or performance pay
progression). However, all Directors and Non-Executive Directors are subject
to annual performance and development reviews. Under performance is a
consideration in determining any annual pay increase. For the year 2011/12
the Remuneration Committee determined that no cost-of-living rises should be
awarded to Executive Directors in line with the two-year NHS pay freeze for
staff nationally.
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Annual Report and Annual Accounts 2011-12

Details of salaries and allowances of senior managers are detailed in note 7.5
on page 203 of the Annual Accounts. Details of senior managers’ pension
benefits can be found in note 7.6 on page 205 of the Annual Accounts.
Annual Accounts
The Annual Accounts have been prepared under a direction issued by Monitor
and are appended to this Report in Appendix 2.
Accounting Policies
The 2011-12 Annual Accounts have been prepared on the basis of
International Financial Reporting Standards (IFRS). Appropriate accounting
policies are reviewed and approved by the Audit Committee annually.
Accounting policies for pensions and other retirement benefits are set out in
note 7.6 on page 205 of the annual accounts. Details of senior employees’
remuneration can be found in notes 7.5 on page 203 of the Annual Accounts.
Going Concern
Following the review and approval of the Trust’s five-year business plan and
long-term financial model by the Trust Board, the Directors have a reasonable
expectation that the Trust has adequate resources to continue in operational
existence for the foreseeable future. For this reason, they continue to adopt
the going concern basis in preparing the Annual Accounts.
Annual Report and Annual Accounts 2011-12 73

Your Comments and Contact Information
Our Communications
We value feedback on our communications. If you have any comments on
this Annual Report, or any feedback about our communications, then please
contact us.
Key Contact:
Michelle Ewen
PR and Publications Specialist
Email: michelle.ewen@5bp.nhs.uk
Our Services
If you have any feedback about our services, please contact us. We will
respond to all comments that we receive.
Key Contact:
Dennis Dewar
Patient Advice and Liaison Services (PALS) Co-ordinator
Email: dennis.dewar@5bp.nhs.uk
Copyright © 5 Boroughs Partnership NHS Foundation Trust 2012
74
Annual Report and Annual Accounts 2011-12

Speaking Your Language
This Annual Report can also be found in formats such as large print, Braille
and audio. Please contact the Equality, Diversity and Inclusion Unit on 01925
664047.
Annual Report and Annual Accounts 2011-12 75

76
Annual Report and Annual Accounts 2011-12

5 Boroughs Partnership
NHS Foundation Trust
Appendix 1 - Quality Report
2011 – 2012
Annual Report and Annual Accounts 2011-12 77

Contents
Part 1 – Our commitment to Quality
1.1 Our Quality Report 2011-12 Page 80
1.2 Chief Executive’s Statement Page 80
1.3 Chairman’s Statement Page 81
1.4 Our Vision Page 82
1.5 The Trust Values Page 82
1.6 Supporting Statements Page 82
1.7 Statements from External Stakeholders Page 83
1.8 Chief Executive’s Written Statement and Signature Page 83
1.9 Responsible Person’s Written Statement and Signature Page 83
Part 2 – Priorities for Improvement
2.1 Quality Priorities for improvement 2012-13 Page 84
2.2 Improving on 2011-12 Quality Measures Page 85
2.3 Trust Quality Improvement Plan Page 85
2.4 Statements of Assurance provided by the Trust Board Page 86
Review of sub-contracted services Page 86
Commissioning for Quality and Innovation Payment Framework Page 86
Participation in Clinical Audits and National Confidential
Enquiries Page 87
Participation in Clinical Research Page 89
Quality of our Data Page 90
Clinical coding Page 91
Information Governance Toolkit Page 91
Registration with the Care Quality Commission Page 91
Part 3 – Other Information
3.1 Trust Quality and Safety Priorities 2011-12 Page 93
3.2 Achievements Against Monitor Targets 2011-12 Page 95
3.3 Trust Quality Measures Page 98
3.4 Trust-wide Achievements Page 101
What we do well Page 101
Infection Prevention and Control Page 101
National Award Winner Page 101
3.5 Workforce Development and Learning Page 102
Bringing our Values to Life Page 102
The Development of a Coaching Culture Page 102
Advancing Quality Programme Page 103
Patient Safety Framework 2011-12 Page 103
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Involving Service Users in Patient Safety Page 103
Involving Service Users in Other Trust Business Page 104
Creating Time to Care Page 104
3.6 Feedback from External Scrutiny Page 106
Response to issues raised by regulators or public
Page 106
representatives in the last year
Care Quality Commission Page 106
Monitor Reporting Requirements 2011-12 Page 108
Care Quality Commission Mental Health and Commissioner Page 108
External assurance reports against three priority Monitor
indicators
Page 108
External assurance reports against the Quality Report Page 108
3.7 Engaging with and listening to Service Users and Local Page 109
Groups
Engaging with Service Users and Carers Page109
Overview and Scrutiny Committees Page 109
Engaging with Third Sector Organisations Page 110
Further Examples of Engagement and Responsiveness Page 111
How Can We Improve? Ask ‘Big Brother’ Page 111
‘Sticks and Stones’ Campaign Page112
3.8 Key Messages from External Statements for 2011-12 Page 112
Messages from St Helens OSC Page 112
Messages from Warrington LINkS Page113
3.9 Benchmarking against other Organisations Page 113
4. Appendices
4.1 Appendix 1 Supporting statements Page 114
4.2 Appendix 2 National Patient Survey Results 2011 Page 129
4.3 Appendix 3 Trust Patient Experience Survey Page 132
4.4 Appendix 4 Directors’ Statement of Responsibility Page 135
4.5 Appendix 5 Monitor External Assurance Statement Page 137
4.6 Appendix 6
2011-12
Performance against CQUIN targets Page 141
4.7 Appendix 7 Advancing Quality Programme Page 146
4.8 Appendix 8 Compliments and Complaints Report
2011-12
Page 148
Annual Report and Annual Accounts 2011-12 79

Part 1 – Our Commitment to Quality
1.1 Our Quality Report 2011-12
This is the third Quality Report that has been produced by 5 Boroughs
Partnership NHS Foundation Trust. Our Quality Report is published alongside
our Annual Report which we will continue to produce each year and make
available as a public statement of our commitment to improving quality and
safety in the Trust.
In April 2011 the Trust acquired Knowsley Integrated Provider Services (KIPS)
as part of the Transforming Community Services initiative. This report includes
the quality priorities established for both organisations in March 2011. The
quality priorities for the coming year have been established for the Trust as a
whole.
The purpose of our Quality Report is to demonstrate the Trust’s commitment
to improving quality and safety for the people who use our services. It
presents:
Where improvements in quality are required
What we are doing well as an organisation
How service users, staff and the wider community are engaged in working
with us to improve quality of care within the Trust.
1.2 Chief Executive’s Statement
All providers of NHS healthcare services are required to produce a Quality
Report - an annual report to the public about the quality of services delivered.
We welcome this opportunity to take an honest look at how well we have
performed during the reporting year and to outline future improvements we
aim to make.
We have worked with the following groups to produce our Quality Report:
Clinical Governance and Clinical Risk Committee
Council of Members via our Compliance with Authorisation Committee
Staff, service users and carers from across the breadth of our
organisation.
We have also consulted with key external stakeholders including:
Overview & Scrutiny Committees
Local Involvement Networks (LINks).
You can read what our stakeholders have to say about our quality
performance in Appendix 1 (page 114).
One of our Trust values is: ‘We value quality and strive for excellence in
everything we do’. I am delighted that this Quality Report evidences our
commitment to this value across the breadth of our services.
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Annual Report and Annual Accounts 2011-12

In particular, we took part in 100 per cent of national clinical audits that we
were eligible for during the reporting year. The importance of clinical audits is
realised when we make changes to improve services based on audit findings.
We have been Creating Time to Care – working with our clinicians to support
them to spend more quality time with our service users. We have also been
developing a coaching programme to promote a culture of personal
responsibility and empowerment. We want to equip our people to deliver on
the commitments we make – another of our Trust values.
You can read more about these and other initiatives, and view detailed
information about our performance against quality and safety priorities and
indicators within the following report.
Simon Barber
Chief Executive
1.3 Chairman’s Statement
Recognising the ‘Expert by Experience’ status of our service users is a key
quality priority we have set for 2012-13 – complementing our value: ‘We
value, encourage and recognise everyone’s contribution and feedback’.
I am delighted that this report evidences a 61 percent increase in the number
of involvement opportunities carried out by volunteers in 2011 when compared
with 2010. We are able to demonstrate where and how we have listened to
our service users’ lived experience and worked with them to drive through key
quality improvements.
For example, by involving service users in the patient safety framework, and
taking into account their insight and experience, we have been able to
improve the quality of the actions we implement to enhance patient safety
within the services we provide.
In a UK-first we also pioneered the full involvement of people living with a
Personality Disorder in the development and delivery of a new and innovative
Personality Disorder Hub Service which is committed to offering the best
possible service to people who meet this diagnosis. For our work in this area
we received a nomination in the ‘Innovation in Mental Health’ category at the
HSJ Awards 2011.
Annual Report and Annual Accounts 2011-12 81

As Chairman of the Council of Members, it’s great to see that our Member
Councillor representatives on the Clinical Governance and Clinical Risk
Committee have approved the Quality Priorities for 2012-13, as detailed in this
report.
I look forward to seeing how as a Trust we can work with all our stakeholders
to deliver on the commitments we have made.
Bernard Pilkington
Chairman
1.4 Our Vision
We work with many partners including primary care trusts, local authorities,
social services and the voluntary sector to help us turn our vision of becoming:
“A leading provider of world-class mental health, learning disability and
community services, with a reputation for quality, innovation and
excellence”
into a reality.
1.5 The Trust Values
“We value people as individuals ensuring we are all treated with dignity and
respect.”
“We value quality and strive for excellence in everything we do.”
“We value, encourage and recognise everyone’s contribution and feedback.”
“We value open, two-way communication, to promote a listening and learning
culture.”
“We value and deliver on the commitments we make.”
More information about the Trust Values are in section 3.5.1 of this report.
1.6 Supporting Statements
In order to help demonstrate the Trust’s commitment to quality improvement,
supporting statements have been provided by the following:
Chair of the Clinical Governance and Clinical Risk Committee
The Trust’s Council of Members (Compliance with Authorisation
Committee).
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These statements are included as Appendix 1 (page 114).
Go to www.5boroughspartnership.nhs.uk/quality-accounts to view the table of
wider engagement.
1.7 Statements from External Stakeholders
Supporting statements have been invited from:
Overview & Scrutiny Committees
Local Involvement Networks ( LINks)
Lead Commissioner statement (NHS Knowsley).
These are also included in Appendix 1.
1.8 Chief Executive’s Written Statement and Signature
I confirm that to the best of my knowledge the information in the 2011-12
Quality Report is accurate.
S Barber
1.9 Responsible Person’s Written Statement and Signature
As the responsible person registered with the Care Quality Commission, I
declare that the content of the Trust’s Quality Report 2011-12 is accurate to
the best of my knowledge.
S Hull
Mr S Hull, Assistant Director Nursing and Safeguarding, Registered
nominated individual for 5 Boroughs Partnership NHS Foundation Trust with
the Care Quality Commission.
Annual Report and Annual Accounts 2011-12 83

Part 2 - Priorities for Improvement
2
2.1 Quality Priorities for Improvement 2012-13
To demonstrate our continual commitment to quality improvement we have
engaged with our service users, local scrutineers, and the Foundation Trust
members to agree our quality priorities for the year ahead.
The three quality priorities will demonstrate improvements in patient safety,
patient experience and effectiveness of our services; the Trust Board will
monitor progress for the quality priorities throughout the forthcoming year.
These three quality priorities have been chosen and designed for the Trust as
a whole and are markers for improvement for mental health, learning
disabilities and community care. The priorities will align with Trust objectives
for 2012-13 and will be quality targets agreed with our commissioners.
Quality & Safety
priorities
2012-13
Safety
Falls
84
Indicator Rationale
To provide evidence on how the
Trust has addressed Falls
amongst the service user
population.
Annual Report and Annual Accounts 2011-12
During 2011-12 the Trust
achieved its quality
priority in relation to
reduction of harm.
In 2012-13 we are going
to focus further on the
prevention of avoidable
harm as a result of falls.
In addition, as part of the
National Mandatory
CQUIN targets for 2012-
13 the Trust will also be
monitoring falls using the
NHS Safety
Thermometer.

Quality & Safety
priorities
2012-13
Effectiveness
Shared Decision-
Making
Experience
Issues of Concern
Indicator Rationale
To identify examples of shared
decision-making between service
user and the clinician, recognition
of the ‘expert’ status of the service
user, developing person-centred
care plans and supporting carers.
The Trust will look at the process
for collecting and acting upon
issues of concern expressed by
service users.
Further embedding of
person-centred care
planning will promote
independence and self
management of care.
Increased engagement
with service users will
ensure they are involved
in decision-making at an
earlier stage about their
care and treatment.
The Trust has also
considered service user
feedback about the
quality and involvement
they want with their care
planning.
The Trust wants to listen
to what our service users
think about the service we
provide, build on positive
experiences they share
with us and change where
they tell us we can do
better.
2.2 Improving on 2011-12 Quality Measures
The Trust’s quality priorities for 2011-12 have been monitored by the Trust for
the past year. Although the Trust achieved these priorities, they will continue
to be reported on for the following year. Details of 2011-12 priorities are
included in section 3.1 of this document.
2.3 Trust Quality Improvement Plan
The Trust is developing a Quality Improvement Plan for 2012-13 which
includes:
Quality and safety priority indicators 2012-13 (as above)
Actions arising from the National Patient Survey results
Actions arising from the Trust Patient Experience Survey results
Safety and quality actions from external regulator’s visits/ reports
Actions relating to data quality in the Monitor External Assurance review.
Go to www.5boroughspartnership.nhs.uk/quality-accounts to view the Trust’s
Quality Improvement Plan 2012-13.
Annual Report and Annual Accounts 2011-12 85

2.4 Statements of Assurance Provided by the Trust Board
As part of our Quality Report, we are required to present a series of
statements which have been agreed by the Trust Board that relate to the
quality of our services. These statements serve to offer assurance to our
members and the general public that we are:
Performing to national essential standards of quality and safety (CQC
Registration standards)
Measuring and improving our clinical performance in audit and research
activity
Engaging in innovative projects (CQUIN framework)
Maintaining compliance with our Monitor targets (see section 3.2 of this
document).
2.4.1 Review of Contracted Services
During 2011-12 5 Boroughs Partnership NHS Foundation Trust provided
and/or sub-contracted 266 NHS services.
The 5 Boroughs Partnership NHS Foundation Trust has reviewed all the data
available to them on the quality of care in all of these NHS services. This is
undertaken through regular service reviews against the strategies set out in
the Trust’s Integrated Business Plan.
The income generated by the NHS services reviewed in 2011-12 represents
100 per cent of the total income generated from the provision of NHS services
by the 5 Boroughs Partnership NHS Foundation Trust for 2011-12.
2.4.2 Commissioning for Quality & Innovation Payment Framework
(CQUIN)
A proportion of 5 Boroughs Partnership NHS Foundation Trust income in
2011-12 was conditional upon achieving quality improvement and innovation
goals agreed with NHS Knowsley - acting as Co-ordinating Commissioner for
Halton, St Helens, Knowsley, Warrington, and Ashton, Leigh and Wigan
separately through the Commissioning for Quality and Innovation payment
framework.
The Trust attracts 1.5% of our contract value as CQUIN payments. The total
available within the CQUIN framework is £1.945m.
Further details of the agreed goals for 2011-12 and for the following 12-month
period are available online.
Go to www.5boroughspartnership.nhs.uk/quality-accounts to view the Trust’s
CQUIN targets for 2012-13.
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2.4.3 Participation in Clinical Audits & National Confidential Enquiries
The Trust considers involvement in clinical audits to be a key indicator of
quality. The importance of clinical audits is realised when it leads to the
implementation of initiatives to improve services.
A key example of this in 2011-12 can be demonstrated by the Prescribing
Observatory for Mental Health (POMH) re-audit, assessing the monitoring of
side-effects to depot antipsychotic medication.
Three audits have been undertaken - the first being the baseline in 2008, the
second in October 2009, and the latest audit was completed in May 2011.
These audits are undertaken by participating Trusts, therefore the results can
be analysed as year-on-year Trust results, comparisons to other mental health
trusts, and national standards.
Full implementation of the action plan by the Medicine Management Team
has demonstrated a dramatic improvement, and as a result we are now one of
the best performing Trusts in the UK.
Actions implemented included: development of monitoring templates;
improving service user knowledge and expectations; launch of the Choice and
Medication website; communication and discussion of the results with the
medical and nursing teams, with a simple message to ask and document
issues related to side-effects.
The results of the latest audit showed the following improvements:
The proportion of patients with no evidence of documentation around sideeffects
has reduced from 40% to 13%
The proportion of patients with documentation of a general statement
regarding presence or absence of side-effects has improved from 49% to
83%
Significant improvements were noted for the documentation of specific
side effects relating to movement disorders, weight, and side-effects of a
sexual nature.
The specific side-effects above are known to be particularly distressing for
patients and are often the cause of non-compliance with medication, resulting
in an increased risk of relapse and possible admission to hospital. Evidence
suggests that side-effects of this nature may only be identified if patients are
specifically questioned about them.
The results of this audit demonstrate that we have improved our monitoring of
side effects and thus improved the quality of care provided. An action
following the latest audit has been the launch the ‘Patient Empowerment
Letter’ which is expected to bring further improvements.
During 2011-12, six national clinical audits and one national confidential
enquiry covered NHS services that 5 Boroughs Partnership NHS Trust
Foundation Trust provides.
Annual Report and Annual Accounts 2011-12 87

During that period 5 Boroughs Partnership NHS Foundation Trust participated
in 100% of national clinical audits and 100% national confidential enquiries of
the national clinical audits and national confidential enquiries which it was
eligible to participate in.
The national clinical audits and national confidential enquires that 5 Boroughs
Partnership NHS Foundation Trust was eligible to participate in during 2011-
12 are as follows:
National Audit of Schizophrenia (NAS)
National Audit of Psychological Therapies
POMH Topic 6C - Assessment of the side-effects of depot antipsychotics
POMH Topic 7C - Lithium Monitoring
POMH Topic 10b - Antipsychotics in CAMHS
POMH Topic 11a – Antipsychotics - Dementia
National Confidential Inquiry into Suicide and Homicide by People with
Mental Illness (NCISH)
The national clinical audits and national confidential enquiries that 5 Boroughs
Partnership NHS Foundation Trust participated in during 2011-12 are as
follows:
National Audit of Schizophrenia (NAS)
National Audit of Psychological Therapies
POMH Topic 6C - Assessment of the side-effects of depot antipsychotics
POMH Topic 7C - Lithium Monitoring
POMH Topic 10b - Antipsychotics in CAMHS
POMH Topic 11a – Antipsychotics - Dementia
National Confidential Inquiry into Suicide and Homicide by People with
Mental Illness (NCISH)
The national clinical audits and national confidential enquiries that 5 Boroughs
Partnership NHS Foundation Trust participated in, and for which data
collection was completed during 2011-12, are listed below alongside the
number of cases submitted to each audit or enquiry as a percentage of the
number of registered cases required by the terms of the audit or enquiry. As
follows:
Name of Audit Number of
cases
submitted
National Audit of Schizophrenia (NAS)
Audit forms completed
National Audit of Schizophrenia (NAS)
Service User Questionnaires returned
National Audit of Schizophrenia (NAS)
Carer Questionnaires returned
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Annual Report and Annual Accounts 2011-12
% of
required
cases
provided
87 87%
31 15%
22 11%

Name of Audit Number of
cases
submitted
% of
required
cases
provided
National Audit of Psychological Therapies 235 100%
POMH Topic 6C – Assessment of the sideeffects
of depot antipsychotics
263 100%
POMH Topic 7C – Lithium Monitoring 164 82%
POMH Topic 10b – Antipsychotics - CAMHS 38 100%
POMH Topic 11a – Antipsychotics - Dementia 510 100%
National Confidential Inquiry into Suicide and
Homicide by People with Mental Illness (NCISH)
201 100%
The reports of four national clinical audits were reviewed by the provider in
2011-12 and 5 Boroughs Partnership NHS Foundation Trust intends to take
actions to improve the quality of healthcare provided.
The reports of 241 local clinical audits were reviewed by the provider in 2011-
12 and 5 Boroughs Partnership NHS Foundation Trust intends to take the
following actions to improve the quality of healthcare provided:
Action Plans are completed and agreed at the appropriate committee or
group
A Trust lead is appointed for each action
Time scales for each action are established and agreed
Follow up actions are agreed by the Trust.
2.4.4 Participation in Clinical Research
Participation in clinical research demonstrates the Trust’s commitment to
improving the quality of care we offer and to making our contribution to wider
health improvement. It helps us ensure that our clinical staff stay abreast of
the latest treatment possibilities and value active participation in research as it
leads to successful patient outcomes.
The number of patients receiving NHS services provided or sub-contracted by
5 Boroughs Partnership NHS Foundation Trust in 2011-2012 that were
recruited during that period to participate in research approved by a research
ethics committee was 300. The total number of participants taking part in
studies was 759 - a steady increase from the baseline figure of less than 80 in
2009-10 and 350 last year.
The Trust is strongly committed to supporting the activities of the
Comprehensive Local Research Networks (CLRN). It is an active member of
the Cheshire and Merseyside CLRN and has participated in a growing number
of clinical studies in their research portfolio. The Trust became a full member
of the Mental Health Research Network.
The Trust was involved in conducting 41 clinical research studies in mental
health and integrated community services during 2011-12. The studies
included those that described new treatments (observational studies) as well
as ones that tested new treatments (interventional studies). They covered a
Annual Report and Annual Accounts 2011-12 89

ange of areas from trials of new therapeutic drugs to testing the effectiveness
of new talking therapies. The studies included commercial clinical trials as well
as NIHR studies and including international collaborations, researching new
treatments across all ages in areas including dementia, schizophrenia, ADHD
and self-harm.
The Trust is the top recruiter in the UK for several commercial and NIHR
portfolio studies. As a result of this we have been approached by a number of
pharmaceutical companies to complete feasibility studies for other clinical
trials for Major Depressive Disorder, Dementia and Attention Deficit
Hyperactivity Disorder (ADHD). With the success of the current studies two of
our Principal Investigators are acting as Chief Investigators with overall
responsibility for the clinical trial. The number of sub/co-investigators has
increase significantly in this year – with many of our consultants gaining more
experience in clinical trials to become principal investigators. More than 40 of
our medical practitioners are currently participating in a range of clinical trials.
In order to promote frontline engagement in research the Trust has launched
a Research Grant Application Scheme. The first scheme ran in September
2012, for which we received seven applications. Following the success of our
inaugural Research Awareness Day, a second day is planned in June 2012.
2.4.5 Quality of our Data
The 5 Boroughs Partnership NHS Foundation Trust attaches a high level of
importance to data quality. The Trust believes that excellent data quality is
one of the foundations for the delivery of quality care, good patient experience
and cost-effective services. It also assists with clinical decision-making.
The 5 Boroughs Partnership NHS Foundation Trust has been taking the
following actions to improve data quality:
Continue to publish monthly data quality and completeness data at
Executive, Management and Operational Levels via the Trust intranet
Continue to publish monthly High-level Trend reports
Continue to publish quarterly benchmarking reports comparing Trust
achievement levels against national, regional and local Trusts
Continue liaison with and training for operational teams to support
improvement of data quality across all services
Continue to liaise with Consultants and their medical teams in relation to
clinical coding and the availability of discharge and clinical information.
5 Boroughs Partnership NHS Foundation Trust submitted records during
2011-12 to Secondary Uses Service for inclusion in the Hospital Episode
Statistics which are included in the latest published data.
The percentage of records in the published data which included the patient’s
valid NHS number was:
Admitted Patient Care (130 & 190) 100%
Care Activity CDS (Outpatient) (020) 100%
Long-term Psychiatric Census(170) 100%
Mental Health Minimum Data Set 99.0%
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Annual Report and Annual Accounts 2011-12

The percentage of records which included the patient’s valid General
Practitioner Registration code was:
Admitted Patient Care (130 & 190) 96.6%
Care Activity CDS (Outpatient) (020) 99.0%
Long-term Psychiatric Census(170) 99.0%
Mental Health Minimum Data Set 98.6%
2.4.6 Clinical Coding
5 Boroughs Partnership NHS Foundation Trust was not subject to the
Payment by Results clinical coding audit during the reporting period by the
Audit Commission.
The Trust commissioned and independent review of clinical coding that was
undertaken by Mersey Internal Audit Agency in December 2011. The overall
level of assurance was ‘high’ - the highest level in a 4-point scale. The audit
results were as follows:
Primary Diagnosis 100%
Secondary Diagnosis 94%
Primary Procedures 100%
Secondary Procedures 100%
2.4.7 Information Governance Toolkit
5 Boroughs Partnership NHS Foundation Trust’s Information Governance
Assessment Report overall score for 2011-12 was 91% and was graded
Satisfactory. 5 Boroughs Partnership NHS Foundation Trust will be taking the
following actions to improve data quality:
There is an Information Governance Management Group which is
responsible for agreeing the assurance and accountability driven work plan
and monitoring its progress throughout the year.
2.4.8 Registration with the Care Quality Commission
5 Boroughs Partnership NHS Foundation Trust is required to register with the
Care Quality Commission and its current registration status is registered
without conditions.
The Care Quality Commission has not taken enforcement action against 5
Boroughs Partnership NHS Foundation Trust during 2011-12.
5 Boroughs Partnership NHS Foundation Trust has participated in special
reviews or investigations by the Care Quality Commission relating to the
following areas in 2011-12.
5 Boroughs Partnership NHS Foundation Trust intends to take the following
action to address the conclusions or requirements reported by CQC:
5 Boroughs Partnership NHS Foundation Trust has made the following
progress by 31st March 2012 in taking such action:
During 2011-12 the Trust was inspected by the Care Quality Commission as
part of their targeted inspection programme to review services for people with
Annual Report and Annual Accounts 2011-12 91

learning disabilities. The review was to establish if in-patients experience
effective, safe and appropriate care and treatment and support that meets
their needs and protects their rights, and whether they are protected from
abuse.
The Trust was subject to two inspections. These were carried out at in-patient
units; Auden Unit, based at Hollins Park in Warrington and at Willis House
situated in Whiston.
Auden Unit
The report from the Auden Unit inspection was received by the Trust in
February 2012. The report includes quotes both from our services users and
carers. Feedback from all was very positive, complimentary and encouraging
about aspects of care, care planning, respect and skills of the staff.
The Care Quality Commission’s overall judgement of the Auden Unit was that
patients receive safe and appropriate treatment that meets their needs and
protects their rights, however patient-centred care planning needs to be fully
embedded.
The report also included moderate concerns as part of the inspection, which
require improvements by the Trust. These related to ensuring that our staff
can identify safeguarding concerns; they be fully aware of the processes and
procedures we have in place and can act on them to safeguard our service
users.
The Trust has accepted the findings from the CQC report and has provided
the CQC with an action plan that fully covers the areas for improvement. The
action plan is now fully completed and the CQC have been informed of the
progress made.
Willis House
Willis House was inspected by the Care Quality Commission in December
2011. The Trust has now received the final report and responded to CQC.
Since the review was undertaken the Unit has closed as part of a planned
redesign of services and the Trust has applied to the Care Quality
Commission to de-register this unit which is part of the Trust’s registered
locations.
The CQC were informed during their inspection that Willis House was due to
close as an in-patient facility, and as a result of its recent closure the CQC
have revised their final report to reflect this. Although the Trust is not
expected to act on the findings of the report due to the facility no longer being
used, the Trust acknowledges the findings of the CQC’s report and has
formulated an action plan that will ensure that lessons are learned.
See section 3.6.2 for a breakdown of performance against 2011-12 CQC
Essential Standards of Quality and Safety.
92
Annual Report and Annual Accounts 2011-12

Part 3 - Other Information
3.1 Trust Quality and Safety Priorities 2011-12
This section of our Quality Report presents information relating to the quality
of our services throughout 2011-12. We start this section by reporting on our
achievement against the Trust Priorities that we set ourselves for 2011-12.
Below are two tables which outline the outcome of quality and safety priorities
established by both the Mental Health and Learning Disabilities and
Integrated Community Services in March 2011 - prior to the coming together
of the services in April 2011. The priorities for the coming year have been
chosen and designed for the Trust as a whole which includes mental health,
learning disabilities and community services provided by KIPS.
Mental Health and Learning Disabilities
Quality & Safety priorities
& indicators 2011-12
Outcome Commentary
Safety
Preventing avoidable harm
By March 2012 we will have taken
improvement actions, leading to
demonstrably safer care by
reducing the ratio of harm to
incident as measured by the
National Patient Safety Agency
Effectiveness
Good physical health care
By March 2012 the Trust will be
able to demonstrate a 10%
increase in the number of service
users in Community Mental Health
Teams who have had physical
health incorporated into their care
plans
met
met
Base line for the reduction of
reportable harm to incident ratio
2010-11 was 72%.
Actual for March 2011-12 was 80%
of reportable incidents resulted in no
harm suffered.
There has been a 43% increase of
service users within the Community
Mental Health Teams with physical
health incorporated in their care
plans.
Annual Report and Annual Accounts 2011-12 93

Quality & Safety priorities
& indicators 2011-12
Experience
Ensuring a positive experience of
care
By December 2011 the Trust will
have agreed a meaningful suite of
patient experience measures with
the Council of Members in each of
its business streams and will have
published them on the internet
94
Outcome Commentary
met
Annual Report and Annual Accounts 2011-12
This phase of the work on patient
experience is now complete.
Patient experience will be taken
forward under a new strategic
objective for 2012-13, which takes
account of the research undertaken
as part of this objective.
In relation to the measurement of
patient experience, a number of
actions have been undertaken.
‘Touch points’ have been identified
for in-patient and community
services within each business
stream and discussed with the Chief
Executive and Deputy Chief
Executive. They have also been
discussed with members of the
wider leadership group including
clinical colleagues. These touch
points are the key points at which
patients can be asked about their
experiences at that particular point in
their journey within our services, for
example, referral into service or
discharge from an inpatient to
community setting. Six themes have
been identified against which the
Trust can assess its performance at
each touch point. These include our
information/communication and our
staff attitude. Focus groups,
including Trust membership and
service users will be established to
fully test the touch points as a key
milestones for the 2012-13 objective.
Work continues around the creation
of an innovative and potentially
marketing-leading approach to
eliciting service user feedback and
on academic research around
Patient Experience in the NHS.
Opportunities around this for the
future will be explored in 2012-13.

