April 1st 2009 to March 31st 2010

Blackpool, Fylde andWyre HospitalsNHS Foundation TrustBlackpool, Fylde andWyre HospitalsNHS Foundation TrustApril 1st 2009 toMarch 31st 2010

Blackpool, Fylde andWyre HospitalsNHS Foundation TrustBlackpool, Fylde andWyre HospitalsNHS Foundation TrustPresented to Parliament pursuant to Schedule 7,Paragraph 25(4) of the National Health Service Act 2006Blackpool, Fylde and WyreHospitals NHS Foundation TrustAnnual Report and AccountsApril 1st 2009 to March 31st 2010Annual Report and Accounts Annual April Report 1st 2009 and Accounts to March 2009/2010 31st 2010 3

ContentsPageChairman and Chief Executive’s Statement 6Hospital Highlights 906Chairman &Chief Executive’sStatement09HospitalHighlights77Membership81Audit CommitteeDirectors’ Report 13- Our Trust 13- Our Vision 14- Our Services 15- Our Patients 17- Our Staff 21- Our Finances 29- Our Performance 39- Delivering Our Plans 45- Our Future Plans 51Board of Directors 59Council of Governors 69Membership 77Audit Committee 8113Directors’ Report85RemunerationReportRemuneration Report 85Nominations Committee 89Quality Report Annex A 91Statement of the Chief Annex B 130Executive’s Responsibilitiesas the Accounting Officer59Board ofDirectors89NominationsCommitteeStatement in respect ofInternal Control Annex C 131Independent Auditor’s Report Annex D 138to the Council of GovernorsAccounts for the Period Annex E i-xxxv1st April 2009 to 31st March 201069Council ofGovernors91Annex A to EAnnual Report and Accounts April 1st 2009 to March 31st 2010 5

Chairman and Chief Executive’s Statement“Improvements havebeen made in keyareas including quality,safety, innovation,environment, waitingtimes and patientexperience.”It has been another successful year forBlackpool, Fylde and Wyre HospitalsNHS Foundation Trust as we continuedto invest in services in order to provide‘Best in NHS’ care for our patients.We are committed to providing services of the highestquality ensuring patient safety is at the heart ofeverything we do. This year we have seen significantreductions in mortality, medication errors, patient fallsand hospital acquired infections – all key patient safetyindicators.We were delighted that our innovative work in theseimportant patient areas has been recognised through anumber of national awards. In February 2010 the Trustwas named the overall winner in the inaugural PatientSafety Awards 2010 in the communication category.Thanks to a successful staff and patient engagementcampaign and the innovative use of technology wehave seen further reductions in MRSA and clostridiumdifficile. In November 2010 we were highly commendedin the Department of Health awards for ‘BestCommunications Improving Quality of Patient Care’ forour high-profile Ban the Bugs Campaign.Once again we were featured in the list of CHKS Top 40Hospitals for being one of the best performing hospitalsTrusts in the UK. We also saw further improvementsin our Care Quality Commission (CQC) ratings, scoring‘good’ for quality of services and ‘excellent ‘ for use ofresources – the highest rating for the NHS in Lancashireand Cumbria.We achieved national targets in key areas such as cancerreferrals, inpatient and outpatient waiting times, accessto heart surgery and A&E waits, however, we narrowlymissed the 62 day cancer screening target. A lot of workhas been done to shorten patient pathways for patientsidentified with cancer and we achieved this target inthe last quarter of the year. Further work will take placethis year.We are particularly proud of our performance inachieving the four-hour wait for A&E as this year wasone of the busiest ever with added pressure on ourhospitals due to swine flu and the bad weather. Wewould like to place on record our thanks to all of ourstaff for their dedication and commitment in helping usto continue to provide high levels of care during theseexceptionally busy times.6Blackpool, Fylde and Wyre Hospitals

The Trust again achieved its financial targetsfor the year by the delivery of a £2.8m surplus(before exceptional items) against a planof £2.7m. The published performance of a£5.7m deficit results from the net impact of animpairment following a downward revaluationof the Trust asset base.We acknowledge that our staff are our greatestasset and a lot of work has been done toimprove staff engagement and involvementand further embed ‘The Blackpool Way’. Wewere delighted to be awarded Investors inPeople Gold in January 2010 – highlightingour commitment in this important area. Wehave also seen significant improvements in theresults of the Staff Survey, sickness absence hasfallen for the fourth year running and we won anational Healthcare People Management Awardfor our work to reduce stress in the workplace.The Trust has continued to invest in newbuildings and developments to ensure patientcare is delivered from state-of-the-art facilities.Work has progressed well on our three majorschemes – the £40m Surgical Centre, £13mWomen’s and Children’s Unit and £6m UrgentCare Centre. We are looking forward to theopening of the Urgent Care Centre in earlysummer 2010. Other improvements have beenmade to the hospital environment to improvethe privacy and dignity of patients. £600,000has been spent across all sites to deliver singlesex accommodation through improvements intoilet and bathing facilities and wall partitionson wards.We also saw the launch of a new service toenable children to have MRI scans locally. Wetook delivery of a brand new state-of-the-artCT scanner in February 2009 and together withspecial anaesthetic equipment raised throughthe £500,000 Blackpools “It’s a Knockout”Appeal we are now able to provide this muchneededservice at Blackpool Victoria Hospital.We would particular like to thank the formerMayor and Mayoress of Blackpool, CouncillorRobert and Gaynor Wynne for their majorcontribution to the success of this appeal.Hartley, who was appointed Chief Executive ofUniversity of South Manchester Hospital NHSFoundation Trust in May 2009.Harry Clarke was appointed Director ofOperations in October 2009. Due to ill healthHarry Clarke has stepped out of this role andCorinne Siddall was appointed to act into therole for six months from January 4th 2010.Looking forward, Peter Hosker will not beoffering himself for re-election in his positionof Non-Executive Director in June 2010 andwe would like to thank him for the valuablecontribution he has made since his appointmentin 2006.We are committed to involving the public indecisions about the provision of local hospitalservices. Our Foundation Trust Membershiphas continued to grow with 788 new publicmembers joining us over the past year. Ourpublic membership now stands at 5,615 and thiswill be an area for further growth in the comingmonths. There have also been a number ofchanges to our Governors which are outlined onpage 72 of this report.As we move into more challenging times thebiggest challenge facing the Trust over thenext three-four years will be managing thecurrent economic situation. This means thatwe will have to look at innovative ways toimprove efficiency in all areas whilst ensuringour services are of the highest quality. We knowwith the continued dedication of our staff andthe support of our Governors, Members andvolunteers we can continue to go from strengthto strength and achieve our vision of beingamong the top 10% hospitals in the country.There have been two changes to the Board ofDirectors since last year since the appointmentof Acting Chief Executive, Aidan Kehoe, tothe substantive post in July 2009. This followsthe resignation of Chief Executive JulianBeverly Lester,ChairmanAidan Kehoe,Chief ExecutiveAnnual Report and Accounts April 1st 2009 to March 31st 2010 7

“Whilst I was on Ward D I have had such excellent treatment, fromconsultants, nurses, auxiliary staff and cleaners, all contributed with such helpfuland efficient care. Information was clear, detailed and useful. I feel stronglythat credit should be given where it is due and wish to express my extremegratitude to all involved. “Margaret Long, Ansdell, Lytham St Annes8Blackpool, Fylde and Wyre Hospitals

Hospital HighlightsThe Trust continues to make progress at all its sites toimprove the quality of services and enhance the patientexperience. A small selection of notable milestones fromthe past year includes:The Victoria Centre: Child Safeguarding CentreThe Victoria Centre, a Child Safeguarding Centre based at Blackpool VictoriaHospital, opened in June 2009.The Centre, the first of its kind in the area, supports youngsters with childprotection issues and saves many children having to travel outside of thedistrict for help.The purpose built centre brings together various agencies including BlackpoolCouncil’s Awaken Team, Social Workers and the Police to support children inneed. The site includes counselling rooms, a police video interviewing suite,colposcopy examination room, a space for teenage pregnancy midwives andan appropriate environment in which to work with children experiencingdifficult times.Sunday Times Best Places to WorkThe Trust was delighted to have been voted one of the 75 Best Places to Workin the Public Sector by the Sunday Times.More than 1,000 of our staff were asked questions on topics such as leadership,wellbeing, personal growth and their thoughts on the organisation’s Visionand Values.The Trust was ranked in the top 50 and was one of only two Hospitals Trusts inthe UK to be included in the list.Chief Executive, Aidan Kehoe, said: “This is a fantastic achievement and onewhich we are extremely proud of. We constantly strive to be a good employerand improve standards for staff.”Annual Report and Accounts April 1st 2009 to March 31st 2010 9

Knockout AppealA magnificent fundraising effort led by a formerBlackpool Mayor and Mayoress was celebratedwith the opening of a new state-of-the-artscanning facility at Blackpool Victoria Hospital.Councillor Robert and Gaynor Wynne raised£500,000 through their Blackpool’s “It’s aKnockout” Appeal which bought specialisedanaesthetic and monitoring equipment so thatlocal children who needed an MRI scan could becared for locally rather than having to travel toLiverpool, Manchester or Preston.The appeal also funded an Anaesthetics andRecovery Room to provide a dedicated spacewhere children could be anaesthetised, and,if required, undergo extra medical tests whileunconscious. This provides an extra benefitto parents as it avoids additional hospitalappointments for their child.40 years of heart surgery inBlackpoolComedian Frank Carson was the star attraction ata special event to mark the official 40th birthdayof the Cardiac Unit in Blackpool.As the fundraising surpassed all expectations, theTrust added more than £1m to the donation toprovide a new top quality MRI scanner that willhelp provide a facility that is one of the best inthe North West.The Belfast-born comic, a former Cardiac Unitpatient, talked about his own experiences in thecentre, after previously suffering heart problemswhich lead to him being fitted with a pacemaker.He said: “I spent a bit of time in a seven star hotelin Dubai a while ago and I wasn’t treated as wellthere as I am here!“The staff were out of this world and could notdo enough for me. The treatment I received wasfirst class and I am extremely grateful for the waythey looked after me.’’Quality Initiatives in Radiology andDiagnostic ServicesThe Radiology Service is one of only 10 nationalsites chosen to pilot the Imaging ServiceAccreditation Scheme, a scheme that rewardssites deemed to be providing an excellent serviceto patients.Clinical Chemistry, Microbiology andHaematology had their Clinical PathologyAccreditation (CPA) renewed for two years, whilstHistology and Cytology received first time CPA.Accreditation from the CPA marks anorganisation that is providing a high qualityservice.PCI treatment expansionThe Lancashire Cardiac Centre extended itsPrimary Percutaneous Coronary Intervention(PCI) treatment to 24 hours a day. The treatmentensures that patients receive potentially lifesaving treatment within 90 minutes of asuspected heart attack whenever it happens.10Blackpool, Fylde and Wyre Hospitals

“On August 24th 2009 my wife was suffering with great pain and after a 999call the Cardiac team went into action, which saved my wife’s life. Please passon all my thanks to the “team” for their timely and expert response. My thanksalso to the Orthopaedic team who replaced my wife’s hip very successfully. “Mr R A Rees, St Annes12Blackpool, Fylde and Wyre Hospitals

Directors’ ReportWe have continued to strengthenour position as a leading FoundationTrust through strong performanceand leadership, robust financialmanagement and by putting patients atthe heart of everything we do.This section includes information about our Trust andthe services we provide as well as our achievements in:• Improving the patient experience• Valuing our staff• Our performance against national and local targets• Our finances• Our future plansOur TrustThe Blackpool, Fylde and Wyre HospitalsNHS Foundation Trust was establishedon December 1st 2007 under theNational Health Service Act 2006.The Trust comprises:• Blackpool Victoria Hospital - the main DistrictGeneral Hospital• Clifton Hospital• Fleetwood Hospital• Rossall Hospital Rehabilitation Unit• Wesham Hospital Rehabilitation Unit• Bispham Hospital Nurse Led Therapy Unit• The National Artificial Eye Service• Blackpool Child Development CentreThe Trust has three main commissioners; NHS Blackpool,NHS North Lancashire and, for Cardiac services,the North West Specialist Commissioner. Furtherinformation on the funding streams of the Trust isprovided in the financial review section of this report.Annual Report and Accounts April 1st 2009 to March 31st 2010 13

Location Map ofBlackpool, Fyldeand WyreOur VisionThe Trust’s vision was approved bythe Board of Directors in April 2006following consultation with staff.The work of the Trust continues to be guided by thevision which is based on four key themes:• To offer ‘Best in NHS’ care for our patients• To be the first choice provider for the residents ofthe Fylde Coast and beyond• To offer outstanding value for money for thetaxpayer• To be a great place to workIn March 2010 we started a piece of work involving stafffrom across the Trust to refresh our vision and values.14Blackpool, Fylde and Wyre Hospitals

Improving the Patient EnvironmentProviding an excellent environment for ourpatients is extremely important to the Trust. Eachyear an annual PEAT audit is undertaken by ourTrust to assess six key areas with regard to thequality of standards we provide to our patients.PEAT stands for Patient Environment Action Teamand comprises of a multi disciplinary team whoconduct annual audits following the guidelinessent out by the National Patient Safety Agency.The key areas which are audited are as follows:CleanlinessSpecific bathroom/toilet cleanlinessCatering ServicesEnvironmentInfection ControlPrivacy & DignityAccess & External AreasIn 2009, the audits were extremely encouragingand all our hospitals scored good or excellent.The scores demonstrate the commitment of ourstaff to ensure the patient’s stay in hospital meetand exceed standards set by the National PatientSafety Agency.SiteOverallRating2008/2009OverallRating2009/2010Victoria Hospital Good GoodLearning from patientsWe actively encourage comments from ourpatients who have experienced our hospitalservices so that we can learn lessons and makeconstant improvements.The Trust received 338 formal and 44 verbalcomplaints for the period April 1st 2009 toMarch 31st 2010. Comparing this with the sameperiod of the previous year we received 361formal complaints and 38 verbal complaintswhich is a decrease of 23 formal complaints andan increase of 5 verbal. The main categories ofconcerns raised in complaints are clinical care,communication and staff attitude. Divisions haveprovided a full written response as required andimplemented action plans where lessons havebeen learned. Complaint trends and lessonslearned are discussed at the Learning fromIncidents and Risk Committee.The Health Service Ombudsman took overresponsibility for second stage review from April2009 and have considered 23 complaint reviewsbetween April 1st 2009 and March 31st 2010,six of which were referred back to the Trust forfurther local resolution, three were not upheld,two were upheld and have been dealt with bythe Trust following final recommendations madeand 12 cases are still ongoing.Clifton Hospital Good ExcellentBispham Nurse Led Unit Excellent ExcellentWesham RehabilitationHospitalRossall RehabilitationHospitalExcellentExcellentExcellentExcellentTotal Number of Complaints Received 2009 – 20102008/20092009/2010Apr-June 09/10Jul-Sep 09/10Oct-Dec 09/10Jan-Mar 09/1039938779941119818Blackpool, Fylde and Wyre Hospitals

Enhancing Patient SafetyImproving patient safety remains a top priorityfor all staff within the Trust led by the Board ofDirectors and Executive Directors.Demonstrating their commitment to patientsafety all the Executive Directors carry outPatient Safety Walkabouts. There have beenover 250 walkabouts and these focus on patientsafety issues where staff and patients can raiseany concerns directly to the Executive Directors.The benefits of this are:• An increased awareness of safety issues andpatient safety concepts among all staff.• A demonstration that safety is a high priorityfor senior management.• Promoting an open and fair culture.• A way of gathering and sharing information.• Information feedback following thewalkabouts is made readily available for staffand issues identified are dealt with in a timelymanner.In addition, patient stories are filmed anddiscussed quarterly at the Board of Directorsmeetings and used for staff training with lessonslearned being shared across the organisation.A safety culture is evident and staff have aconstant and active awareness of the potentialfor things to go wrong. The staff and theorganisation are able to acknowledge mistakes,learn from them and take action to put thingsright.Patient safety training is provided for staff andclinical risk issues are incorporated within thecorporate and local induction. The Trust alsoincorporates risk management and patient safetyinto the organisation’s objectives, corporatefocus, strategic direction, operational systemsand day to day practice.During 2009/2010 the Trust won two nationalawards for patient safety for its work engagingand involving staff and for its effectiveleadership in this important patient area.Productive Ward “Releasing Timeto Care”To maximise the time available for nurses toperform direct care to patients, the Trust hasintroduced the Productive Ward “Releasing Timeto Care” Series. It has been found that acuteward nursing staff spend 40% of their timedelivering direct patient care (NHS Institute forInnovation and Improvement). The ProductiveSeries supports NHS teams to redesign andstreamline the way they manage and work.This helps achieve significant and lastingimprovements – predominately in the extra timethat they give to patients, as well as improvingthe quality of care delivered whilst reducingcosts. The initiative is being piloted on fourwards and will be rolled out across all Trust sitesover the next two years.PALSThe Patient Advice and Liaison Service (PALS) hasbeen operational for seven years and continuesto be a valuable and popular service for thewhole of the Fylde Coast Health Economy.Between April 1st 2009 and March 31st 2010,PALS handled 1,988 cases relating to theBlackpool, Fylde and Wyre Hospitals NHSFoundation Trust. Of these cases, 2,263 separateissues have been addressed and the main themesare as follows:Administration - 437 casesInformation - 436 casesWaiting Times - 399 casesTreatment Issues 326 casesCommunication 311 casesPALS is central to the Trust’s commitment inproviding opportunities for patients to influenceevery level of healthcare services. It is by listeningto the experience of service users that gaps inservices are identified and consideration given tomake sure there is no repetition. Concerns raisedare a key indicator in the quest to maintainstandards to the highest quality and bring aboutservice improvements.There remains a full complement of PALSOfficers, each who are now linked to a divisionto ensure lessons learned are generated andcases closed. They continue to carry out anexcellent job in addressing issues which arisefrom patients, carers, relatives and staff aboutthe service provided at the Trust, with the aimbeing to help in bringing about improvedworking practices.Annual Report and Accounts April 1st 2009 to March 31st 2010 19

