REVIEW OF THE YEAR BY THE CHAIRMAN

Anothertremendousbenefit to patients,not only on theFylde Coast butalso in SouthCumbria andLancashire, was theopening of the Lancashire CardiacCentre in April 2006. This is goingfrom strength to strength and weintend that the unit will be a nationalcentre of excellence in cardiacservices.We also opened a state-of-the-art DaySurgery Unit. This is now in full swingand we are carrying out many moreprocedures as day cases, whichpatients clearly prefer. The unit hasplayed a critical part in enabling us toimprove length of stay and reduce ourcosts. Again thanks are due toeveryone involved.In the Healthcare Commission ratingswe received “fair” for financialmanagement and “good” for qualityof services. This was a pleasing resultbut we are ambitious and aim toachieve an “excellent” rating in bothcategories in time.We aim to be among the top 10hospitals in the UK - and in someareas we are - but we seek to achievethis in all areas. Achieving FoundationTrust status will assist us to reach ourgoal.I have no hesitation in commendingthis Annual Report to you and to sayto our community that we should bethe hospital of choice for you.Beverly LesterChairman03

REVIEW OF THE YEAR BYTHE CHIEF EXECUTIVELooking back to where we were at the beginning of the yearand where we are now, it is quite staggering to see all that hasbeen achieved. I would firstly like to thank every member ofstaff for their magnificent efforts over the past 12 months inwhat has been the most challenging year in the Trust’s history.In April 2006 we faced the prospect ofa £24m gap between income andexpenditure. This represented around12% of our total turnover. We drewup a radical series of cost reductionprogrammes, which were challengingand difficult to implement. Theseinvolved tough decisions and causedgreat anxiety to staff. One of the mostimpressive outcomes of the year’swork has been the way that staff haveresponded to the challenge to look atways to make savings through clinicalservices being more efficient andresponsive. For example, the reductionand protection of surgical in-patientbeds has reduced the length of timepatients stay in hospital, significantlyreduced cancelled operations andsaved valuable resources. By runningour services more efficiently, it meanswe now need fewer beds so we havebeen able to successfully reduce theoverall number of beds across theTrust by more than 200. This has alsomeant that we have needed fewerstaff and we have successfullyredeployed more than 400 staff intovacant posts.04

Not only has theagenda been aboutcost reduction, wehave also made aseries ofimprovements topatient services. Thenew Lancashire Cardiac Centre andDay Surgery Unit offer our patientsmodern, well-equipped environmentsand enable us to provide moreeffective care. In addition, a numberof our clinical teams, supported byeffective management, havedemonstrated our ability to deliverimprovements to patient care –shorter waiting times and significantlyfewer cancellations whilst improvingour efficiency.There have been many similarachievements in a wide range ofareas, which are highlighted in thepages of this Annual Report, thatshow it is possible to deliver both highquality and cost effective services forour patients.We have also reduced waiting times inall areas and we are one of only 12Trusts nationally selected to deliverthe 18 weeks maximum waiting timeby December 2007 – a year earlierthan planned.Looking to the future, we have anexciting but challenging time ahead aswe prepare for Foundation Truststatus, which gives every staff memberthe chance to become a member ofthe Trust and influence itsdevelopment.The on-going implementation of TheBlackpool Way is vital in order toimprove the levels of job satisfactionand effective management across ourTrust. Our future success dependsentirely on your continuingcommitment, dedication and talent ingiving our patients the best possiblecare.Thank you for your efforts in 2006/07and your continued commitment tothe Trust as we aim to achieve evengreater success in 2007/08.Julian HartleyChief Executive05

TRUST VISIONIn April 2006 we launched our Trust’s Vision and Values. The fourpillars of our Vision are supported by detailed strategic andoperational plans. The development of the Trust’s Vision hasbeen a participative process led by the Chief Executive involvingmore than 400 staff at all levels in the organisation. Support forthe Vision was also received from our partner organisations atour fortnightly Joint Strategy Development Meetings.06

OUR VISIONTo offer ‘best in NHS’ care for our patientsTo be the first choice for the residents of the Fylde Coast and beyondTo offer outstanding value for money for the taxpayerTo be a great place to workOUR VALUESWe put patients at the heart of what we doWe respect each other and prize teamworkWe put our customers’ needs firstWe praise more than blameWe have a ‘can do’ attitudeWe embrace change for the betterWe communicate, communicate, communicate07

TRUST VISION08

Trust Vision -Progress Towards RealisationGOALS ACHIEVEMENTS PLANSOffer the ‘best inNHS’ care for ourpatients.This goal is measured byachieving top 10%performance across the NHSfor all Key PerformanceIndicators (KPIs). The Trust isalready in the top 10% forwaiting list size, A&E 4 hourtarget, and MRSA targetachievement. We have beenselected as one of 18 nationalsites to achieve 18 weeks waitby December 2007. Achieved‘good’ for quality in the 05/06Annual Health Check and 3Star rating in 03/04 and 04/05.Lengths of stay have beenreduced from among longestin NHS to CHKS Peer average.We are one of the cleanesthospitals in the NHS with top10% PEAT ratings.The Trust plans to achieve 18weeks target by December2007 with support ofBlackpool PCT and NorthLancashire PCT. We plan toreduce maximum A&E waits tothree hours from four byDecember 2007 also. We aimto achieve an ‘excellent’ ratingfor quality of service in thenext Annual Health Check.Lengths of stay and day caserates are planned to reach top10% performance bySeptember 2007.09

GOALS ACHIEVEMENTS PLANSBe the first choicefor the residents ofthe Fylde Coastand beyond.Opening of new £52mLancashire Cardiac Centre andDay Surgery Unit in spring2006 has enabled us to providestate of the art facilities andenvironment for patients. Newminimally invasive surgicaltechniques for heart patientsplace us at the forefront ofinnovation across a Regionalfootprint. Our performanceagainst KPIs, particularly foraccess, put us in a strongposition locally and regionally.The Trust needs to improve itsresponsiveness to referrers,particularly dischargecommunication. A plan totackle this is currently beingimplemented. The Trust hasset a target of 10% increase inmarket share from key wardareas. The Trust isimplementing a marketingand communications strategyto increase its profile andreach with referring practicesand Practice BasedCommissioners (PBC). Patientsatisfaction needs to increasefurther and the Board hasapproved a plan to take us totop 10% performance by April2008.10

GOALS ACHIEVEMENTS PLANSOffer outstandingvalue for moneyfor the taxpayer.The Trust’s Reference CostIndex has improved from 110in 04/05 to 88 in 05/06. TheTrust has reduced its recurrentcost base by £17m to date.Lengths of stay have reducedsignificantly and, consequently,bed numbers have beenreduced by 227. Clinicalproductivity has increased witha reduction in the total costper spell from £2,609 in 04/5 to£2,247 in 06/7.Delivery of the 2007/2008 costimprovement programme willenable the Trust to generate asurplus at the end of 07/08with further, larger surplusesin 08/09 and 09/10. We aredeveloping ‘service linereporting’ with help fromErnst & Young to develop amore commercial approachand support clinical divisionsto operate as ‘business units’.Be a great place towork.The Trust offers a full range offlexible working options forstaff including an on-sitenursery and on-site leisureclub. We have achieved bothImproving Working Lives andInvestors in People. However,staff feedback indicates wehave much work to do toimprove staff morale,motivation and engagement.The Trust is currentlyimplementing a far reachingOrganisational DevelopmentProgramme called TheBlackpool Way. Details of thisproject are outlined on page60 of the Annual Report.11

TRUST PROFILE12

TRUST PROFILEThe Blackpool, Fylde and WyreHospitals NHS Trust was established on1st April 2002 following the merger ofBlackpool Victoria Hospital NHS Trustand Blackpool, Wyre and FyldeCommunity Health Services NHS Trust.The Trust comprises Blackpool VictoriaHospital, which is the main DistrictGeneral Hospital for the Fylde Coast,and five other community hospitals, aswell as the National Artificial EyeService and the Blackpool ChildDevelopment Centre.The Trust serves a population ofapproximately 330,000 residents ofBlackpool, Fylde and Wyre andapproximately 12m holidaymakerswho visit the area every year.The key features of the Trust in2006/07 are as follows:• Income in excess of £200m.• Employment of approximately 4,000staff.• Treatment of 56,938 in-patients andday case patients.• Treatment of 252,053 out-patients.• 91,446 accident and emergencyattendances.• 2,959 births.• Total bed complement of 834.• Regional Centre for Cardiac Services.• Recognised Cancer Unit.13

Location Map of Blackpool,Fylde and Wyre14

The Trust provides a comprehensiverange of services to the population ofthe Fylde Coast which include:-• 24 Hour Accident and EmergencyFacilities• Anaesthetics• Cardiac• Child Health• General Medicine, including ElderlyCare• Acute Medicine• Specialist Medicine• General Surgery and Urology• Ear, Nose and Throat Surgery• Ophthalmology• Oral Surgery• Orthopaedics• Gynaecology• Intensive, High Dependency andCoronary Care• Maternity Services• Support Services for diagnosis andtreatment including Pathology,X-Ray, Physiotherapy, OccupationalTherapy and Specialist NursesThe Trust manages all the hospitalsites on the Fylde Coast as follows:-• Victoria Hospital – 612 beds• Bispham Hospital – 40 beds• Clifton Hospital – 102 beds• Rossall Hospital – 40 beds• Wesham Hospital – 40 beds• Fleetwood Hospital – out-patientand diagnostic servicesOther services include:-• Blackpool Child Development Centre• National Artificial Eye Service• Poulton Office15

A description of services on the Trust’s hospital sites is given below:-A description of services on the Trust’shospital sites is given below:-Victoria Hospital is a large acutehospital that treats in-patients, daycases and out-patients from acrossBlackpool, Fylde and Wyre. TheAccident and Emergency Departmentis one of the busiest in the countrywith more than 91,000 attendancesduring 2006/07. It provides a widerange of services from maternity tocare of the elderly, and from cancerservices to heart surgery and is one offour tertiary centres in the North Westthat provides specialist CardiacServices to patients from Lancashireand South Cumbria, a catchmentpopulation of 1.6m. A purpose builtDay Surgery Unit opened in April 2006and a new £52m Cardiac Centreopened in April 2006.Clifton Hospital is a community unitthat provides sub-acute and faststreamin-patient care for olderpeople, rehabilitation and respite carefor the disabled and an active outpatientservice. The hospital has anunderlying emphasis on rehabilitationwith the ultimate aim of maximisingthe social, physical, psychological,emotional and spiritual well being ofits patients. A purpose designed RenalUnit opened in May 2005 to replacethe renal services previously providedat Devonshire Road Hospital. Inaddition, a new combinedrheumatology and dermatology unitwas opened on the site in January2007.Fleetwood Hospital is a communityunit that serves residents from Wyreand surrounding areas. There is anOut-Patient Department which housesseven consulting suites, one of whichhas been adapted for audiology useand diagnostic radiology services onthe site.Rossall and Wesham HospitalRehabilitation Units are purpose-builtunits that provide rehabilitation,recovery and continuing care servicesto older people from across the FyldeCoast. Rossall also provides dayhospital facilities, which includes the16

provision of a Falls Service for theFylde Coast.The Nurse Led Ward was transferred tothe Bispham Hospital RehabilitationUnit in May 2006, increasing thenumber of nurse-led beds availablefrom 20 to 40. The Unit provides nurseled rehabilitation, recovery andcontinuing care services to olderpeople from across the Fylde Coast.Blenheim House is a ChildDevelopment and Family SupportCentre for children across Blackpool,Wyre and Fylde who have physical orlearning needs. The Centre forms partof the Trust’s Child Health Department.It aims to provide assessment, ongoingintervention and family supportfor pre-school children in a friendlyand informal environment. There areseven consultant clinics each monthand a genetics clinic and paediatricneurology clinic every three months. Inaddition, orthoptic clinics take place asrequired.The National Artificial Eye Service ismanaged and controlled by the Trustbut operates nationwide.Approximately 30,000 patients aretreated each year and approximately1,000 new patients are referred eachyear. There are more than 70 clinics inEngland and the service provides ongoingaftercare and maintenance forapproximately 40,000 patientsthroughout the country.Poulton Office is based at FurnessDrive, Poulton, and includes Trust stafffrom various administrativedepartments, for exampleManagement Accounts, Payroll,Recruitment and InformationManagement and Technology.Following a public consultation,“Improving Patient Care”, which tookplace from June to September 2006, anumber of changes to the Trust’sinfrastructure have taken place. Theseinclude vacating the Lytham and SouthShore Hospital sites to make way forPrimary Care Centre developments andcompletion of the Trust’s long termstrategy of vacating the DevonshireRoad Hospital site.17