Knowsley Integrated Provider Services
The following quality and safety priorities were established in March 2011,
prior to KIPS transferring into the Trust.
Quality & Safety priorities
& indicators 2011-12
Safety
Care Campus
(Intensive Support Team)
The purpose will be to manage
people with complex health and/or
social care needs contributing to the
overall plan to reduce health
inequalities, unscheduled admissions
to hospital and improve self care and
self management throughout the
Borough
Effectiveness
PARIS
This is the KIPS solution to ensure a
move towards a single electronic
record for all service users
Experience
Centre for Independent Living
(CIL)
This provides a wide variety of
services which can help individuals
to live an independent life. With its
own open plan showroom, patients
and service users can drop in and try
out a range of stair lifts, chairs, beds,
mobility, bathing and toileting
equipment
Outcome Commentary
partially
met
met
met
KIPS has developed a multidisciplinary
approach to case
management resulting in the delivery
of fully coordinated quality care at an
Intensive Support to people with
complex health and/or social care
needs.
The service specification was
received from Commissioners in
December 11 regarding further
requirements for the care of patients
with Intensive Support needs.
KIPS is now working jointly with
commissioners on an
implementation plan and workforce
changes required to deliver the full
care model by May 2012.
During 2011–12 KIPS has
commenced the implementation of
the PARIS system and continues to
develop PARIS as the electronic
patient record system.
The CIL opened to service users in
February 2011. The Centre is a
collaboration of statutory and third
sector organisations with a user-led
management committee providing a
variety of services to promote
independence. KIPS Independent
Living and Design Team, Equipment
Store and Wheelchair services are
embedded in the partnership.
3.2 Achievements against Monitor Targets 2011-12
On a monthly basis throughout 2011-12 the Trust reports progress against the
Monitor compliance targets. Many of the targets relate to safety, service user
experience and effectiveness of care. Our performance is as follows:
Annual Report and Annual Accounts 2011-12 95

Monitor Targets 2011-12 Threshold Year End
Position
Monitor Mental Health and Learning Disability Targets Reported
throughout the year
Patients seen, treated and discharged within 4
hours of arrival at A&E
Quality Rationale
To reduce the time that patients wait to be seen,
95% 99.89%
96
treated and discharged in A&E departments.
Patients receiving contact within 7 days of
discharge
Quality Rationale
Evidence shows safer outcomes for patients who
receive early follow-up by staff following discharge
Patients having a formal review with their care
co-ordinator within 12 months
Quality Rationale
Effective care co-ordination facilitates access for
individual service users to the full range of
community support they need in order to promote
their recovery and integration
Minimising delayed discharge/ transfer of care
Quality Rationale
The patient experience is adversely affected by
delayed discharges once they are fit to be discharged
Access to Crisis Resolution/ Home Treatment
Quality Rationale
To ensure patients receive a speedy and effective
‘step up’ in the support and treatment they receive,
yet avoiding hospital admission
Meeting commitment to serve new psychosis
cases by early intervention teams
Quality Rationale
Patients that are detected and diagnosed with a first
episode of psychosis by Early Intervention teams
gain prompt and appropriate treatment and it reduces
their duration of untreated psychosis
Data completeness: Identifiers
Quality Rationale
Data completeness enables the monitoring of
outcomes for individuals in terms of morbidity, quality
of life and user satisfaction with services
Annual Report and Annual Accounts 2011-12
95% 98.1%
95% 95.3%
No more
than 7.5%
3.3%
90% 99.6%
95% 107.6%
99% 99.4%

Monitor Targets 2011-12 Threshold Year End
Position
Monitor Mental Health and Learning Disability Targets Reported
throughout the year
Data completeness: outcomes
Quality Rationale
Mental health minimum data set (MHMDS) data
completeness enables the monitoring of outcomes
for individuals in terms of morbidity, quality of life and
user satisfaction with services
Valid employment status 98.0%
Valid accommodation status 50% 97.7%
HONOS assessment in the past 12 months 77.6%
Monitor Community Care Indicators – Reported from Quarter 3, October
2011
Community Treatment Activity - Referrals No
threshold
Community treatment activity – Care contact activity
Identifier Information
No
threshold
No
threshold
69.6%
99.7%
78.6%
From October 2011 Monitor established new reporting requirements for
foundation trusts that had acquired community services. There are seven areas
to the data completeness reporting - the three above which have been reported
since quarter three, and a further four that do not require reporting against as
Trust systems do not routinely capture the information. These are:
Referral to Treatment Times - AHP Lead in the Community
Patients dying at home
User experience
Venous leg ulcer treatments.
Monitor Compliance Framework for Walk-In Centres A&E 4 Hour Wait
Time
Reported
Walk-in
Centre
Target and
Threshold
Quarter 1 Quarter 2 Quarter 3 Quarter 4
Halewood
A&E 4 Hour
99.92% 100.00% 100.00% 99.98%
Huyton
Waiting Time
99.93% 100.00% 100.00% 99.80%
Kirby
Target:
≥ 95%
99.99% 100.00% 100.00% 99.93%
Trust
Overall
99.95% 100.00% 100.00% 99.89%
Annual Report and Annual Accounts 2011-12 97

The Trust has three Walk-in Centres as part of our Integrated Community
Services, seeing approximately 70,000 patients per year. Their aim is to
reduce pressure on A&E services by dealing with minor injuries plus advise
and provide treatment for non-life threatening illness. Patients are assessed
and treated to discharge or onward referral.
Walk-in centres are subject to the same 4-hour wait target as applied to
Accident and Emergency departments. The above table demonstrates the
Trust’s achievement of all reported targets in 2011-12. The Trust monitors and
reports performance against these targets on a monthly basis and these
tables alongside further detailed information is reported as part of the Trust’s
monthly performance report.
3.3 Trust Quality Measures
In addition to the quality priorities we have established for 2012-13 in Part 2,
and reporting against the 2011-12 quality priorities in Part 3.1, the Trust has
also established a set of quality measures.
When selecting the Quality Measures we wanted to ensure that we were
measuring quality across our different client groups. As a result of acquiring
KIPS in April 2011 the quality measures were revised.
These measures cover in-patient and community mental health and learning
disabilities and community services across our business streams (listed
below) and fit to the same domains of patient safety, patient experience and
clinical effectiveness:
Later Life and Memory Services
Adult Services
Child and Adolescent Mental Health Services
Forensic Services
Learning Disability Services
Community Services (KIPS).
The progress of all the quality measures are routinely reported to the Trust
Board. The following table shows our progress during 2011-12:
98
Annual Report and Annual Accounts 2011-12

Domain
Patient Safety
99
Trust Quality Measures 2011-12 (using March 2010-11 average as the base line, against 2011-12 average)
Indicator to be
measured
Proportion of
incidents with an
account of no harm
(Trust)
Healthcare
Associated
Infections – MRSA
Bacteraemia (Trust)
Healthcare
Associated
Infections – C Diff
(Trust)
The reconciliation of
medicines for
patients on
admission to
services (MH / LD)
RAG Status
against
March 11
Baseline
March 2011 Base
figure
99
Current
Position
75.2% 77.1% Internal
Reporting
0 0 Department of
Health Vital
Signs
Monitoring
Data Source Detailed Definition
The percentage of incidents
that had an outcome of no
harm. Year-on-year
improvement
Number of MRSA infections
that are hospital or
community acquired
0 0 Health Number of C Difficile
Protection infections that are hospital
Agency or community acquired
85.8% 94.2% Internal
Reporting
A process undertaken to
ensure medicines
prescribed on admission
correspond with those that
the patient was taking prior
to admission

Domain Indicator to be
measured
Patient
Experience
Effectiveness
100
Number of
Compliments (Trust)
Number of
Complaints (Trust)
Satisfaction with our
services (Trust)
Increase in HONOS
(in-patient)
assessment scores
(MH / LD)
Breastfeeding
(KIPS)
Immunisations
(KIPS)
RAG Status
against
March 11
Baseline
March 2011 Base
figure
100
Current
Position
21 88 5BP Service
User
Experience
Data Source Detailed Definition
Survey
15 20 Internal
Reporting
Expression of satisfaction
received verbally or written
Monthly expression of
dissatisfaction requiring a
response that could not be
resolved locally within 24
hours
87.9% 89.2% Percentage of patient
experience questions that
were scored as Excellent or
92.3% 92.3% Internal
Reporting
Good
Percentage of patients who
have had both an
admission and discharge
HONOS who are showing
an improvement
19.1% 20.7% Quality Tracker The target is a Knowsley
Health and Well-being
Figures combined
with NHS Knowsley
in 2010-11
(methodology
changed mid-year)
target
91.98% Quality Tracker Immunisation - Compliance
with schedule for those
children choosing to have
immunisations in clinics by
KIPS team

3.4 Trust-wide Achievements
3.4.1 What we do well
Section three of this report has presented quality and safety achievements
for the Trust realised throughout 2011-12.
There are several sources of valuable external feedback regarding what
the Trust does well. Our Quality Report and our measurements have been
informed by:
National Patient Survey feedback (Appendix 2)
Trust Patient Experience Survey (Appendix 3)
CQC Trust Quality and Risk profile 2011-12.
Areas identified for improvement from each of these sources are included
in the Trust Improvement Action Plan 11-12.
3.4.2 Infection Prevention and Control
Continuous monitoring is undertaken by the Trust to ensure that it remains
compliant to regulations in relation to cleanliness and infection control.
This involves a rigorous programme to prevent MRSA, C. Difficile, and
other serious infections in the Trust. This work is championed by our
Nurse Consultant in Infection Prevention and Control. The Infection
Prevention and Control Team believe that service user involvement in
infection prevention and control is crucial to ensure that they are actively
involved in this important agenda. Examples of service user involvement
include auditing practices on wards such as hand hygiene, cleanliness of
environment and equipment, undertaking unannounced spot-checks at the
Trust, contributing to policy and patient information leaflet development.
The Trust is required to report on MRSA bacteraemias on a monthly basis.
There have been no instances during 2011-12.
3.4.3 National Award-winner
For the second year running the Trust won a prestigious Nursing Times
Award – this time in the ‘Nursing in Mental Health’ category.
The award, which recognises individuals or teams who have developed
initiatives that have improved the delivery of mental health care, was
presented to Advanced Practitioner in Personality Disorder, Gary Lamph.
Gary has developed an ambitious Personality Disorder Strategy, which
sets out to develop strong seamless links between mental health services
and the wider system for the benefit of people with Personality Disorder.
The design and implementation of this revolutionary and entirely unique
low-cost multi-agency model was led by Gary.
Annual Report and Annual Accounts 2011-12 101

102
Fully integrated both multi-agency representatives and Experts by
Experience (known as EBEs), who are people with lived experience of
Personality Disorder, into the development and delivery of the model. The
model has no equivalent nationally.
In a UK first, EBEs and Experts by Occupation (EBOs) from mixed multiagencies
who lend their time without any additional costs have jointly
delivered Personality Disorder Awareness Training to practitioners.
Together they are equipping partners with the tools they need to work
more effectively with this vulnerable client group and use evidence-based
timely interventions. Doing so has the potential to reduce the risk of
transition of people with Personality Disorder to secondary mental health
care.
3.5 Workforce Development and Learning
3.5.1 Bringing our Values to Life
Our Trust Values were launched in March 2011. To ensure they are
effective and support us to develop a strong, shared culture, and to fully
embed them across the organisation an implementation programme has
been developed. The key strands of which are: communication and
promotion; team values sessions and the development of team charters;
incorporating our Values into the Performance and Development Review
(PDR) experience and our staff recognition schemes.
Our Values are central to improving the quality of our staff and patient
experience. The development of Team Charters throughout our Trust will
demonstrate a clear commitment by team members to live our Values
consistently. When staff feel valued, respected and their contribution is
recognised by their colleagues this results a higher level of team
performance and consequently an enhanced experience for our patients
and service users.
Similarly, when an individual’s contribution is acknowledged and
recognised both during their PDR and through the Trust’s recognition
schemes, this will lead to higher levels of performance and an
improvement in the services we provide.
3.5.2 The Development of a Coaching Culture
As part of the Trust’s response to the feedback received from our Values
workshops, a programme has been developed to support a culture of
coaching and coaching conversations throughout the organisation. The
aim of our coaching programme is to promote a culture of personal
responsibility, engagement and empowerment. By encouraging more
involvement in decision-making, and improved innovation and creativity,
this will lead to our staff taking greater ownership for the decisions that are
made. Enhanced levels of personal responsibility will lead to higher levels
of quality of the services that are delivered.
Annual Report and Annual Accounts 2011-12

3.5.3 Advancing Quality Programme
Advancing Quality is a quality initiative that has been in existence since
2010 within mental health and the basic principle of Advancing Quality is
that interventions are provided at the right time, every time, for all service
users.
NHS North West has coordinated work across North West Mental Health
Trusts and have devised a number of common measures to drive
improvement in relation to Dementia care and Early Interventions in
Psychosis.
Through this work a number of quality statements have been developed
that are now being used to measure the care a service user receives on
discharge from mental health services.
The measures are based on simple, evidence-based interventions and are
designed to ensure that services provide consistent high quality care for
all.
Further details of the interventions measured can be found in Appendix 7.
3.5.4 Patient Safety Framework 2011-12
To ensure that our quality and safety activities are co-coordinated across
the different parts of the Trust, we have developed our Patient Safety
Framework which consists of:
Patient Safety Panel (challenge meetings around SUI reports)
Monthly Safety and Quality Metrics Report (all safety incident reporting
in one report)
Executive-level walkabouts to visit clinical services
Thematic review of Serious Untoward Incidents using the Safer Mental
Health Checklist
Proactive use of the Safer Mental Health Checklist for open case loads
resulting in actions to enhance patient safety
Monthly Business Stream Risk Reports that include data and analysis
of incidents, risks, complaints, claims, audits and CQC compliance
Targeted improvement plans for each Business Stream to reduce the
number of incidents that result in harm
Clinical Quality Dashboard to feedback key data to frontline staff.
3.5.5 Involving Service Users in Patient Safety
Service Users and carers are seen as a vital component of the Patient
Safety Framework. They are involved in the following ways:
Membership of the Clinical Governance & Clinical Risk sub – board
Committee
Membership of the monthly Patient Safety Panel meetings
Acting as Serious Incident reviewers.
Annual Report and Annual Accounts 2011-12 103

104
By involving service users in the patient safety framework and taking into
account their insight and experience, we have been able to improve the
quality of the actions we implement to enhance patient safety within the
services we provide.
3.5.6 Involving Service Users in Other Trust Business
The Trust is committed to providing opportunities to involve service users,
carers and members of the public (volunteers) in our business. We
acknowledge the unique contribution to services through their experience
of living with a health problem and using health services, personally or in a
caring role. This expertise is not available from any other source.
The Trust has developed an Involvement Scheme designed to provide a
safe and efficient process to enable volunteers to become involved in all
stages of designing, delivering and monitoring Trust services.
Recent work undertaken by volunteers includes:
Community Groups training staff
Production of awareness-raising DVD
Participating in Trust groups including:
- Capital Planning
- Spirituality Group
- Care Plan Working group
- CAMHS modernisation
- Documentation Review
- Charitable Funds Committee
Attending IMROC (Implementing Recovery - Organisational Change)
Delivering induction training
PALS Volunteers
Undertaking ‘Deep Dive’ audits
Delivering doctors’ training
Supporting ward staff
Participating in ‘Time to Care’ project.
(This is not an exhaustive list.)
In 2010, there were 733 Involvement Opportunities carried out by
volunteers and in 2011 this rose to 1,184 - an increase of 61%
3.5.7 Creating Time to Care
Creating time to care was established in 2011 from a strategic objective to
improve and enhance time with service users. After a trust-wide staff and
service user engagement process key projects were selected for
implementation.
Annual Report and Annual Accounts 2011-12

Productive Mental Health Wards
Productive Mental Health Wards was developed by the Institute for
Innovation and Improvement. The Programme aims to energise and
motivating frontline teams whilst teaching them tools and techniques
which they can use to enable improvements within their own working
environments.
The programme works in alliance with senior management, frontline
teams and service users to foster a culture of continuous improvement in
quality, safety, value and cost-effectiveness.
During 2011-12 three showcase wards have been implementing the
programme and have successfully completed the foundation modules.
This has led to a number of noticeable improvements on these wards
including improved environment, increased therapeutic interventions and
reduction in medical errors. The introduction of Patient Status at a Glance
Boards on two of the wards has enabled staff to have confidential visual
management of patient information, which reduces interruptions, improves
the quality and safety of handovers and reduces errors. Each ward has set
five quality metrics which are reviewed weekly and monthly improvement
goals are implemented by the team. The ultimate aim of the Productive
Programme is to release time spent on non value-added activities and
reinvest in quality direct care time.
The showcase teams have commenced the process modules which aim to
improve the processes on the wards that support safe and effective
delivery of care.
Productive Community Services
The Productive Community Programme follows the same principles as the
productive Ward programme, but has been adapted to meet the
requirements of community settings. One community team has piloted the
programme and has made a number of improvements including the
introduction of a Duty Doctor and Clinical Patient information board, which
has greatly enhanced multi-disciplinary working.
Mental Health Passport
Mental Health Passports aim to enhance the experience of service users
in in-patient services by actively engaging service users and carers in care
planning and enabling them to share personal information which is
important to them. A champions group is currently working on a
standardised approach to the implementation of passports across the
Trust.
Documentation Rationalisation
Accurate and timely documentation of care is a cornerstone of providing
safe, meaningful and effective care. The Business Transformation Team
has been working collaboratively with frontline teams to explore areas
Annual Report and Annual Accounts 2011-12 105

106
where documentation can be rationalised and improved to support
effective documentation and release time to provide face-to-face care.
Creating Time to Care was established in 2011 from a strategic objective
to improve and enhance time with service users. Initiatives and projects
commenced inclusive of qualitative measures and improvements.
3.6 Feedback from External Scrutiny
3.6.1 Response to issues raised by Regulators or Public
Representatives in the last year
This section provides information about our registration with the Care
Quality Commission (CQC) and any monitoring the CQC has undertaken
with the Trust in the past year. It also provides information about the
Quality Report requirements for Monitor.
3.6.2 Care Quality Commission
Since April 2010 the Trust has been registered with the Care Quality
Commission for the locations and types of services provided by the Trust.
Changes to the registration during 2011-12, included the transfer of
services from Knowsley Integrated Provider Services, and their three
registered locations.
The registration and compliance to the 16 essential standards of quality
and safety have been monitored, scrutinised and reported throughout the
year via the Corporate Report and the Safety and Quality Metrics Report,
as part of the Trust’s continual compliance cycle.
In addition, the above reporting is linked to the CQC’s Quality and Risk
Profile; a document that is released routinely throughout the year by the
CQC. The profile captures all that the CQC know about the Trust in one
document, and provides a view of how the Trust is performing against the
16 Essential Standards of Quality and Safety.
Annual Report and Annual Accounts 2011-12

The table below shows the Trust’s position as at the end of March 2012.
Section Outcome Mar-12
Involvement and
information
Personalised care,
treatment and
support
Safeguarding and
safety
Suitability of staffing
Quality and
management
1: Respecting and involving people who use services
2: Consent to care and treatment
4: Care and welfare of people who use services
5: Meeting nutritional needs
6 Cooperating with other providers
7: Safeguarding people who use services from abuse
8: Cleanliness and infection control
9: Management of medicines
10: Safety and suitability of premises
11: Safety, availability and suitability of equipment
12: Requirements relating to workers
13: Staffing
14: Supporting workers
16: Assessing and monitoring the quality of service
provision
17: Complaints
21: Records
The Trust has had two Care Quality Commission inspections at Auden
Unit and Willis House. As a result of the reports, the Trust has selfassessed
itself as ‘Amber’ until assurance can be established that
compliance with safeguarding can be demonstrated across the Trust.
The Trust responded to the Care Quality Commission’s reports with an
action plan which is now fully completed for the Auden Unit, and since
their inspection, Willis House in-patient unit has closed as part of the
Trust’s redesign of services.
From an organisational perspective the Trust needs to feel confident that
its safeguarding processes are meeting the needs of all our service users.
The Trust has put a programme of work in place to assess itself, as part of
a trust-wide programme of learning for safeguarding.
Annual Report and Annual Accounts 2011-12 107

108
The findings from this work will inform any areas of improvement, which
we will act upon. We expect our self declaration to return to ‘Green’ once
any actions have been implemented.
3.6.3 Monitor Reporting Requirements 2011-12
Monitor is the regulator of Foundation Trusts and it is required that we
publish the following in our Quality Report:
The Director’s Statement of Responsibility (Appendix 4)
External assurance on the content of the Quality Report to ensure it is
in line with Monitor’s requirements and is consistent with other
information (Appendix 5)
External assurance on two mandated performance indicators in the
Quality Report: (Any one of the following to be determined by the
Council of Members)
- 100% CPA patients receiving follow up within 7 days of
discharge from hospital
- Minimising delayed transfers of care
- Access to Crisis Resolution Home Treatment
Assurance on one locally-selected quality priority indicator in the
Quality Report to be agreed by the FT governor/ membership.
3.6.4 Care Quality Commission Mental Health Act Commissioner
The Trust has a dedicated team of Mental Health Law Administrators who
work across the Trust and who are the primary link with the Care Quality
Commission in relation to the work of its Mental Health Act
Commissioners. The Commissioners regularly visit wards to ensure
compliance with the provisions of the Act. The Mental Health Act
administrators - in partnership with clinical staff - ensure that all elements
of the operation and implementation of the mental health legislation are
processed in accordance with the requirements of the Act.
A Mental Health Law Implementation Group comprising the administrators
and clinical and managerial staff, undertake monitoring of the
implementation of the legislation and other operational issues.
In addition, Associate Hospital Managers (who are independent lay
people) are an integral part of the operation of the Act. They undertake the
duties of the Trust Board for the purposes of hearings and reviews in
relation to the detention of patients and are also involved in the operation
of this Mental Health Implementation monitoring Group.
3.6.5 External assurance report against Monitor indicators
See Auditor’s report - Appendix 5
3.6.6 External assurance report against the Quality Report
See Auditor’s report – Appendix 5
Annual Report and Annual Accounts 2011-12

3.7 Engaging with and Listening to Service Users and Local
Groups
3.7.1 Engaging with Service Users and Carers
The Trust engages with service users and carers through a variety of ways
including through face-to-face contact with staff; membership of our
Foundation Trust and Council of Members, and Forums linked to our six
business streams (Adults, Later life and Memory Service, Learning
Disability, Child and Adolescent Mental Health, Forensic, KIPS Community
Services). Executive and Non-Executive Directors, and other Senior
Managers attend the Forums for ‘Take it to the Top’ which offers an open
question and answer session and updates on strategic business.
In September last year, Jason Wolf from the Beryl Institute based in the
USA visited the Trust during his ‘On the Road Tour’. Jason aimed to
identify exemplar Patient Experience initiatives and share them through
the Institute’s website. In his online diary following his visit Jason made
reference to the Trust’s ‘Take it to the Top’ sessions.
He said that what stood out in learning about this program was how the
service users described the event: “Any Chief Executive who would open
himself up for a potential barrage of the unknown in order to bring his
facility closer to the needs of the community is a significant action and as
one person stated a particularly brave undertaking. This modelling of
expected behaviour is one of the best examples I have seen in healthcare
of a willingness to step out and engage in a conversation of patient and
community needs. By providing people direct access to the top and
ensuring honest and straightforward answers, the leaders make a
statement about how all staff should behave in engaging with patients,
families and the community.”
Jason also highlighted other work undertaken by the Trust including the
Big Brother Booth, the Personality Disorder Hub Experts By Experience
Programme and the Involvement Scheme.
3.7.2 Overview and Scrutiny Committees
The Trust links with five Overview and Scrutiny Committees on health
issues and proposed developments of the Trust. The Quality Report has
been shared with Local Involvement Networks (LINks) and Overview and
Scrutiny Committees and they have been invited to contribute to the 2011-
12 Quality Report.
Appendix 1 contains supporting statements from a range of external
organisations. This includes:
The Commissioning PCT
LINks Groups
Local Authority Overview and Scrutiny Committees.
Annual Report and Annual Accounts 2011-12 109

110
3.7.3 Engaging with Third Sector Organisations
The Trust works closely with a wide variety of Third Sector organisations
including:
LINks in Halton, Knowsley, St Helens, Warrington, Wigan, Sefton and
Liverpool
Trans Resource Empowerment Centre supported the development of
the Trusts Transgender policies
Lesbian and Gay Foundation - Providing staff training and policy advice
Carers Centres and Groups were involved in the development of a
Carers Booklet
Remploy, Richmond Fellowship and Warrington Disability Partnership
provide employment support to staff and service users
Breakthrough Art in Mental Health have provided national opportunities
to promote artwork produced by our service users
Newfound Theatre Group were involved in the launch of our Carers
Champions
No Secrets - Self Harm Support Group deliver training to staff
Knowsley Older Peoples Voice has been actively involved in the
response to the NPSA Alert regarding Syringe Drivers.
Annual Report and Annual Accounts 2011-12

3.7.4 Further examples of Engagement and Responsiveness
Annual
Foundation Trust
- Council of
Members
• 26 members of the
public make up the 48
Council of Members
Involvement Event
•Attracted over 180 service
users, carers and
representatives from 3 rd
Sector Organisations
Sticks and Stones
Campaign
•Nationalexposure with
107,097 people signed up
•1,490 Twitter followers
and 2,332 Facebook friends
Trust Joint Service
Users and Carers
Forum
•Includes "Take it to the
top" session with Chief
Executive
5BP
Engagement
Trust
Involvement
Scheme
• Co-ordinates the
involvement of 333
service users, carers
and volunteers in
business activities
Other Trust Service
Users and Carers
Forums
•Learning Disability
•Later Life & Memory Services
•Forensic Units
•5 Stars – Children and Young
People
•4 x Knowsley Health Forums
Local LINks
organisations
• Attend meetings of the
Trust Patient & Public
Involvement Advisory
Group
Investingin
Children
• Developing engagement
with young service
users
3.7.5 How can we improve? – ask ‘Big Brother’
Having previously piloted the use of our portable ‘Big Brother Booth’ within
our community settings, during the reporting year we gave our in-patients
at our hospital at Hollins Park in Warrington the opportunity to feedback on
the quality of our services on camera. This included traditionally hard-toreach
audiences including people in our learning disability settings.
For the first time we also used the booth to hear from people who have
received healthcare from our newly-acquired Knowsley Integrated Provider
Services.
Annual Report and Annual Accounts 2011-12 111