“A special thanks to the Urology department for an early diagnosis of prostatecancer, what a wonderful department. The treatment my husband received wasexceptional. Everyone was so kind and helpful. “Mr & Mrs Burrows, Thornton-Cleveleys20Blackpool, Fylde and Wyre Hospitals

Our StaffThe Blackpool WayThe Trust’s work on promoting and practicing deep staffengagement has continued throughout the year leadingto the organisation’s achievements in this field earningnational recognition.The Trust was one of just a small number of public sectoremployers to be cited in the influential MacLeod reporton Staff Engagement produced for the Cabinet Officewith co-author, Nita Clarke, visiting the Trust to meet staffand management representatives.The Boorman Report on health and wellbeing alsoreferenced the Trust’s work undertaken with the supportof the Health and Safety Executive on combating thecauses of workplace stress. This work resulted in the Trustwinning a national award from the Healthcare PeopleManagement Association (HPMA). The Trust’s work onstaff engagement and partnership working has also beenhighlighted by NHS Employers and the Chartered Instituteof Personnel and Development.A further audit of The Blackpool Way was undertakenby Professor John Oliver and published in September2009. Professor Oliver found that the Trust had made“extra-ordinary progress” since the time of his previousstock-take in October 2007 around all four key pillarsof The Blackpool Way, namely, management style andbehaviour, recognition, communication and continuousimprovement. Professor Oliver made a small number ofrecommendations for further improvement includingreforming the Leadership and Management StyleQuestionnaire (LMSQ), creating more recognition boardsand developing an internal pool of Blackpool Waymentors. We have recently revised our LMSQ to make itmore of a self-development tool and more recognitionboards are being produced to celebrate the good workof staff. We will be focusing on how we can introduceBlackpool Way mentors over the next 12 months.Celebrating SuccessThe Trust held its third Celebrating Success Awards eventin 2009, culminating in a Celebration Ball attended byover 500 members of staff. Once again the event wassponsored by a wide range of businesses and supportedby the local media. Awards were given to numerousindividuals and teams who had contributed significantlyto the Trust’s success during the year with some of thekey awards being generated by patient and publicnominations. This event was followed up by a furtherevent held at Blackpool Victoria Hospital for the friendsand families of award winners. This programme was alsosupported by monthly recognition days within the Trustwhere the work of teams is explained and celebrated. Inaddition, the Trust ran a 100% attendance award schemein 2009 to give special praise and thanks to over 700 ofour staff who had no absences from work due to sicknessin the previous year.Annual Report and Accounts April 1st 2009 to March 31st 201021

Staff SurveyThe Trust performed extremely well in thenational survey of staff opinion. We achievedour highest ever response rate - over 65%, again,one of the highest in England for an Acute Trust.Our overall results improved for the fourthyear running with 10 more areas improvingsignificantly and just three worsening. The mostpleasing results showed a very high participationin appraisal (88%), a climate of mutual respect atwork (96%) and that the overwhelming majorityof staff believe that their voice is heard (94%),that care of patients is the Trust’s top priority(88%) and that they would recommend theTrust as an employer (91%). Two of the areaswhere we scored significantly worse comparedto last year were related to error reports beingtreated confidentially and hot water being madeavailable to staff, although we were still rankedas being among the top performing Trusts forthis work. The third area where we significantlyworsened was related to personal developmentplans not being supported by managers.The tables below highlight our response rates for2009/2010 compared to 2008/2009 and our topfour and bottom four ranked scores and how ourperformance compares to the national average.Staff roadshows are being held to share the fullfindings with staff and action plans are beingdeveloped in conjunction with staff.Response rateTrust2008/09 2009/10NationalAverageTrustNationalAverageTrust Improvement /Deterioration61% n/a 65% 55% 4% ImprovementStaff Survey Results2008/09Staff Survey Results2009/10Trust Improvement /DeteriorationTop 4 Ranking ScoresTrustNationalAverageTrustNationalAveragePercentage of staff appraised in last12 months70% n/a 87% 70% 17% ImprovementPercentage of staff appraised withPDP’s in last 12 months59% n/a 76% 59% 17% ImprovementPercentage of staff having wellstructured appraisals in last 12 monthsPercentage of staff feeling satisfiedwith the quality of work and patientcare they are able to deliver30% n/a 40% 30% 10% Improvement74% n/a 82% 74% 8% ImprovementBottom 4 Ranking ScoresPercentage of staff experiencingphysical violence from patients/relatives in last 12 monthsPercentage of staff experiencingphysical violence from staff in last 12monthsPercentage of staff feeling pressurein last 3 months to attend work whenfeeling unwellPercentage of staff experiencingharassment, bullying or abuse frompatients/relatives in last 12 monthsStaff Survey Results2008/09TrustNationalAverageStaff Survey Results2009/10TrustNationalAverageTrust Improvement /Deterioration11% n/a 13% 11% 2% Deterioration2% n/a 2% 2% No change26% n/a 27% 26% 1% Deterioration21% n/a 22% 21% 1% Deterioration22Blackpool, Fylde and Wyre Hospitals

Working Time DirectiveFor doctors, particularly those in training,compliance with EWTD regulations becamemandatory with effect from August 1st 2009.Significant work has been undertaken with allDivisions over the past 2-3 years to ensure thatthe Trust met this target. As part of this work theTrust re-configured all working patterns for juniordoctors to implement compliant EWTD rotas withthe result that compliance was met from August2008 – one year in advance of the target date andin line with the challenge set by NHS North West.All rotas within the Trust remain compliant andDivisions continue to review services to identifyany areas of difficulty that may need to beaddressed to ensure that EWTD, service deliveryand service development can be sustained.Equality and DiversityThe Trust’s approach to equality and diversity isone of inclusivity for all staff and service users.Lead responsibility for equality and diversity isshared jointly by the Director of Human Resourcesand Organisational Development and the Directorof Nursing and Quality. The Trust also appointeda full time Equality and Diversity Manager inNovember 2009 who represents the Trust locally,regionally and nationally, delivers equality anddiversity training to all staff and advises staff at alllevels with regard to equality and diversity issues.The Trust’s methods for monitoring performanceare regularly reviewed in order to adopt the mostsuitable method given the diversity of the servicesprovided and our service users. In this way wecan quickly identify unsuitable methods and ifnecessary amend to ensure full and meaningfuldata is being collected. Outcomes from all reviewsare shared with each department and service areato enable them to re-evaluate the way in whichmonitoring is carried out. There are difficultiesin collating information on disability and sexualorientation for both staff and service users dueto the sensitivity surrounding these strands. Inaddition the Trust has recently completed theEquality Performance Improvement Toolkit reportwhich is evaluated by our commissioning PrimaryCare Trust, NHS Blackpool.To comply with publication duties the Trustpublishes information regarding equality anddiversity on its internet site and in the AnnualReport along with completing requests fromthe Care Quality Commission and other relevantbodies as required.All of the Trust’s equality and diversity relatedschemes, policies, procedures and guidelineshave been Equality Impacted Assessed. The mainschemes and policies all have plans which are thenreported to the Equality Diversity and HumanRights Steering Group for monitoring and to settimeframes in order to address any shortfalls.Table: Summary of Performance – WorkforceStatisticsFrom analysis carried out between data collatedon the makeup of the local community and thatof staff employed, the Trust is reflective of thecommunity it serves.Age0-1617-2122+TotalEthnicityWhiteMixedAsian orAsian BritishBlack orBlack BritishOtherGenderMaleFemaleRecordedDisabilityStaff2008/09070445445244106201972417710213503Notstated%1.698.4100.090.80.44.40.53.922.677.4Staff2009/10066474948154423312213011011293686Notstated%1.498.6100.091.10.64.60.62.323.476.6The results of the staff survey showed that only54% of staff received equality and diversitytraining. This is a key priority and equality anddiversity training now forms part of the full daymandatory training. We expect to see furtherimprovements in this area next year.The Trust has an Equality, Diversity and HumanRights Steering Group, chaired by and vice chairedby Executive Directors of the Trust and with aninclusive membership reflecting all strands ofdiversity and including representation from Truststaff, partner organisations and patient groups.This group oversees the production of an AnnualTrust Action Plan and reports back throughthe Trust’s HR and OD Committee and PatientExperience Committee.Priorities for 2010/11 include:• Ensuring full compliance with the new EqualityAct and NHS Regulation Framework.• Holding our second Annual Equality andDiversity conference.• Progressing areas requiring developmenthighlighted within the North West EqualityImprovement Toolkit (EPIT), staff survey andpatient survey.• Staff training – customer focus on mandatorytraining.• Increasing social value – schools work,employment training and skills agenda.Annual Report and Accounts April 1st 2009 to March 31st 2010 23

Investors in People GoldIn November 2009, the Trust opted to attemptto reach a higher rating against the new choicesof Bronze, Silver or Gold levels. This involved amore rigorous assessment over a full week andmany staff interviewed across all grades of staff.The assessor commended us for our tremendousimprovements in the previous 12 months anddevelopments in The Blackpool Way approachand we were delighted to achieve Investors inPeople Gold – the highest rating possible. Whilstthis is an excellent achievement, the reportrecommended some areas for improvement, inparticular around leadership and managementdevelopment, embedding the Trust’s vision andvalues and improving work-life balance. A majorpiece of work is underway to engage staff inrefreshing our vision and values. A leadershipand management development and coachingprogramme has been recently launched anda Staff Social Committee has been set up toimprove the work-life balance as well as newschemes to reward and recognise staff, in linewith the Staff Pledges of the NHS Constitution.Sickness AbsenceSickness absence rates fell for the fourth yearin succession; down to 4.47% for the year todate April 1st to March 31st 2010. During thepast 12 months work has continued to focus ontraining managers, back to work interviews andcase conferences with a higher level of HumanResources support.The other side of active management of absenceis continuing to make the Trust a good workplace,one where employees feel that their views andtheir work are valued.The Blackpool Way, together with OccupationalHealth’s Stress Project, has advanced this cause togood effect. Reducing work related stress is partof helping the Trust in its target to be “A greatplace to work”.The work on stress has been undertakenin partnership with the Health and SafetyExecutive who highly commended the projectand the Occupational Health department, onbehalf of the Trust, won the Healthcare PeopleManagement Association (HPMA) Award for thisproject in 2009.The 2008 staff survey results indicated asignificant reduction in both complaints of workrelated stress and workplace bullying. Verysignificantly the previous notable differencesbetween Divisions have all but disappeared. Thisshows an increasingly managed and sustainablechange rather than odd pockets of good practice.Continued improvements in attendance areexpected in future years. The table below showsthe progress we have made over the past fouryears.Overall Trust Sickness Absence Rates2006/20072007/20082008/20092009/2010Apr-June 09/10Jul-Sep 09/10Oct-Dec 09/10Jan-Mar 09/105.34%5.01%4.70%4.47%3.78%4.34%4.33%4.83%24Blackpool, Fylde and Wyre Hospitals

AppraisalThe Trust made further improvements to itsstaff appraisal process last year. Central to thiswas the introduction of a three month appraisalwindow within which all appraisals should becompleted and the production of clear trainingplans for each area of the Trust.The idea behind the appraisal window is toensure that all staff are made aware of theTrust’s key aims for the year at the same time, ofhow their job fits in and of what is expected ofthem. The process also allows the Trust to moreeffectively capture all key training needs thatare identified.Staff survey and other feedback show that theappraisal window was successful in ensuringthat over 90% of staff received an appraisalin the first three months of the year andthat further attention needs to be given tostrengthen the effectiveness of the personaldevelopment plan element of the appraisal.The appraisal system for doctors has also beenreviewed in 2009 to ensure it is fit to meetthe forthcoming requirements of medicalrevalidation. This will include the facility forpatient feedback as part of the process.Staff Achievements CeremonyIn October 2009 we held our annual StaffAchievements Ceremony where we celebratedthe contribution of staff completing 20 yearsservice with the Trust and those who havecompleted formal programmes of learning.More than 300 staff and members of the publicattended the ceremony with 32 being presentedwith their long service awards by the Chairmanwith 74 receiving certificates for successfullycompleting their training. Awards were alsopresented to the Red Cross for 25 years ofvoluntary services to the Trust.Training and DevelopmentThe Trust has made a large investment intoOrganisational Development approacheswhich includes the development of coaching,mentoring, self-awareness for staff andleadership and management development.Alongside this the Trust has overhauled themandatory training policy and accessibility tothe programme. We use innovative methodssuch as workbooks and e-learning and arerecognised regionally and nationally for some ofour successes with NVQs, Assistant Practitionersand Appraisal Training. A new recordingsystem called Oracle Learning Managementlinks directly to the Electronic Staff Record andrecords and reports on most of the trainingundertaken by our staff, thus enabling us tomaintain a safe workforce.Annual Report and Accounts April 1st 2009 to March 31st 2010 25

Health and Safety - A Safe WorkingEnvironmentThe Trust places a very high priority on healthand safety in our hospitals. Whilst there is a basiclegal duty to manage the health and safety ofstaff, and those who use our services and visitour premises, the Trust believes that it should gofurther than this. To achieve this higher level ofhealth and safety performance, we have trainedmore staff and expanded the training portfolio toinclude many more staff at higher levels.During the year, work has continued to developan excellent relationship with our link inspectorfrom the Health and Safety Executive (HSE)building on the implementation of our safetywork-plan. The Trust continues to promotethe importance of reporting any incidents orpotential for harm to both staff and patients,so we may learn from things that have gonewrong. The Trust has a Health and Safety andEnvironmental Governance Committee, which ismade up of clinical and non clinical groups, tradeunions and staff. The Committee meets six times ayear to receive reports from all areas and providesan opportunity for managers and staff to raiseconcerns and issues appertaining to Health andSafety.The Committee sets annual health and safetyperformance targets for improvement in specificareas and tracks and monitors progress at eachof its meetings. Over the years, with continualimprovements being introduced, the Trust hasdeveloped into a safer place to both work and toreceive treatment.The table below shows that our performanceis improving in relation to numbers of movingand handling incidents, needlestick incidents,slips, trips and falls and violence and aggressionincidents.Health & Safety Performance TargetsMoving &Handling IncidentsNeedlestickIncidentsSlips, Trips & FallsViolence &AggressionIncidentsSecurity Incidents1497714710390763583181031082008/20092009/201026Blackpool, Fylde and Wyre Hospitals

Security managementThe Local Security Management Service drivesforward change within the Trust and deliversan environment that is safe and secure forpatients and staff. Continual developmentin incident reporting, action planning, riskassessment and ongoing monitoring ensuresthat all security risks within the Trust, inclusiveof property assets, staff and patient safety arebest protected.Mandatory training of Conflict Resolution andsecurity awareness is included within corporateinduction. Crime reduction surveys are alsoundertaken on an annual basis and proactivemeasures implemented to aid Trust performanceand minimise the security risk in relation tophysical security arrangements within Trustpremises.The Trust has introduced a lone worker systemand this will enable staff to discreetly call forassistance in a potentially aggressive situation.This will also ensure staff are quickly andaccurately located and their whereabouts andmovements of lone workers can be found whenan alert is activated.In November 2009 a Security Awareness Monthwas held and supported by the Health andSafety Executive and Lancashire Constabulary toraise the awareness of Safety and Security.The Trust has a zero tolerance policy on theprevention and management of violentaggressive and abusive patients, relatives orvisitors. Zero tolerance posters have beenplaced in prime locations around the hospitalsand anti social behaviour letters by the ChiefExecutive have been sent to those patientsand visitors who have been abusive to NHSemployees helping to assist in the deterrence ofunacceptable behaviour.Occupational HealthOur Occupational Health Service employs ateam of specialist doctors, nurses, counsellorsand support staff who provide a comprehensiveservice to staff and Trust managers.We also provide services to external customersand income generated is re-invested in thedepartment and enables us to offer benefits tothe staff we would not otherwise be able to do.The services we offer range from preemploymentscreening for new staff toassessment of fitness to work following seriousillness or injury. We offer direct referralsto physiotherapy and access to cognitivebehaviour therapy. Our team undertake regularwork related health checks, vaccinations andimmunisation programmes, and developand drive programmes to reduce risks in theworkplace. They offer advice and supportto employees and managers in relation tothe rehabilitation of staff returning to workfollowing illness or with a known disability.Our ongoing stress project has won nationalrecognition at the Healthcare PeopleManagement Association (HPMA) Awards thisyear and we are now regularly guiding andconsulting with organisations throughoutthe country on how to manage work basedstress. In April 2010 we moved back to theVictoria site, which gives us the opportunity tofurther expand and improve our current serviceprovision working in partnership with our publichealth colleagues to implement the health andwell being agenda.A focus for us in the latter part of the year wasto improve uptake of seasonal flu amongst ourworkforce and to inform our staff in relation tothe importance of swine flu vaccinations – bothhave been a resounding success.In 2008/2009 10% of the workforce wasvaccinated against seasonal flu. In 2009/2010this increased to 42%. The uptake for swineflu was 45%. We believe increased uptake wasdue to a major staff awareness campaign whichincluded a film being produced featuring theChief Executive and senior occupational healthstaff stressing the importance of vaccination toprotect staff and to protect patients.In 2010 we will be further developing ourcommunication strategy and engaging staffat an earlier stage to increase the level ofprotection for our staff and patients evenfurther.Annual Report and Accounts April 1st 2009 to March 31st 2010 27