TRUST PERFORMANCE18

TRUST PERFORMANCEOne of the key measures of performance for Health Care organisations, andtheir patients, is the Healthcare Commission Annual Health Check, which ispublished nationally. The table sets out each of the key areas surveyed anddetails the Trust’s performance for 2005/2006.TargetMaximum waiting time of one month from diagnosis to treatmentfor all cancers by December 2005.Maximum waiting time of two months from urgent referral totreatment for all cancers by December 2005.Two week maximum wait from urgent GP referral to firstout-patient appointment for all urgent suspected cancer referrals.From April 2002 all patients who have operations cancelled fornon-clinical reasons to be offered another binding date within 28days or fund the patient’s treatment at the time and hospital ofthe patient’s choice.Ensure that by the end of 2005 every hospital appointment will bebooked for the convenience of the patient, making it easier forthe patients and their GPs to choose a hospital and consultantthat best meets their needs. By December 2005, patients will beable to choose from at least four different healthcare providersfor planned hospital care, paid for by the NHS (Convenience andChoice - provider information in place to support choice).Trust Level ofPerformance100%Achieved95%Achieved100%AchievedUnderachieved100%Achieved19

TargetDelayed transfers of care to reduce to a minimal level by 2006.Trust Level ofPerformanceAchievedMaximum wait of 26 weeks for in-patients. 100%AchievedMaximum wait of 13 weeks for an out-patient appointment. 100%AchievedThree month maximum wait for revascularisation (open heartsurgery) by March 2005.10 percentage point increase per year in the proportion of peoplesuffering from a heart attack who receive thrombolysis within 60minutes of calling for professional help.Four hour maximum wait in A&E from arrival to admission, transferor discharge.Maximum two-week wait standard for Rapid Access Chest PainClinics.100%Achieved100%Achieved99%Achieved100%Achieved20

The one area where the Trust failed to achieve the required level of performance was there-admission of patients to hospital who had had their operation cancelled. In responseto this, more robust management arrangements have been introduced for patients whohave had their operations cancelled at short notice. This has resulted in cancelledoperations due to ward bed shortages reducing from 126 during the period April 2005 toJanuary 2006, to three for the same period in 2006/07. In addition, measures are in placeto ensure that patients who require re-admission to hospital are given a date within 28days of the cancellation.During the year the Trust delivered key patient access targets three months ahead ofschedule and continued to maintain access targets in other areas as set out below:Waiting Times Target Mar-07Out-Patients No patient waiting over 10weeks for first out-patientappointment (LocalTarget)Achieved & MaintainedElective In-Patients & DayCasesRevascularisation Surgerywithin Cardiac ServicesCataract Surgery withinOphthalmologyNo patient waiting over 20weeks (Local Target)No patient waiting over 3monthsNo patient waiting over 3monthsAchieved & MaintainedMaintainedMaintained21

Waiting Times Target Mar-07DiagnosticsCancerMaximum waiting time of13 weeks for diagnostics(excluding NuclearMedicine).1) Maintain a 2-weekmaximum wait fromurgent GP referral to firstout-patient appointmentfor 100% of urgentsuspected cancer referrals.2) A maximum waitingtime of two months (62days) from urgent referralto treatment for 95% ofpatients diagnosed withcancer from December2005.3) A maximum waitingtime of one month (31days) from diagnosis totreatment for 98% ofpatients diagnosed withcancer from December2005.Achieved100%97%100%22

Trust’ s Financial PerformanceAt the start of the financial year2006/07 the Trust faced the prospectof a £24m gap between income andexpenditure. At over 12% of ourturnover this represented a significantpotential debt that threatened theviability of both individual servicesand the Trust as a whole.We had originally planned to managethis over a two year period, however,the NHS financial rules at the timewould have resulted in a ‘doubling up’of any deficit and potentiallyincreased the problem year on year.After lengthy internal debate it wasagreed that the Trust would plan todeliver the savings required in oneyear.To achieve this the Trust developed anumber of cost improvementinitiatives with an overall target of10% cost reduction in clinicaldepartments and 12.5% in corporateareas. These plans were wide rangingacross the whole organisation andincluded bed reductions of 250,reductions in headcount of around400 and rationalisation of servicesfrom Lytham, Devonshire Road andSouth Shore Hospitals. In many areas,as highlighted in the clinical Divisionalreviews, cost reduction has beenachieved by making clinical servicesmore efficient and responsive.As a result of these processes the Trustdelivered £19.1m of costimprovements and recovered anadditional £4m of income from betterrecording of clinical activity. The Trusthas now started 2007/08 in recurrentfinancial balance.23

Divisional AchievementsWomen’ s and Children’ s Division24

Women’ S and Children’ s DivisionChildren’ sAssessment UnitWe were delighted to open a newChildren’s Assessment Area on theChildren’s Ward at Blackpool VictoriaHospital in January 2007. The area hasbeen created for children who needurgent assessment and comprises athree-bedded observation bay, threetreatment cubicles and an open playarea.The unit is staffed by specialistpaediatric nurses and doctors who cancarry out any necessary tests, such asx-rays and blood tests andobservations. As well as providing amore child-friendly environment foryoung patients, the assessment areaaims to reduce any unnecessaryadmissions to hospital.The unit is open from 8.30 am - 9.00pm, Monday to Friday. Children whoneed medical investigations can bereferred directly to the unit by theirGP, via the admitting Senior HouseOfficer, or from the Accident andEmergency Department.Dr Kate Goldberg, ConsultantPaediatrician, said: “Being in hospitalcan be distressing, particularly forchildren and their parents. We wantto make sure that their visit to25

hospital is as pleasant as possible andthat they do not have to stay in anylonger than is necessary.“In the A&E Department there is asection for children but it is very smalland there is no observation area.Previously children would often haveto be admitted to the children’s wardsso that they could be observed for afew hours when sometimes this wasnot necessary. This will make a hugedifference to families.”“I truly feel the staff on the Special CareBaby Unit were always there for anyquestions or problems. Without them Iwould have found my first weeks athome very difficult – they have allgone out of their way to help mewhen I’ve needed advice.”Sarah Tomlinson, Thornton Cleveleys.CNST Level 1The Maternity Services Departmentwas proud to achieve CNST (ClinicalNegligence Scheme for Trusts) Level 1in 2006 and at the end of the financialyear the department was well on itsway to achieving CNST Level 2. Thisrecognises the importance that theTrust places in reducing risk andimproving patient safety.26

A team working on behalf of the NHSLitigation Authority visited thedepartment to interview staff, reviewpaper documentation and protocolsand ensure all risk managementsystems had been implementedproperly. The Trust received a glowingreport.Dr Mary Johnson, Divisional Directorfor Women’s and Children’s Health,said: “This is a fantastic achievementand recognises all the hard work thatstaff from within the Women’s andChildren’s Division and ClinicalGovernance Department have put in.We are totally committed tominimising risk, improving patientsafety and delivering high qualitycare.”Improved Care forDiabetic Mums-to-beA number of developments have ledto improved care for pregnant womenwith diabetes. The Division appointedAlison Leyland as the first DiabeticSpecialist Midwife whose role is toensure women are better supportedthroughout pregnancy. Linked to thisappointment was the launch of a newone-stop clinic which gives diabeticwomen access to a high level ofspecialist care and reduces the numberof hospital appointments they need.Pregnant women can now see theirConsultant Physician, ConsultantObstetrician, Diabetes SpecialistMidwife, Diabetes Specialist Nurse,Dietician and even have a scan in justone appointment. Historically thepatient may have needed fourseparate appointments all in the sameweek.27

Neonatal OutreachTeamThe Neonatal Outreach Team hadcause for celebration when theyscooped a national award for thework they do with premature babiesand their families. The team wasnominated in the Community Team ofthe Year category of the NationalBLISS Baby Charter Awards and wonrunner up prize.The Neonatal Outreach Team makeshome visits to babies who are bornless than 36-weeks into pregnancy andhave on-going nursing needs. Theyoffer guidance and support forfamilies if their baby is dependent onoxygen, or they need extra help withfeeding, such as mums who are tubefeeding or breastfeeding smallerbabies.One Stop Uro-Gynaecology ClinicWomen with bladder problems arebenefiting from a new one-stop clinicwhich has not only reduced the timethey wait for appointments but alsoreduced the amount of appointmentsthey need.Patients can now see an Uro-Gynaecology Consultant, aGynaecology Nurse Practitioner, aPhysiotherapist and have anyinvestigative procedures carried outduring one appointment. Patients canalso be listed for theatre directly fromthe clinic if required. Prior to the clinicbeing developed the patient may haveneeded four separate appointments,each with their own waiting list.28

Two New ConsultantsThe Division has appointed two newconsultants. Miss June Davies joinedthe Trust as a Consultant Obstetricianand Gynaecologist. She is the firstfemale consultant to join thisspecialty. Dr Kate Goldberg joined thepaediatric team as ConsultantPaediatrician. The department alsosaid farewell to ConsultantObstetrician, Mr Bedford, who retiredafter 25 years at Victoria Hospital.“I cannot speak highly enough ofevery member of the team on Ward D.Thank you all sincerely for the care,attention and continued reassuranceduring my stay. Nothing was ever toomuch trouble and everything wasdone with a smile.”Mary Higgins, Thornton Cleveleys.29

Divisional AchievementsMedical division30

Medical DivisionOpening of NewRheumatology/Dermatology UnitDermatology and rheumatologypatients are now receiving their carein bright and spacious facilities in anew purpose-built unit at CliftonHospital. The new £1m unit replacesrheumatology services previouslyprovided at South Shore Hospital anddermatology services previouslyprovided at Devonshire Road Hospital.The centre has 12-in-patient beds, anout-patient suite, a meeting room anda phototherapy suite providingspecialist light therapy treatment forpatients with skin conditions, such aspsoriasis and eczema.Dr John Kellett, ConsultantDermatologist, said: “We aredelighted with the new unit. Thestandard of accommodation is farbetter here than what patients havehad previously. Devonshire Road is anold hospital and dermatology washoused in an open ward. The newdevelopment has single or doublerooms with en-suite facilities, whichwill mean better privacy for patientsand the risk of infection will begreatly reduced.”31

Stroke Unit/EarlySupport DischargeTeamStroke patients across the Fylde Coastare benefiting from a new dedicatedCombined Stroke Unit at BlackpoolVictoria Hospital.Previously, stroke patients wereadmitted to the Acute Stroke Unit atVictoria Hospital for their first phaseof treatment and transferred toClifton Hospital Gloucester Unit fortheir second phase of rehabilitation.Now stroke patients receive all oftheir treatment and rehabilitationfrom the dedicated Combined StrokeUnit.The unit is supported by an EarlySupported Discharge Team (ESDT),who work with patients on the wardand at home following discharge. Themulti-disciplinary team includes aStroke Co-Ordinator, Physiotherapist,Speech and Language Therapist andOccupational Therapist.Dr James McIlmoyle, Consultant inStroke Medicine, said thedevelopment of the new unit wasgreat news for staff and patients.32

He said: “The biggest benefit is thatpatients can now start theirrehabilitation early, which is critical inhelping them to achieve maximumrecovery.”The new 31-bedded unit has 4 fourbeddedbays and 15 single rooms withen suite facilities, a gym and a kitchenwhere occupational therapists workwith patients to regain theirindependence in daily activity forwhen they leave hospital.DVD HaematologyStaff and patients at Victoria Hospitalhave produced a DVD to educatepatients undergoing chemotherapyabout the warning signs ofneutropenic sepsis. The condition canbe potentially fatal if the symptomsare not picked up early. The aim ofthe DVD is to educate patients aboutwhat to look out for so that they canseek help early and recover quicker.“The kindness, caring, patience anddedication shown – not only to me butto all patients on Ward 19 - are a fineexample of excellence and teamwork.”John Gower, Poulton-le-Fylde.“Thank you to the staff on theRehabilitation Unit at Rossall Hospitalfor the kindness in making my Dad’sfinal weeks more bearable.”Doreen Robinson, Worsley.33