112
The Booth continues to be a key tool in our award-winning campaign to
challenge stigma. We are now working with schools and young people to
capture their views both before and after they have received the lessons
that are incorporated within our educational packs.
3.7.6 Sticks and Stones Campaign
Our ‘Sticks and Stones’ campaign to challenge mental health and learning
disability-related stigma received two commendations in 2011, from the
Association of Healthcare Communications and Marketing and ChaMPS
Public Health Network.
During the reporting year we succeeded in achieving a very specific
behavioural goal designed to improve the mental well-being of our service
users - collecting 106,577 pledges on our online petition not to use words
like ‘nutter’ to describe people with mental ill-health and learning
disabilities.
We created 2.3 million opportunities for people to read stories about
mental health and learning disabilities in the media – helping to reduce
stigma by promoting greater public awareness and understanding of
conditions like Personality Disorder.
Specially-designed educational packs produced with the input of teacher
volunteers are currently being delivered in schools across our footprint.
The packs include lesson plans and activities for children aged four to 16 -
supporting teachers to improve the quality of education young people
receive around mental health and learning disabilities.
We have increased our Corporate Partnership membership to more than
30 employers – working with them to embed the campaign values within
their workplaces and improve the quality of support they provide to
employees with mental ill-health.
3.8 Key messages from external stakeholders for 2011-12
3.8.1 Messages from St Helens OSC
Support the quality priorities identified for 2012-13
Would welcome further updates of progress against the priorities
indicators throughout the year
Would welcome information specific to St Helens
Areas of interest are patient safety, falls and safeguarding.
Annual Report and Annual Accounts 2011-12

3.8.2 Messages from Warrington LINks
Keen to see that the Trust is placing emphasis on listening to patient
and carer experiences and focussing on capturing lower-level concerns
Would like to receive progress reports throughout the year as opposed
to a once a year event
Happy that the matrons’ role is being reviewed with a view to delivering
the quality agenda.
3.9 Benchmarking against other organisations
Where possible the Trust engages in benchmarking with similar
organisations. Examples of this include:
Trust membership of the North West Performance Benchmarking
group (which looks at activity data and quality initiatives such as
CQUIN)
Collaborative working with the North West Mental Health Clinical Audit
Network
Collaborative working with the North West Mental Health NICE Group -
working to establish reporting against NICE quality standards
The Trust uses benchmarking data from the National Patient Safety
Agency (NPSA) to provide baselines and definitions of harm
The incident reporting quality measure and thresholds are based on
NPSA benchmark data
From Benchmark data provided by the National Patient Safety Agency
(NPSA) the Trust continues to be a high reporter of incidents in the
past year in comparison with other Mental Health Trusts
The data provided from the National Patient Survey (Appendix 2) is
benchmarked against the top 20% NHS Mental Health Trusts and the
bottom 20% of NHS Mental Health Trusts to provide context and
comparisons for staff and service users
Participation in the Employers’ Forum Disability Standard
Completion of the North West NHS Equality Performance Improvement
Toolkit.
Annual Report and Annual Accounts 2011-12 113

114
Appendices
Appendix 1 - Supporting Statements
Clinical Governance and Clinical Risk Committee
The Clinical Governance and Clinical Risk Committee is one of the two
sub-committees of the Trust Board which delegates authority to ensure
that appropriate structures, systems and processes are embedded in the
organisation to manage patient safety and clinical risk and ensure that
services are continuously improving. The Committee reports to the Board
following each of its meetings who also formally receive the committee’s
minutes. The Committee has close links with the Trust’s Audit Committee
and communicate directly with them over key issues by way of a verbal
report from the Chairman who is a member of both committees.
During 2011-12 closer links have been forged with the Members Council
by way of the service user representative and, more recently, the Chair of
the Compliance with Authorisation Committee. Standing items on the
agenda include detailed scrutiny of: serious untoward incidents;
compliance with the Care Quality Commission Essential Standards for
Quality and Safety; and a Patient Safety Dashboard which displays
integrated patient safety data. This enables the Committee to inform the
Trust Board of any lapses and ensuring appropriate actions are taken to
address any deviation from accepted standards.
The committee was subjected to review by the Trust’s internal auditors in
2012 and their results gave an assessment of “substantial assurance” for
the Trust on the operation of the Committee.
Dr Colin Dale
Non-Executive Chair Clinical Governance & Clinical Risk Committee
Annual Report and Annual Accounts 2011-12

Quality Accounts – 5 Boroughs 2011/12
In reflection on the year 2011/12, I believe the Trust’s quality management
processes have continued to evolve positively both in the measures
developed and utilised and in the transparency of the monitoring process.
Quality management receives strategic leadership and reports are
routinely submitted to the board. External scrutiny is delivered by a
quarterly quality review group chaired by the Commissioning lead for
Mental Health, NHS Knowsley and draws membership from associate
PCTs. This group has reviewed a number of quality measures and has
undertaken a ‘deep dive’ into a range of clinical areas including Learning
Disability Services and Adult Services during 2010/11. The consistent
pattern evident is of an organisation that has quality management at its
core.
Quality management is a continual evolving cycle in which all involved
need to seek to challenge whether systems are robust to drive clinical
quality. The Trust has shown a willingness to facilitate such challenge and
responded positively. There were instances arising in 2011/12 relating to
ward design and environmental safety that are subject to ongoing
consideration to ensure the highest standards of patient safety is
achieved. The Trust and commissioning bodies are seeking to ensure that
appropriate capital investment in infrastructure is deployed based on
robust environmental risk assessment.
During 2011/12 the Trust agreed a number of quality improvement
measures, known as CQUINs, which generated a payment for
achievement. This is the third year of such an arrangement. These
measures cover a range of topics and are challenging and include system
redesign. The Trust has maintained an appetite to deliver such challenging
quality improvement measures and sustain them. The Trust with partners
have developed and taken forward plans for system redesign which have
the quality of care delivery at heart. These will be implemented early in
2012/13.
Commissioning arrangements and relationships are changing during
2012/13 as a result of changes to commissioning roles and responsibilities
resulting from legislation. During this transition all commissioning bodies
remain committed to work with the Trust to support it further in its attempts
to drive quality up further. Commissioners remain vigilant on quality and
governance issues and will continue to monitor these areas closely.
Mr C Vose
Sub-Director for Mental Health and Learning Disabilities, Knowsley
Health and Well-being
Annual Report and Annual Accounts 2011-12 115

116
2011/12 Quality Account
NHS Merseyside Statement
In line with the NHS (Quality Accounts) Regulations 2011, NHS
Merseyside can confirm that we have reviewed the information contained
within the account and checked this against data sources where this is
available to us as part of existing contract/performance monitoring
discussions and is accurate in relation to the services provided. We have
reviewed the content of the account and can confirm that this complies
with the prescribed information, form and content as set out by the
Department of Health.
As Director for Service Improvement and Executive Nurse for NHS
Merseyside I believe that the account represents a fair and balanced view
of the 2011/12 progress that 5 Boroughs Partnership NHS Foundation
Trust has made against the identified quality standards.
Overall NHS Merseyside is supportive of the process 5 Boroughs
Partnership NHS Foundation Trust has taken to engage with patients, staff
and stakeholders in developing a set of quality priorities and measures for
2011/12 and applaud their continued commitment to improvement.
Trish Bennett
Director of Service Improvement & Executive Nurse, NHS Merseyside
Annual Report and Annual Accounts 2011-12

Warrington LINk Statement
5 Boroughs Partnership NHS Foundation Trust Quality
Accounts 2011-2012
The Warrington LINk welcomes the opportunity to be able to
comment on the Trust’s Quality Account. Warrington LINk and
the Trust have a good relationship with LINk members and staff
involved in various meetings within the Trust. The LINk agrees with the
Trust’s main improvement priorities for 2012/13.
The LINk welcomes the Falls Strategy that the Trust plan to develop
across the Trust and will review its success in March 2013.
The LINk recognises the work 5BPS has done in engaging with service
users and carers, especially on Care Plans and supporting carers, but
welcomes the further actions that the Trust will undertake to further
improve this and engage more with service users and carers.
The effective process of feeding in comments and issues raised by the
LINk continues with the Trust. Monthly comments and issues are shared
and within 20 days a response, with actions and outcomes, have been
received. Over the last 12 months six issues have been raised by
individuals and carers, and several issues raised by one carer regarding
Kingsley Ward. A report was also produced documenting 29 service users
and carers views on mental health services in Warrington. A response was
received by 5BPS. Through the LINks Care Navigation Role a further four
issues have been raised and dealt with. The majority of issues can be
categorised as communication issues, attitudes of staff and access to
services.
LINk members and staff have been involved in various meetings and
groups within the Trust and will continue to be involved in 2012-13.
Warrington LINks have contributed to Joint Service User and Carer
meetings, PPI Meetings within the Trust, and have been involved in
Equality and Diversity meetings.
Over the past year the LINk has undertaken one Enter and View visit, with
more planned for 2012-13.
Other priorities for the LINk over the past year have been the continued
work on the A&E Liaison Service Team. This will remain a priority in 2012
– 13. Another priority for the LINk in 2012-13 will be the new Acute Care
Pathway, and engaging with service users and carers on the changes and
any impact for them.
Produced by Warrington LINk
April 2012 KL
Annual Report and Annual Accounts 2011-12 117

118
St. Helens LINk
5 Boroughs Partnership Quality Account Commentary
LINk welcomes the opportunity to provide commentary supporting 5
Boroughs Partnership Quality Account, 2011/12, provided to LINk in a
timely manner and presented during a Q&A session on 2nd May.
During the last year LINk members attended various forums and Patient &
Public Involvement Advisory Group and 5 Boroughs welcomed
partnership-working and the challenges LINk provided.
The coming year’s priorities for improvement are challenging and reflect
issues community members, service users and LINk members want to see
addressed. LINk accepts priorities about preventing falls and raising
concerns as stated.
Shared Decision-Making, Person Centred Planning and communication is
central to comments LINk gathered from service users and carers and key
to quality. Many included actions can be achieved by service users and
carers having good quality care plans; a ‘cultural shift’ is required of Trust
staff to deliver this. Staff coaching/mentoring will help, but take time to
become common practice.
The Trust has participated in work with Implementing Recovery through
Organisational Change (ImRoc). In this Quality Account, its mention is
minimal, focusing on broad processes with ‘recovery’ based on individuals
and outcomes they wish to see.
A specific concern is the ‘red’ indicators in the National Patients Survey
indicators, which were less in previous years.
LINk challenges the Trust to ensure that in service redesign and
commitment to quality, focus is maintained on specific needs of the
discrete areas they provide services to, by gaining further understanding of
communities they serve.
Annual Report and Annual Accounts 2011-12

Knowsley LINk
5 Boroughs Partnership Quality Account Commentary
Knowsley LINk welcomes the opportunity to provide this
commentary in support of the 5 Boroughs Partnership Quality
Account for 2011/12. The Quality Account report was provided
to LINks in a timely manner and presented thoroughly during a question
and answer session held in May.
During the last twelve months the partnership-working and challenges
provided through Knowsley LINk has been welcomed by 5 Boroughs
Partnership. Knowsley LINk members have regularly attended the Joint
Service User and Carer Forum and Patient & Public Involvement Advisory
Group; these have proved to be a good point of contact with the Trust.
We have also welcomed the opportunity to work closely with the Knowsley
Integrated Provider Services who provide community-based services in
Knowsley. Plans are in place to see this continue throughout 2012/13.
It is felt that the Priorities for Improvement identified for the coming year
are both challenging and reflective of the issues community members,
service users and LINk members are keen to see addressed. Shared
Decision-Making and Person Centred Planning are very much at the heart
of the comments Knowsley LINk have gathered from Service Users and
Carers and are a key aspect of quality. It is also important to stress the
need for clear communication between staff, service users and carers and
the availability of information at the point of need in achieving the priorities
that have been set. The priority focusing on the collection of Patient
Experience information is also welcomed. Knowsley LINk members would
be keen for progress in this area to be shared with LINk to support the
ongoing monitoring of this priority over the next 12 months.
Knowsley LINk would also challenge the Trust to ensure that in service
redesign and in their commitment to quality, a focus is maintained on the
specific needs of the areas they provide services to - continuing to gain an
understanding of the local communities which they serve.
Annual Report and Annual Accounts 2011-12 119

120
Halton LINk Statement
Boroughs Partnership NHS Foundation Trust
Quality Accounts 2011-12
“Members welcomed the Trust’s commitment to share the report widely
and to seek the views of the Halton LINk. Members appreciated the
opportunity to be able to give feedback at a presentation to the Board on
22 nd February 2012.
The LINk recognises and values the good work done by the Trust to gain
the views of users and carers and we hope the Trust will continue to build
on the relationships developed through frequent user and carer meetings
and events.
The Trust has been cooperative with Halton LINk, with representatives
attending the Patient & Public Involvement meetings and LINk Host
meetings to share their experiences and to keep abreast of the activities
the Trust carries out to involve the public with their work. We hope this ongoing
dialogue with all the LINks, within the geographical area covered by
the Trust, is maintained.
The Halton LINk appreciates the improvements made during the past year
and welcomes the Trust’s list of priorities for the coming year including
work to be done on preventing falls. We hope that on-going meaningful
dialogue with service users, carers and the wider community will help the
Trust ensure their priorities are achieved.”
Annual Report and Annual Accounts 2011-12

Wigan Borough Local Involvement Network
Health and Care Together
Wigan Borough Local Involvement Network
1st Floor Office CT3, Wigan Investment Centre
Waterside Drive, Wigan, WN3 5BA
Tel: 01942 705 522
Email: info@healthandcaretogether.co.uk
Health and Care Together response to Quality Accounts
Thank you for the opportunity to review your quality Report for 2011/12. I
have detailed below some points which Wigan LINk would be pleased to
have incorporated in the report.
Comments on the Quality Report
Wigan LINk is pleased to read of the many improvements in the services
provided by 5 Borough Trust - particularly where these are evidenced from
surveys of users and their carers. Whilst there is an implication that
standards are the same across all parts of the Trust, it would be helpful in
future years to have a specific section of the document relating to each of
the boroughs and actions by their respective Health and Well-being
Boards and the relevant CCGs. Differing priorities in each area may make
it difficult for the Trust to maintain common standards where funding
priorities differ significantly.
The Priorities for Improvement in 2012/13, section 2.1, do not seem to
address the single amber indicator from the CQC outcomes: i.e.
Safeguarding people who use services from abuse. A more explicit
statement of what these shortcomings were and how they are being
improved would have been helpful.
You indicate a number of actions to be undertaken in response to the
findings of the 241 local clinical audits that have been completed. A useful
further action point would be to report back on the percentage of actions
achieved by the original target date and also to measure the length of any
delay that does occur, along with the reasons for it. In essence the actions
you choose to take are by implication the more important ones for your
Trust and so it would be helpful to understand why they may not have
been achieved.
Section 3.4.3 refers to your staff winning in the Nursing Times Awards –
well done to all of them for the work that has been undertaken and we look
forward to future references to the benefits that have accrued for patients
from the implementation of the Personality Disorder Strategy.
Annual Report and Annual Accounts 2011-12 121

122
It was good to note also in section 3.5.5 the level to which service users
are now being involved in advising on improvements that affect their safety
and the increase in Involvement Opportunities mentioned in section 3.5.6.
Appendix 2 shows a good level of improvement in levels of Patient
Experience, which is welcome.
Thank you for this opportunity to comment and we look forward to
receiving your next Quality report.
Yours Sincerely
Chris Arkwright
Chair of Health & Care Together, Wigan Borough LINk
Annual Report and Annual Accounts 2011-12

Re: 5 Boroughs Partnership NHS Foundation Trust Quality Account
2011/12
Thank you for the opportunity to comment on your Quality Account. The
Health Policy and Performance Board has particularly noted the following
key areas:
In 2011/12 the Trust identified three Quality and Safety priorities and
indicators to be achieved by March 2012. These indicators were as
follows:
Safety: Preventing avoidable harm
Effectiveness: Good physical healthcare
Experience: Ensuring a positive experience of care.
The Board was pleased to see that the Trust did successfully meet the
desired criteria for each of these indicators.
The Board notes that during the period 1 April 2011 to 31 March 2012 the
Trust received a total of 242 complaints. The main themes of complaints
received were as follows:
Treatment issues
Communication
Staff attitude
Waiting times for appointments/access to services
Records issues
Service provision.
The Trust received a total of 1,013 compliments during the same period of
time.
The Board notes that the Trust has been able to identify three quality
priorities for 2012/13 which will demonstrate improvements in patient
safety, patient experience and effectiveness of services. The three quality
priorities are:
Safety: Falls – By October 2012 the Falls Strategy will be rolled out and by
March 2013 the number of falls will have reduced by 10 per cent.
Effectiveness: Shared Decision-Making – Ensure that service users share
in decision-making using such tools as the Triangle of Care.
Annual Report and Annual Accounts 2011-12 123

124
Experience: Issues of Concern – By October 2012 establish methods of
collating, reporting and acting upon issues of concern and compliments
expressed by our service users and carers.
The Board welcomes these quality principles, which will address some of
the complaints that have been received over the 2011/12 period.
It is noted that from the information received that the Trust has done
significant work over the last 12 months to achieve good performance
against a series of indicators - taking part in a number of clinical trials and
receiving a National Award in Mental Health. Members welcome the
opportunity to contribute to the Quality Account process and any
opportunities to contribute further in the future.
Yours sincerely
Cllr Ellen Cargill
Chair, Health Policy and Performance Board
Annual Report and Annual Accounts 2011-12

Knowsley Overview and Scrutiny Board
Commentary to the 5 Boroughs NHS Partnership Foundation Trust
The Knowsley Overview and Scrutiny Board welcomes the opportunity to
provide a commentary on the 5 Boroughs NHS Partnership Foundation
Trust Quality Account.
The Board has delegated responsibility for considering Quality Accounts to
the Chair of the Overview and Scrutiny Board in consultation with the Lead
and Deputy Lead Member for the Well-Being theme. A meeting was
convened on Wednesday 9 May to consider the Quality Account document
received by the 5 Boroughs Partnership NHS Trust. The three members
spent time considering the document and made a number of observations,
which have formed the basis of the Board’s commentary, as set out below.
We focused our discussions around three priority areas. Our first was the
Trust’s Improvement Priorities for 2012-2013 and the achievements
highlighted over the previous year. We discussed where we thought work
should be commended and whether there were areas where we felt more
information may have been useful. Our final observations referred to the
layout, style and format of the document - particularly focusing on how the
document related to and/or involved the public.
We felt that the Trust’s priorities for improvement highlighted specific areas
where improvements should be made although, like other Quality
Accounts, we were unclear as to the rationale behind them. In terms of last
year’s achievements we felt that the Trust’s work around patient safety
was good - particularly the Patient Safety Framework, which had been put
in place to ensure quality and safety activities were co-ordinated. We felt
that the Trust’s work on training and workforce development was
extremely positive - particularly the way service users had been involved in
contributing to training practices. Similarly, we thought that the Trust’s
focus on service user involvement in patient safety and Trust business in
general was commendable. Our only comment was that we felt it was
important that the Trust ensured that patients and their
carers/friends/relatives were at the heart of decision-making around a
patients’ care needs.
We were reassured to see that the Trust’s action plan in response to the
CQC inspection has now been fully completed. We agree that the Trust
needs to feel confident that its safeguarding processes meet the needs of
all service users. We felt that the Trust’s performance against local and
national targets was good and would like to see the thresholds for
Monitor’s community care indicators in next year’s report.
Annual Report and Annual Accounts 2011-12 125

126
We also hope that the Trust will begin to capture the information in relation
to Monitor’s four additional indicators - particularly the one which
measured the number of patients dying at home.
We were interested to see the Trust performing well in terms of treatment
time at Walk-In Centres but we hope that the Trust recognises that the
quality of service provided at the Centres is equally important. We would
be interested in seeing the trend in the number of patients treated at Walk-
In Centres and the referrals made as a result in order to feel reassured
that people are being provided with the high level of care that is expected
of the Trust by the community.
We welcomed the use of tables, charts and diagrams and the three part
approach to the report layout. However, we thought it would be useful if
there was a glossary of terms and acronyms at the back to enable
members of the public to make sense of the technical information. We also
felt that the Knowsley Integrated Provider Services element was not given
sufficient attention within the report and would have welcomed separate
information on the two Providers for this year as we understood that the
Trust was taking a phased approach to integration of KIPS into 5
Boroughs. Overall we thought that the report was informative and
interesting and we would welcome the opportunity to receive updates on
progress towards your improvement priorities in order to provide an
informed and accurate commentary next year.
This commentary has been provided by Councillor Mal Sharp (Chair of
Overview and Scrutiny Board), Councillor Bob Swann (Lead Member for
Well-being) and Councillor Kay Moorhead (Deputy Lead Member for Wellbeing)
on behalf of Knowsley Overview and Scrutiny Board.
Annual Report and Annual Accounts 2011-12

11 May 2012
Many thanks for sharing your quality account with us and asking for
feedback. I shared the report with a number of colleagues to request their
views on the account. One of the observations was around the lack of
reporting around the following areas: 3.7.1; 3.9.1 and 3.9.2. The numbers
around MRSA and C-Diff offer assurance that there are effective
measures in place to ensure patients are not at risk. I must also
congratulate you on your impressive number of compliments from 21 per
cent to 88 per cent is a terrific achievement and the small increase of 4 per
cent to 19 per cent for complaints is also a significant achievement.
A further observation around your Quality and Safety priorities is your
intention to reduce the amount of falls by 10 per cent considering that at
the last quality meeting there was a notable increase in the data with 18
reported falls in January to eight last month with a worrying trend from
June – September last year when there was as many as 18 falls being
registered. Is 10 per cent a sufficient reduction or should the Trust not be
aspiring to reduce this further?
Regarding the Trust’s quality measures I was disappointed that there was
no mention around what measures you were hoping to implement to
address a steady increase in the number of medication / controlled drug
errors during the last 12 months and I wonder what actions will be taken to
improve the steady increase in this area of patient safety.
I welcome the programme that you have put together regarding the patient
safety framework - particularly your strong emphasis on the thematic
review of serious untoward incidents Safer Mental Health Checklist and
the emergence of a clinical quality dashboard to feedback to frontline staff
are all significant improvements to ensure that there is a cohesive
approach to ensuring that quality and safety are shared across the
organisation.
The ‘Creating Time to Care’ strategic objective demonstrates a desire to
address the core values of ensuring that the patient remains at the heart of
care delivery. The productive ward programme has been recognised as an
innovative programme, which will improve the patient experience but also
offer an ideal opportunity for frontline staff to demonstrate their skills to
make real improvements in the main domains of patient care quality,
safety and cost-effectiveness. The inclusion of the five quality metrics,
which are regularly reviewed, will identify areas for improvement by the
team.
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128
I also feel that the mechanisms in place regarding your proactive approach
to seeking ‘How you can improve’ and reduce stigma are innovative and
demonstrate the organisation’s willingness to take on board
comments from stakeholders where there are areas that may benefit from
feedback to improve healthcare delivery.
From a primary care perspective there were some areas that I believe it
would be beneficial to receive assurance on in the future, which would
include access / location clinics; DNA rates; readmissions; quality of
outpatient and discharge letters and adherence to prescribing policies.
Can I also add that one of the comments which I received from a primary
care practitioner congratulated the Trust for their ‘proactive and cooperative’
way of working, which they believe has improved relationships
with primary care and will lead to improvements in future developments of
mental health provision for the local community.
I believe that this report offers a balanced view of the Trust’s quality of
care during the last 12 months.
Yours sincerely
John Wharton
Quality Manager
Annual Report and Annual Accounts 2011-12

Appendix 2 - National Patient Survey Results 2011
Each year since 2004, all NHS Trusts providing mental health services
have taken part in the Care Quality Commission National Patient Survey,
which is designed to gather information about service user experiences
and assess how Trusts are performing.
The findings of the 2011 survey are reported in two ways. The
‘Standardised’ version shows the Trust rated as about the same in all
questions except one which was rated as ‘better’ - Does your care plan set
out your goals?
In addition to the ‘Standardised’ results there is a set of ‘benchmarked’
results which identifies scores for each question and if the Trust is in the
top 20 per cent, middle 60 per cent or bottom 20 per cent when compared
to other Trusts.
Using the benchmarked approach the Trust has six scores in the bottom
20 per cent and 15 in the top 20 per cent, (Fig 1).
Fig 1. Top / Bottom 20 per cent responses to the National Patient
Survey 2011
Question – Red (Bottom)
1 Do you know who your Care Coordinator
(or lead professional) is?
2 Were you told that you could bring
a friend, relative or advocate to
your care review meetings?
3 Were you given a chance to
express your views at the
meeting?
4 Did you find the care review
helpful?
5 Did you discuss whether you
needed to continue using NHS
mental health services?
6 In the last 12 months, have you
received support from anyone in
NHS mental health services in
getting help with financial advice
or benefits?
5BP
score
Threshold for
lowest scoring
20 per cent
78 79
74 74
81 81
68 68
64 67
62 62
Annual Report and Annual Accounts 2011-12 129

130
Question – Green (Top)
Annual Report and Annual Accounts 2011-12
5BP
score
Threshold for
highest scoring
20 per cent
1 Did this person listen carefully to you? 90 89
2 Were you given enough time to discuss your
condition and treatment?
86 85
3 Do you think your views were taken into account in
deciding which medicines to take?
74 74
4 Has a mental health or social care worker
checked with you how you are getting on with your
medication?
84 82
5 Can you contact your Care Co-ordinator (or lead
professional) if you have a problem?
88 87
6 Do you understand what is in your NHS care plan? 76 72
7 Does your NHS care plan set out your goals? 65 64
8 Have NHS mental health services helped you start
achieving these goals?
9 Does your NHS care plan cover what you should
do if you have a crisis?
10 Before the review meeting, were you given a
chance to talk to your Care Co-ordinator about
what would happen?
11 Do you have the number of someone from your
local NHS mental health service that you can
phone out of office hours?
12 The last time you called the number did you have
any problems getting through to someone?
13 Has anyone in NHS mental health services ever
asked you about your alcohol intake?
14 Has anyone in NHS mental health services ever
asked you about your use of non-prescription
drugs?
15 Have NHS mental health services involved a
member of your family or someone else close to
you as much as you would like?
71 71
73 72
74 74
67 66
89 83
71 70
54 52
74 66

Fig 2. The results from the Trust’s Patient Experience Survey in
March 2012 compared to most similar question from the 2011
National Patient Survey
Trust Patient
Experience Survey
(Community Mental
Health Teams)
Questions
Numbers correspond
to those on the actual
questionnaire
1 Dignity and Respect:
In relation to dignity and
respect, how would you
rate the care and
treatment you receive from
our staff?
3 Your Care Plan: How do
you rate the level of
involvement you have in
the development of your
care plan?
4 Care and Treatment:
How well do you feel our
staff deliver what is
contained in your care
plan?
5 Medication: How would
you rate the information
you have been given by
our staff about your
medication?
6 Staff: How would you
describe the amount of
time you were given to
discuss your condition and
treatment with the staff?
7 Crisis: Have you been
given a telephone number
in mental health services
to contact in an
emergency?
10 Overall: Overall, how
would you rate the care
and support you receive
from our staff?
National Patient
Survey 2011
Questions
Did this person treat
you with respect and
dignity?
Do you think your
views were taken into
account when deciding
what was in your care
plan?
Have NHS mental
health services helped
you start achieving
these goals?
Were you given
information about the
medication in a way
that was easy to
understand?
Were you given
enough time to discuss
your condition and
treatment?
Do you have the
number of someone
from your local NHS
mental health service
that you can phone out
of office hours?
Overall, how would you
rate the care you have
received from mental
health services in the
last 12 months?
National
Patient
Survey
2011
Results
Trust Survey
Per Cent of
Good and
Excellent
93 95
72 88
71 91
72 87
86 92
67 84
72 94
Annual Report and Annual Accounts 2011-12 131