“What a pleasure it was to attend X-ray North department, staff on receptiongreeted me with a smile and were so friendly. The trainee radiologist and hersupervisor were both so kind and professional putting me at ease. What anefficiently run department with great teamwork. “Mrs Stella Hartley, Poulton-le-Fylde28Blackpool, Fylde and Wyre Hospitals

Our FinancesIncome andExpenditurePerformanceThe Trust has delivered a deficit of£5.7m in 2009/10 against a plan toachieve a surplus of £2.7m.The variation in surplus is due to the following factors:• A downward asset valuation of £24.5m as a result ofcontinuing adverse market conditions resulted in animpairment of £8.5m;• A dividend reduction of £0.4m as a result of therevaluation;Table 1 below compares the 2009/10 actualperformance to the 2009/10 plan.Table 1Plan £’m Actuals £’m Variance £’mTotal income 259.3 271.2 11.9Expenses (242.1) (255.6) (13.5)EBITDA* 17.2 15.6 (1.6)Depreciation (7.3) (6.1) 1.2Dividend (6.2) (5.8) 0.4Impairment 0.0 (8.5) (8.5)Interest income 0.2 0.2 0.0Interest expense (1.2) (1.1) 0.1Surplus(Deficit) 2.7 (5.7) (8.4)* Earnings before interest, tax, depreciation and amortisation.Annual Report and Accounts April 1st 2009 to March 31st 201029

The Trust’s financial performance profile for the last five years issummarised in Chart 1 below.Chart 1: Surplus PerformanceThe Trust incurred a deficit of £5.7m which includes an impairment of £8.5m as a direct result of adownward revaluation of assets. The surplus prior to impairment was £2.8m against the plan of £2.7m,included in this surplus was a recurrent dividend reduction of £0.4m as a result of the revaluation, and arecurrent reduction in depreciation of £1.2m as a result of a change in accounting policy on componentdepreciation.Action is being taken to ensure that the Trust continues to be in recurrent financial balance.Chart 2: Completed Patient Spells£0.0m £1.6m £3.8m £4.6m (£5.7m)543210-1-2-3-4-5-62005/06 2006/07 2007/08 2008/09 2009/1010000080000600004000075,81583,23988,38792,20096,0202000002005/62006/72007/82008/92009/10Chart 3: Outpatient Attendances300000250000200000150000100000236,264255,321277,165285,442285,7315000002005/62006/72007/82008/92009/1030Blackpool, Fylde and Wyre Hospitals

Chart 4: A&E Attendances100000800006000092,19191,53588,70191,17691,448400002000002005/62006/72007/82008/92009/10Income from providing clinical services to NHS patients, as above, represents the majority of the Trust’sincome £240.7m or 89%). The provision of these services is covered by contracts with Primary CareTrusts and other NHS commissioners. The terms of these contracts are agreed locally between the Trustand commissioners based on the national contract published by the Department of Health and pricedusing the National Tariff or locally agreed prices as appropriate.Chart 5 summarises clinical income recovery by Commissioners.Chart 5: Clinical Income by CommissionerNon-Contracted PCTs(inc Cross-Border)Other ContractedPCTsSpecialistCommissioners£5.0m£13.8m£39.7m£89.3m£92.9mBlackpool PCTNorth LancashirePCTTotal £240.7mIn 2009/10 a new national tariff was introduced utilising HRG version 4. Whilst this potentially increasedthe volatility in the tariff across the NHS, the Trust has worked closely with its main commissionersto fully understand the impacts and develop strategies to mitigate potential impacts for the healtheconomy.In 2010/11 there are some minor changes to the existing tariffs such as the amalgamation of thedaycases and elective inpatients and the introduction of a marginal tariff for non-elective admissions.Again, the Trust is continuing to work closely with partnering health economy organisations to limitthe potential financial impact.In addition to the NHS Clinical income described above, the Trust receives a number of other incomesteams. The trend in this income is summarised in Chart 6 and performance in 2009/10 is summarised inChart 7.Chart 6: Non-NHS Clinical/Non-Clinical Income 2005/06 to 2009/105040302010050403020100£27.0m £48.3m £27.9m £25.4m£30.5m2005/062006/072007/082008/092005/06 2006/07 2007/08 2008/092009/102009/10Annual Report and Accounts April 1st 2009 to March 31st 2010 31

Chart 7: Non-NHS Clinical/Non-Clinical Income by typeOther Non-Protected Clinical Income£1.9mRTA IncomePrivate patient income £1.2m£1.4mOther Income£1.9mResearch and Development£1.1mEducation, trainingand researchSale of Goods &Services£2.8m£6.6m£13.6mNon-patient careservices to other bodiesTotal £30.5mThese income streams equated to £30.5m or 11.2 % of the total income earned for the year. Of this£26.1m or 9.6% relates to the provision of other services not directly related to healthcare, includingcatering and car park income. Any surplus from these services help reduce the cost of patient relatedactivities.Under the terms of the Trust’s authorisation as a Foundation Trust, the proportion of total patient relatedincome of the Trust in any financial year derived from patient charges should not exceed that generatedin the 2002/03 financial year. The results for the period are summarised in the following table with thetrend in private patient income shown in Chart 8.2009/10£’m2002/03£’mPrivate patient income 1.4 3.2Total patient related income 245.2 151.5Proportion as a % 0.6% 2%Chart 8: Private Patient Income 2005/06 – 2009/103.02.52.01.51.00.50.03.02.52.01.51.00.50.0£2.6m £2.8m £2.2m £1.5m2005/062006/072007/082008/092005/06 2006/07 2007/08 2008/09£1.4m2009/102009/10The level of private patient income is decreasing as a proportion of total patient income, reflecting theimprovement in waiting times and the reduction in private healthcare insurance in the current economicclimate.32Blackpool, Fylde and Wyre Hospitals

Chart 9 shows the increase in expenditure over the same five year period.Chart 9: Expenditure£198.6m £233.4m£192.2m £208.8m £255.6m250 300200250200150150100100505002005/06 2006/07 2007/08 2008/092005/06 2006/07 2007/08 2008/092009/102009/10Whilst there has been year on year growth inexpenditure (the majority of which relates tothe increased costs associated with additionalactivity to delivery waiting time targets andinflationary pressures such as annual payawards) the rate of growth is lower than thatfor income and reflects the Trust’s success indelivery of improved value for money andefficiency savings.Performance to deliver savings is closelymonitored at divisional level with a number ofschemes and associated timescales identified.There have been a number of themes todelivering efficiencies including more effectiveprocurement, reconfiguration of services andthe application of lean methodologies.The processes for delivering efficiencies will bebuilt upon in 2009/10 to ensure that the Trust’scost base is effectively controlled.During the year the Trust spent £10.8m onmanagement costs which represents 4% oftotal income. By comparison, in 2008/09,management costs as a percentage of totalincome was 4.1%.Management costs are defined as those on themanagement costs website at www.dh.gov.uk/PolicyandGuidance/OrganisationalPolicy/FinanceandPlanning/NHSManagmentCosts/fs/en.Senior employees remuneration is set out onpage 86 in the Remuneration Report section ofthis report.Annual Report and Accounts April 1st 2009 to March 31st 2010 33

Cash Flow and Statement ofFinancial PositionThe Trust’s cash balance at the end of thefinancial year was £11.7 m against a forecastbalance of £13.0 m. The undershoot is reflectiveof improved creditor payment performance inline with the Prompt Payment Code initiativewhich this organisation has signed up to.Chart 10 summarises the Trust’s year end cashbalances across the last five years. Note that thisreflects from 2007/08, the Trust’s ability, as aFoundation Trust, to retain cash balances at yearend.Chart 10: Year-end Cash Balances£0.2m £0.2m £23.9m £29.1m£11.7m3025201510502005/062006/072007/082008/092005/06 2006/07 2007/08 2008/092009/102009/10As a Foundation Trust, the Trust is required toensure that it has enough liquidity to supportits working capital requirements. To ensurethis the Trust has agreed with Barclay’s Bankplc a working capital facility. With effect from1st December 2009 the Trust renegotiated itsworking capital facility retained with BarclaysBank plc following approval from Monitor inthe sum of £19m, primarily to provide liquiditysupport during a sustained period of capitalinvestment. The Trust did not utilise any of thisfacility in 2009/10 and does not expect to acrossthe next three years.Total Non-NHS tradeinvoices paid in the yearTotal Non-NHS tradeinvoices paid within targetPercentage of Non-NHStrade invoices paid withintargetNumber £’00064,800 104,33563,196 101,55497.5% 97.3%To comply with best practice the Trust is requiredto pay 95% of undisputed invoices within 30days of receipt. The table below summarises theperformance for 2009/10 and Chart 12 shows thetrend for the last five years.Total NHS trade invoicespaid in the yearTotal NHS trade invoicespaid within target2,510 27,2692,167 24,494Percentage of NHS tradeinvoices paid within target86.3% 89.8%34Blackpool, Fylde and Wyre Hospitals

In addition the Trust, as part of the publicsector’s role to support the private sector,has signed up to the Prompt Payment Codeinitiative. The target is to pay small and mediumsize enterprises within 10 days. The performancein 2009/10 has resulted in paying 96% within10 days. The Trust will continue to support itssuppliers across 2010/11.No interest was paid to suppliers under the latepayment of Commercial Debts (Interest) Act1998.The Trust invested over £30m in capital schemesduring 2009/10. Expenditure during the periodincluded the following investments:The limits on the amount the Trust canborrow and the conditions that it must meetto demonstrate that the levels of borrowingare affordable are set out in the PrudentialBorrowing Code (PBC), published by Monitor.The PBC sets out four minimum financial ratiosthat the Trust must meet if it is to undertake anyborrowing.The maximum cumulative borrowing orPrudential Borrowing Limit (PBL) that the Trustmay make is set by Monitor with referenceto the Trust’s annual financial risk rating (seebelow). The Trust has a planned financial riskrating of 3 and as a result a PBL of £78.2m. Theborrowing agreed with the Foundation TrustFinancing Facility is therefore within this limit.£mSurgical Centre 12.0Urgent Care Centre 1.5Women’s and Children’s services 5.7Interim Clinical Information System 3.8The majority of the above expenditure wasfunded from internally funded resources,supported by the drawdown of £10m from theFoundation Trust Financing Facility.From 20010/11 the Trust will continue to investin its renewal programme that will moderniseand improve facilities and equipment. Plannedinvestment in 2010/11 is in excess of £30m.To facilitate the continued planned investmentthe Trust has utilised part of its PrudentialBorrowing Limit (see below) to ensure thatsufficient cash flow is available. To this end theTrust successfully negotiated a loan for £25mwith the Foundation Trust Financing Facility,with the loan agreement approved on 6thMarch 2009. Drawdown against this loan in2009/10 was £10m against a forecast of £15m,the remaining balance of £15m will all be fullyutilised in 2010/11.As a NHS Foundation Trust, the Trust, hasgreater freedoms to borrow money in order tofinance capital investment as described above.Minimumdividend coverMinimum interestcoverMinimum debtserviceMaximum debt toservice revenueTarget2009/10annualperformance2009/10Plan>1x 2.5x 2.6x>3x 7.8x 7.1x>2x 4.9x 4.8x

Performance Against Monitor’sCompliance FrameworkAs a Foundation Trust, the Trust is required todemonstrate that it is operating within Monitor’sCompliance Framework. The Framework sets outMonitor’s approach to regulating FoundationTrusts using a risk based methodology.A key element of the framework sets out theapproach by which the level of financial riskfacing the Trust is assessed and the likelihood thatthe Terms of Authorisation will be breached.A Foundation Trust that has a high risk ofbreaching the financial element of their Termsof Authorisation would achieve a financial riskrating of 1. A low risk would achieve a financialrisk rating of 5.The Trust will continue to build upon the strongfinancial base that it has developed and hasplanned for a £3.3m surplus in 2010/11. Thissupports the Trust’s strategy to deliver surplusesso that the cash generated can be invested inimproving its infrastructure and the quality ofservices provided to patients.At its meeting of 27th May 2010, the Board ofDirectors considered its Annual Plan for 2010/11and supporting financial plans for 2011/12 to2012/13. These plans are based on prudentactivity assumptions that have been agreedwith commissioners, combined with expenditurebudgets that have taken into account the likelycost risks in this period and the requirement for3.5% efficiencies as set out in the NHS OperatingFramework for 2010/11.On the basis of these plans the Board of Directorshas a reasonable expectation that the Trust hasadequate resources to continue in operationalexistence for the foreseeable future. For thisreason that Trust has adopted the going concernbasis in preparing the accounts.The Trust’s main accounting policies includingpolicies for pensions that are used to prepare theaccounts are set out in Annex E to this report.Details of the Directors remuneration is includedin the Remuneration Report. The format of theaccounts and the supporting accounting policieswere reviewed by the Trust’s Audit Committee atits meeting on 8th February 2010.In the opinion of the Directors there are noevents after the reporting date.The Board of Directors is not aware of anyrelevant audit information that has beenwithheld from the Trust’s auditors, and membersof the Board take all of the necessary stepsto make themselves aware of the relevantinformation and to ensure that this is passed tothe external auditors as appropriate.The Board is not aware of any circumstanceswhere market value of fixed assets is significantlydifferent to carrying value as described in theTrust’s financial statements. The Trust’s auditorshave provided an opinion on our 2009/10accounts, which is outlined at Annex D.Target(level 3 risk)2009/10plan2009/10AnnualPerformance2008/09AnnualPerformanceEBITDA % achieved >70% 100% 91.2% 123.9%EBITDA margin >5% 6.6% 5.8% 7.5%Rate of return on assets >3% 4.3% 4.5% 8.1%I&E surplus margin >1% 1.0% 1.0% 3.4%Liquidity ratio >15 days 15 days 21 days 48 days36Blackpool, Fylde and Wyre Hospitals

Financial InstrumentsThe Trust does not have any listed capitalinstruments and is not a financial institution.Due to the nature of the Trust’s Financial Assets/Financial Liabilities, book value also equatesto fair value. All Financial Assets and FinancialLiabilities are held in sterling.Credit RiskThe bulk of the Trusts commissioners are NHS,which minimises the credit risk from thesecustomers. Non-NHS customers do not representa large proportion of income and the majorityof these relate to bodies which are consideredlow risk - e.g. universities, local councils,insurance companies, etc. At the Balance Sheetthe Trust has no investments.Liquidity RiskThe Trust’s net operating costs are incurredunder service agreements with local primarycare Trust, which are financed from resourcesvoted annually by Parliament. The Trust largelyfinances capital expenditure through internallygenerated funds and from loans that can betaken out up to an agreed borrowing limit.The borrowing limit is based upon a risk ratingdetermined by Monitor, the IndependentRegulator for Foundation Trusts and takesaccount of the Trust’s liquidity. All of theFinancial Assets are recoverable within 1 year.The Trust has a non current liability for thePFI as a direct result of IFRS conversion, theannual uplift is based on RPI. The Trust also hasan authorised loan from the Foundation TrustFinancing Facility to support capital investment,this is on a fixed repayment term at a fixed rateof interest.Market RiskAll of the Trust’s financial liabilities carry nilor fixed rate of interest. In addition the onlyelement of the Trust’s financial assets that arecurrently subject to variable rate is cash held inthe Trust’s main bank account and therefore theTrust is not exposed to significant interest raterisk.Cost Allocation and ChargingRequirementsThe Trust has complied with the cost allocationand charging requirements set out in HMTreasury and Office of Public Sector InformationGovernance.External AuditorsThe Council of Governors has approvedthe continued appointment ofPricewaterhouseCoopers as the Trust’sexternal auditors until March 31st 2010.PricewaterhouseCoopers were paid £77K inrespect of statutory audit fees.The Trust limits work done by the externalauditors outside the audit code to ensureindependence is not compromised.Counter FraudThe NHS Counter Fraud and SecurityManagement Service has set out the frameworkwithin the NHS plans to minimise losses throughfraud. The Trust’s local policy compliments thenational and regional initiatives and sets out thearguments for the reporting and the eliminationof fraud.The Deputy Chief Executive is nominated tomake sure that the Trust’s requirements aredischarged and is aided by a local Counter FraudSpecialist (LCFS). The LCFS developed a plan thataimed to proactively reduce fraud and createan anti-fraud culture supported by appropriatedeterrence and prevention measures. Progressagainst the plan is regularly reported to theAudit Committee.Annual Report and Accounts April 1st 2009 to March 31st 2010 37

“I telephoned Fleetwood Hospital at 10.15 am for an x-ray appointment, avery pleasant lady asked if I could make it later that day for 11.50 am. On myarrival it only took a few minutes to be brought through to the x-ray room. Inrecent years I have visited this hospital and each time it has been a very pleasantexperience. The staff are kind, caring and efficient all of which makes a visit farless stressful. “Mr Keith Whiteside, Poulton-le-Fylde38Blackpool, Fylde and Wyre Hospitals