Reduced Length ofStayWork has been on-going to ensurepatients do not have to spend anyunnecessary time in hospital. Anumber of initiatives have beenbrought in including the introductionof seven-day discharging. In the pastpatients who have been fit to gohome over the weekend would havehad to wait until Monday until adoctor had declared them medicallyfit for discharge.Other schemes include Fit forDischarge where patients who areonly waiting for tests to be done (suchas a CT scan) can be discharged homeand given an appointment to comeback for their test. This is better forthe patient and frees up beds. Bybeing more efficient we have beenable to reduce the overall length ofstay, meaning the division now needsfewer medical beds.Introduction ofShort Stay WardA short-stay ward opened at VictoriaHospital in July 2006 for patients withmedical conditions that require ahospital stay of no longer than 72hours. This has enabled the division tofocus on actively managing thosepatients with an anticipated shortlength of stay.34

Gastro WaitingTimes FallPatients are benefiting from shorterwaiting times for gastroenterologyprocedures. During the past 12months, waiting times for colonoscopyand gastroscopy have fallen from ninemonths to six weeks and the waitingtime for flexible sigmoidoscopy is nowjust one week. This is the result of amassive team effort from staff acrossthe department. An additionalconsultant and associate specialisthave been appointed to support theservice.Development of Outof-HoursGI BleedServiceA new on-call rota has been set upwith the ConsultantGastroenterologists to provide aservice for patients who present to A& E with severe upper GI bleedingout-of-hours. The Trust is one of thefirst in the North West to develop sucha service.35

Divisional AchievementsSurgical division36

Surgical DivisionOpening of DaySurgery UnitA new £5.7m Day Surgery Unitopened at Victoria Hospital in April2006. The new multi-million poundfacilities have enabled the Division toincrease the number and types ofprocedures carried out as day cases.This means more patients are able tohave their surgery and go home thesame day without the need for anovernight stay in hospital. The unitalso provides a much-improvedenvironment for staff and patients.The Trust was delighted to welcomeworld famous Manchester United bossSir Alex Ferguson to officially openthe new day case facility in October.37

Opening of SurgicalHigh Care UnitPatients recovering from surgery atVictoria Hospital are benefiting fromthe development of a new andpioneering Surgical High Care Unit.Higher staffing levels ensure patientsare given more intensive nursing care.It is hoped that the presence of thenew unit will free up beds on theHigh Dependency Unit for patientswith the greatest need, such as cancerpatients.Matron of the new Unit, MaggieDoughty, said: “We are not intendingthis unit to be a replacement forHigher Dependency but we recognisethat the recovery of some patientswould be helped by being moreclosely monitored. It is a really excitingdevelopment for all concerned.Having all the post-surgery patients inone place means that we can cater fortheir needs more effectively and alsotake the pressure off other wards.”As the unit only takes post-operativepatients, nursing staff do not have thesame volume of paperwork as normalwards that deal with admissions. Thismeans that nursing staff can dedicatemore time to patient care.Transfer ofOrthopaedics fromSouth Shore HospitalOrthopaedic patients are now beingtreated under one roof thanks to newspacious facilities which opened atVictoria Hospital in February 2007.The unit, which includes a day case38

In addition, day case patientspreviously treated on our Day SurgeryUnit for minor operations are nowbeing treated in the Orthopaedic Unitmeaning dedicated Orthopaedic staffare nearby to supervise the care oftheir patients more closely. The spacefreed up in the Day Surgery Unit willalso have a beneficial impact onwaiting times in other specialties.ward, two new operating theatresand a 20 bedded ward area, replacesfacilities on the South Shore Hospitalsite.Patients who would previously havebeen treated at South Shore nowbenefit from the reassurance ofhaving all the facilities of an acutehospital at their disposal. This includesan Intensive Care and HighDependency Unit in case they needmore specialised care after theiroperation.Orthopaedic Matron Marjorie Holdensaid: “Staff are delighted with thenew facilities; they are lovely andbright and the response from patientsand their visitors has been verypositive. It is better to have ourwhole Orthopaedic Team workingtogether; not only can we give morespecialised care to our patients but italso gives us greater opportunity fortraining.”39

Opening of SurgicalAssessment UnitA new 24-hour Surgical AssessmentUnit opened at Victoria Hospital inAugust 2006. A specialist area hasbeen created on Ward 7 wherepatients who are referred by their GPor from A&E are surgically assessed bya dedicated doctor. If the patientneeds to be admitted to hospital thedoctor will admit them to the shortstayward on Ward 7 or to a moreappropriate ward depending on theirspecialist needs. Some patients areable to be assessed, go home, andcome back on a later date for surgery,which is much better for the patientand frees up hospital beds. BetweenAugust 2006 and March 2007 the unitsaw 2,050 patients, of which 1,800were admitted and 250 weredischarged.One-Stop Nurse LedCataract ServicesCataract patients are now being seenquicker and have fewer trips tohospital, thanks to the introduction ofnurse-led cataract clinics. Whenconsultants receive referrals from GPsor opticians they identify which casesthey consider to be straight forwardand refer them direct to the nurse-ledclinic. The nurses examine the patientsand do their pre-operative checksbefore listing them for surgery –meaning they don’t have to wait for afurther out-patient appointment witha doctor. This reduces waiting timesand cuts down the number of hospitalappointments patients need.40

Diabetes EyeScreeningThe Diabetes Eye Screening team isnow offering annual screening fordiabetic patients. Previously patientswere only invited for screening everytwo years. Now, thanks to fundingfrom the Primary Care Trust foradditional staff, patients can attendonce a year. It is vital that diabeticpatients are screened regularly so thatany complications can be picked upearly and treatment can be started.“Thank you to everyone on Ward 6 foryour attention and help. You are all sowonderful – please stay as you are!”Joyce Brent, Lytham.“A huge and grateful thank you toeveryone involved in making my stayon Ward 6 so pleasant. Your readinessto help me in any way, your lovelysense of humour, genuine warmth andfriendly words have meant a greatdeal to me.”Jeff Chambers, Wesham.41

Divisional AchievementsCardiac division42

Cardiac DivisionNew 52m LancashireCardiac CentreThe Lancashire Cardiac Centre openedits doors to its first patients in April2006. The £52m unit, which is thebiggest development Victoria Hospitalhas seen in its history, provides stateof-the-artcardiac care to heartpatients across South Cumbria andLancashire.The Trust was delighted to welcomeHis Royal Highness the Duke ofGloucester to the hospital in October2006 to officially open the new unit.The unit’s high tech facilities include15 critical care beds, three operatingtheatres and three cardiac catheterlaboratories (both with capacity toexpand to five), around 90 in-patientand day case beds, x-ray facilities andan out-patient department.The Cardiac Unit also houses anEducation Centre featuring a lecturetheatre, seminar rooms, a researchlaboratory and library which can beused by medical and nursing stafffrom across the Trust to keep themup-to-date with the latest technologyand techniques.The centre is kitted out with the mostup-to-dateequipment and is staffedby experienced, dedicated clinicianswho can offer complete cardiac carefrom diagnosis to treatment from theone location.43

New Equipment forUltrasound Imagesof the HeartCardiac Anaesthetists at theLancashire Cardiac Centre can nowproduce detailed images of the heartduring surgery after completing aspecialist qualification in Texas, USA.Consultants Carl Humphries, AndyKnowles and Chris Rozario areamongst only a small number ofCardiac Anaesthetists in the UK togain the Certificate of SpecialCompetence in PerioperativeTransoesophageal Echocardiography(TOE). They join Cardiac AnaesthetistsMike Hartley and Noel Gavin whocompleted the course last year.TOE involves the anaesthetist insertingan ultrasound probe down thepatient’s oesophageas during heartsurgery, giving them and the surgeonsa detailed view of the structure andmovement of the whole of the heart.This enables surgeons to makedecisions prior to, during and aftersurgery.The operating theatres at the new£52m Lancashire Cardiac Centre havebeen kitted out with high-tech TOEequipment at a cost of £70,000 eachand are now able to offer this stateof-the-artservice to patients.44

Minimal AccessValve SurgeryThe Division continued to developminimal access surgery this year withthe introduction of minimal accessvalve surgery. The benefit to patientsis that the procedure involves lesssurgical trauma, patients recover morequickly, and they spend less time inhospital. The Division is alsodeveloping a new technique forminimal access vein harvesting forbypass surgery.“I would like to express heartfelt thanksfor the excellent, prompt emergencytreatment my cousin received on theCoronary Care Unit. There is no doubtthat the early emergency treatment hereceived saved his life.”Brian Kay, Blackpool.Appointment of FiveVisiting ConsultantCardiologistsPatients waiting for coronaryinterventions such as angioplasties orstents are benefiting from shorterwaiting times. Five visiting ConsultantCardiologists, three from Preston andtwo from Blackburn, now spend oneday a week carrying out procedures inLancashire Cardiac Centre’s catheterlaboratories. This has helped us tomaximise capacity in the catheterlaboratories and reduce waiting timesfor patients across Lancashire andSouth Cumbria.45

Waiting TimesFall forEchocardiographyStaff in the echocardiographydepartment have been workingextremely hard to tackle waiting timesfor echocardiography. At thebeginning of April 2006 patients werewaiting up to 20 weeks. Now, thanksto changes in the way the departmentworks, together with funding fromBlackpool PCT for an additionallocum, waiting times have fallen tojust two weeks.Plans to IntroducePrimary AngioplastyAt the end of March 2007 the Divisionwas preparing for the introduction ofa new technique for treating heartattack patients. From June, patientswho are admitted as emergenciesafter suffering a heart attack will begiven an angioplasty. The techniqueinvolves a small cylindrical tube calleda stent being inserted in the arteryand has a 25 per cent higher successrate than current treatment. Theservice will operate from 9am–5pminitially but will be rolled out to a 24-hour service later in the year.46

“The staff on the Cardiac Day CareWard went out of their way to makeme feel comfortable and reassured ina spotlessly clean environment and inall aspects of a procedure which nothaving gone through before I was verygrateful for. Whilst I obviously hope Iwill never have to return to anyhospital – if I have to, and have anychoice in the matter, I will have farfewer fears being re-admitted to yourfacility.”Paul Hayden, Morecambe.New Coronary CareUnitAt the end of March 2007 the Divisionwas preparing for the transfer of theCoronary Care Unit from the mainVictoria site to the Lancashire CardiacCentre, bringing together all cardiacservices under one roof.47

Divisional AchievementsClinical Support division48

One-Stop DispensingThe Pharmacy Department has piloteda one-stop dispensing service on sevenwards at Victoria Hospital. The pilothas been extremely successful and hashelped to reduce delays in patientsbeing discharged from hospital andreduced the volume of medicationthat is wasted.Louise Sadler, Senior PharmacyTechnician, said: “When patients wereadmitted to a ward, the staff woulduse the ward stock for medication andanything that wasn’t available on theward, Pharmacy would give a 14 daysupply for that patient. When it wastime for the patient to be discharged,Pharmacy would dispense anothersupply of medication for the patientto take home. This was duplicatingwork in Pharmacy and was creatingwaste.”49

“Now we have dedicated PharmacyTechnicians on the wards. They visitthe patients when they are admittedto look at what medication they haveand if the technician thinks itappropriate the patient’s ownmedicine is used. Pharmacy thendispenses whatever other medicationthe patient needs to last themthroughout their hospital stay andwhen they leave hospital. This meansthat we dispense drugs once andthere is no delay in the patients beingdischarged while they are waiting fortheir medication to be dispensed. Thisbenefits the ward staff, the Pharmacystaff but most importantly thepatient.”The Division will be rolling the systemout to other wards later this year.“What wonderful care I have receivedfrom all the staff in the Pathology Lab.The doctors, nurses and clerical staff arevery efficient workers, delivering theircare with kindness and understanding.I certainly appreciate the standard ofcare which has enabled my generalhealth to improve.”Sheila Sharratt, Thornton Cleveleys.Aseptic UnitWork is well underway on a £500,000refurbishment of the Aseptic Unit.This is in preparation for when theTrust becomes a Tertiary HaematologyUnit later this year. Haematologypatients will be referred to Blackpoolfrom all over Lancashire and Cumbriafor the initial stages of theirchemotherapy. This means that theworkload within the Aseptic Unit islikely to triple. The Trust has invested£500,000 to allow a full refurbishmentof the existing facilities. The facilitieswill include a new air-handling unitand dedicated ultra clean rooms andisolator cabinets for the preparationof sterile medicines. The suite has fourisolate rooms (two for chemotherapyand two for a Central IntravenousAdditive Service (CIVAS)) and totalparental nutrition.50