132
Appendix 3 - Trust Patient Experience Survey
Mental Health and Learning Disability
The Annual National Patient Survey provides data regarding patient
experience. To gain a real-time understanding of service users’
experiences of services we also operate an internal Patient Experience
Survey.
The survey tool (questionnaire) was designed in partnership with service
users; carers and staff from the Operations and Corporate Directorates.
Each business stream has adapted the wording and format of the survey
tool to best meet the needs of their service users. Each survey covers 10
themes identified within the appropriate National Patient Survey
(community or in-patient).
An easy-read version has been developed for use in Learning Disability
Services and carers/families/advocates are invited to support the survey in
Later Life and Memory Services and Learning Disability Services.
The common themes identified from the National Patient Surveys are:
1 In-patients. Service users are asked to rate the quality of their
experience of:
Admission
Being treated with dignity and respect
Cleanliness of the ward
Quality of information
Level of involvement in the development of care plans
How well staff delivered what was identified in a care plan
Information about medication
Amount of time spent with staff
Feeling safe while on a ward
Their ‘overall’ experience while on the ward.
2 Community Services: Service users are asked to rate the quality of their
own experience of:
Being treated with dignity and respect
Quality of information
Level of involvement in the development of care plans
How well staff delivered what was identified in a care plan
Information about medication
Amount of time spent with staff
Provision of contact details for crisis support
Information, advice or support relating to employment, training or
further education
Cleanliness of Trust premises
Their ‘overall’ experience of receiving services.
Annual Report and Annual Accounts 2011-12

Service users are asked to complete questionnaires as they are
discharged from the ward and a percentage of service users are offered
the questionnaires in community settings. During the past three months
response rates from the in-patient surveys have averaged 64 per cent and
monthly averages of 175 community surveys have been received.
The results are presented by Trust-wide in-patient, Trust-wide community
and by business stream (Adults Services, Later Life and Memory Services;
Learning Disability Services; Forensic Services and Child and Adolescent
Mental Health Services) and by individual ward and team.
Each survey identifies further ways for service users to feed their
experiences back to the Trust including Complaints and PALS. Each
survey also promotes the Patient Opinion website where service users and
carers are encouraged to describe their experiences in their own words.
Postings from the Patient Opinion website are in the Trust’s monthly
Performance Report.
Examples of the 2011 Results
Over 85 per cent of service users from in-patient services answered
‘Good or Excellent’ to the question relating to ‘Medication’ - How would
you rate the information you have been given by our staff about your
medication?
Over 93 per cent of service users from in-patient services answered
‘Good or Excellent’ to the question relating to ‘Safety’ - How safe do
you feel on your ward?
Over 90 per cent of service users from community services answered
‘Good or Excellent’ to the question relating to ‘Care and Treatment’ -
How well do you feel our staff deliver what is contained in your care
plan?
Over 91 per cent of service users from community services answered
‘Good or Excellent’ to the question relating to ‘Staff Time’ - How would
you rate the amount of time our staff are able to spend with you?
Over 99 per cent of service users from learning disability community
services answered ‘Yes’ to the question relating to ‘Dignity and
Respect’ - Do you feel ____________ listened to you?
Knowsley Integrated Provider Services (KIPS)
A Generic Satisfaction Survey has been designed to gain patients’
perception on the various services provided by KIPS.
The results are compared with the results from previous audits and
compared to the standards set by the Commissioning for Quality and
Innovation Payment Framework (CQUIN) targets.
Annual Report and Annual Accounts 2011-12 133

134
The eight objectives of the Generic Satisfaction Survey are:
Gain patients’ perception of the staff delivering their care
Gain patients’ perception on the treatment they received
Determine if patients’ felt involved in the decisions about their care
Determine if patients were given advice/information in relation to
signposting
Determine the overall satisfaction with care received
Determine patients’ understanding of the process for
comments/suggestions or complaints
Gain patients’ perception of information/advice provided
Assess aspects of patients’ well-being and lifestyle.
Each individual service participating in the Generic Satisfaction Survey
tailored the methodology to suit the needs of their service users.
A total of 42 services took part in the Generic Satisfaction Survey for
September 2011 in comparison to 35 services in the previous survey
undertaken in December 2010.
A total of 3,781 surveys were given to patients and 1,914 were returned -
giving a response rate of 51 per cent compared to 42 per cent in 2010.
The survey also contained a number of questions to determine if aspects
of patients’ well-being and lifestyle were being addressed.
Each individual service used their own results to write conclusions, make
recommendations and produce an action plan.
Annual Report and Annual Accounts 2011-12

Appendix 4 Director’s Statement of Responsibility
The Directors are required under the Health Act 2009 and the National
Health Service (Quality Accounts) Regulations 2010 to prepare Quality
Accounts for each financial year.
Monitor has issued guidance to NHS Foundation Trust Boards on the form
and content of annual Quality Reports (which incorporate the above legal
requirements) and on the arrangements that Foundation Trust Boards
should put in place to support the data quality for the preparation of the
Quality Report.
In preparing the Quality Report, Directors are required to take steps to
satisfy themselves that:
The content of the Quality Report meets the requirements set out in the
NHS Foundation Trust Annual Reporting Manual 2011-12
The content of the Quality Report is not inconsistent with internal and
external sources of information including:
- Board minutes and papers for the period April 2011 to May
2012
- Papers relating to Quality reported to the Board over the
period April 2011 to May 2012
- Feedback from the commissioners dated 21 May 2012
- Feedback from governors dated 10 May 2012
- Feedback from LINks dated:
Halton LINks 2 May 2012
Knowsley LINks 10 May 2012
St Helens LINks 10 May 2012
Wigan LINks 4 May 2012
Warrington LINks 3 May 2012
- The Trust’s Complaints Report published under Regulation
18 of the Local Authority Social Services and NHS
Complaints Regulations 2009 dated April 2012.
- The latest National Patient Survey: Survey of people who
use community mental health services 2011
- The latest National NHS Staff Survey 2011
- The Head of Internal Audit’s annual opinion over the Trust’s
control environment dated April 2012
Annual Report and Annual Accounts 2011-12 135

136
- CQC quality and risk profiles dated:
Release 7 – April 2011 Release 12 – October 2011
Release 8 – May 2011 Release 13 – November 2011
Release 9 – June 2011 Release 14 – December 2011
Release 10 – July 2011 Release 15 - February 2011
Release 11 – August 2011 Release 16 – March 2011
The Quality Report presents a balanced picture of the NHS Foundation
Trust’s performance over the period covered
The performance information reported in the Quality Report is reliable
and accurate
There are proper internal controls over the collection and reporting of
the measures of performance included in the Quality Report and these
controls are subject to review to confirm that they are working
effectively in practice
The data underpinning the measures of performance reported in the
Quality Report is robust and reliable; conforms to specified data quality
standards and prescribed definitions; is subject to appropriate scrutiny
and review and the Quality Report has been prepared in accordance
with Monitor’s annual reporting guidance (which incorporates the
Quality Accounts regulations published at www.monitornhsft.gov.uk/annualreportingmanual)
as well as the standards to
support data quality for the preparation of the Quality Report (available
at www.monitor-nhsft.gov.uk/annualreportingmanual).
The Directors confirm to the best of their knowledge and belief they have
complied with the above requirements in preparing the Quality Report.
By order of the Board
...................................... Date...29/05/2012
Chairman
…………………..…...... Date...29/05/2012
Chief Executive
Annual Report and Annual Accounts 2011-12

Appendix 5 Monitor External Assurance Statement
Independent Auditor’s Report to the Council of Members of 5
Boroughs Partnership NHS Foundation Trust on the Annual Quality
Report
I have been engaged by the Council of Members of 5 Boroughs
Partnership NHS Foundation Trust to perform an independent assurance
engagement in respect of 5 Boroughs Partnership NHS Foundation Trust’s
Quality Report for the year ended 31 March 2012 (the ‘Quality Report’)
and certain performance indicators contained therein.
Scope and subject matter
The indicators for the year ended 31 March 2012 (subject to limited
assurance) consist of the national priority indicators as mandated by
Monitor:
Minimising delayed transfers of care
Admissions to in-patient services had access to crisis resolution home
treatment teams.
I refer to these national priority indicators collectively as the ‘indicators’.
Respective responsibilities of the Directors and auditors
The Directors are responsible for the content and the preparation of the
Quality Report in accordance with the criteria set out in the NHS
Foundation Trust Annual Reporting Manual issued by the Independent
Regulator of NHS Foundation Trusts (‘Monitor’).
My responsibility is to form a conclusion, based on limited assurance
procedures, on whether anything has come to my attention that causes me
to believe that:
The Quality Report is not prepared in all material respects in line with
the criteria set out in the NHS Foundation Trust Annual Reporting
Manual
The Quality Report is not consistent in all material respects with the
sources specified in Section 2.1 of Monitor's Detailed Guidance for
External Assurance on Quality Reports 2011-12
The indicators in the Quality Report identified as having been the
subject of limited assurance in the Quality Report are not reasonably
stated in all material respects in accordance with the NHS Foundation
Trust Annual Reporting Manual and the six dimensions of data quality
set out in the Detailed Guidance for External Assurance on Quality
Reports.
I read the Quality Report and considered whether it addresses the content
requirements of the NHS Foundation Trust Annual Reporting Manual and
considered the implications for my report if I became aware of any material
omissions.
Annual Report and Annual Accounts 2011-12 137

138
I read the other information contained in the Quality Report and
considered whether it is materially inconsistent with:
Board minutes for the period April 2011 to May 2012
Papers relating to quality reported to the Board over the period April
2011 to May 2012
Papers relating to quality reported to the Clinical Governance and
Clinical Risk Committee over the period April 2011 to May 2012
Feedback from the Commissioners dated May 2012
Feedback from Governors dated May 2012
Feedback from LINks dated May 2012
The Trust’s Complaints Report published under Regulation 18 of the
Local Authority Social Services and NHS Complaints Regulations
2009, dated April 2012
The latest national patient survey
The latest national staff survey
Care Quality Commission quality and risk profiles from 2011/12
The Head of Internal Audit’s annual opinion over the Trust’s control
environment dated April 2012
Any other information included in our review.
I considered the implications for my report if I became aware of any
apparent mis-statements or material inconsistencies with those documents
(collectively the ‘documents’). My responsibilities do not extend to any
other information.
I am in compliance with the applicable independence and competency
requirements of the Institute of Chartered Accountants in England and
Wales (ICAEW) Code of Ethics. My team comprised assurance
practitioners and relevant subject matter experts.
This report, including the conclusion, has been prepared solely for the
Council of Members of 5 Boroughs Partnership NHS Foundation Trust as
a body, to assist the Council of Members in reporting 5 Boroughs
Partnership NHS Foundation Trust’s quality agenda, performance and
activities.
I permit the disclosure of this report within the Annual Report for the year
ended 31 March 2012 to enable the Council of Members to demonstrate
that it has discharged its governance responsibilities by commissioning an
independent assurance report in connection with the indicators.
To the fullest extent permitted by law I do not accept or assume
responsibility to anyone other than the Council of Members as a body and
5 Boroughs Partnership NHS Foundation Trust for my work or this report -
save where terms are expressly agreed and with my prior consent in
writing.
Annual Report and Annual Accounts 2011-12

Assurance work performed
I conducted this limited assurance engagement in accordance with
International Standard on Assurance Engagements 3000 (Revised) –
‘Assurance Engagements other than Audits or Reviews of Historical
Financial Information’ issued by the International Auditing and Assurance
Standards Board (‘ISAE 3000’).
My limited assurance procedures included:
Evaluating the design and implementation of the key processes and
controls for managing and reporting the indicators
Making enquiries of management
Testing key management controls
Limited testing, on a selective basis, of the data used to calculate the
indicator back to supporting documentation
Comparing the content requirements of the NHS Foundation Trust
Annual Reporting Manual to the categories reported in the Quality
Report
Reading the documents listed above under the respective
responsibilities of the Directors and auditors.
A limited assurance engagement is less in scope than a reasonable
assurance engagement. The nature, timing and extent of procedures for
gathering sufficient appropriate evidence are deliberately limited relative to
a reasonable assurance engagement.
Limitations
Non-financial performance information is subject to more inherent
limitations than financial information - given the characteristics of the
subject matter and the methods used for determining such information.
The absence of a significant body of established practice on which to draw
allows for the selection of different but acceptable measurement
techniques which can result in materially different measurements and can
impact comparability. The precision of different measurement techniques
may also vary. Furthermore, the nature and methods used to determine
such information, as well as the measurement criteria and the precision
thereof, may change over time. It is important to read the Quality Report in
the context of the criteria set out in the NHS Foundation Trust Annual
Reporting Manual.
The nature, form and content required of Quality Reports are determined
by Monitor. This may result in the omission of information relevant to other
users - for example for the purpose of comparing the results of different
NHS Foundation Trusts.
In addition, the scope of my assurance work has not included governance
over quality or non-mandated indicators which have been determined
Annual Report and Annual Accounts 2011-12 139

140
locally by 5 Boroughs Partnership NHS Foundation Trust.
Conclusion
Based on the results of my procedures, nothing has come to my attention
that causes me to believe that for the year ended 31 March 2012:
The Quality Report is not prepared in all material respects in line with
the criteria set out in the NHS Foundation Trust Annual Reporting
Manual
The Quality Report is not consistent in all material respects with the
sources specified above
The indicators in the Quality Report, subject to limited assurance, have
not been reasonably stated in all material respects in accordance with
the NHS Foundation Trust Annual Reporting Manual and the six
dimensions of data quality set out in the Detailed Guidance for External
Assurance on Quality Reports.
Julian Farmer
Officer of the Audit Commission
Audit Commission,
2nd Floor,
Aspinall House, Aspinall Close,
Middlebrook,
Horwich,
Bolton
BL6 6QQ
25 May 2012
Annual Report and Annual Accounts 2011-12

Appendix 6 Performance against CQUIN targets 2011-12
Mental Health and Learning Disability Services
Indicator Name Goal Year-end position
EFFECTIVENESS AND SAFETY
Physical health screen and
examination for people
commencing on depot medication
All patients commencing on depot medication will receive a
physical health screen and examination before
commencement for those who have had no physical health
screen and examination in the previous 12 months
SAFETY AND EXPERIENCE
Prescribing of major tranquilisers Production of a report outlining the level of major tranquilisers
Induction of new care pathway
education programme
prescribing for patients with a diagnosis of dementia
A series of 12 workshops for stakeholders including GPS
outlining the new care pathway for dementia. Workshops will
be held equally in each area (Ashton, Leigh and Wigan,
Warrington, Knowsley, Halton, St Helens).
Workshops will be scheduled to maximise participation from
primary care professionals
Carers Distress To use a rating scale which is mutually acceptable to the
Trust and the Commissioner and is evidence-based with
carers to determine which interventions have the greatest
impact on reducing carers distress
141
Indicator met in all quarters
Indicator met in all quarters
Indicator met in all quarters
Indicator met in all quarters
Annual Report and Annual Accounts 2011-12 141

142
142
Indicator Name Goal Year-end position
OUTCOMES
Acute Care Pathway To review the Acute Care Pathway and implement a new care
pathway that results in demonstrably better access for service
users and improved response times for General Practitioners
SAFETY
Harm Reduction The Trust will systematically introduce processes with the aim
of reducing four specific areas of harm in each of its business
streams (excludes Forensic and KIPS as is covered in a
separate contract)
Safer Mental Health Checklist Piloting of the safer mental health checklist (within adult
services and in a named borough)
Review of Risks and Absconds Trust will submit a paper for the publication to a relevant
professional journal and present the findings at a conference
on the outcome of the pilot
EFFECTIVENESS, QUALITY &
EXPERIENCE
Advancing Quality To improve the quality of care delivered to patients in
Dementia
To improve the quality of care delivered to patients in Early
Intervention
Annual Report and Annual Accounts 2011-12
Indicator met in all quarters. Due to
the delay in consultation stage this
indicator has been re-negotiated to
reflect this
Indicator met in all quarters
Indicator met in all quarters
Indicator met in all quarters
Indicator met in all quarters
Indicator met in all quarters

Indicator Name Goal Year-end position
PATIENT EXPERIENCE
ESSEN Scale To encourage the development of service developments /
improvements informed by the output from previous use of
the ESSEN Scale. Service developments should aim to
improve the service user experience and clinical outcomes
EFFECTIVENESS
HONOS The data submitted through this CQUIN will inform the future
process of agreeing an appropriate tariff for secure mental
health services
EFFECTIVENESS
Length of Stay This CQUIN is intended to incentivise providers to better
understand their current lengths of stay and develop
strategies to reduce them
EFFECTIVENESS
25 Hours Meaningful Activity This CQUIN promotes a balanced and structured day
involving meaningful activity linked to service users agreed
care plans that promote recovery. Implementation of CQUIN
will enhance the experience of care and enhanced clinical
outcomes
Involvement, Choice and
Responsibility
143
This CQUIN promotes the notion of service users and care
staff working in real partnership in order that service users
can move through a shared pathway in a timely manner. It is
assumed that in doing so the length of stay can be reduced
and the experience of care improved
Indicator met in all quarters
Indicator met in all quarters
Indicator met in all quarters
Indicator met in all quarters
Indicator met in all quarters
Annual Report and Annual Accounts 2011-12 143

144
Knowsley Integrated Provider Services (KIPS) 2011-12
EFFECTIVENESS
Indicator Name Goal Year end position
DNA Rate Improvement To reduce the DNA rate in specific services with high DNA
EFFECTIVENESS
TCS Health and Well-being
Pathway – Brief Intervention
Survey
PATIENT EXPERIENCE
To establish a baseline of the percentage of people who
receive brief intervention from KIPS services
Patient Survey - Stretch Targets To improve patient satisfaction
EFFECTIVENESS
High Impact Actions – Keeping
Nourished
144
To monitor the percentage of DN who have received MUST
training and to monitor the percentage of clients who need a
MUST assessment who meet the eligibility criteria
Annual Report and Annual Accounts 2011-12
Achieved in eight of the 13 services –
CQUIN partially met
Indicator met in all quarters
All services were reviewed twice during
2011-12 with an average response rate
of 50 per cent
Indicator met in all quarters

EFFECTIVENESS
TCS Mental Health Pathway –
Dementia
PATIENT EXPERIENCE
TCS Learning Disability Pathway –
Reasonable Adjustments
EFFECTIVENESS
TCS Children and Families
Pathway – Health Visiting
EFFECTIVENESS
High Impact Actions – Falls
Prevention
145
To monitor the percentage of staff in applicable services that
have received dementia awareness training
To establish the baseline information required to monitor the
percentage of people with LD who receive reasonable
adjustments to access services AND to monitor this. To
monitor the percentage of appointments for people with LD
that have reasonable adjustments made
To evidence the number of children who require support
above universal provision and then monitor if they have
received this
To identify falls champions for the following services - District
Nursing, Matrons, Podiatry, Continence, Community Therapy/
Intermediate Care, Walk-in Centres. Within these services:
100 per cent of all new referrals to those services over 65 are
asked if they have had a fall (as per NICE guidance) and 100
per cent of those who have had a fall have a completed stage
1 falls assessment and have been referred on as appropriate.
KIPS - also to develop a three-level training package which
will be rolled out as per plan
Indicator met in all quarters
Indicator met in all quarters
Indicator met in all quarters
Indicator met in all quarters
Annual Report and Annual Accounts 2011-12 145

Appendix 7 Advancing Quality Programme
An explanation of advancing quality is included in this report at section 3.5.3
First-Episode Psychosis Num Dem Rate Num Dem Rate Num Dem Rate Num Dem Rate Num Dem Rate Num Dem Rate Num Dem Rate
Risk assessment
Care coordinator
Medication review
Composite Process Score (CPS)
100.00%
90.00%
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
146
146
69 70 98.57% 14 15 93.33% 9 9 100.00% 17 17 100.00% 7 7 100.00% 11 11 100.00% 11 11 100.00%
70 70 100.00% 15 15 100.00% 9 9 100.00% 17 17 100.00% 7 7 100.00% 11 11 100.00% 11 11 100.00%
67 67 100.00% 14 14 100.00% 8 8 100.00% 17 17 100.00% 7 7 100.00% 11 11 100.00% 10 10 100.00%
206 207 99.52% 43 44 97.73% 26 26 100.00% 51 51 100.00% 21 21 100.00% 33 33 100.00% 32 32 100.00%
AQ - Psychosis
Risk assessment Care coordinator Medication review
Annual Report and Annual Accounts 2011-12
July Total October AugustJune
November September
June
July
August
September
October
November

Total June July August
September
October
November
Dementia Num Dem Rate Num Dem Rate Num Dem Rate Num Dem Rate Num Dem Rate Num Dem Rate Num Dem Rate
Functional capacity assessment 108 120 90.00% 14 17 82.35% 15 18 83.33% 20 20 100.00% 15 18 83.33% 21 24 87.50% 23 23 100.00%
Cognitive ability assessment 106 115 92.17% 16 18 88.89% 19 20 95.00% 19 19 100.00% 13 16 81.25% 23 24 95.83% 16 18 88.89%
Physical health assessment 132 137 96.35% 20 22 90.91% 24 24 100.00% 22 22 100.00% 16 18 88.89% 25 26 96.15% 25 25 100.00%
Tailored care plan 86 91 94.51% 14 15 93.33% 17 17 100.00% 13 13 100.00% 11 13 84.62% 17 19 89.47% 14 14 100.00%
Depression and Anxiety assessment 114 134 85.07% 14 21 66.67% 21 24 87.50% 19 21 90.48% 14 18 77.78% 23 26 88.46% 23 24 95.83%
Composite Process Score (CPS) 546 597 91.46% 78 93 83.87% 96 103 93.20% 93 95 97.89% 69 83 83.13% 109 119 91.60% 101 104 97.12%
100.00%
90.00%
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
147
Functional capacity
assessment
Cognitive ability
assessment
AQ - Dementia
Physical health
assessment
Tailored care plan Depression and Anxiety
assessment
June
July
August
September
October
November
Annual Report and Annual Accounts 2011-12 147

148
Appendix 8 Complaints Report 2011-12
Compliant with Regulation 18 of The Local Authority Social Services
and National Health Service Complaints (England) Regulations 2009.
During the period 1 April 2011 to 31 March 2012:
We received 242 complaints.
We closed 237 complaints. Of these:
204 (86.1 per cent) were closed within a timescale agreed with the
complainant
33 (13.9 per cent) were closed outside of this agreed timescale.
Of the 237 closed complaints:
155 (65.4 per cent) of all complaints closed had none of the issues
complained about upheld.
82 (34.6 per cent) of all complaints closed were well founded (had
some or all of the issues complained about upheld).
During the reporting period, we were informed of eight complaints that
were referred to the Parliamentary and Health Service Ombudsman. The
Ombudsman reported on the investigation of one complaint, partly
upholding the complaint against the Trust.
Breakdown of themes of complaints received (top 5) for MH/LD:
Treatment issues (34 per cent)
Communication (25 per cent)
Staff attitude (13 per cent)
Waiting times for appointments/ access to services (8 per cent)
Records issues (3 per cent)
Breakdown of themes of complaints received (top 5) for ICS:
Treatment issues (41 per cent)
Service provision (18 per cent)
Staff attitude (17 per cent)
Waiting times for appointments/ access to services (14 per cent)
Communication (10 per cent)
We received 1,013 compliments.
We received 10 MP enquiries
We dealt with 110 concerns.
Annual Report and Annual Accounts 2011-12

5 Boroughs Partnership
NHS Foundation Trust
Appendix 2
2011 – 2012
Annual Report and Annual Accounts 2011-12 149

150
Statement of the Chief Executive’s
responsibilities as the Accounting Officer
of 5 Boroughs Partnership NHS Foundation Trust
The NHS Act 2006 states that the Chief Executive is the Accounting
Officer of the NHS Foundation Trust. The relevant responsibilities of
Accounting Officers, including their responsibility for the propriety and
regularity of public finances for which they are answerable and for the
keeping of proper accounts, are set out in the NHS Foundation Trust
Accounting Officer Memorandum issued by the Independent Regulator of
NHS Foundation Trusts (‘Monitor’).
Under the NHS Act 2006 Monitor has directed 5 Boroughs Partnership
NHS Foundation Trust to prepare to each financial year a statement of
accounts in the form and on the basis set out in the Accounts Direction.
The accounts are prepared on an accruals basis and must give a true and
fair view of the state of affairs of 5 Boroughs Partnership NHS Foundation
Trust and of its income and expenditure, total recognised gains and losses
and cash flows for the financial year.
In preparing the accounts the Accounting Officer is required to comply with
the requirements of the NHS Foundation Trust Annual Reporting Manual
and in particular to:
Observe the Accounts Direction issued by Monitor - including the
relevant accounting and disclosure requirements and apply suitable
accounting policies on a consistent basis
Make judgements and estimates on a reasonable basis
State whether applicable accounting standards as set out in the NHS
Foundation Trust Annual Reporting Manual have been followed and
disclose and explain any material departures in the financial
statements
Prepare the financial statements on a going concern basis.
The Accounting Officer is responsible for keeping proper accounting
records which disclose with reasonable accuracy at any time the financial
position of the NHS Foundation Trust and to enable him to ensure that the
accounts comply with requirements outlined in the above mentioned Act.
The Accounting Officer is also responsible for safeguarding the assets of
the NHS Foundation Trust and hence for taking reasonable steps for the
prevention and detection of fraud and other irregularities. To the best of
my knowledge and belief, I have properly discharged the responsibilities
set out in Monitor’s NHS Foundation Trust Accounting Officer
Memorandum.
Simon Barber, Chief Executive 28 May 2012
Annual Report and Annual Accounts 2011-12

Independent Auditor’s Report
to the Council of Members of 5 Boroughs Partnership NHS
Foundation Trust
I have audited the financial statements of 5 Boroughs Partnership NHS
Foundation Trust for the year ended 31 March 2012 under the National
Health Service Act 2006.
The financial statements comprise the Statement of Comprehensive
Income; the Statement of Financial Position; the Statement of Changes in
Taxpayers’ Equity; the Statement of Cash Flows and the related notes.
These financial statements have been prepared under the accounting
policies set out in the Statement of Accounting Policies.
I have also audited the information in the Remuneration Report that is
subject to audit, being:
The table of salaries and allowances of senior managers (and related
narrative notes) in note 7.5
The table of pension benefits of senior managers (and related narrative
notes) in note 7.6
The disclosure of the median remuneration of the reporting entity’s staff
and the ratio between this and the mid-point of the branded
remuneration of the highest paid Director.
This report is made solely to the Council of Governors of 5 Boroughs
Partnership NHS Foundation Trust in accordance with paragraph 24(5) of
Schedule 7 of the National Health Service Act 2006.
My audit work has been undertaken so that I might state to the Council of
Members those matters I am required to state to it in an auditor’s report
and for no other purpose.
To the fullest extent permitted by law I do not accept or assume
responsibility to anyone other than the Foundation Trust as a body for my
audit work for this report or for the opinions I have formed.
Respective responsibilities of the Accounting Officer and Auditor
As explained more fully in the Statement of Accounting Officer’s
Responsibilities the Accounting Officer is responsible for the preparation of
the financial statements and for being satisfied that they give a true and
fair view.
Annual Report and Annual Accounts 2011-12 151

152
My responsibility is to audit the financial statements in accordance with
applicable law, the Audit Code for NHS Foundation Trusts and
International Standards on Auditing (UK and Ireland). Those standards
require me to comply with the Auditing Practice’s Board’s Ethical
Standards for Auditors.
Scope of the audit of the financial statements
An audit involves obtaining evidence about the amounts and disclosures in
the financial statements sufficient to give reasonable assurance that the
financial statements are free from material mis-statement whether caused
by fraud or error.
This includes an assessment of whether the accounting policies are
appropriate to the Trust’s circumstances and have been consistently
applied and adequately disclosed; the reasonableness of significant
accounting estimates made by the Trust and the overall presentation of
the financial statements. I read all the information in the Annual Report to
identify material inconsistencies with the audited financial statements. If I
will become aware of any apparent material misstatements or
inconsistencies I consider the implications for my report.
Opinion on financial statements
In my opinion the financial statements:
Give a true and fair view of the state of affairs of 5 Boroughs
Partnership NHS Foundation Trust’s affairs as at 31 March 2011 and of
its income and expenditure for the year then ended
Have been properly prepared in accordance with the accounting
policies directed by Monitor as being relevant to NHS Foundation
Trusts.
Opinion on other matters
In my opinion:
The part of the Remuneration Report subject to audit has been
properly prepared in accordance with the accounting policies directed
by Monitor as being relevant to NHS Foundation Trusts
The information given in the Annual Report for the financial year for
which the financial statements are prepared is consistent with the
financial statements.
Matters on which I report by exception
I write to you if my opinion the Annual Governance Statement does not
reflect compliance with Monitor’s requirement. I have nothing to report in
this respect.
Annual Report and Annual Accounts 2011-12