Our PerformancePerformance against National Quality StandardsThe Trust maintained its excellentoperational performance during2009/10 delivering the majority of thenational and local performance targets,underachieving on delivery against oneof the new cancer targets.As in previous years, the Trust maintained its impressiverecord of maintaining delivery of the A&E four hourtarget despite the general increase in activity and thepressure on beds over the winter months.The Trust as host of the Lancashire Bowel CancerScreening Centre shared breaches of the 62-day cancerscreening target with treating Trusts and thereforeexperienced difficulties in achieving and sustaining the62-day cancer screening target.A summary of our performance against key operationaltargets is given below. A more detailed report on ourperformance is outlined overleaf and in our QualityReport at Annex A.Quality Standard 2008/09 2009/1018 week referral to treatment times Achieved AchievedAll cancers: one month diagnosis to treatment (including new cancerstrategy commitment)All cancers: two month GP urgent referral • Generalto treatment:• ScreeningAchievedAchievedN/AAchievedAchievedUnder-achievedAll cancers: two week wait Achieved AchievedTime to reperfusion for patients who have had a heart attack Achieved AchievedIncidence of MRSA Bacteraemia Achieved AchievedIncidence of Clostridium Difficile Achieved AchievedDelayed transfers of care (target

Our Performance in more detail18 weeks Referral to TreatmentThe Trust has maintained its performance againstthe 18 week referral to treatment target for boththe admitted and non-admitted pathways sinceDecember 2007. During 2009 the Trust continuedto review and redesign pathways for the benefitof patients enabling the achievement of shorterwaiting times and delivery of the 18 week referralto treatment target across all specialties.Cancer Plan Access TargetsThe introduction and delivery of the new GoingFurther on Cancer Waits performance targetshas been a significant challenge for the Trust,particularly with regards to the delivery of the 62-day Screening target. The Trust failed to achievethe target in the first three quarters of the year.A great deal of work was undertaken to addressissues across organisations to shorten pathwaysfor patients identified with cancer through ascreening service and delivery of the target wasachieved in Quarter 4.Bowel Cancer Screening CentreThe Lancashire Bowel Cancer ScreeningProgramme has been in operation since April2008. The programme has demonstratedimproved outcomes in terms of the healthbenefits for patients who take up the offer ofbowel cancer screening, especially relating toearly detection and treatment of cancers.Through hard work and close co-operationbetween Acute Trusts, Endoscopy Units, PrimaryCare Trusts and Public Health Departments, wehave been able to roll out the programme acrossthe whole of Lancashire and patients are reapingthe benefits. Since April 2008 we have detected123 patients with cancer at an earlier stage.Over the next 12 months we will be extendingthe scheme to patients up to 75 years of age.Health Care Acquired InfectionsFollowing the significant reductions in MRSABacteraemia (78%) and Clostridium DifficileInfection (33%) in 2008/2009, the Trust hascontinued to embed Infection Preventionprinciples across the organisation to ensure thatthe risk of acquiring an infection for patients isfurther reduced.MRSA Bacteraemia rates continue to fall. FromApril 1st 2009 to March 31st 2010 there wereeight MRSA Bacteraemias, only three of which areattributed to the Acute Trust. The remaining fiveare attributed to the relevant PCT as an infectionthat developed in the community as opposed tothe hospital.There were 241 cases of Clostridium DifficileInfection (CDI) between April 2009 and March2010 in comparison to 315 in the same periodlast year. This demonstrates a percentagereduction of 23% which is above the 17% yearlyreduction incorporated into the three year plantrajectories. Of the 241 cases this year, 134 havebeen attributed to the Acute Trust. The Trust isrequired to achieve a 52% reduction in CDI ratesfrom the 2007 level by 2011. The Trust is currentlybelow the planned trajectory of 152 cases for2010/11 with a reduction of 58% in relation tothe 2007/08 figures.Further information on our work to prevent andreduce infections is outlined in our DeliveringPlans section on page 46.40Blackpool, Fylde and Wyre Hospitals

Summary of MRSA Performance2007/20082008/20092009/2010Apr-June 09/10Jul-Sep 09/10Oct-Dec 09/10Jan-Mar 09/1040982123Summary of Clostridium Difficile Performance2007/20082008/20092009/2010Apr-June 09/10Jul-Sep 09/10Oct-Dec 09/10Jan-Mar 09/1046931524158607152Emergency Access TargetsThe Trust continues its success in delivering onwaiting time targets within the Accident andEmergency Department.This year 99% of patients attending were seenor discharged within four hours and around70% were seen or discharged within threehours.With the advent of the Urgent Care Centre,plans for continuously improving waiting timesthrough care pathways and other differentservice models will be introduced.Core Standards DeclarationThe Trust has declared to the Care QualityCommission that it is fully compliant with the 24Core Standards for Better Health.The Core Standards (which form part of theAnnual Health Check ratings) are reflected inthe corporate objectives for the Trust. Theyform the basis of the Assurance Framework withaction plans and leads clearly identified and thisprocess ensures that timely plans are monitored.Annual Report and Accounts April 1st 2009 to March 31st 2010 41

Care Quality Commission RatingsThe Trust made good progress in the most recentNHS Performance Ratings 2008/2009, known asthe annual ‘health check’.Trusts were awarded two overall ratings – one foruse of resources and one for quality of services.The Trust scored ‘excellent’ for its use of resourcesand ‘good’ for quality of services. This comparesto ‘excellent’ for use of resources and ‘fair’ forquality in 2007/2008.This improvement in rating reflects the hard workof staff across the organisation to ensure thecare we deliver to our patients is of the higheststandards and that our services are delivered asefficiently as possible.Heart Disease AuditsThe Trust underachieved on this target as it failedto complete section 1.09 of the Heart Diseaseaudit which was a mandatory field. This was anadministrative error. Processes have been put inplace to address this issue to ensure completenessof data.StrokeWe underachieved on the stroke care targetas we did not meet some of the standards setout in the Stroke Sentinel Audit. Good progresshas been made in this area and full details areoutlined in the Delivering Our Plans section onpage 46.The score for quality covers a range of areaswhich really matter to patients such as cleanliness,safety, standards of care, infection prevention,hospital food, waiting times, heart treatment andprivacy and dignity. In order to achieve our ratingof good we met all 24 core standards and all nineexisting national targets.We also met a number of new national prioritiesaround breastfeeding, smoking, 18 weeks andaccess to cancer treatment.There were three areas where we underachievedand these included participation in heart diseaseaudits, quality of maternity data and stroke.Maternity Data ActionsThe Trust was made aware of a system issuerelating to record type assigned to maternityepisodes being submitted to the nationalSecondary Uses Service (SUS) during the validationperiod for the Care Quality Commission’sindicators. This issue effectively doubled thenumber of delivery episodes in the CQC data files,this was reported to CQC but could not be alteredin their final reporting.Since the issue was highlighted the Trust hasrectified the system issue, placed quality checkson the data before it is uploaded to SUS andregularly (on a monthly basis) downloadsSUS data quality indicator dashboards toensure compliance with targets. The solutionshighlighted above have ensured that the Trustnow scores ‘Green’ on this indicator through theSUS data quality dashboards.42Blackpool, Fylde and Wyre Hospitals

Information GovernanceComplianceInformation Governance allows organisationsand individuals to ensure that personalinformation is handled legally, securely,efficiently and effectively, in order to deliverthe best possible care. It additionally enablesorganisations to put in place procedures andprocesses for their corporate information thatsupport the efficient location and retrieval ofcorporate records where and when needed, inparticular to meet requests for information andassist compliance with Corporate Governancestandards.The Information Governance Committeeidentifies and manages information risks,which reports to the Healthcare GovernanceCommittee. The Deputy Chief Executive, who isalso the nominated Board Lead for InformationGovernance Risk and the Senior InformationRisk Owner for the Trust, chairs the InformationGovernance Committee.Compliance with Information Governancestandards is monitored using the InformationGovernance Toolkit and during 2009-10 theTrust achieved a rating of 87% compliance.In addition to the Toolkit the Trust is requiredto assess and report information risks anddata losses. During 2009/10 the Trust has beenworking to improve incident reporting andawareness of information security issues. Anumber of methods have been used includingan ongoing information flow mappingexercise supported by ward and departmentalinformation security and confidentiality reviews.System Administrators have been undertakinginformation risks assessments for individual coresystems to identify and manage informationrisks.During the financial year 2009-2010 the Trusthad 28 information security related incidentsreported all of which were rated at a level 0.Whilst the severity rating of these incidentswas rated at 0 all were thoroughly investigatedand reported upon. Note: Information Securityincidents are rated on a scale from 0-5, incidentsclassified as a severity rating of 3-5 are reportedas a serious untoward incident and reported toMonitor and the Information Commissioner.The table below provides a summary.Table 1: Summary Of Other Personal Data Related Incidents In 2009-10Category Nature of Incident TotalILoss of inadequately protected electronic equipment, devices or paperdocuments from secured NHS premises.0IILoss of inadequately protected electronic equipment, devices or paperdocuments from outside secured NHS premises0IIIInsecure disposal or inadequately protected electronic equipment, devicesor paper documents7IV Unauthorised disclosure 2V Other 19Annual Report and Accounts April 1st 2009 to March 31st 2010 43

“I was admitted to BVH for bowel surgery. I cannot praise the staff on Ward6 highly enough, their professionalism, care and consideration for patientswas exceptional and nothing was too much trouble. My recovery has beenextremely good and this must be attributed to the care I received on thisward. “Mrs Anne Storrie, Thornton-Cleveleys44Blackpool, Fylde and Wyre Hospitals

Delivering Our PlansImproving the PatientExperiencePhase VI – Surgical DevelopmentThe Trust continues to make goodprogress on the new £40m SurgicalCentre. Work is on schedule with thebuilding due to open in summer 2011.The development will house state-ofthe-artoperating theatres, inpatientwards and a day surgery unit. Thepurpose of the building is to house allelective surgery care in one purposebuiltbuilding and support our aim ofdelivering ‘Best in NHS’ care.The new facilities will:• Provide 30 side rooms allowing patients to be caredfor in a private en-suite room giving them morespace and privacy.• Provide state-of-the-art operating theatres that willsupport the surgical and clinical teams to providefirst class treatment.• Promote the Trust as the provider of choice forsurgical services in the local health economy.• Enhance the Trust’s ability to attract and retain highcalibre staff from all disciplines.Urgent Care CentreThe Urgent Care Centre continues to take shape andis due for completion in June 2010. This exciting newdevelopment will improve the services we offer patientsand the care we deliver. Patients who present at theUrgent Care Centre will have their needs assessed andthen they will be directed appropriately to a range ofservices or service providers, which will ensure that theyare seen in the right place at the right time by the mostappropriate service provider. The centre is a partnershipbetween Blackpool, Fylde and Wyre Hospitals NHSFoundation Trust and NHS Blackpool, NHS NorthLancashire, Blackpool Council, Lancashire Council andFylde Coast Medical Services and is one of the first of itskind in the country.Annual Report and Accounts April 1st 2009 to March 31st 2010 45

Reducing and preventing infectionsInfection Prevention continues to be a priority forthe Trust and further reductions have been madein MRSA and clostridium difficle.MRSA screening of elective patients enables theearly detection of MRSA and facilitates prompttreatment to reduce the risk of infection in thatpatient and transmission to other patients. TheDepartment of Health directive to introduceelective screening by April 2009 was fullyimplemented in March 2009 within the Trust. TheTrust screens all emergency patients admittedto the Trust by Polymase Chain Reaction (PCR)testing, which allows for a positive result to beknown within two hours, thereby facilitatingrapid isolation and treatment. This started inApril 2008, two years ahead of the Departmentof Health requirement to screen emergency andelective admissions by 2010.Women’s and Children’sDevelopmentWork continues on the new £13m Women’s andChildren’s Unit. The development is on track toopen in 2011 bringing together all women’s andchildren’s services under one roof. Clinics will behoused in the new building as well as the SpecialCare Baby Unit and the new Colposcopy Suite.The new development has also seen the openingof a new child safeguarding centre called TheVictoria Centre. Based at Blackpool VictoriaHospital, the Centre, the first of its kind in thearea, supports youngsters with child protectionissues and saves many children having to traveloutside of the district for help.The purpose built centre brings togethervarious agencies including Blackpool Council’sAwaken Team, Social Workers and the Policeto support children in need. The site includescounselling rooms, a police video interviewingsuite, colposcopy examination room, a space forteenage pregnancy midwives and an appropriateenvironment in which to work with childrenexperiencing difficult times.The Trust wide roll-out of Aseptic Non TouchTechnique (ANTT) competencies, with audit toensure compliance, is another measure introducedto reduce (HCAI). These ANTT audits are part ofan audit programme that is incorporated into theInfection Prevention Annual programme and alsoincludes monthly audit of commode cleanliness, toensure this crucial aspect of hygiene is maintained.The purpose of the Audit programme is to provideassurance of compliance with the policies andprocedures in place to reduce HCAI and the risk ofHCAI.The Care Quality Commission visited in November2009 and assessed the Trust against the Healthand Social Care Act 2008 Hygiene Code. The CQCreport confirms there were no breaches of carein relation to Infection Prevention in the Trust.They made two recommendations, which havealready been introduced, namely audit of isolationfacilities and optimising commode cleaning. Thelatter has been addressed by further educationfor all staff and continuation of the monthlycommode audits. An isolation facilities audit hastaken place and will be repeated on a six monthlybasis.Stroke PlanFollowing national advice on the delivery ofStroke Services, the Trust has undertaken manychanges to the way it delivers stroke care overthe last several years. Not all of the changes havebeen managed as well as should be expected. Thedelivery of excellent stroke care has been affectedby the design of the stroke care process, by poorperformance management of that process and byother unintended consequences of the changesimplemented.46Blackpool, Fylde and Wyre Hospitals

As stroke is the third largest cause of death inEngland and is the single largest cause of adultdisability, the improvement of our Stroke andTransient Ischaemic Attack (TIA) service hasbeen a major priority this year. The Trust isworking with the Cumbria & Lancashire Cardiacand Stroke Network in the development of aTelemedicine service, with a view to providing24/7 stroke treatment within Cumbria &Lancashire. Telemedicine enables doctors at onehospital site to interact with patients and othermedical staff at other sites via image transferand videoconferencing. The use of Telestrokevia a rotating hub will provide a service solutionthat will ensure that all patients in the Cumbria& Lancashire area presenting with suspectedstroke out of normal hours, have rapid access tothe appropriate treatment and care, includingintravenous thrombolysis therapy.The Northwest Ambulance Service worksclosely with Blackpool Victoria Hospital and isaware that we offer stroke thrombolysis andpatients are “blue lighted” to our Accidentand Emergency (A&E) Department. In addition,GPs can directly refer patients to our TIA clinicby using a direct phone line and designatedappointment slots are made available each dayto accommodate emergency patients.We have also made significant progress with theintroduction of an Early Supported DischargeService, which enables patients to continue theirrehabilitation at home.Most of our stroke patients have a routinesix week follow up at out-patients to addressany concerns which have arisen since theywere discharged home. One of the mainproblems that our young stroke survivors haveis reintegrating into the workforce. Strokes canoften cause quite subtle problems, which canonly be diagnosed on detailed psychometrictesting. Therefore we are currently lookingat ways of introducing a psychology supportservice to patients on the Stroke Unit.The Trust has engaged an Executive-ledprogramme of change designed to empowerfront-line staff to implement changes toimprove the Stroke Service. We have a clinicallydesigned change programme in place, withprogress monitored by the Executive Team, withthe lead clinicians, weekly to ensure that theStroke Service provides the expected level ofquality to this particularly vulnerable group ofpatients.Winter PlanningThe Trust implemented its Winter Plan tomanage the predicted demands of the service,improve quality of care for our patients and toimprove patient safety by reducing harms.Below are some of the initiatives implementedto enable the service to continue to providehigh quality care to patients during its busiestperiod:• 20 Care Home Beds were purchased to carefor patients with continuing health careneeds. This scheme helped to reduce thenumber of delayed discharges.• A band 7 senior nurse was appointed tomanage patient flow on the medical wards,ensuring that patients are discharged inthe mornings and there are no unnecessarydelays.• A band 6 Alcohol Liaison Nurse was recruitedto expand the service to include weekendand evenings and avoid unnecessaryadmissions to hospital.• A Nurse Practitioner was recruited in theCommunity Hospitals to effectively facilitateand manage patient care and flow.Several changes were made to wards to ensurethe right levels of beds were available to meetthe needs of patients:• Additional beds were opened on Ward 9.• Ward 19 became the Short Stay Ward forpatients with less than 72 hours stay.• Ward 18 became the Endocrinology Ward.• Wards 11 & 12 became GastroenterologyWards.• Ward 8 opened as an Isolation Unit.Annual Report and Accounts April 1st 2009 to March 31st 2010 47