A&E PerformancePatients needing treatment atBlackpool’s Accident and EmergencyDepartment are benefiting fromshorter waiting times. Staff haveworked tirelessly to ensure patientsare seen, treated and either admittedor discharged as quickly as possible.The department has consistentlyexceeded the Government target of98% and is amongst the topperforming Trusts in the country.Nigel Kidner, A & E Consultant, said:“This is a fantastic achievement and isdown to the hard work andcommitment of staff, not only in A &E but throughout the whole hospital.It has been a huge team effort andstaff should be proud of the progressthey have made in cutting waitingtimes and improving the experience ofpatients attending our A & EDepartment.”Blackpool has one of the busiest A & Edepartments in the country with morethan 91,000 attendances last year.“To the staff on the Accident andEmergency Department… Never haveI felt so humbled. Thanks to yourskill, dedication and amazing caringabilities, I am alive to write this card.I owe you all an immense dept.”Doreen Robinson, Worsley.51

InternationalRecognition for ADASServiceFylde patients who require regularblood tests are needing fewerappointments and their treatment ismore stable, thanks to the work ofthe Anti-Coagulant Dosing AdvisoryService. The department has beenrecognised in an international report,which compared the performance ofits service with that of 81 othersworldwide. The Blackpool servicereceived special recognition for itssuccess in stabilising the treatment ofpatients who use warfarin.Around 4,500 patients on the FyldeCoast use warfarin (a blood thinningdrug) which reduces the risk ofthrombosis and strokes. Patients whouse the drug need to be monitoredregularly to ensure that themedication is keeping their blood at asuitable consistency. Fifteen clinics areheld each week around the Fyldecoast conducting over 70,000 bloodtests a year.Urgent Care CentrePlans are underway to develop anUrgent Care Centre at VictoriaHospital, bringing together theexisting A&E and GP out-of-hoursservice under one roof. This is a jointventure across the whole of the healtheconomy, which will improve accessfor patients needing unplannedtreatment and will reduceinappropriate admissions to hospital.52

Reduction inWaiting Times forMRI ScansThe Radiology Directorate hasdeveloped a tele-radiology service inconjunction with Eurad Consult, aBelgian group of Radiologists, for thereporting of MRI scans. Thispartnership has enabled around 900patients awaiting a routine MRIinvestigation to have their scan, whichotherwise would not have beenpossible. It allows for MRI sessions tobe held flexibly to suit the needs ofpatients and radiographers.At the end of March 2007 themaximum waiting time for a routineMRI scan was 15 weeks with themajority of patients being seen in lessthan 10 weeks.Radiography LedReportingRadiographer reporting wasintroduced to the Trust over six yearsago and has continued to developduring the year. More than 30,000radiographs are reported in this wayallowing for a timely and qualityassured review of plain films. An auditof radiographer reporting has showncombined report variances to besignificantly better (2%) than thetarget gold standard for Radiologists(3%).Daily multi-disciplinary meetings areheld in A&E to discuss any missedfractures/pathology that requirefurther treatment and management.More than 500 patients per year seetheir treatment improve following thisprocess.53

Social and Community Services54

Social and Community ServicesThe Trust takes its responsibilities of working with the local communityseriously. Initiatives relating to the progression of this agenda include:• The Trust has over 480 volunteersfrom a variety of organisations whoprovide invaluable and muchappreciated services to patients.The Trust has employed a VoluntaryServices Manager to furtherenhance and develop ourrelationship with this importantsector of the community. All ourvolunteers are supported by a fullinduction programme and trainingopportunities.• The Trust is a member of theBlackpool Compact Agreementtogether with the local voluntarysector, Blackpool Primary Care Trust,Police, Fire Service, Social Servicesand Blackpool Council. The aim ofthe Compact is to clarify therelationship between PublicOrganisations and the CommunityVoluntary Sector by recognising thesector’s desire for greater security,the organisation’s desire for genuineaccountability and the user’s desirefor the delivery of good qualityservices.55

• Working relationships with the localPatients Forum is extremely positive.Forum members are involved inmany of the Trust’s Committees andhave provided input to monitoringthe quality of the Trust’s services inseveral areas.• Members of the Executive Teamregularly attend meetings of theLancashire and Blackpool Overviewand Scrutiny Committees to explainto their members the rational forservice reconfigurations,developments, etc.• The Trust has developed apartnership with the Grange ParkResidents Association. Youngstersfrom the area have taken part in aphotography taster course, bulbplanting and litter clean-upcampaigns within the hospitalgrounds.• In preparation for our applicationfor Foundation Trust status, theTrust has actively engaged withmembers of the public within ourcatchment areas to develop a robustmembership.56

ORGANISATIONAL DEVELOPMENT ANDSTAFF ENGAGEMENT58

Organisational Development andStaff EngagementThe Trust Board is firmly of the viewthat if the organisation is to flourishin the long term, then this will beachieved by fully harnessing thepotential of our staff. The changingenvironment in which the NHS isoperating means that the traditionaltop-down approach to managementand operational performance can onlyachieve limited results. All of our staffneed to feel they have a role to playin the development of high qualitycost-effective services to patients. Thisin turn will ensure the on-goingsuccess of the Trust. It is recognisedthat to achieve our goal of beingamongst the top 10% of Trusts weneed to put in place an organisationaldevelopment programme that willchange the way in which we operate.This has led to the introduction of‘The Blackpool Way’.The Blackpool Way will involve:• Developing a fully engagedworkforce where individuals andteams have greater influence andautonomy in driving the Trusttowards best in class performance.• Charging managers with achievingthe Trust’s objectives through aninspired and motivated workforce.Management success will bemeasured in future not only byresults but by how those results areobtained.• Introducing a policy deploymentapproach where managementensures that local priorities matchthe overall imperatives andperformance measures of theorganisation.59

This will be achieved by:• A much more structured programmeof communication with staff.• Changing the way in whichmanagers manage, so thatmanagers listen, share and consultmore and display a positivedemeanour.• Recognition and acknowledgementof good work.• Creation of action teams and focusgroups to deliver continuousimprovement.• Development of standards ofbehaviour expected by theBlackpool Person and BlackpoolManager.An action plan has been developed todeliver the above changes.60

Working In PartnershipDuring the last 12 months the Trust has continued to work with healthcarepartners, as set out below, to deliver its strategy and contribute to wholeHealth Community goals:Blackpool Primary Care TrustNorth Lancashire Primary Care TrustSpecialist CommissionersNorth West Strategic Health AuthorityBlackpool Social ServicesLancashire Social ServicesBlackpool and Lancashire Overviewand Scrutiny CommitteesLancashire Care TrustPatient ForumsVolunteers61

Strategy for the Future Deliveryof Health Care on the Fylde CoastIn June 2006, a three-month publicconsultation was held entitled“Improving Patient Care”. This set outthe proposed joint vision for futurehealth services across the Fylde Coastas follows:• Expand the provision of high qualitycommunity and primary health carewith some new purpose-built healthpremises.• Transfer some services out of theCommunity Hospitals and providethem in different ways, in responseto the changing health needs of thepopulation.• Concentrate specialist acute hospitalservices on the Victoria Hospital siteand further develop the hospital asa centre of excellence.• Further enhance community andhome-based services for people withlong term conditions such asasthma, diabetes and coronary heartdisease.• Provide more out-patient anddiagnostic services such as x-rays,ultrasounds and MRI scans, in thecommunity.62

Artist Impressions Of The New PrimaryCare Centre at LythamThe proposals were widely accepted by the public, particularly the closureof three of the hospital sites; namely Devonshire Road, South Shore andLytham. The Trust is now working closely with the local health economyto implement the proposals.63

Foundation Trust ApplicationOur application for Foundation Trust status was submitted to the Departmentof Health in February 2007 following a three-month consultation exercise.The Trust’s aim is to continue toprovide and develop excellent servicesand provide high quality care andtreatment. During the next few years,the Trust will face increasingcompetition from within and outsidethe NHS and, as a Foundation Trust,we will be able to build on ourstrengths whilst having the flexibilityto meet the challenges. Theachievement of Foundation TrustStatus is, therefore, critical in order forthe Trust to continue to develop asthe healthcare provider of first choiceon the Fylde Coast.The Trust’s progress during the pastyear has been significant, particularlyin the areas of finance, performanceand Board development. However,there is still more to learn, withidentified areas for improvement.The key reasons for becoming aFoundation Trust, and the way theTrust intends to use the freedoms itoffers, are set out opposite:-64

Rationale for FoundationTrust StatusRationale for Foundation Trust StatusCommunity OwnershipEstablish real and lasting engagementwith our community to inform thedevelopment of strategy and services.Benefit Realisation as a Foundation TrustOur members will provide a criticalresource in terms of feedback, regularparticipation in Members’ events, specialinterest groups. Responses toconsultation (579) indicate a promisinglevel of engagement. Our Governors willcement our local accountability and rootour planning in a local context.A Model Corporate CitizenOur place as a major local employer in anarea of deprivation and badly neededregeneration provides us with theopportunity as a Foundation Trust toprovide employment, skills training andto forge strategic partnerships withother local organisations.We will use our freedoms to forgestrategic partnerships with localorganisations, particularly education,business and regeneration, to increaseskill levels in young people and provideclinical and non-clinical careeropportunities in our Trust. We will useour Members and Governors to facilitatethese partnerships.65

Rationale for Foundation Trust StatusA Great Place to WorkWe want to develop deep employeeengagement as part of ‘The BlackpoolWay’ and encourage our staff Membersto influence the future direction of theTrust.Benefit Realisation as a Foundation TrustWe will use our freedoms to consideradditional rewards and incentives forstaff, linked to improved performance.Staff Members and volunteer Memberswill have the opportunity to act asGovernors of the Trust, helping to shapeits future and increase the profile of staffinput.Providing a Better ServiceWe aim to improve both the range andquality of health care treatment serviceswe provide. The current capitalinvestment regime is slow to translateservice plans into improved facilities forpatients. Foundation Trust status willenable us to act quickly and responsivelyto our patients’ needs.We will use the financial freedoms togenerate surpluses to consider reinvestmentin service and associatedcapital developments such as:-• New Vascular Laboratory• Centralised Theatre Suite• New Children’s Centre• New Main Entrance• Staff Development Centre• New MortuarySuch developments will be important ifwe are to operate successfully as apatient and customer focusedorganisation in a dynamic market forhealthcare.66

THE TRUST BOARDManagement ChangesThe term of office for two of the Non-Executive Directors, Mr Jim Armfieldand Mr Michael Carr, expired in May2006. The Appointments Commissionappointed Mr Peter Hosker and Mr BillRobinson as their replacement witheffect from 1st July 2006.Mr Andrew Foster replaced Mr JohnLyons as Director of Human Resourcesand Organisational Development on1st May 2006. Mr Foster subsequentlyresigned from the Trust in January2007 and will be replaced by Mr NickGrimshaw in May 2007. Mr Grimshawwas formerly the Director of HR atTameside and Glossop Acute ServicesNHS Trust.Dr Paul Kelsey, ConsultantHaematologist at the Trust, replacedDr Peter Hayes, Consultant Physician,as the Trust’s Medical Director on 1stJune 2006.67

68ChairmanChiefExecutiveNon-ExecutiveDirectorsDeputyChiefExecutiveMedicalDirectorDirectorof NursingandQualityFinanceDirectorDirectorof HR &ODDirectorofFacilitiesClinicalGovernanceRiskManagementChaplaincyTissueViabilityComplaintsVolunteersPPIMedicalDivisionClinicalSupportServicesDivisionSurgicalDivisionCardiacDivisionWomen’sandChildren’sDivisionPlanningCancerServicesBookedAdmissionsOut PatientServicesFinancialServicesIM&TManagementAccountsProcurementMedicalRecordsPersonnelStaffDevelopmentOccupationalHealthPayrollNurse BankFacilitiesEstatesHotelServices