Certificate
I certify that I have completed the audit of the accounts of 5 Boroughs
Partnership NHS Foundation Trust in accordance with the requirements of
the National Health Service Act 2006 and the Audit Code for NHS
Foundation Trusts issued by Monitor.
Julian Farmer
Engagement Lead
2nd Floor, Aspinall House
Aspinall Close
Middlebrook
Horwich
Bolton
BL6 6QQ
29 May 2012
Annual Report and Annual Accounts 2011-12 153

154
Annual Governance Statement 2011/12
1. Scope of Responsibility
As Accounting Officer I have responsibility for maintaining a sound System
of Internal Control that supports the achievement of the 5 Boroughs NHS
Foundation Trust’s policies, aims and objectives whilst safeguarding the
public funds and departmental assets for which I am personally
responsible in accordance with the responsibilities assigned to me. I am
also responsible for ensuring that the NHS Foundation Trust is
administered prudently and economically and that resources are applied
efficiently and effectively. I also acknowledge my responsibilities as set out
in the NHS Foundation Trust Accounting Officer Memorandum.
As part of the Transforming Community Services agenda the planned
transfer of Knowsley Integrated Provider Services (KIPS) took place on 1
April 2011. The Trust completed a robust period of due diligence to ensure
the alignment of governance arrangements and the safe transfer of
services.
2. The Purpose of the System of Internal Control
The System of Internal Control is designed to manage risk to a reasonable
level rather than to eliminate all risk of failure to achieve policies, aims and
objectives. It can therefore only provide reasonable and not absolute
assurance of effectiveness. The System of Internal Control is based on an
ongoing process designed to identify and prioritise the risks to the
achievement of the policies, aims and objectives of the 5 Boroughs
Partnership NHS Foundation Trust; to evaluate the likelihood of those risks
being realised (and the impact should they be realised) and to manage
them efficiently, effectively and economically. The System of Internal
Control has been in place in 5 Boroughs Partnership NHS Foundation
Trust for the year ended 31 March 2012 and up to the date of approval of
the Annual Report and accounts.
3. The Capacity to Handle Risk
Leadership
As the Accounting Officer and Chief Executive of the Trust I take lead
responsibility and accept accountability for ensuring that a sound System of
Internal Control and a robust assurance framework is in place. The
organisational management structure illustrates the Trust’s commitment to
effective governance including the risk management processes.
KPMG completed a review of the Trust Corporate Governance
Arrangements in February 2012 with an overall rating given of
Substantial Assurance
Annual Report and Annual Accounts 2011-12

I have delegated responsibility for the co-ordination of risk management to the
Director of Nursing and Governance. She is supported by the Deputy Chief
Executive, Chief Operating Officer, Director of Finance, Director of Human
Resources and Organisational Development and the Medical Director who are
responsible for overseeing risk management activities within their individual
areas of responsibility.
The Risk Management Policy clearly defines the governance and risk
management structures across the Trust and devolvement within each Trust
Directorate.
The breadth and depth of experience in the Trust Board is clearly reflected in
the way important decisions are developed, challenged and achieved.
Strategic planning and decision-making is carried out by the full Trust Board
without compromising the required independence and challenge of the Non-
Executive Directors as appropriate.
The Chief Operating Officer is responsible for leading strategy within the Trust
- taking account of external and internal influences including national strategy,
local needs and the Trust’s competitors’ plans.
KPMG completed a review of the Trust Risk Management Arrangements in
March 2012 with an overall rating given of Substantial Assurance
Risk Management Accountability
The Trust Risk Management Policy sets out the overall aims and objectives
for Risk Management that are delivered through an annual work plan set
against each of the objectives. The Risk Management Policy describes a clear
structured and systematic approach to the management of risk across
organisational, financial and clinical activities.
The Risk Management Policy sets out both the collective responsibilities of
the Trust Board and its Committees and individual responsibility of the Chief
Executive, Directors and all level of staff across the Trust.
The Trust Audit Committee seeks assurance that the risk management
process is comprehensive, effective, complies with regulatory requirements
and is fit for purpose by taking independent objective advice through the
appointment of internal auditors and approves the Annual Governance
Statement.
The Trust Board receives an Assurance and Risk Report at each meeting to
review the identification, evaluation and control of financial, clinical and nonclinical
risk and the risks against the achievement of the Trust High-level
Objectives.
Annual Report and Annual Accounts 2011-12 155

Staff Education and Development
Induction
The principles of risk management are included as part of the mandatory
corporate induction that covers an introduction to a wide range of topics
including subjects such as risk, governance, health and safety, fire
awareness, handling complaints, equality and diversity, safeguarding children
and adults, patient and public involvement and human resource issues for all
staff.
Induction is extended for clinical staff to include clinical skills such as Basic
Life Support and Breakaway techniques. Also included is training on the
electronic care records system and the Care Planning Approach (CPA)
process. The Trust Training Needs Analysis identifies additional risk-based
training that is available to staff as appropriate to their duties.
Statutory, Core and Developmental Training
This is available for all staff groups within the training programmes as stated
within the Trust’s Core and Statutory Training Policy.
In addition to the statutory and core training schedule, staff are further
developed based on the outcomes of their Performance and Development
Review leading to the development of a Personal Development Plan.
Incident Management
Incident reporting and learning from experience is an essential part of
effective risk management. Training on the management of Serious Untoward
Incidents and the use of root cause analysis has continued to support robust
review of incidents and learning.
The Incident Management Policy provides a framework to facilitate in-depth
analysis of and learning from events. Step-by-step guidance outlining what to
do following an incident (including immediate incident management), how to
report the incident and once reported how this is taken forward within the
Trust is clearly described.
Analysis of Serious Untoward Incidents, complaints and claims takes place at
the well-established weekly Incidents, Complaints and Claims Accountability
Meeting. All Serious Untoward Incident reviews and high-level complaint
reviews are reviewed at the Patient Safety Panel Meeting which is held
monthly. This allows for challenge and scrutiny and for corporate level and
Business Stream ownership of action plans. The Patient Safety Panel is
Chaired by the Director of Nursing and Governance or Assistant Director of
Nursing and Safeguarding and has PCT Commissioner and service user carer
membership.
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Policy and Guidance
A range of clinical and non-clinical policies, procedures and guidance is
available to staff in electronic format on the intranet that all staff have access
to. This assists them in managing risk.
The review and ratification process ensures that all policies go through a
process of engagement and consultation with staff - including formal staff-side
consultation. They also undergo impact assessment in relation to training,
equality and diversity, safeguarding and NHSLA requirements. Appropriate
training and development requirements are identified at the impact
assessment stage and are added to the Training Needs Analysis database.
There is a system for ensuring due process has been followed before policies
are ratified by the Clinical Governance and Clinical Risk Committee.
When Knowsley Integrated Provider Services were incorporated into the Trust
portfolio, they brought some policies and procedures with them under TUPE.
These too are available on the intranet and identified as being for KIPS staff.
When policies are due for review policies are rewritten so as to apply to all
Trust staff - with separate procedures if they are warranted for mental health,
learning disability or integrated community services business streams as
appropriate.
The Trust was assessed against the National Health Service Litigation
Authority Risk Management Standards in December 2011 at Level 1 and
achieved 100 per cent compliance
Quality and Safety Learning
The Trust is proud to be a learning organisation and is continually striving to
improve. The Trust has a range of mechanisms in place to ensure the timely
and effective communication of lessons learned and changes made to
improve practice and Systems of Internal Control.
To ensure quality and safety learning is co-coordinated across the different
parts of the Trust, we have developed our Patient Safety Framework, which
consists of:
Patient Safety Panel (challenge meetings around Serious Untoward
Incident reports)
Safety and Quality Metrics reporting aggregated risk management data
Patient Safety walkabouts to visit clinical services
Thematic review using the Safer Mental Health Checklist
Monthly Business Stream Risk Reports providing bespoke risk
management data and analysis
Clinical Quality Dashboard to feed back key data to frontline staff.
Annual Report and Annual Accounts 2011-12 157

A series of briefings alerts and newsletters that aim to ensure learning is
shared are distributed throughout the Trust regularly. Learning is further
shared in the form of annual conferences such as the Service User and Carer
Involvement Conference, Service User Physical Health and Well-Being
Conference and the Trust’s Patient Safety Conference.
4. The Risk and Control Framework
Risk Management Policy
The overall aim of risk management is to ensure that high-quality healthcare
services are delivered with the safety, health and well-being of services users,
carers and staff at the forefront of everything we do and to provide assurance
through clear reporting structures that the risk management system across
the Trust is embedded and effective.
The Trust is committed to ensuring the safety of service users, staff and the
public through an integrated approach to managing risk whether financial,
organisational or clinical, within systems that are open and transparent and
demonstrate sound governance.
Risk Management Process
In pursuit of implementing effective risk management the Trust Risk
Management Policy has adopted the overarching process for managing all
risk within a single framework. The Risk Management Policy details the
framework for identification, evaluation, analysis, treatment, control,
monitoring and review of risks within a single Trust-wide Risk Register.
Knowsley Community Provider Services were integrated into the Trust-wide
Risk Register on the transfer of services - ensuring that a single system of risk
management was in place.
The risk management process begins with the identification of risks
throughout the Trust. Risks are identified through a number of sources
including risk assessment, audit, incidents, complaints, safety alerts, external
reviews and inspection, emerging financial and environmental risks and
compliance with statutory and regulatory requirements.
Risks are evaluated and prioritised using a qualitative approach where the risk
levels, (Consequence and Likelihood) are estimated. This provides an
estimate of where the most serious overall risks lie and assists both the
evaluation and prioritisation of risks within the management decision-making
process.
The Risk Management Policy clearly describes the process for authority to
manage risk within the Trust with low-level risk being managed locally and
high-level risk escalated to the Trust Management Team and reported to the
Trust Board. The Trust Board receives bi-monthly reports on the current
status and management of all risks within the Trust.
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Directors attending the Trust Operational Performance Team meetings review
high-level risks monthly and in further detail at the Clinical Governance and
Clinical Risk Committee, which is a sub-committee of the Trust Board.
During 2011/2012 developments have taken place to integrate reporting of the
Trust Risk Register and the Assurance Framework. Since October 2011 the
Trust Board has received an integrated Assurance and Risk Report. This now
provides the Trust Board with a joined-up Risk Management Report to fully
consider the risks to achieving the high-level objectives.
The Trust’s main risks as set out in the Trust Risk Register in year are:
The Trust raised a high-level risk in relation to demonstrating compliance
with Care Quality Commission Essential Standards of Safety and Quality.
The Trust has a system of continual compliance in place that involves
scrutiny by the Clinical Governance and Clinical Risk Committee. Through
Internal Systems of Control the Trust identified areas of improvement
around policy to practice. The Trust has implemented an annual
programme of internal inspections aimed at testing practice in line with
CQC standards. The internal inspections will be integrated into the existing
compliance cycle
During 2011/2012 the Trust reviewed its Serious Untoward Incident
Review process with a focus on further improving the quality of the
reviews. This has included commissioning of a 72-hour review to inform
and set the Terms of Reference for the review to ensure critical questions
are set and a focused timeline is established. In addition further quality
assurance steps have been included in the process. The Trust has raised
a risk relating to the timeliness of completion of the reviews in line with
National Patient Safety Agency Guidance
The Trust has taken steps to integrate the Risk Register and the
Assurance Framework throughout 2011/2012. KPMG completed a review
of the Risk Management and Board Assurance Framework in March 2012
with an outcome of substantial assurance. Areas of best practice were
identified by KPMG and the Trust is working to further develop and
integrate the Risk Register. A risk has been raised and mapped to the
Trust Objective to incorporate the identified areas of best practice.
Risk movement and control is monitored monthly at the Trust Operational
Performance Management meetings, where accountabilities for risk control
and risk movement are discussed. The operational groups for managing risk
are the Trust Management Team (Quality) and the Corporate Quality,
Performance and Risk Forum, which receives a monthly Safety and Quality
Metrics Report.
Annual Report and Annual Accounts 2011-12 159

The Trust accepts that risk cannot be completely eliminated but that it can be
managed and minimised. The Trust’s risk appetite is to accept a level of
acceptable or tolerable risk and defines this as a risk unlikely to lead to or
cause injury, illness or damage or only minimal disruption to the service we
provide.
Information Governance Risk Management
The management of Information Governance (IG) has significant profile
across the Trust. IG requires strong governance and risk management
processes to ensure compliance with relevant legislation and NHS Codes of
Practice. Integration of IG risks and incidents into the Trust’s Risk
Management and Incident Management Policy ensures effective local and
strategic management and scrutiny of risks and incidents.
The reporting of information security incidents into the DATIX risk
management system has been reviewed and a bespoke reporting system
developed to ensure specific information is captured. Two new reports were
developed - the Information Governance Incident Report and the Caldicott
Issues Log. This has enabled a more proactive approach towards IG incidents
to be undertaken. In addition information security breaches are reported
monthly through local and strategic aggregated incident reports. This allows a
broader analysis of security incidents and a Trust-wide approach to
improvement and learning.
The Trust continues to comply with the IG Toolkit’s requirements and declared
91 per cent (Satisfactory) compliance for 2011/12 (Version 9). The Director of
Nursing and Governance continues to be the Senior Information Risk
Owner/IG Lead and the Medical Director is the Caldicott Guardian. There
have been no incidents that have had to be reported to the Information
Commissioner.
160
KPMG audited the Information Governance Toolkit submission in
March 2012 with an overall rating given of Substantial Assurance
Data Quality
The Trust attaches a high level of importance to Data Quality and believes
that this is a foundation for the delivery of quality care, good patient
experience, the delivery of cost-effective services and assists with clinical
decision-making.
In 2011 the Trust has taken the following actions to improve data quality:
Continue to publish monthly data quality and completeness data at
Executive; Management and Operational Levels via the Trust intranet
Annual Report and Annual Accounts 2011-12

Continue to publish monthly High-level Trend Reports
Continue to publish quarterly benchmarking reports comparing Trust
achievement levels against, national, regional and local Trusts
Continue liaison with and training for operational teams to support
improvement of data quality across all services
Continue to liaise with Consultants and their medical teams in relation to
clinical coding and the availability of discharge and clinical information.
The Trust has implemented actions following the Monitor ‘dry run’ exercise
which looked at quality issues for data reporting against a number of Monitor
targets.
Compliance with CQC Essential Standards of Quality and Safety
5 Boroughs Partnership NHS Foundation Trust is required to register with the
Care Quality Commission and its current registration status is registered
without conditions. The Care Quality Commission has not taken enforcement
action against 5 Boroughs Partnership NHS Foundation Trust during 2011/12.
During 2011/12 the Trust was inspected by the Care Quality Commission as
part of their targeted inspection programme to review services for people with
learning disabilities. The review was to establish if in-patients experience
effective, safe and appropriate care and treatment and support that meets
their needs and protects their rights and whether they are protected from
abuse. The Trust has maintained registration without conditions. However, the
CQC visits identified some actions needed to maintain compliance with two
standards inspected during Q4 of 2011/12.
The Trust responded to the Care Quality Commission’s reports with an action
plan which is now fully completed. From a Trust-wide perspective the Trust
needs to feel confident that its processes are meeting the needs of all our
service users. The Trust has put a programme of work in place to self-assess
itself against the CQC Standards to ensure compliance is maintained across
the Trust.
Compliance with the 16 Essential Standards of Quality and Safety are
reported on a comparison dashboard via the Corporate Performance Report
within the Safety and Quality dataset. The dashboard shows compliance
measured by the Trust alongside the data issued monthly in the CQC Quality
and Risk Profile.
NHS Pension Scheme
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
into 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.
Annual Report and Annual Accounts 2011-12 161

Carbon Reduction and Climate Change
The Trust has undertaken risk assessments and Carbon Reduction Delivery
Plans are in place in accordance with emergency preparedness and civil
contingency requirements as based on UKCIP 2009 weather projects to
ensure that this organisation’s obligations under the Climate Change Act and
the Adaptation Reporting requirements are complied with.
The Trust continues to recognise its responsibility towards protecting the
environment. The Climate Change Act 2008 contains provisions that set a
legally-binding target for reducing UK carbon dioxide emission by at least 26
per cent by 2020 - with a target to cut emissions by 80 per cent by 2050
(compared to 1990 levels). The major impact of this legislation for the NHS
has been the requirement to join the emissions trading scheme knows as the
Carbon Reduction Commitment Energy Efficiency scheme (CRC). This will
require the current level of growth of emissions to not only be curbed but the
trend to be reversed and absolute emissions reduced. The Trust falls below
the threshold for inclusion within the CRC scheme, but has continued to seek
to demonstrate a reduction in carbon emissions in accordance with NHS
requirements.
Last year the Trust Board recognised a Sustainable Development
Management Plan; the signing up to the Good Corporate Citizenship
Assessment Model and the monitoring and review of carbon (and the need to
raise awareness of carbon at every level of the organisation). The Sustainable
Development Management Plan sets out how the Trust will initiate a low
carbon management programme to both lower carbon emissions and improve
the health of staff, patients and the wider population we serve.
The basis of measurement of a sound carbon management programme is the
carbon footprint of its activities. One of the responsibilities of the Sustainability
Working Group will be to set up audit procedures to monitor the impact on the
environment across all sectors of the Trust.
Our carbon emissions from electricity and gas (excluding KIPS) for the
reporting year is 4,112 tonnes. This does not include travel, procurement,
waste and water. Further work is required to calculate the Trust’s total carbon
footprint which will be based on all agreed activity. This will be included in the
Sustainability Working Group’s objectives.
Emergency Planning
Prior to 2011 the Trust was a Category Two responder under the Civil
Contingencies Act 2004. In 2011 the Trust took over responsibility for
Knowsley Integrated Community Services, who have a Category One
function. The Trust plays a full part in the local command and control structure
- working with NHS Merseyside in their capacity as tactical and strategic
commanders. Emergency plans are produced and audited by NHS
Merseyside on behalf of NHS North.
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These include Business Continuity and Major Incident Plans, and eventspecific
plans such as Heat Wave; Winter; Flood and Fuel Shortage plans.
Equality Impact Assessments
Control measures are in place to ensure that all the organisation’s obligations
under equality, diversity and human rights legislation are complied with.
Equality Impact Assessments are routinely undertaken as part of the Trust
policy ratification process. Copies of the assessments are audited by the
Equality Diversity and Inclusion Unit. Reports are presented to the
Trust Equality Diversity and Inclusion Steering Group, which is Chaired by an
Executive Director.
5. The Assurance Framework
The Trust regards the Assurance Framework as an essential element of the
management of risk within the Trust. The Assurance Framework is integrated
into the overarching Risk Management Framework.
The Assurance Framework provides evidence to support the Statement of
Internal Control and is based on the following key elements:
Defined Trust Objectives with clear lines of responsibility and
accountability
Identification of risks and the potential likelihood and consequence of risks
against achieving the Trust Strategic Objectives
Detail of controls currently managing the risks and identification of controls
needed to mitigate residual risk and provide assurance
Clear timescales for achievement of assurance and target risk
Internal reporting and governance arrangements in place to monitor
progress of risks
External sources of assurance linked to each risk
Identified gaps in assurance.
The Trust Board approves the Assurance Framework and receives bi-monthly
reports through the Assurance and Risk Report detailing progress against risk
control and assurance for the delivery of objectives.
The Leadership Forum is the accountable and responsible group for
monitoring and critical review of the Assurance Framework. Progress against
key targets are discussed at each meeting.
The Internal Audit Plan is developed based on the risks identified in the
Assurance Framework - providing the Trust Board and Audit Committee with
assurance on internal controls in place.
The Internal Audit Assurance Framework Opinion for 2011-12 provides an
overall rating of Substantial Assurance
Annual Report and Annual Accounts 2011-12 163

6. Involvement of Public Stakeholders in Managing Risk
Internal and External Stakeholders are involved in managing risks which
impact on them through their involvement in and contributions to many
aspects of the work of the Trust. The Trust has a range of mechanisms in
place to facilitate effective working with internal and external stakeholders to
ensure effective communication.
Partner Organisations
Partnership Agreements have been formally reviewed and agreed this year
with Halton, St Helens, Warrington and Wigan Local Authorities. NHS
Knowsley has formally signed a full partnership agreement under Section 75
of the NHS Act 2006 that also includes the Primary Care Trust.
The boroughs of Halton, Knowsley, St Helens and Warrington have
agreed the designation of Knowsley as the co-ordinating health
commissioner to link across all the boroughs on cross-borough service
commissioning issues
The Trust has a three-year multilateral Mental Health contract with NHS
Merseyside as the Cluster (previously NHS Knowsley co-ordinating
commissioner) and a three-year bilateral contract with NHS Ashton, Leigh
and Wigan - both of which are effective from the 1 April 2010. A contract
variation has been signed for both of these contracts for 2012-13 to
include changes to activity, finances and CQUIN
The Trust has a two-year multilateral Community contract with NHS
Merseyside (formerly NHS Knowsley) including NHS Halton and St Helens
- for Integrated Community Services with effect from 1 April 2011. A
contract variation has been signed for both of these contracts for 2012-13
to include changes to activity, finances and CQUIN
The Trust now has a one-year contract with NHS Western Cheshire on
behalf of the Specialist Commissioning Team for secure services. This
was previously contracted through NHS Knowsley
Partnership Boards/Local Implementation Teams are in place and deal
with the planning, commissioning, and monitoring of Adult Services; Later
Life and Memory Services; Forensic Services; Learning Disability Services
and Child and Adolescent Mental Health Services. These groups are multiagency
and include service users and carers
Liaison with the Overview and Scrutiny functions of each Local Authority in
respect of the service modernisation for planning updates, our Trust
application and in relation to the Trust Quality Accounts
Liaison and partnership work with staff and members from the five Local
Involvement Networks (LINks).
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Internal and External Stakeholders are involved in managing risks which
impact on them through their involvement in and contributions to many
aspects of the work of the Trust. The Trust has a range of mechanisms in
place to facilitate effective working with internal and external stakeholders to
ensure effective communication.
The Council of Members
The Trust has in excess of 9,000 members. The Council of Members is made
up of members of the public and our staff and people who have been
nominated by partner organisations. People who are elected to sit on the
Council of Members are called Member Councillors.
Member Councillors will make sure that the views of the community are
contributed when the Board of Directors develops strategies and plans for the
Trust. They also make sure that the Board complies with its Terms of
Authorisation and upholds the Trust's values.
Involving service users
The Trust is committed to providing opportunities to involve service users,
carers and members of the public (volunteers) in our business. We
acknowledge the unique contribution to services through their experience of
living with a health problem and using health services, personally or in a
caring role. This expertise is not available from any other source.
The Trust has developed an Involvement Scheme designed to provide a safe
and efficient process appropriate to enable volunteers to become involved in
all stages of designing, delivering and monitoring Trust services.
Service users and carers from all six business streams are invited to a
range of forums that meet regularly providing opportunities to meet with
members of the Trust Leadership Group via ‘Take it to the Top’ which
operate as open question-and-answer sessions
More than 320 service users, carers and volunteers are signed up to the
Trust Involvement Scheme - co-ordinating participation in more than 50
business activities including staff training; recruitment of senior managers;
audit; investigation and working groups; promotional events and corporate
committees
Participation of service users and carers with staff in Essence of Care
Audits (a framework tool that focuses on benchmarking the basics of care)
and PEAT (Patient Environment Action Team) Audits (an environmental
audit tool, results are benchmarked nationally)
In-house Patient Satisfaction Surveys operating across in-patient and
various community services that are analysed and reported monthly
Comments on service users’ (patients) experience collected from forums
and postings on the Patient Opinion website are reported via the Trust’s
monthly Performance Reports
Annual Report and Annual Accounts 2011-12 165

An innovative opportunity for service users and carers to comment on
services and express views using a Big Brother Booth-style audio/video
box. Footage is shown to the Trust Board, senior managers meetings and
during staff training
More than 180 service users, carers and representatives from 3rd sector
organisations attended the Trusts fourth Annual Involvement Event
Public membership of the Foundation Trust has risen to 5,552. The 48
Council Members represent a variety of constituencies including staff,
statutory sector partners and the general public. The majority of ‘public’
Council Members have direct experience of Trust services - many are
involved in local community organisations. This provides a communication
link to and from the wider public membership.
Staff
Staff are integral to effective risk management across all Trust activities in
existing services we provide and in the development of new systems,
processes and frontline services. Staff members identify and assess risk on a
daily basis and report through the Trust’s online risk management system
DATIX. Staff are involved in the ongoing management of risk throughout the
Trust and receive timely and effective communication of existing risks and
emerging risks. There are a number of communication methods in place
including:
Safe Place to Work Group that implements and monitors staff security and
safety issues
Health and Safety Committee
Participation in Business Stream Performance Meetings where risks and
incidents are discussed and monitored
Monthly distribution of Business Stream Risk Reports and Safety and
Quality Metrics
BME staff network
Staff health, well-being and engagement group.
The Trust also looks to identify risks through the views of stakeholders via the
Patient Opinion website, the internal complaints process, results from the
National Patient Survey and Staff Satisfaction Survey.
7. Annual Quality Reporting
Governance and Leadership
The Directors are required under the Health Act 2009 and the National Health
Service (Quality Accounts) Regulations 2010 to prepare Quality Accounts for
each financial year. Monitor has issued guidance to NHS Foundation Trust
boards on the form and content of annual Quality Reports which incorporate
the above legal requirements in the NHS Foundation Trust Annual Reporting
Manual.
The Trust Priorities for quality improvement (safety, experience and
effectiveness indicators) for 2011 have been monitored monthly by the Trust
166
Annual Report and Annual Accounts 2011-12

Board throughout the year. The Quality Accounts Priorities and other quality
measures are included in the Trust’s Performance Report.
The Quality Priorities and Quality Measures were agreed in consultation with
clinical staff and service users to ensure a balanced approach. When
selecting the Quality Measures we wanted to ensure that we were measuring
quality across our different client groups and as a result of acquiring KIPS in
April 2011, the quality measures were revised.
These measures cover in-patient and community mental health; learning
disabilities and community services across our business streams below and fit
to the same domains of patient safety, patient experience and clinical
effectiveness.
Later Life and Memory Services
Adult Services
Child and Adolescent Mental Health Services
Forensic Services
Learning Disability Services
Community Services (KIPS).
Performance with the Quality Priorities and Quality Measures for 2011/2012
and the agreed priorities and measures for 2012/2013 are published in the
Trust Quality Report.
Data Quality Policies
The Trust has an approved Data Quality strategy and policy. These
documents provide guidance for staff. The documents were jointly developed
and agreed by the Trust’s Leadership Forum. The Trust produces monthly
reports at Executive, Management and Operational level to enable the
continued improvement of data quality. These reports highlight any areas for
improvement and provide recommended actions to achieve this.
Further guidance is available to staff regarding the collection, storage,
reporting and disposal of data with detailed operating procedures for staff use.
All policies are stored on the Trust’s intranet system and are available to all
staff members with a limited number of hard copies available to each clinical
area. All policies are monitored and Annual Reports on care records, audit of
care records and information governance are presented to a Trust Board subcommittee
annually.
Systems and Processes
A range of systems and processes are in place for the collection, recording
and analysis of reporting of data and the Trust employs a member of staff to
work with clinical staff to assist with understanding/ training and improving
data quality. Staff roles and responsibilities with regard to data quality are
made clear in policies/process notes and workbooks. There is a programme
of data quality training in place.
Annual Report and Annual Accounts 2011-12 167