Workforce DevelopmentKey priorities in the past year have includedthe expansion of medical student training,development of a coaching culture and trainingfor the next generation of clinical leaders.The requirements of good governance havealso seen a considerable emphasis on improvingmandatory training with the aim of ensuringthat all staff are safe, competent and sufficientlyknowledgeable to perform their roles.New roles and ways of working have continuedto be developed reflecting the changing needsof the health service. The Trust has introducedgreater numbers of assistant and advancedpractitioners this year than ever before replacingtraditional roles. Our success in this has beenreflected in the Trust being used as a best practicecase study by NHS North West.Sustainability ReportingBlackpool, Fylde and Wyre Hospitals NHSFoundation Trust is committed to providingsustainable healthcare to the people of the FyldeCoast and beyond. This sustainability reportaims to satisfy requirements for Public SectorSustainability Reporting and fulfil the Trust’scommitment to: “develop systems to placeinformation relating to the environment into thepublic domain”.We recognise that our operations have anenvironmental impact. These include, but arenot limited to: waste production; the impacts oftransport; energy and resource use; dischargesto water; and emissions to air. In addition weacknowledge the significance of the indirectimpacts that we influence through procurementand our choice of contractors and suppliers.It is the Trust’s objective to act in a responsiblemanner to control and reduce any negativeimpacts on the environment whilst continuing toprovide high quality patient care. In particular,we aim to continue to ensure that our activitiescomply with, or exceed, applicable regulation andwe will work to meet any environmental targetsimposed by government.During 2009 the Trust implemented a number ofimprovements, in particular:• The Energy Grant Scheme was completedand is anticipated to save approximately11,000 Tones of CO2 in the first full year ofoperation.• The appointment of an Energy Technician toimplement the Carbon Reduction Strategyand a Waste Reduction officer to overseethe development and implementation of ourWaste strategy.• Achievement of the Carbon Trust Standardas recognition of our work reducing carbonemissions from energy use in buildings and ourowned transport over the last three years.• Implementation of a recycling scheme atPoulton Offices to test the feasibility ofdeveloping this across the Trust.The figures opposite represent a broadly positivepicture of the Trust’s performance. We used lessenergy overall with slightly lower associatedcarbon emissions. We believe this reduction is theresult of upgrades to Victoria Hospital’s boilerscompleted late in 2008/09 as part of the EnergyEfficiency Scheme. We also reduced the year onyear increase in electrical energy consumption,although we recognise we have more work to doin this area.The Trust is particularly pleased to have beenawarded the Carbon Trust’s Carbon ReductionStandard for achieving a 3% reduction in ourdirect CO2 emissions over the previous threeyears. This certificate remains valid until March31st 2011 and represents an important part ofthe Trust’s preparation for mandatory inclusion inthe Carbon Reduction Commitment (CRC) EnergyEfficiency Scheme which commences in April2010.The Trust also used significantly less water in2009/10. This is partially due to the closure ofthe Annex wards to allow for construction of thenew surgical unit but also reflects work carriedout in 2008/9 to remediate water leaks and theimprovement in boiler efficiency.The quantity of waste produced by the Trust roseslightly in 2009/10 (although we believe thatimproved data quality may account for some ofthe differences seen), continuing a trend seenover the last few years. However we are pleasedto see a slight reduction in overall quantities ofclinical waste.The Trust is also pleased to see slightimprovements in the absolute amount of materialrecycled and the proportion of our total wastearising subject to recycling or energy recovery.However we recognise that there is significantroom for improvement in these figures and haveappointed a Waste Reduction Officer to addressthis issue.48Blackpool, Fylde and Wyre Hospitals

Table: Environmental Performance in Key Areas for 2008/9 and 2009/10Table: Environmental PerformanceNon Financial DataFinancial Data2008/09 2009/10 2008/09 2009/10Waste Arising (Total waste from allsources)Clinical Waste (all waste disposed ofvia high temperature incineration)1,611Tonnes1,668Tonnes£341,024 £416,346566 Tonnes 562 Tonnes £281,904 £320,591WasteMinimisationWaste sent to Landfill 734 Tonnes 739 Tonnes £54,929 £82,141Waste Recycled 311 Tonnes 367 Tonnes £4,188 £13,614Waste Electrical and ElectronicItemsPercentage of Waste arising subjectto a recycling or recovery exercise11 Tonnes 14 Tonnes £8,668 £1,92953% 54%Water 188,075 m 3 167,029 m 3 £500,885 £494,283Managementof FiniteResourcesElectricity 57,586 GJ 57,605 GJ £2,124,547 £1,584,791Gas 174,201 GJ 170,105 GJ £1,583,518 £1,098,224Other Energy 1,924 GJ 2699 GJ £20,329 £36,406Fuel used in Owned Transport34,831litres35,322litres£39,884 £45,467Direct GreenHouseGas (GHG)Emissions(Direct emissions from the energysources above only)17,768Tonnes17,616TonnesN.B.: The figures above are based on the most accurate data available at the time of publication. Whereinformation held by the Trust for the year is incomplete the last 12 complete months have been used and/orfigures have been extrapolated to year end. Because of this, in the event that the data above differs from thatprovided by the Trust in our ERIC return for 2009/10 the ERIC return is to be preferred. The Trust final ERIC returnfor 2009/10 will be available on June 30th 2010. If you would like details of the final data at that point pleasecontact Robert Bell, Director of Facilities, on 01253 306859 or Robert.bell@bfwh.nhs.ukRelationship with Commissionersand StakeholdersDuring 2009/10, relationships withCommissioners and other stakeholders, suchas the Blackpool Overview and ScrutinyCommittee, have been sustained and developed.The organisations have worked together toidentify strategies to promote and improve thehealth of the local population.Plans for the delivery of new services andimprovements to patient care, are discussedand agreed with Commissioners, with particularemphasis on improving the accessibility tohealthcare through the provision of services atvarious locations across the Fylde Coast.Trust Executives continue to meet regularly withtheir PCT counterparts, to discuss and agree thestrategy for and cost effectiveness of healthcareacross the Fylde Coast and to review progressagainst operational plans.We have also continued to strengthen ourrelationships with our members and governorsas outlined on page 78.Annual Report and Accounts April 1st 2009 to March 31st 2010 49

I attended Green Reception, Outpatients Department for my five-year-old son. I have“so much praise for the doctors and nurses who were so pleasant and efficient, happyand smiling. The staff must have been hand picked. There was so much love and care ineverything they do, a wonderful example of a paediatric team. Tremendous support forchildren and anxious parents. “Mrs M O’Connel, St-Annes-on-Sea50Blackpool, Fylde and Wyre Hospitals

Our Future PlansStrategic OverviewIt is recognised that the changingenvironment and external factors, suchas The Operating Framework 2010/11,the Financial Climate, Patient Choiceand the Quality Improvement agendaimpact on the Trust and its futurebusiness plans.We believe that our vision and implementation ofthe QuIPP (Quality, Improvement, Productivity andPerformance) agenda will ensure that our futurebusiness plans accommodate the impact of these factorsand are aligned with the direction of travel for thewider NHS.Whole Health Community VisionIn 2006, the health community undertook a publicconsultation exercise, to ask for views on theconfiguration of health services on the Fylde Coast. Theoutcome of the exercise resulted in the agreement of aHealth Community vision to:• Deliver excellence in patient and customer care.• Support the delivery of locally based communityservices, where appropriate.• Provide services from facilities that support theefficient delivery of patient care in the 21st century.• Support Blackpool, Fylde and Wyre Hospitals NHSFoundation Trust in providing high quality servicesthat patients will choose to use.• Ensure that all locations are attractive places forpatients and staff working there.Annual Report and Accounts April 1st 2009 to March 31st 2010 51

The Health Community vision aligns closely withthat of the Trust and this has fostered the jointworking required to plan and deliver healthcareservices to meet the needs of patients on theFylde Coast.Examples of joint working to deliver locally basedservices are:• Outpatient services established at GarstangClinic in the High Street.• MRI facilities provided at Whitegate DrivePrimary Care Centre.• Outpatient services established at LythamPrimary Care Centre.• The Anti-Coagulant Dosing and AdvisoryService (ADAS) moved out of Victoria Hospitaland into community settings, providing moreconvenient and local access to patients.Plans for the development of new models ofcare and to move services closer to the patientwill continue to evolve during 2010/11 as furthercommunity based facilities become available.• Divisions are reviewing plans to increaseservices at Garstang Clinic.• Opportunities are being explored withPrimary Care to locate appropriate clinics intheir Community premises in Fleetwood andBlackpool.• Pathways of care are being reviewed andremodelled and intermediate servicesestablished to provide care in the mostappropriate setting.Interim Clinical Solution – VisionFollowing on from the approval to proceed in2008/09 the Board of Directors agreed the FullBusiness Case in 2009/10 for the Interim ClinicalSolution, named Vision by staff. The Board ofDirectors also ratified the recommended supplierof the system, ALERT Life Sciences, after a fullprocurement process. In partnership with ALERTthe Trust will implement a world class clinicalsystem to provide real time information tomonitor and improve on the effectiveness andefficiency of care, thereby improving clinicalquality and the patient experience. The Visionproject is formerly a change management projectthat will involve everyone providing care topatients.The initial phase of Vision will seeimplementation in Accident and Emergencyand the Lancashire Cardiac Centre by the end of2010. This will be followed by the Divisions ofMedicine and Surgery, completing in Women’sand Children’s.52Blackpool, Fylde and Wyre Hospitals

Continuous ImprovementDuring 2009 the Trust entered into a threeyear partnership with The ManufacturingInstitute, to develop and embed the use of Leanmethodologies across the organisation, as partof the approach to continuous improvement.Over this three year period many staff willbe involved in Lean projects and will receivetraining in Lean, enabling staff to delivermeaningful, sustainable change in their ownworkplace.In order to identify priorities, the ManufacturingInstitute undertook a Trust Diagnostic andpresented a summary of the findings along witha five day training programme to the ExecutiveTeam in November and December 2009.Work streams will focus on the delivery of thehighest quality of patient care in the mostefficient way possible and ensure that all of thethings we do add value to the patient pathway.A Steering Group with members of staff fromacross the Trust at the heart of the groupand its work will be set up early in 2010, todrive forward the Continuous ImprovementProgramme.Sustainability reportingThe financial year 2010/11 will see furtherimprovements in our energy performance. Weanticipate that we will see the full benefits ofover £1.3m investment in energy efficiency overthe previous two years. In particular we will seethe first full year of operation of the CombinedHeat and Power Plant that was commissionedearlier this year. We anticipate that this willreduce our CO2 emissions by c. 1300 tonnes(approximately 7% of our total emissions). Thisreduction will enable the Trust to maintain ourCarbon Trust Certification for the year 2011/12.The commissioning of the Combined Heat andPower (CHP) scheme concludes the measuresproposed by the Trust’s Carbon ReductionStrategy 2007. This document will be revisedand updated this summer. We will work withthe Carbon Trust through its NHS CarbonManagement Programme to identify furtherschemes to reduce energy use, emissions andcost for the years 2010/11 through to 2012/13.Next year will also see further improvementsin Waste Management within the Trust. OurSustainable Waste Management Strategywill also be updated and aligned with therevised Estates Strategy to ensure our wastefacilities are compliant and meet our projectedneeds. We hope to see further improvementsin recovery and recycling levels along witha reverse of a long term trend of increasingquantities of waste. We will also review ourexisting procedures to ensure they are compliantwith new guidance from the Department ofHealth when it is published.Next year we anticipate new requirements toreport indirect CO2 emissions in addition tothose from our building energy and ownedtransport usage. Over this year we will thereforedevelop systems to accurately record and reportthis information.Medical School DevelopmentThe first year of hosting student doctorsfrom Liverpool University was a tremendoussuccess. Resident on site for the entire 2008/9academic year were 24 students in their fourthyear of study during which time they rotatedthrough all hospital specialties and into primarycare. Testimony to the clinical opportunitiesavailable, the teaching provided and thestudents’ diligence they all passed their finalexaminations.Several of these students returned to the Trustin September 2009 to complete their fifthand final year of study in Blackpool. This is animportant year for the students as they progresstowards being qualified and apply for their firstposts as doctors. It is anticipated that many ofthese students will apply to the Trust and be thefirst cohort of “home grown” junior doctors.In addition to these students, as planned, 48students arrived on site for their fourth yearstudies. The success and favourable feedbackfrom the original group had led to all 48choosing to come to Blackpool, which was veryrewarding for all who had been involved.A new venture in September was theintroduction of student dentists to the Trust.This is a collaboration with Liverpool Universityand the University of Central Lancashire withthe Trust providing clinical experience forthird and fourth year dental students. During2009/2010 there are eight students present with16 expected in 2010/11.Given the involvement in both medical anddental education with large numbers ofstudents the Trust aspires to achieve TeachingHospital status. This will not only recognise thecommitment to medical and dental educationbut also reinforce the Trust’s commitmentto delivering the highest standards of care,enhance the recruitment and retention of seniorclinicians and open up other opportunities fordevelopment of research and teaching locally.It is hoped to complete the process of securingTeaching Hospital status by the end of 2010.Annual Report and Accounts April 1st 2009 to March 31st 2010 53

Fit for FoundationTo allow Clinical Divisions to pursue excellencethe Trust has granted a degree of ‘earnedautonomy’ based on performance. Thisapproach is similar to the development of‘devolved business units’ that exist in commercialorganisations. Our five Clinical Divisions (Cardiac,Medicine, Surgery, Women’s and Children’s,Clinical Support) are the heart of the Trust, withall other services supporting them in deliveringclinical care.Under the approach adopted that, the Boardof Directors ‘license’ each Division once theyhave been assured they are sufficiently strong interms of leadership governance, finance, qualityand workforce. Once licensed the divisionsenjoy a model of regulation similar to that ofFoundation Trusts that works on the basis of riskratings for governance, finance and mandatoryservices with a ‘light touch’ approach taken if keytargets are met and strong planning and controlis demonstrated. Before pursuing this approachthe Clinical Divisions and Corporate Departmentsundertook an assessment process to ensure thateach Division is capable of handling a greaterdegree of autonomy in terms of its governanceand controls, and that they receive appropriatecorporate support to allow them to manage theirservice effectively.Having become ‘licensed’ a Division benefitsfrom a scheme of delegation, which offerscertain freedoms and benefits. The purpose ofthis approach is to strengthen organisationalperformance, by incentivising Divisions todevelop, grow stronger and deliver excellence.The original timetable for Fit for Foundationachievement planned for all Divisions beinglicensed was April 1st 2009.Following assessment the Cardiac and SurgicalDivisions were licensed on April 1st 2009, theWomen’s and Children’s Division on July 1st 2009and the Medical and Clinical Support Divisionsfrom 1st August 2009. The reasons for defermentswere made explicit to the divisions, and mutuallyagreed action plans to address identified issuesdeveloped.From April 1st 2009 as Clinical Divisions becamelicensed their performance was monitored via aset of primary targets that are reported to theBoard of Directors on a monthly basis. Divisionsare required to make a monthly declarationconfirming the expected performance againstall primary targets and criteria, together withany action plans in place to correct any adversevariances against particular targets. The Board ofDirectors have the ability to intervene based onany concerns raised from the monthly monitoring,with specific intervention being agreed to fit theparticular circumstances identified.The Trust has increased its level of engagementwith our local GPs. The Trust hosts events thatallow our consultants and local GPs to meetinformally to discuss the opportunities aroundpartnership working to ensure that we tailor ourfuture plans and objectives to provide healthcarein the most appropriate setting.The launch of our recruitment campaign,“Blackpool – The Place To Be”, is a marketingstrategy aimed at recruiting staff to the Trust,in an effort to ensure that we attract and retainhigh-quality employees to further strengthen ourobjective of providing best in NHS care to ourlocal community.54Blackpool, Fylde and Wyre Hospitals

Effective risk and performancemanagementThe Trust was not successful in achievingClinical Negligence Scheme for Trusts (CNST)Maternity Level 2 award on February 26th2010 and was awarded Level 1 compliance. TheTrust has developed an action plan to maintainLevel 1 and achieve Level 2. Progress towardscompliance with the clinical CNST standardswill be monitored on a quarterly basis by theHealthcare Governance Committee and theBoard.The Trust was successful in attaining Level 2General National Health Litigation Authority(NHSLA), Risk Management standards inSeptember 2008. An Action Plan has beendeveloped to achieve Level 3 in 2011.Effective risk assessment arrangements are inplace. Divisional, Directorate and DepartmentalRisk Registers have been developed and arereflected within the Corporate Risk Register.Risks are regularly reviewed and quantifiedby the Divisional Boards and the HealthcareGovernance Committee on a quarterly basis. TheBoard Assurance Framework and the CorporateRisk Register are considered and presented tothe Board of Directors and the Audit Committeeon a quarterly basis. Key strategic risks, controlsassurance and gaps in assurance are identified.Co-operation with NHS bodiesand local authoritiesThe NHS Foundation Trust continues to workclosely with key commissioners, stakeholdersand Local Authorities. Alliances have beenmade with Blackpool and Lancashire LocalInvolvement Networks (LINks). Regular meetingsare held with our main commissioners of NHSBlackpool and NHS North Lancashire in relationto the monitoring of in year performance.Significant Governance RisksThe most challenging issue for the Trustremains the elimination of Health CareAcquired Infections; Reducing Mortality Rates;Information Governance; maintaining financialbalance and compliance with health and safetyregulations. A range of initiatives have beenimplemented by the Trust to mitigate theserisks. These risks are included on the BoardAssurance Framework which is monitored on aquarterly basis by the Healthcare GovernanceCommittee; Audit Committee and the Board.Mandatory Services RiskThere are no foreseeable service changes thatthreaten the delivery of mandatory servicesprovided by the Trust, nor are there any issuesof accreditation that threaten the viability of aservice in 2010/11.The Trust continues to work with the Cumbriaand Lancashire Cancer Network to implementImproving Outcomes Guidance for CancerPatients, across all tumour sites. This will involveongoing collaboration and networking ofservices with other local service providers.The Trust has developed a robust set of businesscontinuity and contingency plans to ensurethat services can continue to be provided inthe event that a catastrophic event takes placewhich impacts upon patient services. Theseplans have been cascaded throughout theorganisation and where appropriate have beenfully tested.Annual Report and Accounts April 1st 2009 to March 31st 2010 57

“I was under the care of staff on Ward 32 BVH and Ward 4, Clifton Hospitaluntil discharged home with a care package, it is now time to say thank you toall. The care I received at both hospitals could not be faulted. Staff showedcare, encouragement and dedication that one hears too little of whenever theNHS is under discussion. May I place on record my sincere thanks to everyoneconcerned with my treatment. “Mr Hardman, Lytham-St-Annes58Blackpool, Fylde and Wyre Hospitals