Trust BoardThe following are voting members of the Trust Board:Beverly Lester (Chairman)appointed in April 2002Qualification:• Qualified Solicitor – LL.BExperience and Interests:• Former Non-Executive Director ofBlackpool Victoria Hospital• Former Chairman of Blackpool,Wyre and Fylde Community HealthServices NHS Trust• Partner at Cooper, Law & LesterSolicitors• Part time Deputy District Chairmanand Tribunal Chairman for theTribunals Judiciary (Department forConstitutional Affairs)• Trustee of the Ladies Sick PoorAssociation• Governor of Carters Primary School• Member of the SHA RegionalTraining Board• Member of Blackpool Council’sChildren’s Trust Board• Member of the Court – University ofCentral Lancashire• Former Deputy District Judge• Trustee of Thornton Horse Club69

Paul Olive(Non-Executive Director)appointed in May 2002Qualification:• Chartered Accountant –Fellow Institute of CharteredAccountantsExperience and Interests:• Former Finance Director ofStanley Leisure plc• Former Non-ExecutiveDirector of Crown Leisure plc• Former Governor of BlackpoolSixth Form College• Trustee of Age ConcernChris Breene(Non-Executive Director)appointed in May 2002Experience and Interests:• Former Non-Executive Director ofthe Blackpool, Wyre and FyldeCommunity Health Services NHSTrust• Former Manager for Marks andSpencer• Vice Chairman of the EmploymentCommittee for Blackpool, Wyreand Fylde Blind Society• Former Member of the BlackpoolPartnership Against CrimeCommunity Group• Former Governor of BlackpoolSixth Form College70

MichaelBrown(Non-ExecutiveDirector)appointed inMarch 2004Qualification:• Qualified Solicitor – LL.BExperience and Interests:• Former Chief Executive of WyreBorough Council• Former Board Member - LAWTEC• Former Board Member -Lancashire Learning & SkillsCouncil• Former Vice Chairman of BusinessLink Lancashire• Former Member of Blackpool andthe Fylde College Governing Body• Former Governor of Baines School• Chairman of Wyre HousingAssociation• Managing Director of EcclestonServices Ltd• Director of Canatxx Gas StorageLtdPeter Hosker(Non-ExecutiveDirector)appointed inJuly 2006Qualification:• Qualified Solicitor – LL.B (Hons)Experience and Interests:• Former Senior Partner at NapthensSolicitors• Part time Deputy District Chairmanand Tribunal Chairman for theTribunals Judiciary (Department forConstitutional Affairs)• Chairman of the AvenCentralRegeneration Partnership inPreston• Select Vestryman of the Churchesof St John the Evangelist and StGeorge the Martyr in Preston.• Director of The Select Vestry ofPreston Charity Ltd• Former Trustee of the British RedCross in Lancashire• Vice Patron of Deafway• Governor and Trustee and formerChairman of the KirkhamEducational Foundation andKirkham Grammar School71

BillRobinson(Non-ExecutiveDirector)appointed in July2006Qualification:• Chartered Public FinanceAccountant – C.P.F.A.Experience and Interests:• Former Director of Finance atSouth Ribble Borough Council• A Vice President of LancashireCounty Cricket Club• Chairman of the LancashireYouth Cricket CoachingCommittee• Honorary Treasurer of theLancashire Cricket Board• Trustee of Lancashire CountyYouth Cricket Trust• Director/Trustee and HonoraryCompany Secretary to the BritishCommercial Vehicle MuseumTrustJulian Hartley(Chief Executive)appointed inDecember 2005Qualifications:• Master of Business Administration(MBA)• Certificate in Healthcare Marketing• Certificate in Managing HealthServices• Post Graduate Certificate inEducation• BA (Hons) – English Language andLiteratureExperience and Interests:• Former Chief Executive of Tamesideand Glossop Primary Care Trust• Former Director of Planning andOperations at North Tees andHartlepool NHS Trust• Joined NHS as National Trainee ofthe NHS General ManagementTraining Scheme• Non Executive Director of Skills forHealth• Trustee of National Association ofAssistants in Surgical Practice7200

AidanKehoe(Deputy ChiefExecutive)appointed inApril 2004Qualifications:• Qualified Chartered Accountant– Institute of CharteredAccountants (ACA)• Diploma in Health ServiceManagement (Dip HSM)• B.sc (Hons) – Managerial andAdministrative StudiesExperience and Interests:• Former Director of Operationsat Blackpool, Fylde and WyreHospitals NHS Trust• Former Divisional Manager atUniversity Hospital BirminghamNHS Trust• Joined NHS as National Traineeof the NHS GeneralManagement Training SchemeTim Welch(Director ofFinance)appointed inAugust 2005Qualifications:• CIPFA CPD Certified• Member CIPFA• BSc (Hons) – BiochemistryExperience and Interests:• Former Director of Finance at Cityand Hackney Teaching PCT• Former Deputy Director ofFinance at City and HackneyTeaching PCT• Joined NHS as FinancialManagement Trainee7300

MandieSunderland(Director ofNursing andQuality)appointed inJanuary 2001Qualifications:• Registered General Nurse• MSc Health Professional Practice(Nursing)• Post Graduate Certificate inEducation (ENB ApprovedRegistered Nurse Tutor)• BSc Health Care Studies• Diploma in ManagementExperience and Interests:• Former Director of Nursing andPatient Services at Halton GeneralHospital NHS Trust• Former Nursing Officer forQuality at the NHS Executive,Department of HealthDr PaulKelsey(Medical Director)appointed in June2006Qualifications:• M.B.,B.S. (Hons) – Pathology• MRCP (UK)• MRCPathExperience and Interests:• Consultant Haematologist atBlackpool, Fylde and Wyre HospitalsNHS Trust• Former Senior Registrar inHaematology – North WestRotational Training Scheme• Director of Fylde Pathology Ltd7400

The following are non-voting members of the Trust Board:MikeGallagher(Director ofFacilities)appointed in July1989Qualifications:• PhD in Environmental Management• MSc in Facilities Management• Royal Institution of CharteredSurveyors• Chartered Institute of BuildingExperience and Interests:• Former Director of Facilities atBlackpool Victoria Hospital NHSTrust• Director of Estates at Blackpool,Wyre and Fylde Health Authority• Deputy Director of Estates at WiganHealth AuthorityAndrewFoster(Director of HumanResources andOrganisationalDevelopment)appointed in May2006Qualification:• Fellow of the Chartered Instituteof Personnel and Development(FCIPD)Experience and Interests:• Former Workforce DirectorGeneral at the Department ofHealth• Director of World Crest Ltd• Senior Civil Servant at theDepartment of Health7500

Board DevelopmentFollowing the Trust diagnostic processearly in 2006, the Chairman reviewedthe skills and experience of the Non-Executive Directors to ensure that thecomposition of the Board wasappropriate for the challenges ahead.This review resulted in theappointment of two new Non-Executive Directors as existing postholdersreached the end of their termof office. One of the new Non-Executive Directors has a strongfinancial background and the otherhas had a long career in corporatelaw. It was also felt that the Trustwould benefit from the appointmentof an additional Non-ExecutiveDirector with experience in marketingand communications and therecruitment process is currentlyunderway.It was also recognised that thechanging financial regime,competitive environment and movetowards Foundation Trust statuswould change the way in which theBoard operated. With this in mind, theinduction, training and developmentarrangements for Non-ExecutiveDirectors have been updated. It wasalso recognised that all Boardmembers would need continuousdevelopment and, as a result, a seriesof development days have been heldwith a plan to continue these on aregular basis in the future. Thesedevelopment days have been used torefine our strategic plans and toimprove understanding of our internaland external environment. Inparticular, key issues around the useof resources and service quality havebeen explored and debated.The Trust has also commissioned theservices of IMD to provide coachingand mentoring services to members ofthe Board.76

TRUST COMPLIANCEEmergencyPreparednessThe Trust has in place robust systemsin the event of a major incident. TheMajor Incident Plan is reviewedannually, is regularly tested, and isfully compliant with “Handling MajorIncidents: An Operational Doctrine”and all other NHS guidance on majorincident preparedness and planning.DisabilityDiscrimination ActThe Trust has a Policy on theEmployment of Disabled Persons andhas achieved the Two Tick Symbol inrelation to its recruitment practices.Training and the introduction of E-Recruitment have further diminishedthe chances of discrimination in thisarea. The Occupational HealthDepartment routinely advises ondisability issues and the way in whichposts can be re-designed to cater forthose employees affected by disability.Equality StatementThe Trust has an Equal OpportunitiesPolicy and trains managers in bestpractice. The Trust has developed aRace Equality Scheme and has anaction plan to ensure compliance withlegislative changes.Public MeetingsThe Trust holds an Annual PublicMeeting to discuss the Annual Reportand Accounts. The next Annual PublicMeeting is being held at 6pm onThursday September 27th at the DeVere Hotel, Herons Reach, Blackpool.Nine Trust Board Meetings have beenheld in public during 2006/2007.77