People and Skills
The implementation of these measures and the specific training provided to
staff ensures that the skills for the effective collection, recording and analysis
of data are present for relevant staff and for the managers driving the Data
Quality Improvement Plan. Data quality is incorporated into relevant job
descriptions throughout the Trust.
Internal Control of Data Quality
All information systems and processes will have routines developed and
designed to systematically identify errors and other aspects of poor data
quality
Data Quality Reports will be generated regularly and considered by the
appropriate monitoring body which will make recommendations regarding
the improvement of data quality
Data Quality Reports will be routinely fed back to operational managers
with advice as to corrective action to be taken such as improving
processes and systems and staff training and development.
8. Review of Economy, Efficiency, Effectiveness of the Use of
Resources
The Trust has a dynamic process for setting business objectives across the
whole organisation which is documented and reviewed on an ongoing basis in
order to drive forward improvements in clinical and non-clinical services and
to ensure that key national and local targets are met. All objectives are
quantifiable, measurable and risk-assessed and are regularly reviewed via the
robust performance management arrangements embedded within the Trust.
Performance management arrangements are such that each Directorate is
challenged and held to account for those areas that they are expected to
deliver on.
Throughout the year the Board has received regular reports providing
information on the economy, efficiency and effectiveness of the use of
resources. Integrated performance reports have provided data in respect of
financial, clinical, workforce and national targets and objectives. Any areas of
concern are highlighted and mitigating actions taken where deemed
necessary.
The Trust has a successful track record of delivery against its historic cost
improvement plan targets and future cost improvement plans have been
drawn up. Performance against plans is reviewed and monitored on a monthly
basis and management action taken where appropriate to ensure successful
delivery against targets. Cost improvement plans are an output from service
strategies.
Achievement of economy, efficiency and effectiveness is an underpinning
focus of the Trust’s internal governance arrangements, which are supported
by internal and external audit reviews. Findings and recommendations from
audits undertaken are monitored and reported through the Audit Committee.
168
Annual Report and Annual Accounts 2011-12

The Audit Committee provides an appropriate challenge to management to
ensure that recommendations are actioned and that significant assurance can
be provided to the Trust Board.
9. Review of effectiveness
As Accounting Officer I have responsibility for reviewing the effectiveness of
the System of Internal Control. My review of the effectiveness of the System
of Internal Control is informed by the work of the internal auditors, clinical
audit and the Executive members and clinical leads within the NHS
Foundation Trust who have responsibility for the development and
maintenance of the Internal Control Framework. I have drawn on the content
of the Quality Report (page 77) attached to this Annual Report and other
performance information available to me.
My review is also informed by comments made by the external auditors in
their management letter and other reports. I have been advised on the
implications of the result of my review of the effectiveness of the System of
Internal Control by the Trust Board, the Audit Committee and the Clinical Risk
and Clinical Governance Committee and a plan to address weaknesses and
ensure continuous improvement of the system is in place.
The Audit Committee has a remit to review the adequacy of assurance for all
risk and control-related disclosure statements. This is supported by the
opinion of internal audit provided to the Audit Committee founded on a riskbased
audit programme. The audit plan covers risks to the achievement of
Trust objectives identified through the assurance framework process.
Progress against implementation of audit recommendations is stringently
monitored by the Audit Committee to ensure that any identified gaps in control
are closed.
Maintaining and reviewing Systems of Internal Control throughout the Trust is
monitored through the Trust Board, its sub-committees and an effective
Governance Structure. Specific roles are detailed in the following table:
Group Chaired
by
Trust Board Trust
Chairman
Functions
Holds responsibility for assuring the
effectiveness and suitability of internal control
systems.
Receives reports on Trust-wide significant and
current risk status through a bi-monthly Risk
Report.
Receives reports on risks mapped to the
achievement of the High-level Trust Objectives
through a bi-monthly Assurance Framework
Report.
Annual Report and Annual Accounts 2011-12 169

Group Chaired by Functions
Audit
Committee
Operational
Performance
Meeting
Clinical
Governance
and Clinical
Risk
Committee
Incidents,
Complaints
and Claims
Accountability
Group
Corporate
Quality,
Performance
and Risk
Forum
170
Non-Executive
Director
Reviews the establishment and
maintenance of effective Systems of
Internal Control and risk management,
approving the Statement of Internal
Control.
Sets and approves the Annual Internal
Audit programme and holds delegated
Board responsibility to monitor
implementation of actions identified for
improvement.
Approves work plan of Clinical
Governance and Clinical Risk
Committee.
Chief Executive Receives reports on business,
performance and financial risk.
Non-Executive
Director
Head of Risk
Management and
Patient Safety
Head of Clinical
Quality
Focus attention on assurance framework
high-level risks and improvement on all
risks on the risk register.
Receives reports on clinical and
operational risk.
Receives the Trust Safety and Quality
Metrics.
Challenges robustness of risk movement
and level of controls.
Challenges and scrutinises the Serious
Untoward Incident Review process.
Reports to Trust Board.
Focus attention on timely management of
incidents and commissioning of the
review process. Monitors the
management of complaints to ensure
effective and timely action is taken.
Reports to Clinical Governance and
Clinical Risk Committee.
Detailed monitoring of risk-related issues
and compliance with standards.
Reports exceptions to Clinical
Governance and Clinical Risk Committee.
Annual Report and Annual Accounts 2011-12

Group Chaired by Functions
Business
Stream
Performance
Meetings
Information
Governance
Management
Group
Assistant
Director/Business
Manager
Assistant Director
of Nursing &
Safeguarding
Reports and shares risk-related issues,
complaints management/audit findings/
improvement and local learning.
Reports to Corporate Quality,
Performance and Risk Forum.
Receives reports on progress towards
achieving the Information Governance
Toolkit (IGT) and approves the yearly IGT
submission.
Regularly monitors Information
Governance objectives and information
risks and incidents, including the
Caldecott Issues Log, to ensure
appropriate actions are undertaken and
lessons are learnt.
Reports to the Clinical Governance and
Clinical Risk Committee.
Internal Audit Devises a yearly risk-based Internal Audit
Plan based on the Assurance
Framework to provide external
assurances to the Audit Committee and
then the Trust Board.
Clinical Audit Clinical audit is the assessment of the
processes and/or the outcome of care.
Its aim is to stimulate and support national
and local quality improvement
interventions and, through re-auditing to
assess the impact of such interventions.
5BP in full demonstrates this through the
clinical audit calendar.
Outcomes from clinical audit are reported
to Clinical Effectiveness Panel and via the
Research and Audit Forum for review of
recommendations and action plans.
In addition my review is also informed by other explicit reviews/assurance
mechanisms:
Annual Report and Annual Accounts 2011-12 171

5 Boroughs Partnership NHS Foundation Trust is required to register with
the Care Quality Commission and its current registration status is
registered without conditions. The Care Quality Commission has not taken
enforcement action against 5 Boroughs Partnership NHS Foundation Trust
during 2011/12
The Trust was assessed against the National Health Service Litigation
Authority Risk Management Standards in December 2011 at Level 1 and
achieved 100% compliance
The Trust appointed KPMG to provide its counter fraud service from 1
October 2011. The Trust has access to a Local Counter Fraud Specialist
(LCFS) who delivers both a pro-active and reactive counter fraud service.
The Audit Committee have approved a work plan and they receive regular
progress reports from the LCFS. The Trust is committed to creating a
lasting and robust anti-fraud culture throughout the organisation. During
the year, fraud awareness amongst staff has been enhanced via initiatives
such as fraud awareness training at both induction and bespoke
presentations to staff groups. Awareness is further enhanced with the
twice-yearly publication of a fraud newsletter and other initiatives. During
2011 the Trust has also taken steps to respond to the Bribery Act - raising
awareness and publishing information on the intranet. A Counter Fraud
Policy and Response Plan have been posted to the Trust’s intranet which
explains the steps that must be taken if fraud or corruption is suspected.
The plan is reviewed on an annual basis
National Patient Survey, National Staff Survey results and an in-house
Trust Service User experience survey
Mental Health Act Commission visits and reports
Participation in a Quality Improvement Programme set up by the Royal
College of Psychiatrists that benchmarks prescribing practice across all
participating mental health trusts known as Prescribing Observatory for
Mental Health (POMH)
Annual audit by all educational establishments involved; the Deanery
Assessment of medical training programmes and educational reviews by
Chester University, John Moores University, University College of
Lancashire and Liverpool University.
This Annual Governance Statement has been developed following:
The development and Board review of the Assurance Framework
KPMG Internal Audit review of the Board Assurance Framework that
provided a judgement of substantial assurance
KPMG Internal Audit review of the Trust’s Corporate Governance
Arrangements that provided a judgement of substantial assurance
KPMG Internal Audit review of the Risk Management process that
provided a judgement of substantial assurance
KPMG Internal Audit review of the Information Governance Toolkit
submission that provided a judgement of substantial assurance
172
Annual Report and Annual Accounts 2011-12

The Trust maintains a status of registered without conditions with the Care
Quality Commission. The Care Quality Commission has not taken
enforcement action against 5 Boroughs Partnership NHS Foundation Trust
during 2011/12.
The Head of Internal Audit Opinion is that:
Significant assurance can be given that there is generally a sound System of
Internal Control on key financial and management processes. These are
designed to meet the Trust’s objectives and ensure controls are
generally being applied consistently.
10. Conclusion
My review confirms that 5 Boroughs Partnership NHS Foundation Trust has a
generally sound System of Internal Control that supports the achievement of
its policies, aims and objectives. I have been advised on the implications of
the result of my review of the effectiveness of the System of Internal Control
by the Executive Directors, the Committees and the Audit Committee. No
significant control issues have been identified.
Simon Barber, Chief Executive
Date: 28 May 2012
Annual Report and Annual Accounts 2011-12 173

174
Annual Report and Annual Accounts 2011-12

Foreword to the Accounts
5 Boroughs Partnership NHS Foundation Trust
These accounts for the period ended 31 March 2012 have been prepared
by the 5 Boroughs Partnership NHS Foundation Trust in accordance with
paragraphs 24 and 25 of Schedule 7 to the National Health Service Act 2006.
.
Signed:
Simon Barber,
Chief Executive
28/05/2012
N.B. - The Trust acquired Knowsley Integrated Provider Services on 1 April
2011. This transaction added £45m to the turnover of the Trust in 2011/12. In
accordance with Monitor guidance, prior year comparator figures have not
been re-stated to reflect this transaction. As such, the majority of figures
reported for financial year 2010/11 throughout these accounts are not directly
comparable to those reported for financial year 2011/12.
Trust name 5 Boroughs Partnership NHS Foundation Trust
This year 2011/12
Last year 2010/11
This year ended 31 March 2012
Last year ended 31 March 2011
This year commencing 1 April 2011
Annual Report and Annual Accounts 2011-12 175

Statement of Comprehensive Income
1 April 2011 to 31 March 2012
2011/12 2010/11
Note £000 £000
Operating income from continuing
operations 3 - 4 152,186 107,242
Operating expenses of continuing
operations 5 - 7 (147,167) (102,482)
Operating surplus 5,019 4,760
Finance costs:
Finance income 10 95 36
Finance expense - financial liabilities
Finance expense - unwinding of discount
on provisions 24 (13) (15)
PDC Dividends payable (2,129) (2,181)
Net finance costs (2,047) (2,160)
Share of profit / (loss) of associates / joint
ventures accounted for using the equity
method
Corporation tax expense
Surplus / (deficit) from continuing
operations 2,972 2,600
Surplus / (deficit) of discontinued
operations and the gain / (loss) on disposal
of discontinued operations
SURPLUS/(DEFICIT) FOR THE PERIOD* 2,972 2,600
Other comprehensive income:
Impairments (77) (364)
Revaluations (208)
Receipt of donated assets
Asset disposals
Share of comprehensive income from
associates and joint ventures
Movements arising from classifying non
current assets as Assets Held for Sale 558
Fair Value gains/(losses) on Available-forsale
financial investments
Recycling gains/(losses) on Available-forsale
financial investments
Other recognised gains and losses
Actuarial gains / (losses) on defined benefit
pension schemes
Other reserve movements (889)
TOTAL COMPREHENSIVE INCOME /
(EXPENSE) FOR THE PERIOD 2,564 2,028
176
Annual Report and Annual Accounts 2011-12

Prior period adjustments
TOTAL COMPREHENSIVE INCOME /
(EXPENSE) FOR THE PERIOD 2,564 2,028
Note: Allocation of profits / (losses) for the
period:
(a) Surplus / (deficit) for the period attributable to:
minority interest
owners of the parent 2,972 2,600
TOTAL 2,972 2,600
(b) Total comprehensive income / (expense)
for the period attributable to:
minority interest
owners of the parent 2,564 2,028
TOTAL 2,564 2,028
The notes on pages 185 to 233 form part of these accounts.
* After adjusting for exceptional items, the underlying surplus for the Trust as
at 31 March 2012 was £4.4m.
The Statement of Comprehensive Income records the Trust's income and
expenditure in summary form in the top part of the statement and any other
recognised gains and losses taken through reserves under other
comprehensive income. It includes cash-related items such as income from
commissioners of our services and expenditure on staff and supplies. It also
includes non-cash items such as depreciation and other changes in value of
our land and buildings.
Annual Report and Annual Accounts 2011-12 177

Statement of Financial Position
31 March 2012
31
March
2012
178
Annual Report and Annual Accounts 2011-12
31
March
2011
Note £000 £000
Non-current assets:
Intangible assets 13 10
Property, plant and equipment 14 65,796 67,545
Investment property
Investments in associates (and
jointly controlled operations)
Other investments
Trade and other receivables 19 159 109
Other financial assets
Other assets
Total non-current assets 65,965 67,654
Current assets:
Inventories 18 53 49
Trade and other receivables 19 2,047 2,219
Other financial assets
Non current assets for sale and
assets in disposal groups 16 2,496 514
Cash and cash equivalents 20 12,570 7,273
Total current assets 17,166 10,055
Current liabilities:
Trade and other payables 22 (10,000) (7,244)
Borrowings
Other financial liabilities
Provisions 24 (566) (157)
Other liabilities 23 (66) (114)
Liabilities in disposal groups
Total current liabilities (10,632) (7,515)
Total assets less current
liabilities 72,499 70,194
Non-current liabilities
Trade and other payables 22 (29)
Borrowings
Other financial liabilities
Provisions 24 (415) (648)
Other liabilities 23 (185)
Total non-current liabilities (444) (833)
Total Assets Employed 72,055 69,361

Financed by taxpayers' equity:
Minority interest
Public Dividend Capital 45,579 45,579
Revaluation reserve 15 17,173 18,139
Donated asset reserve
Available for sale investment
reserve
Other reserves 10 10
Merger reserve 130
Income and expenditure reserve 9,163 5,633
Total Taxpayers' Equity 72,055 69,361
The financial statements on page 176 to 233 were approved by
the Board on 22 May 2012 and signed on its behalf by:
Signed: (Chief Executive)
Date: 28 May 2012
The Statement of Financial Position provides a snapshot of the Trust’s
financial position at a specific date i.e. 31 March 2012. In simple terms it lists
the assets (what the Trust owns or is owed) liabilities (what the Trust owes)
and taxpayers’ equity (public funds invested in the Trust). At any given time,
the Trust’s total assets less total liabilities must equal taxpayers’ equity.
Annual Report and Annual Accounts 2011-12 179

Statement of Changes in Tax Payer’s Equity
for the period 1 April 2011 to 31 March 2012
180
Total Minority
Interest
Public
Dividend
Capital
Revaluation
Reserve
Annual Report and Annual Accounts 2011-12
Donated
Assets
Reserve
Available
for Sale
Investment
Reserve
Other
Reserves
Merger
Reserve
Income and
Expenditure
Reserve
£000 £000 £000 £000 £000 £000 £000 £000 £000
Taxpayers’ Equity at 1 April 2011 – as previously stated 69,361 45,579 18,139 10 5,633
Prior period adjustment
TCS and merger adjustments
Taxpayers’ Equity at 1 April 2011 – restated 69,361 45,579 18,139 10 5,633
Surplus / (deficit) for the year 2,972 2,972
Transfers between reserves
Impairments (77) (77)
Revaluations
Receipt of donated assets
Asset disposals
Share of comprehensive income from associates and joint
ventures
Movements arising from classifying non current assets as
assets held for sale
Fair value gains / (losses) on available for sale financial
investments
Recycling gains / (losses) on available for sale financial
investments
Other recognised gains and losses
Actuarial gains / (losses) on defined benefit pension schemes
Public Dividend Capital received
180
558 558

Public Dividend Capital repaid
Public Dividend Capital written off
Other movements in PDC in year
Reserves eliminated on dissolution
Total Minority
Interest
Public
Dividend
Capital
Revaluation
Reserve
Donated
Assets
Reserve
Available
for Sale
Investment
Reserve
Other
Reserves
Merger
Reserve
Annual Report and Annual Accounts 2011-12 181
Income and
Expenditure
Reserve
£000 £000 £000 £000 £000 £000 £000 £000 £000
Other reserve movements (759) (889) 130
Taxpayers' Equity at 31 March 2012 72,055 45,579 17,173 10 130 9,163
181

Taxpayers' Equity at 1 April 2010 - as previously stated 67,335 45,579 18,941 10 2,805
Prior period adjustment
Taxpayers' Equity at 1 April 2010 - restated 67,335 45,579 18,941 10 2,805
At start of period for new FTs
Surplus / (deficit) for the year 2,600 2,600
Transfers between reserves
Impairments (364) (364)
Revaluations (208) (208)
Receipt of donated assets
Asset disposals
Share of comprehensive income from associates and joint
ventures
Movements arising from classifying non current assets as
assets held for sale
Fair value gains / (losses) on available for sale financial
investments
Recycling gains / (losses) on available for sale financial
investments
Other recognised gains and losses
Actuarial gains / (losses) on defined benefit pension schemes
Public Dividend Capital received
Public Dividend Capital repaid
Public Dividend Capital written off
Other movements in PDC in year
Reserves eliminated on dissolution
Other reserve movements (2) (230) 228
Taxpayers' Equity at 31 March 2011 69,361 45,579 18,139 10 5,633
The Statement of Changes in Taxpayers' Equity essentially shows the changes in reserves and public dividend capital from one year to the next. Public dividend capital is a type of
public sector equity finance based on the excess of assets over liabilities at the time of establishment of the predecessor NHS Trust. It is similar to a company's share capital.
182
182
Annual Report and Annual Accounts 2011-12

Statement of Cash Flows
For the Period 1 April 2011 to 31 March 2012
2011/12 2010/11
Note £000 £000
Cash flows from operating activities
Operating surplus from continuing operations
Operating surplus / (deficit) of discontinued operations
5,019 4,760
Operating surplus 5,019 4,760
Non-cash income and expense:
Depreciation and amortisation 1,885 1,973
Impairments 370 185
Reversals of impairments (631)
Transfer from donated asset reserve
Interest accrued and not paid 41
Dividends accrued and not paid or received 47
Amortisation of government grants
Amortisation of PFI credit
(Increase) / decrease in trade and other receivables 122 (52)
(Increase) / decrease in other assets
(Increase) / decrease in inventories (4) (4)
Increase / (decrease) in trade and other payables 2,768 (453)
Increase / (decrease) in other liabilities (233) 104
Increase / (decrease) in provisions 178 (65)
Tax (paid) / received 87
Movements in operating cash flow of discontinued
operations
Other movements in operating cash flows (74)
Net cash generated from / (used in) operations 9,488 6,535
Cash flows from investing activities:
Interest received 54 36
Purchase of financial assets
Sale of financial assets
Purchase of intangible assets (13)
Sale of intangible assets
Purchase of property, plant and equipment (2,762) (1,783)
Sale of property, plant and equipment 576
Cash flows attributable to investing activities of
discontinued operations
Cash from acquisitions of business units and subsidiaries
Cash from disposals of business units and subsidiaries
Net cash generated from / (used in) investing
activities (2,145) (1,747)
Annual Report and Annual Accounts 2011-12 183

184
Cash flows from financing activities:
Public dividend capital received
Public dividend capital repaid
Loans received from the Department of Health
Other loans received
Loans repaid to the Department of Health
Other loans repaid
Capital element of finance lease rental payments
Other capital receipts 130
Capital element of Private Finance Initiative Obligations
Interest paid
Interest element of finance leases
Interest element of Private Finance Initiative obligations
PDC Dividend paid (2,176) (2,178)
Cash flows attributable to financing activities of
discontinued operations
Cash flows from / (used in) other financing activities
Net cash generated from / (used in) financing
activities (2,046) (2,178)
Increase / (decrease) in cash and cash equivalents 5,297 2,610
Cash and cash equivalents at 1 April 7,273 4,663
Cash and cash equivalents at start of period for new
FTs
Cash and cash equivalents at 31 March 20 12,570 7,273
The Statement of Cash Flows summarises the cash flows in and out of the
Trust during the accounting period. It analyses these cash flows under the
headings of operating, investing and financing cash flows. The Statement
of Cash Flows differs from the Statement of Comprehensive Income by
focusing on the cash implications of the actions taken by the Trust during
the year. The statement is useful in assessing whether the Trust has
enough cash to be able to pay its bills as they fall due.
Annual Report and Annual Accounts 2011-12

Notes to the accounts
1. Accounting Policies and Other Information
Monitor has directed that the financial statements of NHS Foundation
Trusts shall meet the accounting requirements of the NHS Foundation
Trust Annual Reporting Manual which shall be agreed with HM Treasury.
Consequently, the following financial statements have been prepared in
accordance with the 2011/12 NHS Foundation Trust Annual Reporting
Manual issued by Monitor. The accounting policies contained in that
manual follow International Financial Reporting Standards (IFRS) and HM
Treasury's Financial Reporting Manual to the extent that they are
meaningful and appropriate to NHS Foundation Trusts. The accounting
policies have been applied consistently in dealing with items considered
material in relation to the accounts.
1.1 Accounting Convention
These accounts have been prepared under the historical cost convention
modified to account for the revaluation of property, plant and equipment,
intangible assets, inventories and certain financial assets and financial
liabilities.
1.2 Income
Income in respect of services provided is recognised when, and to the
extent that, performance occurs and is measured at the fair value of the
consideration receivable. The main source of income for the Trust is
contracts with commissioners in respect of healthcare services.
Where income is received for a specific activity that is to be delivered in
the following financial year, that income is deferred.
Income from the sale of non-current assets is recognised only when all
material conditions of sale have been met and is measured as the sums
due under the sale contract.
1.3 Expenditure on employee benefits
Short-term employee benefits
Salaries, wages and employment-related payments are recognised in the
period in which the service is received from employees. The cost of annual
leave entitlement earned but not taken by employees at the end of the
period is recognised in the financial statements to the extent that
employees are permitted to carry forward leave into the following period.
Pension Costs
NHS Pension Scheme
Past and present employees are covered by the provisions of the NHS
Pensions Scheme. The scheme is an unfunded, defined benefit scheme
that covers NHS employers, general practices and other bodies allowed
under the direction of the Secretary of State in England and Wales.
Annual Report and Annual Accounts 2011-12 185

186
Notes to the Accounts - 1. Accounting Policies (Continued)
It is not possible for the Trust to identify its share of the underlying scheme
liabilities. Therefore, the scheme is accounted for as a defined contribution
scheme.
Employer’s pension cost contributions are charged to operating expenses
as and when they become due.
Additional pension liabilities arising from early retirements are not funded
by the scheme except where the retirement is due to ill-health. The full
amount of the liability for the additional costs is charged to operating
expenses at the time the Trust commits itself to the retirement regardless
of the method of payment.
1.4 Expenditure on other goods and services
Expenditure on goods and services is recognised when, and to the extent,
that they have been received and is measured at the fair value of those
goods and services. Expenditure is recognised in operating expenses
except where it results in the creation of a non-current asset such as
property, plant and equipment.
1.5 Property, plant and equipment
Recognition
Property, plant and equipment is capitalised where:
It is held for use in delivering services or for administrative purposes
It is probable that future economic benefits will flow to, or service
potential will be supplied to, the Trust
It is expected to be used for more than one financial year
The cost of the item can be measured reliably; and
The item has a cost of at least £5,000; or
Collectively, a number of items have a cost of at least £5,000 and
individually have a cost of more than £250. Where the assets are
functionally interdependent, they had broadly simultaneous purchase
dates and are anticipated to have simultaneous disposal dates and are
under single managerial control; or
Items forming part of the initial equipping and setting-up cost of a new
building, ward or unit irrespective of their individual or collective cost.
Where a large asset, for example a building, includes a number of
components with significantly different asset lives the components are
treated as separate assets and depreciated over their own useful
economic lives.
Annual Report and Annual Accounts 2011-12

Notes to the Accounts - 1. Accounting Policies (Continued)
Measurement
Valuation
All property, plant and equipment assets are measured initially at cost -
representing the cost directly attributable to acquiring or constructing the
asset and bringing it to the location and condition necessary for it to be
capable of operating in the manner intended by management. All assets
are measured subsequently at fair value.
Land and buildings used for the Trust’s services or for administrative
purposes are stated in the Statement of Financial Position at their revalued
amounts - being the fair value at the date of revaluation less any
subsequent accumulated depreciation and impairment losses.
Revaluations are performed with sufficient regularity to ensure that
carrying amounts are not materially different from those that would be
determined at the end of the reporting period. Fair values are determined
as follows:
Land and non-specialised buildings – market value for existing use
Specialised buildings – depreciated replacement cost.
Until 31 March 2008 the depreciated replacement cost of specialised
buildings was estimated for an exact replacement of the asset in its
present location. HM Treasury has adopted a standard approach to
depreciated replacement cost valuations based on modern equivalent
assets and, where it would meet the location requirements of the service
being provided, an alternative site can be valued. The Trust revalued its
asset base under the new modern equivalent assets methodology in July
2009. In 2011/12 the Trust requested the District Valuer to provide an
interim valuation for land and buildings to ensure that these are recorded
at fair value at the reporting date.
Properties in the course of construction for service or administration
purposes are carried at cost - less any impairment loss. Cost includes
professional fees but not borrowing costs, which are recognised as
expenses immediately as allowed by IAS 23 for assets held at fair value.
Assets are revalued and depreciation commences when they are brought
into use.
Until 31 March 2008 fixtures and equipment were carried at replacement
cost as assessed by indexation and depreciation of historic cost. From 1
April 2008 indexation ceased. The carrying value of existing assets at that
date will be written off over their remaining useful lives and new fixtures
and equipment are carried at depreciated historic cost as this is not
considered to be materially different from fair value.
Annual Report and Annual Accounts 2011-12 187

188
Notes to the Accounts - 1. Accounting Policies (Continued)
Subsequent expenditure
Subsequent expenditure relating to an item of property, plant and
equipment is recognised as an increase in the carrying amount of the
asset when it is probable that future economic benefits or service potential
deriving from the cost incurred to replace a component of such item will
flow to the Trust and the cost of the item can be determined reliably.
Where a component of an asset is replaced the cost of the replacement is
capitalised if it meets the criteria for recognition above. The carrying
amount of the part replaced is de-recognised. Other expenditure that does
not generate additional future economic benefits or service potential, such
as repairs and maintenance, is charged to the Statement of
Comprehensive Income in the period in which it is incurred.
Depreciation
Items of property, plant and equipment are depreciated over their
remaining useful economic lives in a manner consistent with the
consumption of economic or service delivery benefits. Freehold land is
considered to have an infinite life and is not depreciated.
Property, plant and equipment which has been reclassified as 'Held for
Sale' ceases to be depreciated upon the reclassification. Assets in the
course of construction are not depreciated until the asset is brought into
use.
Revaluation gains and losses
Revaluation gains are recognised in the revaluation reserve except where
and to the extent that they reverse a revaluation decrease that has
previously been recognised in operating expenses (in which case they are
recognised in operating income).
Revaluation losses are charged to the revaluation reserve to the extent
that there is an available balance for the asset concerned and thereafter
are charged to operating expenses.
Gains and losses recognised in the revaluation reserve are reported in the
Statement of Comprehensive Income as an item of 'other comprehensive
income'.
Impairments
In accordance with the NHS Foundation Trust Annual Reporting Manual,
impairments that are due to a loss of economic benefits or service
potential in the asset are charged to operating expenses.
Annual Report and Annual Accounts 2011-12