The Board of Directors comprises seven Non-Executive Directors (including the Chairman)and six Executive Directors (including the ChiefExecutive).There were changes to the Board of Directorsin 2009/10 due to the resignation of JulianHartley as Chief Executive in May 2009 followinghis successful appointment to the substantiveposition of Chief Executive of the UniversityHospital of South Manchester NHS FoundationTrust.Aidan Kehoe was appointed Chief Executivein July 2009 and Harry Clarke was appointedDirector of Operations in October 2009.Due to ill health Harry Clarke stepped out of hisrole as Director of Operations and Corinne Siddallwas appointed to act into the role for six monthsfrom January 4th 2010.Beverly Lester offered herself for re-election asthe Chairman and was successful in November2009.As a self-governing Foundation Trust, the Boardof Directors has ultimate responsibility for themanagement of the Trust but is accountablefor its stewardship to the Trust’s Council ofGovernors and Members. In addition, the Trust’sperformance is scrutinised by Monitor (theRegulator for Foundation Trusts) and by the CareQuality Commission (formerly the Health CareCommission).The Non-Executive Directors are appointed by theTrust’s Council of Governors and, under the termsof the Trust’s Constitution, they must form themajority of the Directors.The Board considers that it has an appropriatebalance of expertise and experience and hasaccess to specialist advice as required.The Chairman has committed to spend threedays per week on Trust business. The Chairman’sother significant commitments are outlined onpage 63 of the Annual Report. There have beenno changes to these commitments during thepast 12 months. The Non-Executive Directors arecommitted to spend four days per month on Trustbusiness.The Board of Directors meets on a monthly basisand the Board Agenda is produced to ensure thatsufficient time is devoted to strategic, operationaland financial matters.The Board of Directors has undertaken aformal annual evaluation of its performanceduring 2009/2010. This has included a Boardself-assessment which looked at five separatedomains: focus on core business, trust andsupport, contribution and execution, engagementwith stakeholders and leadership of the board.The results of this self-assessment, which wereoverall positive, were discussed at a BoardSeminar in March 2010.Internal Audit has reviewed the performance ofthe committees within the corporate governancestructure. This is undertaken on a two yearlybasis.There have been nine formal Board Meetings,five Board Seminars and one additional BoardMeeting during 2009/10.As per the constitution there are five Sub-Committees of the Board as follows:• Audit Committee• Charitable Funds Committee• Healthcare Governance Committee• Human Resources and OrganisationalDevelopment Committee• Remuneration CommitteeCompliance with the NHSFoundation Trust Code ofGovernanceThe creation of Foundation Trusts has led tothe requirement for a framework for corporategovernance, applicable across the FoundationTrust Network. This is to ensure that standards ofprobity prevail and that Boards operate to thehighest levels of corporate governance.Monitor, the independent regulator of NHSFoundation Trusts, has produced the NHSFoundation Trust (FT) Code of Governance. Thiscode consists of a set of Principles and Provisionsand may be viewed on Monitor’s website at www.monitor.nhsft.gov.uk/publications.php?id=930.Foundation Trusts are required to report againstthis Code each year in their Annual Report onthe basis of either compliance with the Codeprovisions or an explanation where there is noncompliance.The compliance statement below reflects theTrust’s declaration as to compliance with the Codeas stated in the latest Annual Report 2009/10.The Board of Directors considers that, throughoutthe 2009/10 reporting year, the Trust has appliedthe principles and met the requirements of theCode of Governance. A paper has been submittedto the Audit Committee and the Board ofDirectors to provide assurance of compliance withthe Code of Governance.60Blackpool, Fylde and Wyre Hospitals

Attendance at the Board of Directors Meetings and Board Sub-Committees is summarised in thefollowing table:Attendance at Board of Directors Meetings and Board Sub-Committees:-Board ofDirectorsAuditCommitteeCharitableFundsCommitteeHealthcareGovernanceCommitteeHR & OD *GovernanceCommitteeRemunerationCommitteeNumber of Meetings 14 6 4 4 5 3Beverly Lester 14 N/A 3 3 3 3Paul Olive 14 6 N/A N/A N/A 3Christine Breene 13 6 N/A N/A 4 2Michael Brown 12 6 N/A N/A N/A 3Peter Hosker 10 4 4 N/A N/A 1Bill Robinson 14 6 4 N/A 4 3Malcolm Faulkner 11 3 N/A N/A N/A 2Aidan Kehoe 14 N/A N/A 3 5 N/ATim Welch 13 N/A 3 4 4 N/AMarie Thompson 12 N/A 2 4 4 N/ADr Paul Kelsey 13 N/A 1 1 0 N/ANick Grimshaw 13 N/A N/A 3 5 N/ARobert Bell 13 N/A N/A 4 N/A N/AHarry Clarke10 (fromApril toDecember2009)N/AN/A2 (fromApril toDecember2009)N/AN/ACorinne Siddall3 (fromJanuary toMarch2010)N/AN/A0 (fromJanuary toMarch2010)N/AN/A* Human Resources and OrganisationalDevelopmentThe work of the Sub-Committees is evaluatedon an annual basis against agreed workprogrammes, with summary reports and minutesprovided to the Board of Directors.Annual Report and Accounts April 1st 2009 to March 31st 2010 61

Profile of the BoardVoting members of theBoard of Directors:-Beverly Lester (Chairman)– term of office from 1.11.09 to 31.10.12 (third term)Experience:• Former Chairman of Blackpool, Wyreand Fylde Community Health ServicesNHS Trust• Former Partner in Law Firm• Former Deputy District Judge• Part time Tribunal Judge of theTribunals Judiciary• Trustee of the Ladies Sick PoorAssociation• Governor of Carters Primary School• Member of Blackpool Council’sChildren’s Trust Board• Member of the Court of the Universityof Central LancashireQualification:• Qualified Solicitor – LL.BPaul Olive (Non-Executive Director and Deputy Chairman)– term of office from 20.5.06 to 19.5.10 (second term)Experience:• Former Finance Director of StanleyLeisure plc• Former Non-Executive Director ofCrown Leisure plc• Former Governor of Blackpool SixthForm College• Former Trustee of Age Concern• Trustee of the Ladies Sick PoorAssociationQualification:• Chartered Accountant – FellowInstitute of Chartered AccountantsChris Breene (Non-Executive Director)– term of office from 20.5.06 to 19.5.10 (second term)Experience:• Former Non-Executive Directorof the Blackpool, Wyre and FyldeCommunity Health Services NHS Trust• Former Manager for Marks andSpencer• Former Vice Chairman of theEmployment Committee forBlackpool, Wyre and Fylde BlindSociety• Former Member of the BlackpoolPartnership Against Crime CommunityGroup• Former Governor of Blackpool SixthForm CollegeAnnual Report and Accounts April 1st 2009 to March 31st 2010 63

Michael Brown (Non-Executive Director and Senior IndependentDirector) – term of office from 1.12.08 to 30.11.11 (second term)Experience:• Former Chief Executive of WyreBorough Council• Chairman of Regenda Group• Director Eccleston Services Ltd.• Director A.S Associates Ltd.Qualification:• Qualified Solicitor – LL.BPeter Hosker (Non-Executive Director) – term of office from 1.7.06to 30.6.10. Peter is standing down from the role on 30.6.10.Experience:• Former Senior Partner at NapthensSolicitors• Part time Tribunal Judge of theTribunals Judiciary• Former Chairman of the AvenCentralRegeneration Partnership in Preston• Select Vestryman of the Churches ofSt John the Evangelist and St Georgethe Martyr in Preston.• Director of The Select Vestry ofPreston Charity Ltd• Former Trustee of the British RedCross in Lancashire• Vice Patron of Deafway• Former Chairman and Trustee of theKirkham Educational Foundation andKirkham Grammar SchoolQualification:• Qualified Solicitor – LL.B (Hons)Bill Robinson (Non-Executive Director)– term of office from 1.7.06 to 30.6.10Experience:• Former Director of Finance at SouthRibble Borough Council• A Vice President of Lancashire CountyCricket Club• Former Chairman of the LancashireYouth Cricket Coaching Committee• Honorary Treasurer of the LancashireCricket Board• Director/Trustee to the BritishCommercial Vehicle Museum Trust• Trustee of Lancashire Youth CricketTrust• Member of the Audit Committee ofthe England and Wales Cricket BoardQualification:• Chartered Public Finance Accountant– (Retired)64Blackpool, Fylde and Wyre Hospitals

Malcolm Faulkner (Non-Executive Director)– term of office from 1.6.07 to 31.5.11Experience:• Former Independent Consultant• Former Director of United Utilities• Former Chairman of Norweb• Former MD of Norweb Energy andTelecommunications Division• Former Commercial Director ofNorweb plc• Director of Great Places HousingGroup• Former Pro Chancellor and Chair ofthe Board of the University of CentralLancashire (UCLAN)• Member of the Court of the Universityof Central Lancashire (UCLAN)Qualification:• B.Sc(Hons) M.Sc. Electrical Engineering• Diploma in Management Studies• Chartered EngineerAidan Kehoe (Chief Executive) – appointed in July 2009(formerly Director of Operations from April 2004)Experience:• Former Deputy Chief Executive atBlackpool, Fylde and Wyre HospitalsNHS Trust• Former Divisional Manager atUniversity Hospital Birmingham NHSTrust• Joined NHS as National Trainee of theNHS General Management TrainingSchemeQualification:• Qualified Chartered Accountant– Institute of CharteredAccountants (ACA)• Diploma in Health ServiceManagement (Dip HSM)• B.Sc(Hons) – Managerial andAdministrative StudiesTim Welch (Deputy Chief Executive) – appointed in July 2009(formerly Finance Director from August 2005)Experience:• Former Director of Finance atBlackpool, Fylde & Wyre HospitalsNHS Foundation Trust• Former Director of Finance at City andHackney Teaching PCT• Former Deputy Director of Finance atCity and Hackney Teaching PCT• Joined NHS as Financial ManagementTraineeQualification:• Chartered Public Finance Accountant• B.Sc(Hons) – BiochemistryAnnual Report and Accounts April 1st 2009 to March 31st 2010 65

Harry Clarke (Director of Operations)– appointed in October 2009Experience:• Former Associate Director forPerformance Improvement atBlackpool, Fylde and Wyre HospitalsNHS Foundation Trust• Former Head of Service Improvementat Blackpool, Fylde and WyreHospitals NHS Foundation Trust.• Appointed to various DirectorateManagers posts between 1998 and2004.• Joined the NHS in 1991 as Project andCommissioning Manager at RoyalLancaster Infirmary.Qualification:• Post Graduate Certificate in HRLeadership.• Master of Business Administration.• Post Graduate Diploma in PublicAdministration.Corinne Siddall (Acting Director of Operations)– appointed January 2010Experience:• Acting Director of Operationsat University Hospitals of SouthManchester.• General Manager, Heart and LungDivision at University Hospitals ofSouth Manchester.• 18 week Programme Lead at SalfordRoyal Hospitals NHS Trust.• Directorate Manager, Critical Care atSalford Royal Hospitals NHS Trust.• Resuscitation Training Officer atSalford Royal Hospitals NHS Trust.• Sister in Emergency Nursing at SalfordRoyal Hospitals NHS Trust.Qualification:• Registered General Nurse• Diploma in Professional Studies inNursing• Management in Health Services• PRINCE 2 Project Management• Certificate in PerformanceManagementDr Paul Kelsey (Medical Director)– appointed in June 2006Experience:• Consultant Haematologist atBlackpool, Fylde and Wyre HospitalsNHS Trust since 1988• Former Senior Registrar inHaematology – North West RotationalTraining SchemeQualification:• M.B.,B.S. (Hons) – Pathology• MRCP (UK)• FRCPath66Blackpool, Fylde and Wyre Hospitals

Nick Grimshaw (Director of Human Resources andOrganisational Development) – appointed in May 2007Experience:• Former Director of Human Resourcesat Tameside and Glossop AcuteServices NHS Trust• Former Director of Human Resourcesat Greater Manchester WorkforceDevelopment Confederation• Former Director of Human Resourcesat North Manchester Healthcare NHSTrustQualification:• BA - English and History• Post Graduate Diploma inManagement• Post Graduate Diploma in Personnel(MCIPD)Marie Thompson (Director of Nursing and Quality)– appointed in February 2009Experience:• Registered General Nurse. FormerDeputy Director of Nursing andGovernance for Wrightington, Wiganand Leigh Hospitals NHS Trust• 20 years nursing experience in avariety of roles and excellent trackrecord in professional and operationalleadershipQualification:• Registered General Nurse• MSc Human Resource Leadership• B.Sc(Hons) Nursing Studies• Post Graduate Certificate in Education• Post Graduate Diploma ManagementStudiesNon-voting member of the Board of Directors:-Robert Bell (Director of Facilities and Estates)– appointed in March 2009Experience:• Head of Technical Services for Ocado(Waitrose) Ltd.• Technical Services Director for Tibbett& Britten Ltd.• Principal Technical Officer forMerseyside Police Authority.Qualification:• Bachelor of Science Degree inMechanical Engineering• Chartered Engineer• Member of the Chartered Institute ofBuilding Services Engineers.• Associated Member of the Institute ofMechanical Engineers.Annual Report and Accounts April 1st 2009 to March 31st 2010 67

“I am writing to thank you for a pleasant stay in hospital. Too much is writtentoday against the NHS and to receive such a pleasant stay in hospital with sucha top level of help, I feel should not go unnoticed. I was admitted to Ward 10Orthopaedics and the nursing staff were brilliant. Physios and occupationaltherapy staff were nothing but helpful, I was proud to be on such a lovelyward. “Mrs Helen West, Bispham, Blackpool68Blackpool, Fylde and Wyre Hospitals

Council of GovernorsThe Council of Governors was formedwith effect from December 1st 2007in accordance with the NationalHealth Service Act 2006 and the Trust’sConstitution. The Council of Governorsis responsible for representing theinterests of NHS Foundation Trustmembers and partner organisations inthe local health economy.The roles and responsibilities of the Council ofGovernors, which are to be carried out in accordancewith the Trust’s Constitution and the Foundation Trust’sTerms of Authorisation, are as follows:-• To appoint or remove the Chairman and the otherNon-Executive Directors.• To approve the appointment (by the Non-ExecutiveDirectors) of the Chief Executive.• To decide the remuneration and allowances, and theother terms and conditions of office, of the Non-Executive Directors.• To appoint or remove the Foundation Trust’s Auditor.• To appoint or remove any other External Auditorappointed to review and publish a report on anyother aspect of the Foundation Trust’s affairs.• To be presented with the Annual Accounts, anyreport of the Auditor on the Annual Accounts andthe Annual Report.• To provide their views to the Board of Directorswhen the Board of Directors is preparing thedocument containing information about theFoundation Trust’s forward planning.• To respond as appropriate when consulted bythe Board of Directors in accordance with theConstitution.• To undertake such functions as the Board of Directorsshall from time to time request.• To prepare and, from time to time, review theFoundation Trust’s membership strategy andits policy for the composition of the Council ofGovernors and of the Non-Executive Directors andwhen appropriate to make recommendations for therevision of the Constitution.Annual Report and Accounts April 1st 2009 to March 31st 2010 69

The Council of Governors and the Board ofDirectors continue to work together to developan effective working relationship.The Council of Governors comprises a total of31 Governors, including 16 Public Governors(elected from the constituencies of Blackpool,Fylde, Wyre and Lancashire & South Cumbria),5 Staff Governors (elected from the Trust) and10 Appointed Governors (from a range of keystakeholder organisations).The Elected Governors are appointed for eithertwo years or three years and the term of officefor the Appointed Governors is at the discretionof the nominating organisation.The Trust’s Constitution sets out the composition for the Council of Governors as follows:-APPOINTED GOVERNORSPrincipal Commissioning Primary Care Trusts – 2:-NHS Blackpool (1)NHS North Lancashire (1)Principal Local Councils – 2:-Blackpool Council (1)Lancashire County Council (1)Principal University - 1University of Central LancashireROLETo represent main Trust commissioners and key NHSeconomy partners.To represent key local non-NHS Local HealthEconomy partners.To ensure strong teaching and research partnershipand to represent other University interests.Principal Patient Representative Body - 1Blackpool Local Involvement Network (formerly thePatient and Public Involvement Forum)To reinforce the representation of patients’ viewsand interests.Voluntary Sector - 1To engage and assist the Trust in identifying needsof local community.Lancashire Care Trust - 1To engage and assist the Trust in identifying needsof local community.Lancashire Business Link – 1Blackpool Regeneration Project - 1To engage and assist the Trust in dialogue withlocal developments and businesses.To engage and assist the Trust in dialogue withlocal developments and businesses.Total Appointed Governors - 1070Blackpool, Fylde and Wyre Hospitals

STAFF ELECTED GOVERNORSROLEClass 1 – Medical Practitioners – 1Class 2 - Nursing and Midwifery – 2Class 3 - Clinical Support – 1To assist the Trust in developing its services andensure active representation from those whodeliver the services.Class 4 - Non-Clinical Support – 1Total Elected Staff Governors - 5PUBLIC ELECTED GOVERNORSTo represent:-Area 1 – Blackpool - 8Area 2 – Wyre - 4Area 3 – Fylde - 3Area 4 Lancashire & South Cumbria - 1ROLETo represent patients who are resident inBlackpool.To represent patients who are resident in Wyre.To represent patients who are resident in Fylde.To represent approximately 4% of patients whoare resident in the wider environs of Cumbria andLancashire.Total Public and Patient Elected Governors – 16TOTAL MEMBERSHIP OF COUNCIL OF GOVERNORS:-Appointed Governors - 10 (currently two vacancies)Staff Governors (elected) - 5Public and Patient Governors (elected) - 16 (currently three vacancies)Total – 31Annual Report and Accounts April 1st 2009 to March 31st 2010 71