Financial Information78

Audit ReportFinancial InformationThe Trust’s Audit Committee has thefollowing responsibilities:-Governance, RiskManagement andInternal ControlTo review the establishment andmaintenance of an effective system ofintegrated governance, riskmanagement and internal controlacross the whole of the organisation’sactivities (both clinical and nonclinical),that supports the achievementof the organisation’s objectives, inparticular the adequacy of:-• All risk and control related disclosurestatements (in particular theStatement on Internal Control anddeclarations of compliance with theStandards for Better Health),together with any accompanyingHead of Internal Audit statement,external audit opinion or otherappropriate independent assurances,prior to endorsement by the Board.• The underlying assurance processesthat indicate the degree of theachievement of corporate objectives,the effectiveness of the managementof principal risks and theappropriateness of the abovedisclosure statements.• The policies for ensuring compliancewith relevant regulatory, legal andcode of conduct requirements.• The policies and procedures for allwork related to fraud and corruptionas set out in Secretary of StateDirections and as required by theCounter Fraud and SecurityManagement Service.Internal AuditTo ensure that there is an effectiveinternal audit function established bymanagement, that meets mandatoryNHS Internal Audit Standards andprovides appropriate independentassurance to the Audit Committee,Chief Executive and Board. This will beachieved by:-• Consideration of the provision of theInternal Audit Service, the cost of theaudit and any questions ofresignation and dismissal.• Review and approval of the InternalAudit strategy, operational plan andmore detailed programme of work,ensuring that this is consistent withthe audit needs of the organisationas identified in the AssuranceFramework.• Consideration of the major findingsof internal audit work (andmanagement’s response), and ensureco-ordination between the Internaland External Auditors to optimiseaudit resources.• Ensuring that the Internal Auditfunction is adequately resourced andhas appropriate standing within theorganisation.• Annual review of the effectiveness ofinternal audit.External AuditTo review the work and findings of theExternal Auditor appointed by theAudit Commission and consider theimplications and management’sresponses to their work. This will beachieved by:-• Consideration of the appointmentand performance of the ExternalAuditor, as far as the AuditCommission’s rules permit.• Discussion and agreement with theExternal Auditor, before the auditcommences, of the nature and scopeof the audit as set out in the AnnualPlan, and ensure co-ordination, asappropriate, with other ExternalAuditors in the local health economy.• Discussion with the External Auditorsof their local evaluation of audit risksand assessment of the Trust andassociated impact on the audit fee.• Review all External Audit reports,including agreement of the annualaudit letter before submission to theBoard and any work carried outsidethe annual audit plan, together withthe appropriateness of managementresponses.Other AssuranceFunctionsTo review the findings of othersignificant assurance functions, bothinternal and external to theorganisation, and consider theimplications to the governance of theorganisation.To review the work of othercommittees within the organisation,whose work can provide relevantassurance to the Audit Committee’sown scope of work. This willparticularly include the ClinicalGovernance Committee and any RiskManagement committees that areestablished.ManagementTo request and review reports andpositive assurances from directors andmanagers on the overall arrangementsfor governance, risk management andinternal control.To request specific reports fromindividual functions within theorganisation (eg clinical audit) asappropriate to the overallarrangements.Financial ReportingTo review the Annual Report andFinancial Statements before submissionto the Board, focusing particularly on:-• The wording in the Statement onInternal Control and other disclosuresrelevant to the Terms of Reference ofthe Committee.• Changes in, and compliance with,accounting policies and practices.• Unadjusted mis-statements in thefinancial statements.• Major judgmental areas.• Significant adjustments resultingfrom the audit.To ensure that the systems for financialreporting to the Board, including thoseof budgetary control, are subject toreview as to completeness andaccuracy of the information providedto the Board.Other MattersThe Terms of Reference for the AuditCommittee were reviewed by theCommittee on 5th July 2006 and wereapproved by the Trust Board on 26thJuly 2006.The Trust’s External Auditors arePricewaterhouseCoopers based at 101Barbirolli Square, Manchester, M2 3PW.Their assurance (audit) work cost theTrust £181,250.Membership of the Audit Committee:-Mr P Olive – ChairmanMrs C BreeneMr M BrownMr P HoskerMr B RobinsonMiss J A Oates – SecretaryFive meetings of the Audit Committeetook place during 2006/2007.REMUNERATION REPORTThe membership of the Trust’sRemuneration Committee includes allsix Non-Executive Directors as follows:-Mr M Brown - ChairmanMrs C BreeneMr P HoskerMiss B LesterMr P OliveMr B RobinsonMiss J A Oates – SecretaryFour meetings of the RemunerationCommittee took place during 2006/07.The Committee establishes pay rangesand progression within those payranges for executive director posts andfor director posts which report to theChief Executive.The Committee establishes the rangesfor director posts by reference to theannual pay awards made to other NHSStaff Groups and by comparison withpay information for similar posts inacute Trusts of the same size andcomplexity. The Trust participates inthe annual salary survey for senior NHSposts conducted by NHS Partners andthis information is presented to theCommittee to enable comparison ofpay ranges. The Committee recognisesthe need to ensure that salaries remaincompetitive with NHS comparators toaid recruitment and retention. TheCommittee awarded a staged cost ofliving pay increase of 2.2% for 2006 /2007 for directors, with 1% being paidfrom April 2006 and a further 1.2%from November 2006.Progression within the salary ranges isdetermined by an assessment ofperformance against personalobjectives. The Chairman assesses theperformance of the Chief Executiveand recommends salary progression asappropriate. The Chief Executiveassesses the performance of thoseDirectors who report to him andrecommends salary progression asappropriate. There are six points onthe salary ranges for the executivedirectors and directors who report tothe Chief Executive. Progressionthrough these six points is whollydependent on appraisal andassessment of performance againstobjectives.All executive directors and directorswho report to the Chief Executive areemployed on open-ended contracts ofemployment (i.e. not fixed-term) andall have notice periods of six months.Termination payments are made inaccordance with the provisions set outin the standard NHS terms andconditions of service and the NHSsuperannuation scheme as applied toall staff and contractual period ofnotice.During the year 2005/06 the posts ofDirector of Operations and Director ofPlanning and Performance were disestablishedand a new post of DeputyChief Executive was established. Thisresulted in the redundancy of theformer Director of Planning andPerformance. The postholder workedhis notice period and was maderedundant on 31st October 2006. Thepostholder received a redundancypayment in line with terms andconditions of service for NHS staff. InMay 2006 the post of Director of HRwas dis-established and a new post ofDirector of Human Resources andOrganisational Development wascreated. The Director of HR was maderedundant and received a terminationpayment in line with the guidelines setout in the NHS SuperannuationScheme and the NHS Terms andConditions of Service Handbook. Therehave been no other significant awardsto senior managers.FINANCIAL REVIEWAt the start of the financial year2006/07 the Trust faced the prospect ofa £24m gap between income andexpenditure. At over 12% of ourturnover, this represented a significantpotential debt that threatened theviability of both individual services andthe Trust as a whole.We had originally planned to managethis over a two year period, however,the NHS financial rules at the timewould have resulted in a ‘doubling up’of any deficit and potentially increasedthe problem year on year. Afterlengthy internal debate it was agreedthat the Trust would plan to deliverthe savings required in one year.To achieve this the Trust developed anumber of cost improvementinitiatives with an overall target of10% cost reduction in clinicaldepartments and 12.5% in corporateareas. These plans were wide rangingacross the whole organisation andincluded bed reductions of 250,reductions in headcount of around 400and rationalisation of services fromLytham, Devonshire Road and SouthShore Hospitals. In many areas, ashighlighted in the clinical Divisionalreviews, cost reduction has beenachieved by making clinical servicesmore efficient and responsive.As a result of these processes the Trustdelivered £19.1m of cost improvementsand recovered an additional £4m ofincome from better recording ofclinical activity. The Trust has nowstarted 2007/08 in recurrent financialbalance.The Trust receives the majority of itsincome for patient services fromBlackpool PCT, North Lancashire PCT(formerly Fylde and Wyre PCTs) andthe North West SpecialistCommissioners (who haveresponsibility for paying for CardiacServices). The following charthighlights where income is recoveredfrom:-There are no other elements ofremuneration such as bonuses oradditional pension contributions, withthe exception of a lease car scheme orpayment for business miles at WhitleyCouncil rates. The Trust’s lease carscheme is available to ExecutiveDirectors but there are no otherbenefits paid to Executive Directors.The remuneration of Non-ExecutiveDirectors is determined by theSecretary of State and was £5,673 perannum from 1st April 2006 with anincrease to £5,800 from 1st November2006.The following tables provide details ofthe remuneration and pension benefitsfor senior managers in 2006/07.Signed ……………….…………………(Chief Executive)Date August 31st 2007Salary and Pension Entitlements of SeniorManagersA) RemunerationName and TitleSalary(bands of£5000)£0002006-07 2005-06OtherRemuneration(bands of£5000)£000Benefits inKindRounded tothe nearest£100Salary(bands of£5000)£000B Lester - Chairman 20 - 25 20 - 25J Hartley - Chief Executive 120 - 125 35 - 40PR Male - Chief Executive(resigned 30.11.05)A Kehoe - Deputy ChiefExecutive85-90Allowing for exceptional items theTrust’s income increased by 2.5% from2005/06 and reflects the year on yearincreases in the level of activityprovided.The resources received are utilised asdemonstrated in the following twocharts:a) By DivisionOtherRemuneration(bands of£5000)£000Benefits inKindRounded tothe nearest£10085 - 90 3,000 70 - 75 3,300T Welch - Finance Director 95 - 100 60 - 65TH Evans - FinanceDirector (resigned 30.6.05)PJ Hayes - MedicalDirector (resigned 30 May06)P Kelsey - Medical Director(appointed 1 June 06)A Sunderland - Director ofNursing and QualityPJ Dewdney - Director ofPlanning and Performance(to 31.1.06)J Lyons - Director ofHuman Resources(resigned 30 June 06)MJ Gallagher - Director ofFacilitiesJC Armfield - Non-Executive (resigned 12May 06)20-25 5005-10 15- 20 35 - 40 105- 11015 - 20 120- 12590 - 95 6,100 75 - 80 6,10035 - 40 80 - 8575-80 3,90080 - 85 3,100 80 - 85 3,0000 - 5 5-10C Breene - Non-Executive 5-10 5-10M Carr - Non-Executive(resigned 19 May 06)0 - 5 5-10PA Olive - Non-Executive 5-10 5-10M Brown - Non-Executive 5-10 5-10P Hosker - Non-Executive(appointed 1 July 06)WG Robinson - Non-Executive (appointed 1July 06)0 - 50 - 5Salary and Pension Entitlements of SeniorManagersB) Pension BenefitsName and TitleJ Hartley - ChiefExecutiveA Kehoe - DeputyChief ExecutiveT Welch - FinanceDirectorPJ Hayes - MedicalDirector (resigned 30May 06)P Kelsey - MedicalDirector (appointed 1June 06)A Sunderland -Director of Nursingand QualityJ Lyons - Director ofHuman Resources(resigned 30 June 06)MJ Gallagher -Director of FacilitiesRealincrease inpension andrelatedlump sum atage 60(bands of£2500)£000Total accruedpension andrelated lumpsum at age 60at 31 March2007(bands of£2500)£000CashEquivalentTransferValue at 31March 2007CashEquivalentTransferValue at 31March 2006Real Increasein CashEquivalentTransferValueEmployersContributionto StakeholderPension£000 £000 £000 To nearest£1002.5 - 5 97.5 -100 289 261 15 017.5 - 18 75 - 77.5 237 177 38 02.5 - 5 57.5 - 60 148 130 10 0(7.5) - (10) 182.5 - 185 n/a n/a n/a 07.5 - 10 190 - 192.5 775 687 41 02.5 - 5 77.5 - 80 248 226 12 00 - 2.5 142.5 - 145 n/a n/a n/a 02.5 - 5 152.5 - 155 642 602 17 0The pension benefits for Executive Directors who left post in 2005/06 has not beendetermined. As identified in Table A above these were P R Male, T H Evans and P JDewdney.As Non-Executive members do not receive pensionable remuneration, there will be noentries in respect of pensions for Non-Executive members.A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of thepension scheme benefits accrued by a member at a particular point in time. Thebenefits valued are the member's accrued benefits and any contingent spouse'spension.Non-Clinical Income 9%Other Clinical Income 2%Specialist Commissioning 14%North Lancashire PCT 37%Blackpool PCT 38%Medicine 16%Finance and Other 16%Facilities 11%Corporate 14%Clinical Support Service 13%Women and Children 6%Cardiac 11%Surgery 17%In 2006/07 over 60% of the Trust’sresources were spent within the clinicalareas, with the balance spent oncorporate, facilities and estate costs.b) By type ofexpenditureThe Trust spends over 55% of itsresources on staff pay with the largestspend being on nurses. The Trust has ahigher than average spend on non-payitems and this reflects the high cost ofthe specialist devices and equipmentused in our Cardiac Services.The Trust has met its statutory financialduties and achieved the followingresults:-• Broke even when comparing incomeand expenditure, and generated asurplus of £1,572k.• Operated within our net cash limit of£5,145k.• Absorbed a 3.4% return on capitalassets in our costs.There are a number of other measuresagainst which the Trust’s financialLooking Forward to 2007/08performance is assessed:-• The “Better Payment Practice Code”requires the Trust to pay all validvariances by a due date, or within 30days of receipt of the goods or a validinvoice, whichever is the later. We wereable to pay 84% of invoices by valuewithin the Government’s prompttarget. No payments were made duringthe year under the Late Payment ofCommercial Debts (Interest) Act 1998.• The Trust restricted the pay inflation ofits Senior Managers to 2.5%. Thisfigure is in line with the inflationincrease agreed nationally for staff in2006/07. Details of Senior Managersremuneration are given in the previouscolumn.• Management costs for the year were£9,083K or 4.2% of the incomegenerated by the Trust. This is in linewith the % of income from 2005/06.The management and administrationcosts are detailed overleaf.The Trust invested £11,062k in capitalprojects during the year, with the mainexpenditure being incurred on the newLancashire Cardiac Centre and the DaySurgery Unit. Both of these projectswere commissioned and formally openedduring 2006/07.Summarised financial statements areincluded on this fold out section of thisreport. The Trust’s financial statementshave been prepared in accordance withthe 2006/07 NHS Trusts Manual forAccounts. The accounting policiescontained in the Manual follow UKGenerally Accepted Activity Practice (UKGAAP) to the extent that it isappropriate for the NHS.The Trust aims to build upon the success of 2006/07 and continue to deliverrobust financial performance. In conjunction with The Blackpool Way all areascontinue to review their efficiency and develop new ways of working. Thisprocess will support the Trust’s application to become a Foundation Trust andensure the on-going future of the Trust’s services.In support of developing Divisions as ‘business units’, the Trust will develop in2007/08 service line reporting. This will support managers to betterunderstand the relationship between the income earned and the cost ofproviding services and will support more robust decision-making in the future.The following Summary Financial Statements are extracted from the 2006/07Annual Accounts of the Blackpool, Fylde and Wyre Hospitals NHS Trust.Information on obtaining a full set of accounts is detailed on the reverse ofthis document.INCOME AND EXPENDITURE ACCOUNT FOR THE YEARENDED 31 March 20072006/07 2005/06NOTE £000 £000Income from activities 3 220,816 189,026Other operating income 4 16,932 16,391Operating expenses 5 (229,612) (199,154)OPERATING SURPLUS/(DEFICIT) 8,136 6,263Cost of fundamental reorganisation/restructuring* 0 0Profit/(loss) on disposal of fixed assets 8 (11) 0SURPLUS/(DEFICIT) BEFORE INTEREST 8,125 6,263Interest receivable 466 405Interest payable 9 0 0Other finance costs - unwinding of discount 16 (53) (52)Other finance costs - change in discount rate on provisions 0 (176)SURPLUS/(DEFICIT) FOR THE FINANCIAL YEAR 8,538 6,440Public Dividend Capital dividends payable (6,966) (6,433)RETAINED SURPLUS/(DEFICIT) FOR THE YEAR 1,572 7NOTE TO THE INCOME AND EXPENDITURE ACCOUNTFOR THE YEAR ENDED 31 March 200731 March 2007 31 March 2006£000 £000Retained surplus/(deficit) for the year 1,572 7Financial support included in retained surplus/(deficit) for theyear - NHS BankFinancial support included in retained surplus/(deficit) for theyear - Internally Generated0 00 2,647Retained surplus/(deficit) for the year excluding financial support 1,572 (2,640)Financial support is income providedwholly to assist in managing the NHSTrust's financial position. Internallygenerated financial support is financialsupport received from within the localhealth economy, consisting of the areaof responsibility of NHS North West.BALANCE SHEET AS AT 31 March 2007FIXED ASSETSMedicine 16%Finance and Other 16%Facilities 11%Corporate 14%Clinical Support Service 13%Women and Children 6%In 2006/07 the provision of financialsupport has been replaced by a regimeof loans and deposits with theDepartment of Health. Details of loansreceived or deposits placed with theDepartment of Health can be found innotes 14.2 and 15.1 to the accounts.31 March 2007 31 March 2006NOTE £000 £000Intangible assets 10 343 324Tangible assets 11 189,004 205,102Investments 14.1 0 0CURRENT ASSETS189,347 205,426Stocks and work in progress 12 3,601 3,213Debtors 13 32,804 16,231Investments 14.2 0 0Cash at bank and in hand 18.3 181 18136,586 19,625CREDITORS: Amounts falling due within one year 15 (13,939) (19,442)NET CURRENT ASSETS/(LIABILITIES) 22,647 183TOTAL ASSETS LESS CURRENT LIABILITIES 211,994 205,609CREDITORS: Amounts falling due after more thanone year15 0 0PROVISIONS FOR LIABILITIES AND CHARGES 16 (3,897) (1,744)TOTAL ASSETS EMPLOYED 208,097 203,865FINANCED BY:TAXPAYERS' EQUITYPublic dividend capital 22 160,028 165,173Revaluation reserve 17 36,150 41,646Donated asset reserve 17 2,875 2,832Government grant reserve 17 0 0Other reserves* 17 0 0Income and expenditure reserve 17 9,044 (5,786)TOTAL TAXPAYERS' EQUITY 208,097 203,865The financial statements on these pageswere approved by the Board on 21stJune 2007 and signed on its behalf by:Signed ……………….………………………(Chief Executive)Date August 31st 2007STATEMENT OF TOTAL RECOGNISED GAINS ANDLOSSES FOR THE YEAR ENDED 31 March 20072006/07 2005/06£000 £000Surplus/(deficit) for the financial year before dividend payments 8,538 6,440Fixed asset impairment losses 0 0Unrealised surplus/(deficit) on fixed assetrevaluations/indexationIncreases in the donated asset and government grant reservedue to receipt of donated and government grant financedassets7,942 3,461221 194Defined benefit scheme actuarial gains/(losses) 0 0Additions/(reductions) in "other reserves" 0 0Total recognised gains and losses for the financial year 16,701 10,095Prior period adjustment 0 0Total gains and losses recognised in the financial year 16,701 10,095