Notes to the Accounts - 1. Accounting Policies (Continued)
A compensating transfer is made from the revaluation reserve to the
income and expenditure reserve of an amount equal to the lower of (i) the
impairment charged to operating expenses and (ii) the balance in the
revaluation reserve attributable to that asset before the impairment.
An impairment arising from a loss of economic benefit or service potential
is reversed when and to the extent that the circumstances that gave rise to
the loss is reversed. Reversals are recognised in operating income to the
extent that the asset is restored to the carrying amount it would have had if
the impairment had never been recognised. Any remaining reversal is
recognised in the revaluation reserve. Where at the time of the original
impairment a transfer was made from the revaluation reserve to the
income and expenditure reserve, an amount is transferred back to the
revaluation reserve when the impairment reversal is recognised.
Other impairments are treated as revaluation losses. Reversals of 'other
impairments' are treated as revaluation gains.
De-recognition
Assets intended for disposal are reclassified as 'Held for Sale' once all of
the following criteria are met:
The asset is available for immediate sale in its present condition
subject only to terms which are usual and customary for such sales
The sale must be highly probable - i.e. management are committed to
a plan to sell the asset; an active programme has begun to find a buyer
and complete the sale; the asset is being actively marketed at a
reasonable price; the sale is expected to be completed within 12
months of the date of classification as 'Held for Sale' and the actions
needed to complete the plan indicate it is unlikely that the plan will be
dropped or significant changes made to it.
Following reclassification, the assets are measured at the lower of their
existing carrying amount and their 'fair value less costs to sell'.
Depreciation ceases to be charged. Assets are de-recognised when all
material sale contract conditions have been met.
Property, plant and equipment which is to be scrapped or demolished
does not qualify for recognition as 'Held for Sale' and instead is retained as
an operational asset and the asset's economic life is adjusted. The asset
is de-recognised when scrapping or demolition occurs.
Annual Report and Annual Accounts 2011-12 189

190
Notes to the Accounts - 1. Accounting Policies (Continued)
1.6 Intangible assets
Recognition
Intangible assets are non-monetary assets without physical substance
which are capable of being sold separately from the rest of the Trust's
business or which arise from contractual or other legal rights. They are
recognised only where it is probable that future economic benefits will flow
to or service potential be provided to the Trust and where the cost of the
asset can be measured reliably.
Measurement
Intangible assets are recognised initially at cost - comprising all directly
attributable costs needed to create, produce and prepare the asset to the
point that it is capable of operating in the manner intended by
management. Subsequently, intangible assets are measured at fair value.
Revaluations gains and losses and impairments are treated in the same
manner as for property, plant and equipment.
Amortisation
Intangible assets are amortised over their expected useful economic lives
in a manner consistent with the consumption of economic or service
delivery benefits.
1.7 Leases
Operating Leases
Leases other than finance leases are regarded as operating leases and
the rentals are charged to operating expenses on a straight-line basis over
the term of the lease. Operating lease incentives received are added to the
lease rentals and charged to operating expenses over the life of the lease.
Leases of land and buildings
Where a lease is for land and buildings, the land component is separated
from the building component and the classification for each is assessed
separately.
1.8 Inventories
Inventories are valued at the lower of cost and net realisable value. The
cost of inventories is measured using the First In First Out (FIFO) method.
This is considered to be a reasonable approximation to fair value due to
the high turnover of stocks.
Annual Report and Annual Accounts 2011-12

Notes to the Accounts - 1. Accounting Policies (Continued)
1.9 Cash and cash equivalents
Cash is cash in hand and deposits with any financial institution repayable
without penalty on notice of not more than 24 hours. Cash equivalents are
investments that mature in three months or less from the date of
acquisition and that are readily convertible to known amounts of cash with
insignificant risk of change in value.
1.10 Provisions
The Trust recognises a provision where it has a present legal or
constructive obligation of uncertain timing or amount for which it is
probable that there will be a future outflow of cash or other resources and
a reliable estimate can be made of the amount. The amount recognised in
the Statement of Financial Position is the best estimate of the resources
required to settle the obligation. Where the effect of the time value of
money is significant, the estimated risk-adjusted cash flows are discounted
using HM Treasury's discount rate of 2.2 per cent in real terms except for
early retirement provisions and injury benefit provisions which both use the
HM Treasury's pension discount rate of 2.9 per cent in real terms.
Clinical negligence costs
The NHS Litigation Authority (NHSLA) operates a risk pooling scheme
under which the Trust pays an annual contribution to the NHSLA which, in
return, settles all clinical negligence claims. Although the NHSLA is
administratively responsible for all clinical negligence cases, the legal
liability remains with the Trust. The total value of clinical negligence
provisions carried by the NHSLA on behalf of the Trust is disclosed at note
24.
Non-clinical risk pooling
The Trust participates in the Property Expenses Scheme and the Liabilities
to Third Parties Scheme. Both are risk pooling schemes under which the
Trust pays an annual contribution to the NHS Litigation Authority and in
return receives assistance with the costs of claims arising. The annual
membership contributions, and any excesses payable in respect of
particular claims, are charged to operating expenses when the liability
arises.
1.11 Contingencies
Contingent assets (that is, assets arising from past events whose
existence will only be confirmed by one or more future events not wholly
within the entity's control) are not recognised as assets, but are disclosed
in note 25 where an inflow of economic benefits is probable.
Contingent liabilities are not recognised, but are disclosed in note 25
unless the probability of a transfer of economic benefits is remote.
Annual Report and Annual Accounts 2011-12 191

192
Notes to the Accounts - 1. Accounting Policies (Continued)
Contingent liabilities are defined as:
Possible obligations arising from past events whose existence will be
confirmed only by the occurrence of one or more uncertain future
events not wholly within the entity's control; or
Present obligations arising from past events but for which it is not
probable that a transfer of economic benefits will arise or for which the
amount of the obligation cannot be measured with sufficient reliability.
1.12 Financial instruments and financial liabilities
Recognition
Financial assets and financial liabilities which arise from contracts for the
purchase or sale of non-financial items (such as goods or services), which
are entered into in accordance with the Trust's normal purchase, sale or
usage requirements are recognised when and to the extent which
performance occurs (i.e. when receipt or delivery of the goods or services
is made).
All other financial assets and financial liabilities are recognised when the
Trust becomes a party to the contractual provisions of the instrument.
De-recognition
All financial assets are de-recognised when the rights to receive cash
flows from the assets have expired or the Trust has transferred
substantially all of the risks and rewards of ownership.
Financial liabilities are de-recognised when the obligation is discharged,
cancelled or expires.
Classification and measurement
Financial assets are categorised as 'loans and receivables'.
Financial liabilities are classified as 'other financial liabilities'.
Loans and receivables
Loans and receivables are non-derivative financial assets with fixed or
determinable payments which are not quoted in an active market. They
are included in current assets.
The Trust's loans and receivables comprise cash and cash equivalents,
NHS debtors, accrued income and other debtors.
Loans and receivables are recognised initially at fair value, net of
transaction costs, and are measured subsequently at amortised cost using
the effective interest method.
Annual Report and Annual Accounts 2011-12

Notes to the Accounts - 1. Accounting Policies (Continued)
The effective interest rate is the rate that discounts exactly estimated
future cash receipts through the expected life of the financial asset or,
when appropriate, a shorter period to the net carrying amount of the
financial asset.
Interest on loans and receivables is calculated using the effective interest
method and credited to the Statement of Comprehensive Income.
Other financial liabilities
All other financial liabilities are recognised initially at fair value, net of
transaction costs incurred, and are measured subsequently at amortised
cost using the effective interest method. The effective interest rate is the
rate that discounts exactly estimated future cash payments through the
expected life of the financial liability or, when appropriate, a shorter period
to the net carrying amount of the financial liability.
They are included in current liabilities except for amounts payable more
than 12 months after the Statement of Financial Position date, which are
classified as long-term liabilities.
Interest on financial liabilities carried at amortised cost is calculated using
the effective interest method and charged to Finance Costs. Interest on
financial liabilities taken out to finance property, plant and equipment or
intangible asets is not capitalised as part of the cost of those assets.
Impairment of financial assets
At the Statement of Financial Position date, the Trust assesses whether
any financial assets - other than those held at 'fair value through income
and expenditure' - are impaired. Financial assets are impaired and
impairment losses are recognised if, and only if, there is objective
evidence of impairment as a result of one or more events which occurred
after the initial recognition of the asset and which has an impact on the
estimated future cash flows of the asset.
1.13 Public Dividend Capital
Public Dividend Capital (PDC) is a type of public sector equity finance
based on the excess of assets over liabilities at the time of establishment
of the predecessor NHS Trust. HM Treasury has determined that PDC is
not a financial instrument within the meaning of IAS 32.
A charge, reflecting the cost of capital utilised by the Trust, is payable as
Public Dividend Capital dividend. The charge is calculated at the rate set
by HM Treasury (currently 3.5 per cent) on the average relevant net assets
of the Trust during the financial year.
Annual Report and Annual Accounts 2011-12 193

194
Notes to the Accounts - 1. Accounting Policies (Continued)
Relevant net assets are calculated as the value of all assets less the value
of all liabilities, except for (i) donated assets; (ii) net cash balances held
with the Government Banking Service (GBS) excluding cash balances
held in GBS accounts that relate to a short-term working capital facility and
(iii) any PDC dividend balance receivable or payable. In accordance with
the requirements laid down by the Department of Health (as the issuer of
PDC), the dividend for the year is calculated on the actual average
relevant net assets as set out in the 'pre-audit' version of the annual
accounts. The dividend thus calculated is not revised should any
adjustment to net assets occur as a result of the audit of the annual
accounts.
1.14 Value Added Tax
Most of the activities of the Trust are outside the scope of VAT and, in
general, output tax does not apply and input tax on purchases is not
recoverable. Irrecoverable VAT is charged to the relevant expenditure
category or included in the capitalised purchase cost of fixed assets.
Where output tax is charged or input VAT is recoverable the amounts are
stated net of VAT.
1.15 Foreign Exchange
The functional and presentational currencies of the Trust are sterling.
A transaction which is denominated in a foreign currency is translated into
the functional currency at the spot exchange rate on the date of the
transaction.
1.16 Third party assets
Assets belonging to third parties (such as money held on behalf of
patients) are not recognised in the accounts since the Trust has no
beneficial interest in them. However, they are disclosed in a separate note
to the accounts in accordance with the requirements of HM Treasury's
Financial Reporting Manual.
1.17 Losses and special payments
Losses and special payments are items that Parliament would not have
contemplated when it agreed funds for the health service or passed
legislation. By their nature they are items that ideally should not arise.
They are therefore subject to special control procedures compared with
the generality of payments. They are divided into different categories
which govern the way that individual cases are handled. Losses and
special payments are charged to the relevant functional headings in
expenditure on an accruals basis - including losses which would have
been made good through insurance cover had the Trust not been bearing
their own risks (with insurance premiums then being included as normal
revenue expenditure).
Annual Report and Annual Accounts 2011-12

Notes to the Accounts - 1. Accounting Policies (Continued)
The losses and special payments note is compiled directly from the losses
and special payments register which reports on an accruals basis with the
exception of provisions for future losses.
1.18 Accounting standards that have been issued but have not
yet been adopted
The following accounting standards and interpretations have been issued
by the IASB but have not yet been adopted within the NHS Foundation
Trust Annual Reporting Manual. None of them are expected to have a
material impact upon the Trust's financial statements.
IFRS 7 Financial Instruments: Disclosures (amendment)
IFRS 9 Financial Instruments
IFRS 10 Consolidated Financial Statements
IFRS 11 Joint Arrangements
IFRS 12 Disclosure of Interests in Other Entities
IFRS 13 Fair Value Measurement
IAS 12 Income Taxes (amendment)
IAS1 Presentation of Financial Statements on other comprehensive
income
IAS 27 Separate Financial Statements
IAS 28 Associates and Joint Ventures
2. Operating segments
All activities of the Trust relate to the provision of healthcare - therefore no
segmental analysis has been prepared.
Annual Report and Annual Accounts 2011-12 195

196
3. Income from activities
3.1 Analysis of income from activities
by category 2011/12 2010/11
£000 £000
Other NHS clinical income 4,539
Cost and volume contract income 1,017
Block contract income 97,548 99,573
Other clinical income from mandatory services 2,374 3,742
Community Services - Income from PCTs 39,005
Community Services - Income not from PCTs 1,392
Annual Report and Annual Accounts 2011-12
145,875 103,315
3.2 Analysis of income from activities
by source 2011/12 2010/11
£000 £000
NHS Foundation Trusts 283 146
NHS Trusts 5,000 174
Strategic Health Authorities
Primary Care Trusts 138,208 101,450
Local Authorities 1,847 1,266
Non-NHS:
Private patients
Overseas patients (non-reciprocal)
NHS injury scheme 157
Other * 380 279
145,875 103,315
* Other income includes the following items:
Alternative Futures (£265k); Edge Hill In-Reach Service (£44k)
3.3 Private patient income
The Trust received no private patient income during the reporting period.

4. Other operating income 2011/12 2010/11
£000 £000
Education, training and research 2,454 1,933
Non-patient care services to other bodies 389
Profit on disposal of land and buildings 77
Reversal of impairments of property, plant and
equipment 631
Other income ** 2,887 1,605
Income in respect of staff costs where accounted on
gross basis 262
6,311 3,927
** Other income includes the following items: NPfIT (£1,007k); Workforce
Modernisation Hub (£413k); Warrington Estates SLA (£299k);
Occupational Health (£254k); Estates Recharge (£211k); Clinical
Excellence (£45k)
Annual Report and Annual Accounts 2011-12 197

198
5. Operating expenses 2011/12 2010/11
£000 £000
Services from NHS Foundation Trusts 692
Services from NHS Trusts 1,376
Services from PCTs 14
Purchase of healthcare from non NHS bodies 29
Employee expenses - Executive Directors 852 933
Employee expenses - Non-Executive Directors 134 137
Employee expenses - Staff 117,511 82,409
Drug costs 3,178 3,138
Supplies and services - clinical (excluding drug costs) 3,443 1,279
Supplies and services - general 2,899 2,664
Establishment 4,112 2,776
Transport 398 346
Premises 6,990 4,935
Increase in provision for impairment of receivables 334 15
Depreciation 1,882 1,973
Amortisation 3
Impairments of property, plant and equipment 355 185
Impairments of assets held for sale 15
Audit fees:
audit services - statutory audit 66 59
audit services - regulatory reporting
Other auditors remuneration:
further assurance services
other services 87 75
Clinical negligence 204 148
Loss on disposal of land and buildings
Loss on disposal of other property, plant and equipment 3
Legal fees 189 169
Consultancy costs 549 289
Training, courses and conferences 995 612
Patient travel 4 5
Car parking and security 102 47
Redundancy 77
Hospitality 8 3
Insurance 88 73
Other services
Losses, ex gratia and special payments 226 38
Other 352 174
147,167 102,482
Other auditors remuneration relates to internal audit and counter fraud services.
There is no limit on auditor's liability. Clinical negligence costs relate to the
Trust's contribution to the NHSLA for all clinical negligence cases.
Annual Report and Annual Accounts 2011-12

6. Operating leases
As lessee
Payments recognised as an
expense
£000 £000
Minimum lease payments
Contingent rents
Sub-lease payments
238 205
238 205
Total future minimum lease
payments
As at
31
March
2012
Annual Report and Annual Accounts 2011-12 199
As at
31
March
2011
£000 £000
Payable:
Not later than one year 102 130
Between one and five years 94 429
After five years 63
Total 196 622

7. Employee costs and numbers
7.1 Employee costs
2011/12 2010/11
Total Permanently Other Total Permanently Other
Employed
Employed
£000 £000 £000 £000 £000 £000
Salaries and wages *
Social security costs
Employer contributions to NHS
96,180 87,131 9,049 69,196 64,806 4,390
Pension scheme 6,914 6,585 329 4,016 4,016
Other pension costs
Other post-employment benefits
Other employment benefits
11,880 11,335 545 8,020 8,020
Termination benefits 1,455 1,455
Agency / contract staff 2,186 2,186 2,285 2,285
TOTAL GROSS STAFF COSTS 118,615 106,506 12,109 83,517 76,842 6,675
TOTAL STAFF COSTS 118,615 106,506 12,109 83,517 76,842 6,675
Of the total above:
Charged to capital 175 175 175 175
Charged to revenue 118,440 106,331 12,109 83,342 76,667 6,675
118,615 106,506 12,109 83,517 76,842 6,675
* Salaries and wages exclude Non-Executive Directors as per annual reporting guidance for NHS Foundation Trusts.
200
200
Annual Report and Annual Accounts 2011-12

7. Employee costs and numbers continued.
7.2 Average number of people employed
2011/12 2010/2011
Total Permanently Other Total Permanently Other
Employed
Employed
Number Number Number Number Number Number
Medical and dental 132 74 58 125 75 50
Administration and estates 741 701 40 490 475 15
Healthcare assistants and other
support staff 152 139 13 65 61 4
Nursing, midwifery and health visiting
staff 1,451 1,372 79 1,209 1,173 36
Nursing, midwifery and health visiting
learners 10 10 11 11
Scientific, therapeutic and technical
staff 520 476 44 161 151 10
Social care staff 6 6 11 11
Bank and agency staff 132 132 111 111
Other 60 60 7 7
Total 3,203 2,832 372 2,190 1,953 237
Of the above:
Number engaged on capital projects 3 3 3 3
201
Annual Report and Annual Accounts 2011-12 201

202
7. Employee costs and numbers continued.
7.3 Retirements due to ill-health
During the period 1 April 2011 to 31 March 2012 there were three early
retirements on the grounds of ill-health at an additional cost of £173k.
7.4 Staff Exit Packages
Exit Package Cost Band
Number of
compulsory
redundancies
Other departures agreed relate to agreements reached under a Mutually
Agreed Resignation Scheme (MARS). Any such payments made to
directors are disclosed separately under note 7.5.
Annual Report and Annual Accounts 2011-12
Number of
other
departures
agreed
Total
number of
exit
packages
agreed
< £10,000 1 20 21
£10,000 - £25,000 26 26
£25,001 - £50,000 22 22
£50,001 - £100,000 1 1
£100,000 - £150,000
>£150,000
Total number of exit packages by
type 2 68 70
Total resource cost £000 77 1283 1360

203
7. Employee costs and numbers continued / 7.5 Salaries and Allowances of Senior Managers
Name and Title
April 2011 to March 2012
Salary Other
Remuneration
Benefits in Kind
(bands of
£5000)
£000
B Pilkington Chairman 45 - 50
J Guthrie Non-Executive Director (1)
P Tubb Non-Executive Director (2) 10 - 15
D Taylor Non-Executive Director 15 - 20
A Chan Non-Executive Director 10 - 15
C Dale Non-Executive Director 10 - 15
R Nichols Non-Executive Director 10 - 15
B Marshall Non-Executive Director 15 - 20
(bands of £5000)
£000
S Barber Chief Executive 170 - 175 15 - 20 *
L Sell Medical Director (3) 40 - 45 40 - 45 **
F Ibitoye Medical Director (4) 35 - 40 35 - 40 **
G Briers Director of Nursing and Governance (5) 65 - 70
R Walker Director of Nursing and Governance (6) 20 - 25
N Rowe Deputy Chief Executive 110 - 115 10-15 *
Rounded to the
nearest £100
T Patten Director of Operations 95 - 100 10-15 * 5
D Marsh Director of Finance & Informatics 95 - 100 10-15 *
J Kelly Director of Partnerships (7) 35 - 40 95 - 100 ***
T Hill Director of HR and Organisational Development (8) 65 - 70
Highest Paid Director's Total Remuneration
Median Total Remuneration
Ratio ****
190 - 195
27,096
7.1
(1) Resigned 28/02/2011
(2) Appointed 31/05/2011
(3) Appointed 01/10/2011
(4) Resigned 30/09/2011
(5) Appointed 20/06/2011
(6) Resigned 19/06/2011
(7) Resigned 31/08/2011
(8) Appointed 01/07/2011
These payments were made due to
the successful integration of
Knowsley Integrated Provider Services.
** These payments relate to clinical
Duties rather than Board Director responsibilities.
*** This payment was made under a
Mutually Agreed Resignation Scheme (MARS).
**** The Trust is required to disclose the ratio
between the mid-point of the banded remuneration of
the highest paid director and the median
remuneration of the Trust's staff. The
median calculation is based on the full-time
equivalent staff of the Trust at the reporting end date
on an annualised basis.
Annual Report and Annual Accounts 2011-12 203

7. Employee costs and numbers continued / 7.5 Salaries and Allowances of Senior Managers cont.
Name and Title
204
April 2010 to March 2011
Salary Other
Remuneration
(bands of
£5000)
£000
B Pilkington Chairman 45 - 50
J Guthrie Non-Executive Director (1) 10 - 15
P Tubb Non-Executive Director (2)
D Taylor Non-Executive Director 15 - 20
A Chan Non-Executive Director 10 - 15
C Dale Non-Executive Director 10 - 15
R Nichols Non-Executive Director 10 - 15
B Marshall Non-Executive Director 15 - 20
S Barber Chief Executive 170 - 175
L Sell Medical Director (3)
(bands of £5000)
£000
F Ibitoye Medical Director (4) 35 - 40 110 - 115
G Briers Director of Nursing and Governance (5)
Annual Report and Annual Accounts 2011-12
Benefits in
Kind
Rounded to
the nearest
£100
R Walker Director of Nursing and Governance (6) 95 - 100 4
N Rowe Deputy Chief Executive 95 - 100
T Patten Director of Operations 95 - 100 3
D Marsh Director of Finance & Informatics 95 - 100
J Kelly Director of Partnerships (7) 95 - 100
T Hill Director of HR and Organisational Development (8)
Highest Paid Director's Total Remuneration
Median Total Remuneration
Ratio ****
204
Accurate 2010-11 comparison not available due to
transfer of Knowsley Integrated Provider Services staff

205
7. Employee costs and numbers continued / 7.6 Pension Benefits
Name and title
Real increase
in Pension at
age 60
(bands of
£2500)
£000
Real increase
in lump sum
at age 60
(bands of
£2500)
£000
Total accrued
pension at age
60 at 31 March
2012
(bands of
£5000)
£000
Lump Sum at
age 60 related
to accrued
pension at 31
Mar 2012
(bands of
£5000)
£000
Cash
Equivalent
Transfer
Value at 31
March 2012
The Trust contributed £116k into the pension scheme of the above directors during 2011/12.
As Non-Executive members do not receive pensionable remuneration, there are no entries in respect of pensions for Non-Executive Directors.
* Under the normal rules and regulations regarding the 1995 section of the scheme if a member has turned 60 or is receiving their pension they are
not entitled to transfer their benefits out of the scheme. Therefore the NHS Pensions Agency would not provide CETV details (unless the request is in
respect of divorce proceedings). The NHS Pensions Agency decided that they would also follow this procedure regarding the Greenbury Disclosures.
Signed: Simon Barber, Chief Executive Date: 28/05/2012
Cash
Equivalent
Transfer
Value at 31
March 2011
Real Increase
in Cash
Equivalent
Transfer
Value
Employers
Contribution to
Stakeholder
Pension
£000 £000 £000 £000
S Barber Chief Executive 0 - 2.5 5.0 - 7.5 5 - 10 25 - 30 150 102 47 33
D Marsh Director of Finance and
Informatics 0 - 2.5 0 - 2.5 20 - 25 55 - 60 330 276 54 38
L Sell Medical Director (1) 0 - 2.5 5.0 - 7.5 45 - 50 145 -150 861 718 71 50
F Ibitoye Medical Director (2) (0) - (2.5) (2.5) - (5.0) 25 - 30 70 - 75 0 * 0 * 0 * 0 *
G Briers Director of Nursing and
Governance (3) 0 - 2.5 0 - 2.5 15 - 20 35 - 40 618 512 106 74
R Walker Director of Nursing and
Governance (4) 0 - 2.5 2.5 - 5.0 10 - 15 40 - 45 224 192 32 22
J Kelly Director of Partnerships (5) (2.5) - (5.0) (0) - (2.5) 25 - 30 115 - 120 0 760 (760) (532)
N Rowe Deputy Chief Executive 0 - 2.5 0 5 - 10 0 88 52 36 25
T Patten Director of Operations 0 - 2.5 2.5 - 5.0 10 - 15 35 - 40 194 152 42 30
T Hill Director of HR and Organisational
Development (6) 0 - 2.5 2.5 - 5.0 20 - 25 55 - 60 300 235 65 46
(1) Appointed 01/10/2011
(2) Resigned 30/09/2011
(3) Appointed 20/06/2011
(4) Resigned 19/06/2011
(5) Resigned 31/08/2011
(6) Appointed 01/07/2011
Annual Report and Annual Accounts 2011-12 205

206
8. Retirement benefits
Past and present employees are covered by the provisions of the NHS
Pensions Scheme. Details of the benefits payable under these provisions can
be found on the NHS Pensions website at www.nhsbsa.nhs.uk/pensions.
The scheme is an unfunded, defined benefit scheme that covers NHS
employers, General Practices and other bodies allowed under the direction of
the Secretary of State in England and Wales. The scheme is not designed to
be run in a way that would enable NHS bodies to identify their share of the
underlying scheme assets and liabilities. Therefore, the scheme is accounted
for as if it were a defined contribution scheme. The cost to the NHS Body of
participating in the scheme is taken as equal to the contributions payable to
the scheme for the accounting period.
The scheme is subject to a full actuarial valuation every four years and an
accounting valuation every year. An outline of these follows:
a) Full actuarial (funding) valuation
The purpose of this valuation is to assess the level of liability in respect of the
benefits due under the scheme (taking into account its recent demographic
experience), and to recommend the contribution rates to be paid by
employers and scheme members. The last such valuation, which determined
current contribution rates, was undertaken as at 31 March 2004 and covered
the period from 1 April 1999 to that date. The conclusion from the 2004
valuation was that the scheme had accumulated a notional deficit of £3.3
billion against the notional assets as at 31 March 2004.
Following the full actuarial review by the Government Actuary undertaken as
at 31 March 2004, and after consideration of changes to the NHS Pension
Scheme taking effect from 1 April 2008, his valuation report recommended
that employer contributions could continue at the existing rate of 14 per cent
of pensionable pay, from 1 April 2008, following the introduction of employee
contributions on a tiered scale from 5 per cent up to 8.5 per cent of their
pensionable pay depending on total earnings. On advice from the scheme
actuary, scheme contributions may be varied from time to time to reflect
changes in the scheme’s liabilities.
b) Accounting valuation
A valuation of the scheme liability is carried out annually by the scheme
actuary as at the end of the reporting period by updating the results of the full
actuarial valuation.
Between the full actuarial valuations at a two-year midpoint, a full and detailed
member data-set is provided to the scheme actuary. At this point the
assumptions regarding the composition of the scheme membership are
updated to allow the scheme liability to be valued.
Annual Report and Annual Accounts 2011-12

8. Retirement benefits continued.
The latest assessment of the liabilities of the scheme is contained in the
scheme actuary report, which forms part of the annual NHS Pension Scheme
(England and Wales) Resource Account published annually. These accounts
can be viewed on the NHS Pensions website. Copies can also be obtained
from The Stationery Office.
c) Scheme provisions
The NHS Pension Scheme provides defined benefits which are summarised
below. This list is an illustrative guide only and it is not intended to detail all
the benefits provided by the Scheme or the specific conditions that must be
met before these benefits can be obtained.
Annual Pensions The Scheme is a 'final salary' scheme. Annual pensions
are normally based on 1/80th for the 1995 section and of the best of the last
three years’ pensionable pay for each year of service and 1/60th for the 2008
section of reckonable pay per year of membership. Members who are
practitioners as defined by the Scheme Regulations have their annual
pensions based upon total pensionable earnings over the relevant
pensionable service. With effect from 1 April 2008 members can choose to
give up some of their annual pension for an additional tax-free lump sum up
to a maximum amount permitted under HMRC rules. This new provision is
known as 'pension commutation'.
Pensions Indexation Annual increases are applied to pension payments at
rates defined by the Pensions (Increase) Act 1971 and are based on changes
in retail prices in the 12 months ending 30 September in the previous
calendar year.
Lump Sum Allowance A lump sum is payable on retirement which is
normally three times the annual pension payment.
Ill-Health Retirement Early payment of a pension, with enhancement in
certain circumstances, is available to members of the Scheme who are
permanently incapable of fulfilling their duties or regular employment
effectively through illness or infirmity.
Death Benefits A death gratuity of twice their final year's pensionable pay for
death in service - and five times their annual pension after retirement - is
payable.
Additional Voluntary Contributions (AVCs) Members can purchase
additional service in the NHS Scheme and contribute to money purchase
AVCs run by the Scheme's approved providers or by other Free Standing
Additional Voluntary Contributions (FSAVC) providers.
Annual Report and Annual Accounts 2011-12 207