There have been a number of changes to theCouncil of Governors during 2009/10 as follows:-Other changes to the Council of Governors during2009/10 are as follows:-• Eric Allcock and Arthur Roe were elected tothe Blackpool Constituency in April 2009.• Ramesh Gandhi was elected to the WyreConstituency in April 2009.• Cerise Fleming resigned as a Governor(Blackpool Constituency) in September 2009.• Canon Godfrey Hirst resigned as a Governor(Fylde Constituency) in October 2009.• Mike Hodkinson resigned as a Governor(Blackpool Constituency) in December 2009.• Denise Wilson resigned as an AppointedGovernor (Lancashire Care Trust) in December2009All elections to the Council are conducted by theElectoral Reform Services Limited on behalf of theTrust and in accordance with the Model ElectionRules.Membership of the Trust’s Council of Governors is set out below:• Brian Rowe replaced Dr Frank Atherton as theAppointed Governor for NHS North Lancashire(April 2009).• County Councillor Paul Rigby replaced CountyCouncillor Penny Martin as the AppointedGovernor for Lancashire County Council(August 2009).• Christopher Lamb replaced Ramesh Gandhi asthe appointed Governor for the Council forVoluntary Services (August 2009).• Chris Sconce replaced Eileen Martin as theAppointed Governor for the University ofCentral Lancashire (December 2009).• Richard Emmess replaced Councillor IvanTaylor as the Appointed Governor for NHSBlackpool (February 2010).NamePublic GovernorsConstituency/OrganisationTerm of OfficeJohn Butler Blackpool 3 yearsMichael Hodkinson (resigned December 2009) Blackpool 3 yearsClifford Chivers Blackpool 3 yearsHannah Harte Blackpool 2 yearsChris Thornton Blackpool 2 yearsCerise Fleming (resigned September 2009) Blackpool 2 yearsEric Allcock (from April 2009) Blackpool 3 yearsArthur Roe (from April 2009) Blackpool 3 yearsCarol Gradwell Fylde 2 yearsGodfrey Hirst (resigned October 2009) Fylde 3 yearsAnne Smith Fylde 3 yearsPeter Askew Wyre 3 yearsJean Marsh Wyre 2 yearsAustin McNally Wyre 3 yearsRamesh Gandhi (from April 2009) Wyre 3 yearsBill HolmesLancashire andSouth Cumbria2 years72Blackpool, Fylde and Wyre Hospitals

NameStaff GovernorsDr Tom KaneSam WoodhouseAndrew GoacherTina DanielsConstituency/OrganisationMedical andDentalNursing andMidwiferyNursing andMidwiferyNon-ClinicalSupportTerm of Office3 years3 years2 years3 yearsRichard Day Clinical Support 2 yearsAppointed GovernorsCouncillor Ivan Taylor (resigned February 2010)Richard Emmess (from February 2010)Brian Rowe (from April 2009)NHS Blackpool(PCT)NHS NorthLancashire (PCT)N/AN/ACouncillor Roy Haskett Blackpool Council N/ACounty Councillor Penny Martin (resigned August 2009)County Councillor Paul Rigby (from August 2009)Lancashire CountyCouncilN/ADoug Garrett Re Blackpool N/AVacancyCouncillor Ramesh Gandhi (resigned August 2009)Christopher Lamb (from August 2009)Denise Wilson (until December 2009)David SlaterEileen Martin (resigned November 2009)Chris Sconce (from December 2009)LINks (formerlythe Patient andPublic InvolvementForum)Council forVoluntaryServiceLancashire CareTrustBusiness LinkNorth WestUniversity ofCentral LancashireN/AN/AN/AN/AN/AMeetings of the Council ofGovernors took place on thefollowing dates in 2009/10:-May 1st 2009August 7th 2009November 6th 2009February 15th 2010An additional meeting was held on July 1st 2009to discuss and ratify the appointment of AidanKehoe as Chief Executive.Annual Report and Accounts April 1st 2009 to March 31st 2010 73

Attendance at Council ofGovernors Meetings:Governor AttendanceNumber of Meetings 5John Butler 5Clifford Chivers 2Hannah Harte 4Mike Hodkinson * 4Chris Thornton 3Cerise Fleming * 1Eric Allcock * 4Arthur Roe * 4Carol Gradwell 1Godfrey Hirst * 0Anne Smith 5Peter Askew 5Jean Marsh 5Austin McNally 5Bill Holmes 5Dr Tom Kane 4Sam Woodhouse 3Andrew Goacher 1Tina Daniels 3Richard Day 4Councillor Ivan Taylor * 2Richard Emmess * 0Brian Rowe * 2Councillor Roy Haskett 2County Councillor Penny Martin * 0County Councillor Paul Rigby * 3Doug Garrett 4Councillor Ramesh Gandhi * 4Denise Wilson 2David Slater 3Eileen Martin * 0The Chief Executive, Deputy Chief Executive andDirector of Operations routinely attend meetingsof the Council of Governors. The Non-ExecutiveDirectors attend the Council of GovernorsMeetings on a rotational basis.During 2009/10, the Council received regularupdates from the Chief Executive plus regularperformance, finance and membership reports.Presentations were also given to the Councilabout the use of Day Hospitals/Modern HealthCare Facilities for the Elderly, Membership of theFoundation Trust Governors Association, the roleof the Head Nurse/Matron and the progress inrelation to Fit for Foundation within the Cardiacand Surgical Divisions.Other items discussed at Council of Governorsmeetings included the Annual Plan, Chairman’s/Non-Executive Directors’ Appraisals andRemuneration, Re-Appointment of the ExternalAuditors, Corporate Objectives, GovernorsObjectives, Annual Report and Accounts, AnnualHealth Check Declaration, Appointment of LinkGovernor, Complaints and Serious UntowardIncidents.In addition Governors have provided feedbackfrom the following events:-Governors Conference – March 18th 2009.North West Governors Forum – April 28th 2009.North West Staff Governors Event – July 6th 2009.North West Governors Meeting – October 15th2009.FTGA Development Day – October 19th 2009.Governors Workshops have taken place on July31st and December 8th and Governors have heldprivate meetings on July 14th and December 7th.There are currently two Governor Sub-Committees, namely the Nominations Committeeand the Membership Committee, comprising 3and 11 Governors respectively. Attendance atthese meetings is detailed below:Attendance at Nominations Committee Meetings:Governor Attendance - Nominations CommitteeNumber of meetings 1Peter Askew 1Godfrey Hirst (until October 2009) 0Doug Garrett 1Chris Sconce * 1* Resigned or elected/appointed during 2009/10.74Blackpool, Fylde and Wyre Hospitals

Governor Attendance - Membership CommitteeNumber of MeetingsAnne Smith (Chairman) 4John Butler 4Mike Hodkinson (until December 2009) 2Hannah Harte 3Jean Marsh 4Austin McNally 4Bill Holmes 4Cerise Fleming (until September 2009) 0Roy Haskett 2Richard Day 2Penny Martin (until July 2009) 0Brian Rowe (from April 2009) 0Arthur Roe (from April 2009) 3Sam Woodhouse 0In addition, Governors are also involved ina number of Trust Committees, namely theMarketing Strategy Group, InformationGovernance Committee, Charitable FundsCommittee, Patient Environment ActionTeam, Healthy Transport Committee, Equalityand Diversity Committee, Patient ExperienceCommittee and Phase VI Reference Group.Governors are required to comply with theTrust’s Code of Conduct and to declare intereststhat are relevant and material to the Council.All Governors have read and signed the Trust’sCode of Conduct which includes a commitmentto actively support the NHS Foundation Trust’svision and values and to uphold the SevenPrinciples of Public Life, determined by theNolan Committee.All Governors have declared their relevant andmaterial interests and the Register of Interestsis available for inspection by members of thepublic via the Foundation Trust Secretary at thefollowing address:-Address:Trust HeadquartersVictoria HospitalWhinney Heys RoadBlackpoolFY3 8NRTelephone: 01253 306856Email: judith.oates@bfwhospitals.nhs.ukAny member of the public wishing to makecontact with a member of the Council ofGovernors or the Board of Directors, should, inthe first instance, contact the Foundation TrustSecretary.Annual Report and Accounts April 1st 2009 to March 31st 2010 75

“I would very much like to express my sincere appreciation for all the staff atBVH. My husband was readmitted following a mild stroke, he has been treatedwith total kindness, given full explanations of his treatment and provided withtotal care. It is so easy to forget to say thank you and very well done to theNHS. “Mrs Kathleen Rainbow, Lytham-St-Annes76Blackpool, Fylde and Wyre Hospitals

MembershipOver the past 12 months, the Trust’smembership has continued to grow.Public MembersAll members of the public who are 16-years-old or overand who live within the boundaries of Blackpool, Fyldeand Wyre Borough Councils, or the wider catchmentarea of Lancashire and South Cumbria, for which weprovide tertiary cardiac and haematology services, areeligible to become members. Other members of thepublic who do not fall into these categories, either dueto age or place of residence, are eligible to becomeaffiliate members of the Trust.Staff MembersStaff who work for the Trust automatically becomemembers unless they choose to opt out. These include:• Staff who are employed by the Foundation Trustunder a contract of employment which has no fixedterm or has a fixed term of at least 12 months.• Staff who have been continuously employed by theFoundation Trust under a contract of employment.Trust volunteers are eligible to become members underthe public constituency.Growth of Public MembersThe number of public members has increased steadilyover the last year, with 788 being recruited in total overthe past 12 months. The public membership total isnow 5,615.Annual Report and Accounts April 1st 2009 to March 31st 2010 77

Recruitment of MembersIn order to achieve our overall target of recruitingmore public members, we have implementedvarious initiatives over the past year. Theseinclude:• Direct mailshot campaign to underrepresentedareas to encourage members tosign up.• Recruitment stands in the outpatientsdepartment and at public meetings.• Radio and newspaper advertising campaigns.• Presentations at meetings of communitygroups about the benefits of membership.• Improvements to the online membershipsection of the website.• Information about membership in the patientbedside folder at all of our hospitals.• Membership recruitment leaflets at GPsurgeries.Over the next 12 months we will continue tolook at new ways of promoting the benefits ofmembership in order to achieve our target of8,000 public members by 2012. These include:• Increasing the number of membershipstands and boards in areas where the publicattend the hospital, and making them moreprominent.• Using our volunteers to man these standsand discuss with the public the benefits ofmembership to encourage them to sign up.• Attending meetings in the community todiscuss membership, especially targetingunder-represented groups by age, ethnicityand gender.• Recruitment stands at local colleges to increasethe number of young people becomingmembers.• Setting up social networking sites, such asFacebook and Twitter to attract new members.• Mailshots to local businesses, such as hotels/gymnasiums/fitness centres, informing staffof the benefits and inviting them to becomemembers.Retention of MembersThe Trust understands the importance of not onlybuilding on its existing membership base, but toensure those existing members are retained.• New members are sent a welcome pack withinformation on membership and a discountcard.• All members are sent a copy of the “YourHospitals” quarterly newsletter with newsabout the Trust and consultations.• Members seminars are now held monthlywith topics such as, Bowel Cancer, CancerPrevention, Diabetes, Organ Donation andCataract/Cornea problems. We continue to puton seminars of interest through feedback fromour members.• A dedicated membership hotline and emailaddress allows our members to have a point ofcontact with any enquiries about membership.Membership RepresentationWe are keen to ensure that our membership isrepresentative of the whole community. Wehave been looking at ways to engage with theyounger generation, which is currently slightlyunder-represented. Presentations have beenheld in colleges across the Fylde Coast and we arecurrently working with 15 and 16-year-old schoolchildren to promote membership.78Blackpool, Fylde and Wyre Hospitals

Membership Report for Blackpool Fylde andWyre Hospitals NHS Foundation Trust fromApril 1st 2009 to March 31st 2010.Socio-economic groupings:Number ofMembersPublic constituencyNumber ofMembersAs at start (April 1) 5,049New Members 788Members leaving 222ABC1 4,473C2 705D 100E 318At year end (March 31) 5,615Gender analysis:Number ofMembersStaff constituencyNumber ofMembersAs at start (April 1) 4,821Male 3,066Female 2,429New Members 374Members leaving 328At year end (March 31) 4,867Public constituencyNumber ofMembersAge (years)0 - 16 817 - 21 25922+ 4,733Ethnicity:Number ofMembersWhite 4,656Mixed 17Asian 61Black 14Other 15Annual Report and Accounts April 1st 2009 to March 31st 2010 79

“Our son has just spent some time on Berry Ward, Child Assessment Unit. Iwould just like to say how grateful we were for the friendly attention andreassurance we received. We found the parents’ room extremely useful, agreat asset to parents in situations like ours. I would like to convey our gratefulthanks to the staff, without whom our worrying time would have been evenmore stressful. “Mrs Donna Louise Green, Wrea Green, Nr Preston80Blackpool, Fylde and Wyre Hospitals

Audit CommitteeRole of the AuditCommitteeThe role of the Audit Committee is toprovide to the Board of Directors anindependent and objective review overthe establishment and maintenanceof effective systems of integratedgovernance, risk managementand internal control across theorganisation’s activities (both clinicaland non-clinical) that supports theachievement of the Trust’s objectives.It also provides assurance on theindependence and effectiveness of bothexternal and internal audit and ensuresthat standards are set and compliancewith them is monitored in the nonfinancialand non-clinical areas of theTrust that fall within the remit of theCommittee. The Audit Committee issignificantly instrumental in reviewingthe integrity of the Annual FinancialAccounts and related External Auditor’sReports thereon. In addition it reviewsthe Statement of Internal Controlprepared by the Chief Executive in hisrole as the Accountable officer.The Council of Governors has approved the continuedappointment of PricewaterhouseCoopers as theTrust’s external auditors until March 31st 2010.PricewaterhouseCoopers were paid £60,000 in respectof statutory audit fees.The Trust limits work done by the external auditorsoutside the audit code to ensure independence isnot compromised. In 2009/10 no additional work wascarried out by the External Auditors outside of normalaudit requirements.Annual Report and Accounts April 1st 2009 to March 31st 2010 81

Composition of the AuditCommitteeThe Committee operates in accordance withthe Terms of Reference agreed by the Board ofDirectors on July 29th 2009 and has met on sixoccasions during the year ended March 31st 2010.Each member’s attendance at these meetingscomplied with the criterion for frequency ofattendance as set out in the Audit Committee’sTerms of Reference.The Committee Membership comprises all theNon-Executive Directors of the Board (with theexclusion of the Chairman) and is chaired by PaulOlive, FCA. The Board considers Paul Olive tohave recent and relevant financial experiencefollowing his role as a former Finance Director ofa FTSE listed company.In addition to the Committee members, standinginvitations are extended to the Finance Director(who also acts as the Deputy Chief Executive),External and Internal Audit representatives, theLocal Counter Fraud Officer and the AssociateDirector of Corporate Affairs. In addition otherofficers have been invited to attend the AuditCommittee where it was felt that to do sowould assist the Committee to effectively fulfilits responsibilities; these included the ChiefExecutive, the Director of Human Resourcesand Organisational Development, the AssistantDirector of Finance, the Clinical Governance RiskManager and members from the Learning andDevelopment team. Administrative support hasbeen provided by Miss Judith Oates, FoundationTrust Secretary, from April 2009 – September 2009and by Miss Kayleigh Briggs, PA to Deputy ChiefExecutive, from November 2009 – March 2010.Audit Committee ActivitiesFinancialThe Committee reviewed the Annual Reportand Accounts for the year ended March 31st2009 at its meeting on May 5th 2009 and atthe subsequent meeting on June 3rd 2009 andformally recommended to the Trust Board thatthe accounts be approved at the Board meetingheld on June 3rd 2009. The first draft of theAnnual Report for the year ending March 31st2010 was reviewed at the meeting held onFebruary 8th 2010. In addition a presentationby the Trust Auditors, PricewaterhouseCoopers(PwC), on Quality Accounts was also considered.A restatement of the 2008/09 accounts under IFRSwas reviewed and approval given by the TrustBoard in October 2009 to the restated balancesheet.As stated in last year’s Audit Committee reportthe Trust is continuing to monitor its performanceagainst ALE standards and the progress of thisreview was considered throughout the currentyear. The Committee also considered the AuditCommission paper on data quality entitled“Figures you can Trust”, the recommendationscontained therein being taken to the Board forconsideration. The results of the review underthe Data Assurance Framework on Payment byResults was also considered by the Committee.Internal Control and RiskManagement SystemsThroughout the year the Committee has receivedregular reports from both Internal and ExternalAudit in relation to the adequacy of the systemsof internal control and also received regularreports from the Associate Director of CorporateAffairs on the robustness of risk managementarrangements throughout the Trust. Specificallythe Committee has gained assurance by reviewingthe Governance Briefing Report, Standards forBetter Health Core Standards, Divisional RiskRegisters, the Corporate Risk Register and theBoard Assurance Framework. In addition theAnnual Reports of the Clinical GovernanceCommittee and the Annual Report on theDivisional Risk Registers were revised.The Trust Statement of Internal Control (SIC) wasconsidered at the meeting held on May 5th 2009and recommended to the Board for approval.With regard to ‘Assurance’ the Audit CommissionReport entitled ‘How do Boards get theirAssurance’ was discussed in detail and a Trustwide review followed at Board level aided by adetailed paper on the subject prepared by theAssociate Director of Corporate Affairs.External AuditThe Trust’s External Auditors,PricewaterhouseCoopers (PwC) were re-appointedas Auditors of the Trust for the financial year2009/10 at the Council of Governors Meeting heldon August 7th 2009 and their audit fee for theyear approved. Their reappointment for 2010/11will be considered following the conclusion of the2009/10 audit. The Committee has reviewed thework and findings of the External Auditors by:-• Discussing and agreeing the scope and cost ofaudit detailed in the Annual Plan for 2009/10.• Considering the extent of co-ordination with,and reliance on, Internal Audit.82Blackpool, Fylde and Wyre Hospitals