CASH FLOW STATEMENT FOR THE YEAR ENDED 31March 2007OPERATING ACTIVITIESStaff costs and numbersStaff CostsTotal2006/07 2005/06PermanentlyEmployedOtherTotal£000 £000 £000 £000Salaries and wages 111,250 109,994 1,256 110,754Social Security Costs 8,173 8,173 0 8,138Employer contributions to NHSPA 12,042 12,042 0 11,665Other pension costs 0 0 0 0131,465 130,209 1,256 130,557Average number of persons employedTotal2006/07 2005/06PermanentlyEmployedOtherTotalNumber Number Number NumberMedical and dental 333 325 8 397Ambulance staff 0 0 0 0Administration and estates 827 818 9 869Healthcare assistants and other supportstaff340 340 0 408Nursing, midwifery and health visiting staff 1,759 1,759 0 1,958Nursing, midwifery and health visitinglearners9 9 0 0Scientific, therapeutic and technical staff 434 432 2 469Social care staff 0 0 0 0Other 2 0 2 0Amounts included within Interest Payable (Note 9) arisingfrom claims made under this legislationCompensation paid to cover debt recovery costs under thislegislation3,705 3,684 21 4,101The Late Payment of Commercial Debts(Interest) Act 19982006/07 2005/06£000 £0000 00 02006/07 2005/06NOTE £000 £000Net cash inflow/(outflow) from operating activities 18.1 13,629 9,319RETURNS ON INVESTMENTS AND SERVICING OF FINANCE:Interest received 466 405Interest paid 0 0Interest element of finance leases 0 0Net cash inflow/(outflow) from returns on investments andservicing of financeCAPITAL EXPENDITURE466 405(Payments) to acquire tangible fixed assets (12,927) (25,587)Receipts from sale of tangible fixed assets 10,943 450(Payments) to acquire intangible assets 0 0Receipts from sale of intangible assets 0 0(Payments to acquire)/receipts from sale of fixed assetinvestments0 0Net cash inflow/(outflow) from capital expenditure (1,984) (25,137)DIVIDENDS PAID (6,966) (6,433)Net cash inflow/(outflow) before management of liquidresources and financingMANAGEMENT OF LIQUID RESOURCES5,145 (21,846)(Purchase) of investments with DH 0 -(Purchase) of other current asset investments 0 0Sale of investments with DH 0 -Sale of other current asset investments 0 0Net cash inflow/(outflow) from management of liquid resources 0 0Net cash inflow/(outflow) before financing 5,145 (21,846)FINANCINGPublic dividend capital received 2,200 21,848Public dividend capital repaid (not previously accrued) (7,345) 0Public dividend capital repaid (accrued in prior period) 0 0Loans received from DH 0 -Other loans received 0 0Loans repaid to DH 0 -Other loans repaid 0 0Other capital receipts 0 0Capital element of finance lease rental payments 0 0Net cash inflow/(outflow) from financing (5,145) 21,848Increase/(decrease) in cash 0 2Management costs2006/07 2005/06Management costs 9,083 8,487Income 215,149 205,400Management costs are defined as those on the management costs website atwww.dh.gov.uk/PolicyAndGuidance/OrganisationPolicy/FinanceAndPlanning/NHSManagementCosts/fs/enRetirements due to ill-healthDuring 2006/07 there were 9 (2005/06, 9) early retirements from the NHS Trust on thegrounds of ill-health. The estimated additional pension liabilities of these ill-healthretirements will be £905,000 (2005/06 £449,501). The cost of these ill-healthretirements will be borne by the NHS Business Services Authority -Pensions Division.Better Payment Practice Code2006/07Number £000Total Non-NHS trade invoices paid in the year 50,807 69,864Total Non NHS trade invoices paid within target 42,608 58,938Percentage of Non-NHS trade invoices paid within target 84% 84%Total NHS trade invoices paid in the year 1,429 17,231Total NHS trade invoices paid within target 1,059 13,980Percentage of NHS trade invoices paid within target 74% 81%The Better Payment Practice Code requires the Trust to aim to pay all undisputedinvoices by the due date or within 30 days of receipt of goods or a valid invoice,whichever is later.Profit/(Loss) on Disposal of Fixed AssetsProfit/(loss) on the disposal of fixed assets is made up as follows:2006/07 2005/06£000 £000Loss on disposal of plant and equipment (11) 0Interest Payable(11) 02006/07 2005/06£000 £000Finance leases 0 0Late payment of commercial debt 0 0Loans 0 0Other 0 00 0Related PartyTransactionsBlackpool, Fylde and Wyre HospitalsNHS Trust is a body corporateestablished by order of the Secretaryof State for Health.During the year none of the BoardMembers or members of the keymanagement staff or parties related tothem have undertaken any materialtransactions with Blackpool, Fylde andWyre Hospitals NHS Trust.Mr M J Gallagher, Director of Facilitiesfor Blackpool Fylde and Wyre HospitalsNHS Trust, has a minor shareholding inPatientline Limited. All transactions inthe year between the Trust andPatientline Limited were conducted asarms length transactions under normalcommercial terms.The Department of Health is regardedas a related party. During the yearBlackpool Fylde and Wyre HospitalsNHS Trust has had a significant numberof material transactions with theDepartment, and with other entitiesfor which the Department is regardedas the parent Department. Theseentities are listed below:• NHS North West *• Blackpool PCT• Blackburn with Darwen PCT• Cumbria PCT *• East Lancashire PCT *• Central Lancashire PCT *• North Lancashire PCT *• Lancashire Care NHS Trust• North West Ambulance ServiceNHS Trust *• NHS Litigation Authority• NHS Purchasing and Supply Agency.* includes predecessor organisationsIn addition, the Trust has had anumber of material transactions withother Government Departments andother central and local Governmentbodies. Most of these transactionshave been with Blackpool BoroughCouncil in respect of business rates andcouncil tax.The Trust has also received revenueand capital payments from a numberof charitable funds. As the Trust is thecorporate trustee of charitable funds,all Trust Board members are alsotrustees of charitable funds.STATEMENT OF THECHIEF EXECUTIVE'SRESPONSIBILITIES AS THEACCOUNTABLE OFFICER OFTHE TRUSTThe Secretary of State has directedthat the Chief Executive should be theAccountable Officer to the Trust. Therelevant responsibilities ofAccountable Officers, including theirresponsibility for the propriety andregularity of the public finances forwhich they are answerable, and forkeeping of proper records, are set outin the Accountable Officers'Memorandum issued by theDepartment of Health.To the best of my knowledge andbelief, I have properly discharged theresponsibilities set out in my letter ofappointment as an accountable officer.Signed ……………….………………………(Chief Executive)Date August 31st 2007STATEMENT OFDIRECTORS'RESPONSIBILITIES INRESPECT OF THEACCOUNTSThe Directors are required under theNational Health Services Act 1977 toprepare accounts for each financialyear. The Secretary of State, with theapproval of the Treasury, directs thatthese accounts give a true and fairview of the state of affairs of the Trustand of the income and expenditure ofthe Trust for that period. In preparingthose accounts, the directors arerequired to:• apply on a consistent basisaccounting policies laid down by theSecretary of State with the approvalof the Treasury,• make judgements and estimateswhich are reasonable and prudent,• state whether applicable accountingstandards have been followed,subject to any material departuresdisclosed and explained in theaccounts.The Directors are responsible forkeeping proper accounting recordswhich disclose with reasonableaccuracy at any time the financialposition of the Trust and to enablethem to ensure that the accountscomply with requirements outlined inthe above mentioned direction of theSecretary of State. They are alsoresponsible for safeguarding the assetsof the Trust and hence for takingreasonable steps for the preventionand detection of fraud and otherirregularities.The Directors confirm to the best oftheir knowledge and belief they havecomplied with the above requirementsin preparing the accounts.By order of the BoardSigned ……………….………………………(Chief Executive)Date August 31st 2007Signed ……………….………………………(Finance Director)Date August 31st 2007STATEMENT ON INTERNALCONTROL 2006/2007Scope of ResponsibilityThe Board is accountable for internalcontrol. As Accountable Officer, andChief Executive of this Board, I haveresponsibility for maintaining a soundsystem of internal control thatsupports the achievement of theorganisation’s policies, aims andobjectives. I also have responsibility forsafeguarding the public funds and theorganisation’s assets for which I ampersonally responsible as set out in theAccountable Officer Memorandum.As Accountable Officer I have overallaccountability for Internal Control. Tosupport this role, there are clearsystems of accountability within theorganisation with each ExecutiveDirector having specific areas ofresponsibility. Performance against theTrust’s objectives is reported to theBoard on a monthly basis.In accordance with the responsibilitiesassigned to me, I am also personallyresponsible for ensuring that theorganisation is administered prudentlyand economically and that resourcesare applied efficiently and effectively.Partnership working arrangementshave been established and I meet withall Chief Executives across the NorthWest Strategic Health Authority (andtheir predecessor organisations) on asix weekly basis.I foster a cohesive workingrelationship with Blackpool PrimaryCare Trust and North LancashirePrimary Care Trust (and theirpredecessor organisations) by meetingfortnightly at Chief Executive Level.Regular officer level meetingsunderpin the Trust’s integratedbusiness plan and contract targets.The Purpose of theSystem of InternalControlThe system of internal control isdesigned to manage risk to areasonable level rather than toeliminate all risk of failure to achievepolicies, aims and objectives; it cantherefore only provide reasonable andnot absolute assurance ofeffectiveness. The system of internalcontrol is based on an ongoing processdesigned to:• Identify and prioritise the risks to theachievement of the organisation’spolicies, aims and objectives.• Evaluate the likelihood of those risksbeing realised and the impact shouldthey be realised, and to managethem efficiently, effectively andeconomically.The system of internal control hasbeen in place in Blackpool, Fylde andWyre Hospitals NHS Trust for the yearended 31st March 2007 and up to thedate of approval of the annual reportand accounts.Capacity to HandleRiskAs Accountable Officer, I lead the riskmanagement process as Chair of theTrust’s Risk Management Committee,which meets on a quarterly basis.The Director of Nursing and Qualityalso provides leadership to the TrustBoard for the implementation ofintegrated governance and riskmanagement. The Director of Financeis designated as the accountable andresponsible officer for managingfinancial risk in the Trust. The TrustBoard approved Risk ManagementStrategy clearly defines theresponsibilities of individual ExecutiveDirectors specifically and generally. TheRisk Management Strategy also appliesto all employees and requires an activelead from managers at all levels toensure risk management is afundamental part of the totalapproach to quality, corporate andclinical governance and controlsassurance. The Risk ManagementStrategy is available to all staff via theDocument Library on the Trustintranet.To ensure the successfulimplementation and maintenance ofthe Trust’s approach to riskmanagement, staff at all levels areappropriately trained in incidentreporting and carrying out a riskassessment. An ongoing riskmanagement training programme hasbeen developed which includes ClinicalRisk Management/Patient Safety,Health and Safety, Fire, Resuscitation,Moving and Handling, Child Protectionand Conflict Resolution training and ismandatory for appropriate staff.The Clinical Incident ReviewCommittee, comprising senior staff,meets on a monthly basis to ensureconcerns identified from incidents,claims and complaints are investigatedto ensure that lessons are learned andas a method of sharing best practice.The Trust fosters an environmentwhere individuals are treated in a fairand just way, and where lessons arelearned rather than blame beingattributed.The Risk and ControlFrameworkThe Risk Management Strategy isBoard approved, covers all risks and issubject to an annual review. Staffaccountable and responsible for riskmanagement are clearly identified aswell as the system for identifying,managing, evaluating and controllingindividual risk. Risks are identifiedfrom risk assessments and from theanalysis of untoward incidents.Risk management is embedded in theactivity of the organisation viainduction training, regular riskmanagement training and ad hoctraining when need is identified. Anuntoward incident reporting system isin place and the incidents are enteredonto a database for analysis. Rootcause analysis is undertaken andidentified changes in practice areimplemented.The Corporate Risk Structure consistsof clinical and non-clinical committees,which report to the Risk ManagementCommittee.The Risk Management Committee linksto the Audit Committee and theClinical Governance Committee andalso reports direct to the Trust Board.A Board approved AssuranceFramework has been in place during2006/07. The Assurance Framework:• Covers all of the Trust’s mainactivities.