208
8. Retirement benefits continued.
Transfer Between Funds Scheme members have the option to transfer their
pension between the NHS Pension Scheme and another scheme when they
move into or out of NHS employment.
Preserved Benefits Where a Scheme member ceases NHS employment
with more than two years’ service they can preserve their accrued NHS
pension for payment when they reach retirement age.
Compensation for Early Retirement Where a member of the Scheme is
made redundant they may be entitled to early receipt of their pension plus
enhancement at the employer's cost.
Annual Report and Annual Accounts 2011-12

209
9. Better Payment Practice Code
Better Payment Practice Code - measure of compliance
2011/12 2010/11
Number £000 Number £000
Total Non-NHS trade invoices paid in the year 20,188 17,403 11,410 12,412
Total Non NHS trade invoices paid within
target 19,534 16,826 11,042 11,662
Percentage of Non-NHS trade invoices paid
within target 97% 97% 97% 94%
Total NHS trade invoices paid in the year 1,047 14,531 914 11,394
Total NHS trade invoices paid within target 997 13,669 880 10,992
Percentage of NHS trade invoices paid within
target 95% 94% 96% 96%
Total invoices paid in the year 21,235 31,933 12,324 23,806
Total invoices paid within target 20,531 30,495 11,922 22,654
Percentage of invoices paid within target 97% 95% 97% 95%
Under the Better Payment Practice Code, the Trust aims to pay all undisputed invoices by the due date or within 30 days of receipt of
goods or a valid invoice, whichever is later. The Trust is also an approved signatory to the Prompt Payment Code.
The Late Payment of Commercial Debts (Interest) Act 1998
During the reporting period there were no claims for interest made against the Trust under the above legislation.
Annual Report and Annual Accounts 2011-12 209

210
10. Finance income
2011/ 2010/
12 11
£000 £000
Interest revenue:
Bank accounts 95 36
Other loans and receivables 0 0
Other financial assets 0 0
Total 95 36
11. Other gains and losses
2011/12 2010/11
£000 £000
Gain/(loss) on disposal of property,
plant and equipment
Gain/(loss) on disposal of intangible
assets
Gain/(loss) on disposal of financial
assets
Gain/(loss) on foreign exchange
Change in fair value of financial assets
carried at fair value through
profit and loss
Change in fair value of financial
liabilities carried at fair value through
profit and loss
Recycling of gain/(loss) from equityon
disposal of financial assets
available for sale
Total 0 0
12. Finance Costs
2011/12 2010/11
£000 £000
Interest on loans
Interest on obligations under finance
leases
Interest on overdrafts
Other interest expense
Other finance costs
Total 0 0
Annual Report and Annual Accounts 2011-12

13. Intangible assets
Software
licences
Total
2011/12:
(purchased)
£000 £000
Valuation/Gross Cost at 1 April 2011 - as
previously stated
Prior period adjustments*
TCS and merger adjustments
Valuation/Gross cost at 1 April 2011 -
restated
Valuation/Gross cost at start of period for
new FTs
Additions - purchased
Additons - donated
Additions - internally generated
Additions - Government granted
Impairments
Reversal of impairments
Reclassifications
Revaluations
Transferred to disposal group as asset held
for sale
Disposals
13 13
Gross cost at 31 March 2012
Amortisation at 1 April 2011 - as
previously stated
Prior period adjustments*
TCS and merger adjustments
Amortisation at 1 April 2011 - restated
Amortisation at start of period for new FTs
13 13
Provided during the year
Impairments
Reversal of impairments
Reclassifications
Revaluation surpluses
Transferred to disposal group as asset held
for sale
Disposals
3 3
Amortisation at 31 March 2012 3 3
Annual Report and Annual Accounts 2011-12 211

212
13.2 Intangible assets financing
2011/12:
Software
licences
(purchased) Total
Net book value
£000 £000
NBV - Purchased at 31 March 2012
NBV - Finance leases at 31 March 2012
NBV - Donated at 31 March 2012
10 10
NBV total at 31 March 2012 10 10
Amortised historic cost is considered to be a reasonable indicator of fair
value.
The economic life of the above intangible assets is expected to be five
years.
Annual Report and Annual Accounts 2011-12

14. Property, plant and equipment
2011/12:
Land Buildings
excluding
dwellings
Dwellings Assets
under
construct
and poa
Plant and
machinery
Transport
equipment
Information
technology
Furniture
and
fittings
£000 £000 £000 £000 £000 £000 £000 £000 £000
Valuation/Gross cost at 1 April
2011 - as previously stated 10,399 67,298 427 284 23 1,842 2,276 82,549
Prior period adjustments
TCS and merger adjustments
Valuation/Gross cost at 1 April 2011 - restated 10,399 67,298 427 284 23 1,842 2,276 82,549
Additions purchased 2,419 174 115 2 56 13 2,779
Additions donated
Additions - Government granted
Impairments (77) (77)
Reversal of impairments
Reclassifications 427 (427)
Reclassified as held for sale (1,297) (1,545) (2,842)
Revaluations
Transferred to disposal group as asset held for sale
Disposals (3) (3)
Valuation/Gross cost at 31 March 2012 9,102 68,522 174 396 25 1,898 2,289 82,406
213
Annual Report and Annual Accounts 2011-12 213
Total

214
14. Property, plant and equipment continued.
Accumulated depreciation at 1 April 2011 - as
previously stated 185 10,894 195 23 1,637 2,070 15,004
Prior period adjustment
TCS and merger adjustments
Accumulated depreciation at 1 April 2011 –
restated 185 10,894 195 23 1,637 2,070 15,004
Provided during the year 1,740 47 1 50 44 1,882
Impairments 37 318 355
Reversal of impairments (6) (625) (631)
Reclassifications
Reclassified as held for sale
Revaluation surpluses
Transferred to disposal group as asset held for
sale
Disposals
Accumulated depreciation at 31 March 2012 216 12,327 242 24 1,687 2,114 16,610
Net Book Value
Land
Buildings
excluding
dwellings
Dwellings Assets
under
construct
and poa
Annual Report and Annual Accounts 2011-12
Plant and
machinery
Transport
equipment
Information
technology
Furniture
& fittings Total
Owned 8,886 56,195 174 154 1 211 175 65,796
Finance lease
On-balance-sheet PFI contracts and other
service concession arrangements
PFI
Government granted
Donated
Total at 31 March 2012 8,886 56,195 174 154 1 211 175 65,796
Net Book Value
Protected assets 8,599 52,345 60,944
Unprotected assets 287 3,850 174 154 1 211 175 4,852
Total at 31 March 2012 8,886 56,195 174 154 1 211 175 65,796
214

14. Property, plant and equipment continued.
2010/11:
Land Buildings
excluding
dwellings
Dwellings Assets
under
construct
and poa
Plant and
machinery
Transport
equipment
Information
technology
Furniture
and
fittings
£000 £000 £000 £000 £000 £000 £000 £000 £000
Valuation/Gross cost at 1 April 2010 10,987 65,563 1,367 299 29 1,644 2,261 82,150
Prior period adjustments*
Valuation/Gross cost at 1 April 2010 - restated 10,987 65,563 1,367 299 29 1,644 2,261 82,150
Additions purchased (1) 871 427 25 198 37 1,557
Additions donated
Additions - Government granted
Impairments (364) (364)
Reversal of impairments
Reclassifications 1,367 (1,367)
Reclassified as held for sale (223) (363) (586)
Revaluations (140) (40) (6) (22) (208)
Transferred to disposal group as asset held for sale
Disposals
Valuation/Gross cost at 31 March 2011 10,399 67,298 427 284 23 1,842 2,276 82,549
Accumulated depreciation at 1 April 2010 9,222 181 23 1,466 2,026 12,918
Prior period adjustments*
Accumulated depreciation at 1 April 2010 - restated 9,222 181 23 1,466 2,026 12,918
Provided during the year 1,744 14 171 44 1,973
Impairments 185 185
Reversal of impairments
Reclassifications
Reclassified as held for sale (72) (72)
Revaluation surpluses
Transferred to disposal group as asset held for sale
Disposals
Accumulated depreciation at 31 March 2011 185 10,894 195 23 1,637 2,070 15,004
215
Annual Report and Annual Accounts 2011-12 215
Total

216
14. Property, plant and equipment continued.
Net Book Value
Land
Buildings
excluding
dwellings
Dwellings Assets
under
construct
and poa
Annual Report and Annual Accounts 2011-12
Plant and
machinery
Transport
equipment
Information
technology
Furniture
and
fittings Total
Owned 10,214 56,404 427 89 205 206 67,545
Finance lease
On-balance-sheet PFI contracts and other
service concession arrangements
PFI
Government granted
Donated
Total at 31 March 2011 10,214 56,404 427 89 205 206 67,545
Net Book Value
Protected assets 9,345 51,277 60,622
Unprotected assets 869 5,127 427 89 205 206 6,923
Total at 31 March 2011 10,214 56,404 427 89 205 206 67,545
216

14. Property, plant and equipment continued
As at 31 March 2012 there were no land, buildings or dwellings valued at open market
value.
During 2011/12 the District Valuer conducted an interim valuation on the Trust's land and
buildings. The results of this exercise were used to ensure that land and buildings were
reported at fair value as at 31 March 2012.
For all other items of non-current assets, depreciated historic cost is considered to be a
reasonable indicator of fair value.
Economic life of property, plant and equipment is as follows:
Buildings - Five to 99 years (dependent on component)
Plant and machinery - Five to 10 years
Transport equipment - Seven years
Information technology - Three to five years
Furniture and fittings - Five to 10 years.
15. Revaluation reserve
2011/12:
Property,
plant and
equipment
Assets
held
for
sale
Total
£000 £000 £000
Revaluation reserve at 1 April
2011 17,250 889 18,139
Prior period adjustments
TCS and merger adjustments
Revaluation reserve at 1 April
2011 - restated 17,250 889 18,139
Impairments (77) (77)
Revaluations
Transfers to other reserves
Asset disposals
Fair Value gains/(losses) on
Available-for-sale financial
investments
Recycling gains/(losses) on
Available-for-sale financial
investments
Other recognised gains and losses
Other reserve movements * (889) (889)
Revaluation reserve at 31 March
2012 17,173 17,173
Annual Report and Annual Accounts 2011-12 217

218
15. Revaluation reserve continued
2010/11:
Property,
plant
and
equipment
Annual Report and Annual Accounts 2011-12
Assets
held
for
sale
Total
£000 £000 £000
Revaluation reserve at 1 April
2010 18,052 889 18,941
Prior period adjustments
TCS and merger adjustments 18,052 889 18,941
Revaluation reserve at 1 April
2010 - restated (364) (364)
Impairments (208) (208)
Revaluations
Transfers to other reserves
Asset disposals
Fair Value gains/(losses) on
Available-for-sale financial
investments
Recycling gains/(losses) on
Available-for-sale financial
investments
Other recognised gains and losses (230) (230)
Other reserve movements *
Revaluation reserve at 31 March
2011 17,250 889 18,139
* Other reserve movements relate to balances transferred from the
revaluation reserve to the income and expenditure reserve in respect of
assets held for sale in accordance with prescribed accounting treatment.

16. Non-current assets for sale and assets in disposal groups
2011/12:
Intantgible
assets
Property,
plant and
equipment
Financial
investments
Other Total
£000 £000 £000 £000 £000
NBV of non-current assets for sale and assets in disposal groups at 1
April 2011 514 514
Prior period adjustments
TCS and merger adjustments
NBV of non-current assets for sale and assets in disposal groups at 1
April 2011 - restated 514 514
Assets identified as available for sale in the year 2,842 2,842
Assets sold in the year (514) (514)
Impairment of assets held for sale (15) (15)
Reversal of impairment of assets held for sale
Assets no longer classified as held for sale (for reasons other than disposal by
sale) (331) (331)
NBV of non-current assets for sale and assets in disposal groups at 31
March 2012 2,496 2,496
219
Annual Report and Annual Accounts 2011-12 219

16. Non-current assets for sale and assets in disposal groups continued.
2010/11:
NBV of non-current assets for sale and assets in disposal groups at 1
April 2010
220
Intantgible
assets
Property,
plant and
equipment
Annual Report and Annual Accounts 2011-12
Financial
investments
Other Total
£000 £000 £000 £000 £000
Assets identified as available for sale in the year 514 514
Assets sold in the year
Impairment of assets held for sale
Reversal of impairment of assets held for sale
Assets no longer classified as held for sale (for reasons other than disposal by
sale)
NBV of non-current assets for sale and assets in disposal groups at 31
March 2011 514 514
The net book value of non-current assets held for sale comprises the Oakdene, Fourways and St Bartholomew sites - all of which have been approved by the board as surplus to
requirements. All sites have been actively marketed with a sale expected within 12 months. The sale of Fourways has been completed in April.
220

17. Capital commitments
There are no contractual capital commitments as at 31 March 2012.
18. Inventories
18.1 Inventories
18.2 Inventories recognised in expenses
31
March
2012
31 March
2011
£000 £000
Drugs
Work in progress 12
Consumables 41 49
Energy
Inventories carried at fair value less costs to sell
Other
Total 53 49
31
March
2012
31
March
2011
£000 £000
Inventories recognised as an expense in the
period 1,228 953
Write-down of inventories (including losses)
Reversal of write-downs that reduced the
expense
Total 1,228 953
Annual Report and Annual Accounts 2011-12 221

222
19. Trade and other receivables
19.1 Trade and other receivables
NonNon-
Current current Current current
31 31 31 31
March March March March
2012 2012 2011 2011
£000 £000 £000 £000
NHS Receivables - Revenue
Other receivables with related
1,011 1,195
parties - Revenue 252 159 223 109
Provision for impaired receivables (415) (109)
Prepayments (Non-PFI) 309 389
Accrued income 192
Interest Receivable 39
PDC dividend receivable 61 14
VAT receivable 269 226
Other receivables
Other receivables - Capital
329 281
Total 2,047 159 2,219 109
The great majority of trade is with primary care trusts as commissioners for NHS patient
care services. As primary care trusts are funded by Government to buy NHS patient care
services, no credit scoring of them is considered necessary. The credit risk exposure is
therefore low.
19.2 Provision for impairment of receivables
2011/12 2010/11
£000 £000
At 1 April 109 98
Increase in provision 343 37
Amounts utilised (28) (4)
Unused amounts reversed (9) (22)
At 31 March 415 109
Annual Report and Annual Accounts 2011-12

19.3 Ageing of impaired receivables
31 March 31 March
2012
2011
£000 £000
0 - 30 days 5
30 - 60 Days
60 - 90 days
90 - 180 days (was ‘In three to six
19 2
months’) 7
over 180 days (was ‘Over six months’) 389 102
Total 415 109
19.4 Ageing of non-impaired receivables past their due date
31 March 2012 31 March 2011
£000 £000
0 - 30 days 815 766
30 - 60 Days 92 280
60 - 90 days 58 4
90 - 180 days (was ‘In three to six months’) 87 74
over 180 days (was ‘Over six months’) 68 125
Total 1,120 1,249
20. Cash and cash equivalents
2011/12 2010/11
£000 £000
At 1 April 7,273 4,663
Net change in year 5,297 2,610
At 31 March 12,570 7,273
Made up of:
Cash at commercial banks and in hand 73 75
Cash with the Government Banking Service 12,497 7,198
Current investments
Cash and cash equivalents as in statement
of financial position 12,570 7,273
Bank overdraft - Government Banking Service
Bank overdraft - Commercial banks
Cash and cash equivalents as in statement
of cash flows 12,570 7,273
Annual Report and Annual Accounts 2011-12 223

224
21. Third party assets held by the NHS Foundation Trust
2011/12 2011/12 2010/11 2010/11
Bank Money on Bank Money on
Balances Deposit Balances Deposit
£000 £000 £000 £000
At 1 April 126 134 47
Gross inflows 314 486
Gross Outflows (301) (494) (47)
At 31 March 139 126
22. Trade and other payables
NonNon-
Current current Current current
31 31 31 31
March March March March
2012 2012 2011 2011
£000 £000 £000 £000
Receipts in advance
NHS payables - capital
NHS payables - revenue 848 1,434
Amounts due to other related parties
- revenue 1,550 199
Other trade payables - capital 509 492
Other trade payables - revenue 1,909 677
Social Security costs 1,126 778
VAT payable
Other taxes payable 1,193 908
Other payables 339 29 1,047
Accruals 2,526 1,709
PDC dividend payable
Reclassified to liabilities held in
disposal groups in year
Total 10,000 29 7,244
Annual Report and Annual Accounts 2011-12

23. Other liabilities
Current Non-current Current
Noncurrent
31 31
31 March 31 March March March
2012 2012 2011 2011
£000 £000 £000 £000
Deferred grants income 185
Other Deferred income
Deferred PFI credits
Lease incentives
Net Pension Scheme Liability
66 114
Total 66 114 185
24. Provisions for liabilities and charges
Current Non- Current Noncurrentcurrent
31 31
March March 31 March 31 March
2012 2012 2011 2011
£000 £000 £000 £000
Pensions relating to former
Directors
Pensions relating to other staff 24 245 24 262
Legal claims 490 170 97 386
Agenda for Change
Restructurings
Continuing care
Equal pay
Redundancy
Other *** 52 36
Total 566 415 157 648
Annual Report and Annual Accounts 2011-12 225

226
Pensions
relating to
former
directors
Pensions
relating to
other staff
Legal
claims
Agenda
for
Change
Restructurings
Annual Report and Annual Accounts 2011-12
Continuing
care
Equal
pay
Redundancy Other Total
£000 £000 £000 £000 £000 £000 £000 £000 £000 £000
At 1 April 2011 286 483 36 805
Prior period adjustments
TCS and merger
adjustments
At 1 April 2011 - restated 286 483 36 805
Change in the discount rate
Arising during the year 327 52 379
Used during the year (24) (92) (10) (126)
Reclassified to liabilities
held in disposal groups in
year
Reversed unused (64) (26) (90)
Unwinding of discount 7 6 13
At 31 March 2012 269 660 52 981
Expected timing of cash
flows:
- not later than one year 24 490 52 566
- later than one year and
98 126
not later than five years
224
- later than five years 147 44 191
Total 269 660 52 981
Pensions relating to other staff are based on figures provided by the Benefits Agency. Under legal claims £202k relates to permanent injury claims. These claims are calculated using
recommended policies relating to life span (thus indicating the length of the provision). Figures are discounted to adjust for the anticipated date of settlement and the time value of
money. The balance of £458k relates to risk pooling arrangements - the amounts and timings of which are notified by the NHS Litigation Authority (NHSLA). Provisions are adjusted for
the probability factor for settlement. There are anticipated reimbursements of £159k in the form of NHSLA receivables.
£223k is included in the provisions of the NHS Litigation Authority at 31 March 2012 (£103k at 31 March 2011) in respect of clinical negligence liabilities of the Trust.
226

25. Contingences
25.1 Contingent liabilities
2011/12 2010/11
£000 £000
Gross value of contingent liabilities (263) (105)
Amounts recoverable against liabilities 239 86
Total (24) (19)
The gross value of contingent liabilities relates to risk pooling as notified by the NHSLA.
26.1 Financial Instruments
26.2 Financial assets
NHS Trade and other
receivables excluding
non financial assets (at
31 March 2012)
Non-NHS Trade and
other receivables
excluding non financial
assets (at 31 March
2012)
At fair
value
through
I and E
Loans and
receivables
Held to
maturity
Available
for sale
Total
£000 £000 £000 £000 £000
758 758
880 880
Other Investments (at
31 March 2012)
Other Financial Assets
(at 31 March 2012)
Non current assets held
for sale and assets held
in disposal group
excluding non financial
assets (at 31 March
2012)
Cash and cash
equivalents at bank and
in hand (at 31 March
2012)
12,570 12,570
Total at 31 March 2012 14,208 14,208
Annual Report and Annual Accounts 2011-12 227

NHS Trade and other
receivables excluding
non financial assets (at
31 March 2011)
Non-NHS Trade and
other receivables
excluding non financial
assets (at 31 March
2011)
228
At fair
value
through
I and E
Loans and
receivables
Held to
maturity
Annual Report and Annual Accounts 2011-12
Available
for sale
Total
£000 £000 £000 £000 £000
1,123 1,123
693 693
Other Investments (at
31 March 2011)
Other Financial Assets
(at 31 March 2011)
Non current assets held
for sale and assets held
in disposal group
excluding non financial
assets (at 31 March
2011)
Cash and cash
equivalents (at bank
and in hand (at 31
March 2011)
7,273 7,273
Total at 31 March 2011 9,089 9,089

26.2 Financial liabilities
NHS Trade and other payables
excluding non financial assets
(at 31 March 2012)
Non-NHS Trade and other
payables excluding non financial
assets (at 31 March 2012)
Other financial liabilities (at 31
March 2012)
Provisions under contract (at 31
March 2012)
At fair
value
through I
and E
Other Total
£000 £000 £000
951 951
6,759 6,759
660 660
Liabilities in disposal groups
excluding non-financial assets
(at 31 March 2012)
Total at 31 March 2012 8,370 8,370
NHS Trade and other payables
excluding non financial assets
(31 March 2011)
Non-NHS Trade and other
payables excluding non financial
assets (31 March 2011)
Other financial liabilities (31
March 2011)
Provisions under contract (at 31
March 2011)
1,434 1,434
4,124 4,124
483 483
Liabilities in disposal groups
excluding non-financial assets
(at 31 March 2011)
Total at 31 March 2011 6,041 6,041
27. Financial risk management
Financial reporting standard IFRS 7 requires disclosure of the role that financial
instruments have had during the period in creating or changing the risks a body
faces in undertaking its activities. Because of the continuing service provider
relationship that the NHS trust has with primary care trusts and the way those
primary care trusts are financed, the NHS Trust is not exposed to the degree of
financial risk faced by business entities.
Annual Report and Annual Accounts 2011-12 229

230
27. Financial risk management continued.
Also, financial instruments play a much more limited role in creating or
changing risk than would be typical of listed companies to which the financial
reporting standards mainly apply. The NHS Trust has limited powers to borrow
or invest surplus funds and financial assets and liabilities are generated by dayto-day
operational activities rather than being held to change the risks facing
the NHS Trust in undertaking its activities.
The Trust’s treasury management operations are carried out by the Finance
department, within parameters defined formally within the Trust’s standing
financial instructions and policies agreed by the Board of Directors. Trust
treasury activity is subject to review by the Trust’s internal auditors.
Currency risk
The Trust is principally a domestic organisation with the great majority of
transactions, assets and liabilities being in the UK and sterling based. The Trust
has no overseas operations. The Trust therefore has low exposure to currency
rate fluctuations.
Interest rate risk
The Trust currently has no borrowing. The Trust therefore has no exposure to
interest rate fluctuations.
Credit risk
Because the majority of the Trust’s income comes from contracts with other
public sector bodies, the trust has low exposure to credit risk. The maximum
exposures as at 31 March 2012 are in receivables from customers as disclosed
in the Trade and other receivables note.
Liquidity
The Trust’s operating costs are incurred under contracts with primary care
trusts, which are financed from resources voted annually by Parliament. The
Trust funds its capital expenditure from funds obtained within its Prudential
Borrowing Limit. The Trust is not, therefore, exposed to significant liquidity
risks.
28. Prudential Borrowing Limit
The Trust is required to comply with and remain within a prudential borrowing
limit.
This is made up of two elements:
The maximum cumulative amount of long-term borrowing. This is set by
reference to the four ratio tests set out in Monitor's Prudential Borrowing
Code. The financial risk rating set under Monitor's Compliance Framework
determines one of the ratios and can therefore impact upon the long-term
borrowing limit; and
The amount of any working capital facility approved by Monitor.
Annual Report and Annual Accounts 2011-12

Further information on the NHS Foundation Trust Prudential Borrowing Code
and Compliance Framework can be found on the website of Monitor - the
Independent Regulator of Foundation Trusts.
28. Prudential Borrowing Limit continued.
Performance against the Prudential Borrowing Limit was as follows:
Prudential Borrowing Limit 2011/12 2010/11
£'000 £'000
Total long-term borrowing limit set by Monitor (per
Schedule 5 of Trust's terms of Authorisation) 21,600 21,200
Working capital facility limit agreed by Monitor (per
Schedule 5 of Trust's terms of Authorisation) 8,000 8,000
Actual (contracted) working capital facility 8,000 8,000
Total Prudential Borrowing Limit 29,600 29,200
Borrowing (as defined in the Prudential Borrowing
Code) at 1 April 0 0
Net actual borrowing/(repayment) in year 0 0
Long-term borrowing at 31 March 0 0
Working capital borrowing at 1 April 0 0
Net actual borrowing/(repayment) in year - working
capital 0 0
Working capital borrowing at 31 March 0 0
Prudential Borrowing Code (PBC) ratio performance:
Actual
Actual
Ratios Thresholds Ratios Thresholds
2011/12 2011/12 2010/11 2010/11
Minimum Dividend Cover 3.4 >1x 3.1 >1x
Minimum Interest Cover n/a >3x n/a >3x
Minimum Debt Service Cover n/a >2x n/a >2x
Maximum Debt Service to Revenue n/a

232
Department, and / or with other entities for which the Department is regarded
as the parent Department. These entities are listed as follows:
Income Expenditure
£'000 £'000
NHS North West 2,405
Ashton, Leigh and Wigan PCT 23,076
Halton and St Helens PCT 41,350 30
Knowsley PCT 48,180 50
Liverpool PCT 925 24
Warrington PCT 17,135
Western Cheshire PCT 7,597
St Helens and Knowsley Hospitals NHS
Trust 4,539 3,459
Warrington and Halton Hospitals NHS
Foundation Trust 1,632
Wrightington, Wigan and Leigh NHS
Foundation Trust 1,241
NHSLA 291
In addition, the Trust has had a number of material transactions with other
government departments and other central and local Government bodies. Most
of these transactions have been with HM Revenue and Customs, NHS
Pensions Scheme and Local Authorities.
Certain members of the Board of Directors, key members of staff (or parties
related to them) and members of the Council of Governors have connections
with organisations which have also had transactions with the Trust. These
organisations are listed below:
Income Expenditure
£'000 £'000
St Helens MBC 279 101
Warrington Disability
Partnership
Knowsley MBC 1,106 849
Warrington MBC 182 291
Wigan MBC 141 37
Halton MBC 423 24
Warrington PCT 17,135
Knowsley PCT 48,180 50
Halton and St Helens PCT 41,350 30
Annual Report and Annual Accounts 2011-12

30. Third Party Assets
The Trust held £139k cash and cash equivalents at 31 March 2012 (£126k at
31 March 2011) which relates to monies held by the Trust on behalf of patients.
This has been excluded from the cash and cash equivalents figure reported in
the accounts.
31. Inter Government Receivables and Payables
Current
receivables
at 31
March 2012
Noncurrent
receivables
at 31
March 2012
Current
payables
at 31
March
2012
Noncurrent
payables
at 31
March
2012
£000 £000 £000 £000
NHS Foundation
Trusts 140 732
NHS and
Department of
Health 1,048 159 664
Local Government 252 167
Central Government 269 3,721
Total WGA
Receivables /
Payables 1,709 159 5,284
Non WGA Balances 338 4,782 29
Balance at 31
March 2012 2,047 159 10,066 29
Current
receivables
at 31 March
2011
Noncurrent
receivables
at 31 March
2011
Current
payables
at 31
March
2011
Non-
Current
payables
at 31
March
2011
£000 £000 £000 £000
74 957
1,139 109 477
223 292
226
Total WGA
Receivables /
Payables 1,662 109 1,726
Non WGA
Balances 371 1,616
Balance at 31
March 2011 2,033 109 3,342
Annual Report and Annual Accounts 2011-12 233

234
32. Losses and Special Payments
During the year there were 20 losses with a total value of £7k relating to bad debts. In
addition there were 22 special payments with a total value of £22k relating to loss of
personal effects.
Annual Report and Annual Accounts 2011-12

Annual Report and Annual Accounts 2011-12 235

236
Annual Report and Annual Accounts 2011-12