• Identifies the corporate objectivesand targets the Trust is striving toachieve.• Identifies risks to achievement ofthese objectives and targets.• Identifies the system of internalcontrol in place to manage the risks.• Identifies review and assurancemechanisms, which relate to theeffectiveness of the system ofinternal control.• Covers the core standards on whichthe Trust has been required todeclare its compliance during2006/07.The elements of the AssuranceFramework are monitored andreviewed on a quarterly basis by theRisk Management Committee and theAudit Committee followed by the TrustBoard. This provides the evidence tosupport the Statement on InternalControl.The Audit Committee is a subcommittee of the Trust Board andprovides independent assurance onaspects of governance, riskmanagement and internal controls.The Finance Director and the Head ofClinical Governance are also membersof the Risk Management Committeeand provide Governance and RiskManagement assurance to the AuditCommittee at each of its meetings,thus ensuring an integrated riskmanagement approach.There are no significant gaps incontrol. However, I have to highlightthe major financial risks that the Trustfaced in 2006/07. As a consequence ofan inadequate financial recovery planfor 2005/06 the Trust faced a deficit of£24m before cost improvementinitiatives. The Trust has made majorprogress and demonstrated the abilityto meet its financial obligation toachieve breakeven in 2006/07. Overthe last year, this has been achieved byimplementing the following controlsand review processes:• A Board level Finance Committee hasbeen established to continuouslyoversee and make recommendationson financial strategy and reviewfinancial performance;• A revised Financial Recovery Plan wasapproved by the Trust Board in June2006;• An enhanced performanceframework, including the use ofrobust benchmarking data, has beenestablished within the Trust;• A Turnaround Team has supportedthe achievement of costimprovements across the Trust;• A Turnaround Director has beenappointed to lead the TurnaroundTeam;• An External audit review of theTrust’s recovery plan and progressagainst it by PricewaterhouseCooperhas validated the Trust’s approachand confirmed our achievements.As an employer with staff entitled tomembership of the NHS PensionScheme, control measures are in placeto ensure all employer obligationscontained within the SchemeRegulations are complied with. Thisincludes ensuring that deductions fromsalary, employer’s contributions andpayments into the Scheme are inaccordance with Scheme rules, andthat member Pension Scheme recordsare accurately updated in accordancewith the timescales detailed in theRegulations.An established communicationsframework is in place in the form of aMajor Incident Plan, and crosscommunity emergency planningarrangements are in place.Public Stakeholders, which includeBlackpool Primary Care Trust, NorthLancashire Primary Care Trust,Blackpool Overview and ScrutinyCommittee, Lancashire Overview andScrutiny Committee and the Patientand Public Involvement Health Forum,are consulted on service developmentsand changes. These PublicStakeholders are identified within theBoard Assurance Framework; thisensures that they are involved inmanaging the risks, which impactupon them.Review ofEffectivenessAs Accountable Officer, I haveresponsibility for reviewing theeffectiveness of the system of internalcontrol. My review is informed in anumber of ways.The Head of Internal Audit providesme with an opinion on the overallarrangements for gaining assurancethrough the Assurance Framework andon the controls reviewed as part of theinternal audit work.Executive Directors within theorganisation who have responsibilityfor the development and maintenanceof the system of internal controlprovide me with assurance.The Board Assurance Framework itselfprovides me with evidence that theeffectiveness of controls that managethe risks to the organisation achievingits principle objectives have beenreviewed.My review is also informed by thework of the internal auditors viareports on control issues and theExecutive Directors who haveresponsibility for the development andmaintenance of the internal controlframework. It also takes account ofcomments made by the externalauditors and other review bodies intheir reports.The Trust Board, Audit Committee, RiskManagement Committee and theClinical Governance Committee haveadvised me on the implications of theresult of my review of theeffectiveness of the system of internalcontrol. These committees also advisemyself and outside agencies on seriousuntoward events.A plan to address weaknesses andensure continuous improvement of thesystem is in place.The process that has been applied inmaintaining and reviewing theeffectiveness of the system of internalcontrol is achieved by:• The Trust’s self-assessmentdeclaration of compliance against thetwenty-four Core ‘Standards forBetter Health’ and twoDevelopmental standards. Thisdemonstrates continuousimprovement against the standardsand supporting evidence is availablefor all members of the Trust Board toreview as a source of assurance and isan essential part of the Trust’s systemof internal control.• The North West Strategic HealthAuthority (SHA) monitors andreviews the portfolio of evidence inrelation to the implementation ofClinical Governance and Standardsfor Better Health to assist in thereview of effectiveness of the systemof internal control. This also ensurescontinuous improvement of thesystem in place.• The Trust Board also monitors andreviews the effectiveness of theBoard Assurance Framework on aquarterly basis.• The Risk Management Committeemanages and reviews the BoardAssurance Framework, which isagreed in conjunction with ExecutiveDirectors. The Risk ManagementCommittee minutes are presented tothe Trust Board. The RiskManagement Committee producesan annual Risk Management report,which is presented to the AuditCommittee followed by the TrustBoard to provide assurance oncontrols.• The Audit Committee reviews theestablishment and maintenance of aneffective system of integratedgovernance, risk management andinternal control across the whole ofthe organisation’s activities (bothclinical and non-clinical) thatsupports the achievement of theorganisation’s objectives. It reviewsthe Board Assurance Framework on aquarterly basis.• The relevant clinical and non-clinicalsub committees report directly to theRisk Management Committee andthe Clinical Governance Committee.• Internal Audit reviews the BoardAssurance Framework and theeffectiveness of the system ofinternal control as covered by theaudit work to assist in the review ofeffectiveness.• NHS Litigation Authority (NHSLA)assessment on 2nd March 2006resulted in the achievement ofClinical Negligence Scheme for Trusts(CNST) Maternity level 1 status thatprovides assurance on controls.• NHS Litigation Authority (NHSLA) riskmanagement standards pilotassessment on 19th September 2006resulted in the achievement ofGeneral Clinical Negligence Schemefor Trusts/Risk Pooling Scheme forTrusts (CNST/RPST) level 1 status thatprovides assurance on controls.• The Head of Internal Audit providessignificant assurance that there is agenerally sound system of internalcontrol designed to meet theorganisations objectives.There have been no significantinternal control issues identified.Signed ……………….………………………(Chief Executive)Date August 31st 2007INDEPENDENT AUDITORS’REPORT TO BLACKPOOL,FYLDE AND WYREHOSPITALS NHS TRUST ONTHE SUMMARY FINANCIALSTATEMENTSWe have examined the summaryfinancial statements set out on thesepages.This report is made solely to the Boardof Blackpool, Fylde and Wyre HospitalsNHS Trust in accordance with Part II ofthe Audit Commission Act 1998 andfor no other purpose, as set out inparagraph 54 of the Statement ofResponsibilities of Auditors and ofAudited Bodies, prepared by the AuditCommission.Respectiveresponsibilities ofdirectors and auditorsThe directors are responsible forpreparing the Annual Report. Ourresponsibility is to report to you ouropinion on the consistency of thesummary financial statements with thestatutory financial statements. We alsoread the other information containedin the Annual Report and consider theimplications for our report if webecome aware of any misstatements ormaterial inconsistencies with thesummary financial statements.Basis of opinionWe conducted our work in accordancewith Bulletin 1999/6 ‘The auditor’sstatement on the summary financialstatements’ issued by the AuditingPractices Board for use in the UnitedKingdom.OpinionIn our opinion the summary financialstatements are consistent with thestatutory financial statements of theTrust for the year ended 31st March2007 on which we have issued anunqualified opinion.Notice of the Trust’ sAnnual Public MeetingThe Annual Public Meeting of theBlackpool, Fylde and Wyre HospitalsNHS Trust will be held on Thursday27th September 2007 at 6pm in theHeron’s Suite, De Vere Hotel,Blackpool.Obtaining the Trust’ sFull AccountsA copy of the Trust’s full set ofAccounts can be obtained by writingto:-Miss J A OatesSecretary to the TrustBlackpool, Fylde and Wyre HospitalsNHS TrustTrust HeadquartersBlackpool Victoria HospitalWhinney Heys RoadBlackpoolFY3 8NRThe supply of a full set of Accountswill be subject to an administrative feeof £5.00.If you have any comments on ourAnnual Report or would like anyfurther information, please write to:-Mr J HartleyChief ExecutiveBlackpool, Fylde and Wyre HospitalsNHS TrustTrust HeadquartersBlackpool Victoria HospitalWhinney Heys RoadBlackpoolFY3 8NRBlackpool, Fylde and Wyre Hospitals

Blackpool, Fylde and Wyre HospitalsBIf you have any comments on our Annual Report, or would like any further information, please write to:-Mr J Hartley, Chief Executive, Blackpool, Fylde and Wyre Hospitals NHS TrustTrust Headquarters, Blackpool Victoria Hospital, Whinney Heys RoadBlackpool, Lancashire FY3 8NRIf you require a copy of this document in large print, Braille, audio or a different language,please call 01253 306856.