• Consideration of alternative mechanismsregarding self assessment of the AuditCommittee’s effectiveness• Receiving and considering the Annual AuditLetter at its meeting on June 3rd 2009, whichwas presented to the Board of Directors at itsmeeting on June 3rd 2009.• Receiving and considering reports outside thescope of audit, particularly with regard to therestatement of the prior year Accounts underIFRS.Members of the Audit Committee have also metin private with External Audit representatives soas to allow discussion of matters in the absenceof executive officers.Internal AuditThe Committee has reviewed and considered thework and findings of Internal Audit by:• Discussing and agreeing the nature andscope of the Annual Internal Audit Plan.• Receiving and considering progress againstthe plan presented by the Chief InternalAuditor and the reports consequent thereon.• Receiving reports on the AssuranceFramework, Risk Management System andStandards for Better Health.At its meeting on May 5th 2009, the Committeereceived the Head of Internal Audit Opinionwhich gave “significant assurance that there wasa generally sound system of internal control” forthe year ended March 31st 2009.Other MattersIn addition to the matters outlined in thisreport, the following areas/issues were reviewedby the Committee during the year:• Continuing Review of Clinical Audit bothin terms of staffing levels and functionaldevelopment.• Review of 2008/09 Audit Committee Report.• Review of sickness absence and mandatorytraining.• Local Counter Fraud Specialist Report andAnnual Report.• Ensuring Fraud is embedded in Trust riskregisters.• Reviewing the policy ‘Raising Concerns’(Whistle Blowing)• Presentations by PwC to the Committee onthe following subjects, Board Assurance,Information Governance, Lessons Learnt fromMid Staffs Review and Quality Accounts.• Consideration of alternative mechanismsregarding self assessment of AuditCommittees Effectiveness. This review is totake place at the May 4th 2010 committeemeeting.• Consideration of the process forconsolidation, or otherwise, of the Trust’sCharitable Funds.• Discussion regarding system for presentationof information regarding waivers to standingorders.• Continuous review of training needs forAudit Committee members and attendanceat relevant courses.Conclusion2009/10 has been a ‘developmental’ year withregard to Governance and Risk Managementthroughout the Trust. Particular emphasishas been placed on the development of ameaningful and patient centered Clinical AuditFunction. In addition considerable attentionhas been given to the lessons learnt from theMid Staffs Review and also issues around DataQuality.Looking Ahead2010/11 and beyond present many challengesboth to the NHS and Acute Trusts in particular.Increased efficiencies, improved patient careand substantial capital projects all present theirparticular challenges.The Committee will need to be strong andvigilant in its role to ensure that the Trustoperates within its agreed ratings with Monitor,particularly having regard to the economicclimate and at the same time ensure that itdelivers continuing and improving patient care.The year ahead therefore looks challengingand I take this opportunity to thank my fellowAudit Committee Members for their help andassistance during the year covered by thisreport.Paul OliveChairman of Audit CommitteeAnnual Report and Accounts April 1st 2009 to March 31st 2010 83

“On January 2nd 2010 I suffered a heart attack at Blackpool football ground.Thanks to the prompt response of the paramedic crew I was in A&E, BVH in 15minutes, where tests showed I required a by-pass, I decided to wait and havethe operation in BVH. In every department I found staff very efficient, cheerfuland professional. Every procedure was fully explained. After my operationthe excellent nursing care continued through to my transfer to BisphamHospital, where the high standards were maintained. I cannot stress enoughthe excellent care I received, without which things might have turned out verydifferent. Again, many thanks. “Mr Robert (Bob) Taylor, Ipswich84Blackpool, Fylde and Wyre Hospitals

Remuneration ReportThe membership of the Trust’s RemunerationCommittee comprises all six Non-Executive Directors,plus the Chairman. The Committee is chaired byMr Michael Brown.Membership of the Remuneration CommitteeMr Michael Brown-Chairman of the CommitteeMrs Christine BreeneMr Malcolm FaulknerMr Peter HoskerMiss Beverly LesterMr Paul OliveMr Bill RobinsonMr Nick Grimshaw-SecretaryThree meetings of the committee took place during 2009/10 with attendancesas follows:April 20th 2009Mr M Brown/Mrs C Breene/Mr M Faulkner/Miss B Lester/Mr P Olive/Mr B Robinson/Mr N Grimshaw.October 2nd 2009Mr M Brown/Miss B Lester/Mr P Olive/Mr B Robinson/Mr N Grimshaw/Mr A KehoeFebruary 24th 2010Mr M Brown/Mrs C Breene/Mr M Faulkner/Mr P Hosker/Miss B Lester/Mr P Olive/Mr B Robinson/Mr N Grimshaw/Mr A KehoeThe Committee establishes pay ranges, progression and pay uplifts forexecutive director posts and other posts that report to the Chief Executive andDirector of Operations.The Committee undertakes its duties by reference to national guidance, payawards made to other staff groups through national awards and by obtainingintelligence from specialists in pay and labour market research.At its meeting on April 20th 2009 the Remuneration Committee considered theperformance of the Trust, its Chief Executive and other directors for the year2008/2009. The Chairman of the Board of Directors assesses the performanceof the Chief Executive and the Chief Executive assesses the performance ofthe other directors and associate directors responsible to him. The Directorof Operations assesses the performance of the Divisional Associate Directors.Having considered these assessments the committee determined to uplift thesalaries of all staff for whom it sets the pay and conditions by 2.4%, the samevalue as had already been agreed nationally for all Trust staff covered byAgenda for Change pay and conditions of service. The Trust does not operateany bonus scheme in addition to basic salary for Executive Directors and othersenior staff whose pay is determined by the Committee.Annual Report and Accounts April 1st 2009 to March 31st 2010 85

All staff whose pay and conditions are set bythe Remuneration Committee are employed onsubstantive contracts of employment, i.e. not fixedterm and all have notice periods of six months.Termination payments are made in accordancewith the provisions set out in the standard NHSconditions of service and NHS pension scheme asapplied to all NHS staff.The following tables provide details of theremuneration and pension benefits for seniormanagers for the period April 1st 2009 to March31st 2010. These tables are subject to audit review.A) RemunerationName and title Year ended to 31st March 2010 2009Salary(bands of£5000)OtherRemuneration(bands of£5000)Benefits inKindrounded tothe nearest£100Total(bands of£5000)Total(bands of£5000)£000 £000 £ £000 £000B Lester - Chairman 45 - 50 45 - 50 45 - 50J Hartley - Chief Executive (to 31/03/09) 175 - 180A Kehoe - Chief Executive 165 - 170 3,300* 170 - 175 125 - 130T Welch - Deputy Chief Executive 126 - 130 126 - 130 125 - 130HG Clarke - Director of Operations 100 - 105 100 - 105 0C Siddall - Acting Director of Operations(from 04/01/10)25 - 30 25 - 30 0PR Kelsey - Medical Director 50 - 55 140 - 145 190 - 195 180 - 185A Sunderland - Director of Nursing andQuality (to 28/11/08)J Langwade - Acting Director of Nursingand Quality (28/11/08 to 01/02/09)M Thompson - Director of Nursing andQuality (from 02/02/09)MJ Gallagher - Director of Facilities (to24/10/08)BR McEwan - Acting Director of Facilities(27/10/08 to 13/03/09)R Bell - Director of Facilities (from16/03/09)0 70 - 750 40 - 45100 - 105 100 - 105 15 - 200 70 - 750 40 - 45105 - 110 105 - 110 0 - 5N Grimshaw - Director of HR & OD 105 - 110 105 - 110 105 - 110C Breene - Non-Executive 10 - 15 10 - 15 10 - 15PA Olive - Non-Executive 15 - 20 15 - 20 15 - 20M Brown - Non-Executive 10 - 15 10 - 15 10 - 15P Hosker - Non-Executive 10 - 15 10 - 15 10 - 15WG Robinson - Non-Executive 10 - 15 10 - 15 10 - 15MG Faulkner - Non-exec director 10 - 15 10 - 15 10 - 15*The non-cash payments relate to lease cars.86Blackpool, Fylde and Wyre Hospitals

Salary and pension entitlements of senior managers (continued)B) Pension benefitsName and titleReal increasein pensionat age 60(bands of£2500)Total accruedpension atage 60 at 31March 2010(bands of£5000)Real increasein relatedlump sumat age 60(bands of£2500)Related lumpsum at age60 at 31March 2010(bands of£5000)CashEquivalenttransfervalue at 31March 2010(rounded tothe nearest£1000)CashEquivalenttransfervalue at 31March 2009(rounded tothe nearest£1000)Real increasein CashEquivalenttransfervalue(rounded tothe nearest£1000)£000 £000 £000 £000 £000 £000 £000A KehoeChief ExecutiveT WelchDeputy ChiefExecutiveHG ClarkeDirector ofOperationsC SiddallActing Directorof Operations(From 04/01/10)P KelseyMedicalDirectorM ThompsonDirector ofNursing andQualityN GrimshawDirectorof HumanResourcesR BellDirector ofFacilities12.5 - 15 40 - 45 37.5 - 40 125 - 130 753 475 2540 - 2.5 25 - 30 2.5 - 5 75 - 80 343 290 877.5 - 10 40 - 45 27.5 - 30 125 - 130 875 597 2480 - 2.5 25 - 30 2.5 - 5 85 - 90 483 340 30(2.5) - 0 60 - 65 (2.5) - 0 190 - 195 1,463 1,348 4812.5 - 15 30 - 35 42.5 - 45 90 - 95 478 289 1750 - 2.5 30 - 35 0 - 2.5 95 - 100 568 493 510 - 2.5 0 - 5 0 - 2.5 0 - 5 30 0 30As Non-Executive members do not receive pensionableremuneration, there will be no entries in respect ofpensions for Non-Executive members.A Cash Equivalent Transfer Value (CETV) is theactuarially assessed capital value of the pensionscheme benefits accrued by a member at a particularpoint in time. The benefits valued are the member’sand any other contingent spouse’s pension payablefrom the scheme. A CETV is a payment made by apension scheme, or arrangement to secure pensionbenefits in another pension scheme or arrangementwhen the member leaves a scheme and chooses totransfer the benefits accrued in their former scheme.The pension figures shown relate to the benefitsthat the individual has accrued as a consequence oftheir total membership of the pension scheme, notjust their service in a senior capacity to which thedisclosure applies. The CETV figures, and from 2004/05the other pension details, include the value of anypension benefits in another scheme or arrangementwhich the individual has transferred to the NHSpension scheme. They also include any additionalyears of pension service in the scheme at their owncost. CETV’s are calculated within the guidelines andframework prescribed by the Institute and Faculty ofActuaries.Real increase in CETV - this reflects the increase inCETV effectively funded by the employer. It takesaccount of the increase in accrued pension dueto inflation, contributions paid by the employee(including the value of any benefits transferred fromanother pension scheme or arrangement) and usescommon market valuation factors from the start andend of the period.Aidan Kehoe,Chief ExecutiveAnnual Report and Accounts April 1st 2009 to March 31st 2010 87

Nominations CommitteeThe Nominations Committee is a formally constitutedSub-Committee of the Council of Governors andcomprises the Trust Chairman (Chair of the Committee)and three Governors.Membership of the Nominations Committee:-Miss Beverly Lester – Trust Chairman (Chairman)Mr Peter Askew – Elected Governor (Wyre Constituency)Mr Doug Garrett – Appointed Governor (ReBlackpool)Canon Godfrey Hirst – Elected Governor (Fylde Constituency) (until 16.10.09)There has been one meeting of the Nominations Committee during 2009/10and three of the four members were present.The Nominations Committee has the following responsibilities:-Recruitment and Appointment of Non-Executive Directors:-• To agree the skill mix and process for the appointment of Non-ExecutiveDirectors, in accordance with the Trust’s Terms of Authorisation andMonitor requirements.• To draw up person specifications for each of these posts to take accountof general and specific requirements in terms of roles and responsibilities.• Monitor’s requirements• To recommend suitable people for appointments to be ratified by theCouncil of Governors.Terms and Conditions – Chair and Non-Executive Directors:-• To recommend salary arrangements and related terms and conditions forthe Chairman and Non-Executive Directors for agreement by the Councilof Governors.Performance Management and Appraisal:-• To agree a process for the setting of objectives for Non-ExecutiveDirectors, subsequent appraisal by the Trust Chairman and feedback tothe Council of Governors.• To agree a mechanism for the evaluation of the Trust Chairman, whichwould be led by the Senior Independent Director.• To address issues related to Board development and to ensure that plansare in place for succession to posts as they become vacant so that abalance of skills and experience is maintained.Annual Report and Accounts April 1st 2009 to March 31st 2010 89

“I would like to compliment the staff of the Day Case Surgery unit, the lady inreception, the pre-op assessment staff, Mr Khan and his team, the ward staffresponsible for my aftercare all made me feel valued as a patient and did theirbest to make my visit as pleasant as possible under the circumstances. By theiractions BVH demonstrated that when it gets it right it is a hospital at the top ofits game. “Mr Austin Grayer, Blackpool90Blackpool, Fylde and Wyre Hospitals

Annex A: Quality ReportApril 1st 2009 to March 31st 2010Annual Report and Accounts April 1st 2009 to March 31st 2010 91

Part 1: Quality Narrative1.1 A Statement on Quality fromthe Chief ExecutiveI am delighted to present the Trust’s secondQuality Report for the 2009/10 period, which givesthe Trust the opportunity to demonstrate to ourpatients and staff how we have worked over thepast year to continually improve the quality ofcare we provide to our patients.We aim to provide services thatconsistently deliver the best clinicaloutcomes for our patients, which are safe,accessible and responsive to patients’needs. This Quality Report sets out howwe are progressing with this ambition andwhere we are focusing our attention tomake further progress.This report provides an overview of thequality of care delivered in 2009/10 as wellas describing how we have responded tochallenges faced by the Trust. The reportidentifies how we are performing againsttargets that enable us to measure quality,outlines the priorities for improvementover the coming year and our plans for2010/11.Over the last three years great progress has beenmade in delivering on our vision and values. Thishas been achieved by the implementation ofThe Blackpool Way which is our OrganisationalDevelopment Programme focusing on engagingstaff and harnessing their potential.The Trust continues to make great progress indelivering ‘Best in NHS’ Care. This progress wasrecognised through the Trust emphasising qualityof care, patient safety and reduction in infection,which you can read more about in the pages ofthis quality report. For the second consecutiveyear, the Trust has been named in the CHKSUK’s Top 40 Hospitals, which celebrates the bestperforming Trusts in the country. Hospitals arerated on 24 key performance indicators whichare identified in Table 10. These are critical todelivering high quality patient care. These includewaiting times, mortality rates, length of stay,hospital readmissions and infection rates. TheTrust has won a number of awards for improvingquality and patient safety. These awards include:• Communicating Patient Safety Award 2010• Best communications that has improved PatientCareAlso to ensure our Trust is a great place to work,the Trust was awarded the Investors in PeopleGold Standard Award and was named in theSunday Times 75 Best Places to Work in the PublicSector.The Trust participated in the Advancing QualityProgramme which focuses on five key clinicalareas. In two of these areas the Trust underperformed in pneumonia and heart failure.The data published related to October 2008 toSeptember 2009 and since then our performancehas improved in all areas. We are working withour clinicians with detailed action plans to ensurefurther improvements.Our plans for continuing to improve anddemonstrate quality in everything we do willevolve throughout the year. We aim to work withour staff, service users, their families and carers,Commissioners, stakeholders, Governors, Membersand the wider public in continuing to drive up thequality of our services. Contributions to developthe quality report have been received from theGovernors, Local Involvement Networks, Overviewand Scrutiny Committees together with theCorporate Governance Team.The Trust aims to achieve excellence in everythingit does and its challenges and aspirations forquality improvement are identified in the QualityStrategy which sets ambitious targets for the nextthree years in relation to direct patient care, as setout below:• Improve our hospital standardised mortalityrate.• Conform to best practice by fully implementingAdvancing Quality, 100,000 Lives and SavingLives interventions.• Reduce avoidable harms.• Improve the patient experience.The report details the approach this workwill take, the measures the Board ofDirectors have identified as being key toits delivery and how success in these areaswill be measured. This approach gives anorganisational focus to our key qualitymeasures and will ensure that we continueour journey towards delivering the ‘Best inNHS’ care.The Quality Report April 1st 2009 – March 31st2010 to the best of my knowledge and beliefcontains accurate information in relation to NHSServices provided by the Trust.Aidan KehoeChief Executive92Blackpool, Fylde and Wyre Hospitals

Part 2: Review of Quality of Performance identifyingPriorities for Improvement against 2009/10In light of the NHS, ‘High Quality Care for All’,Lord Darzi review, the Trust developed a qualityFramework which was approved by the Boardof Directors and launched in November 2008,which identified three key elements in thequality of care it delivers to its patients. Thesedefine specific targets for action.These are:• Patient safety• Clinical effectiveness• Patient experienceDetails of the priorities for quality improvementthat were agreed by the Board of Directors asoutlined in the Annual Report and Accounts2008/09 are detailed in Table 1.Table 1QualityImprovementPriorities2008/09 -2009/10Quality Improvement Performance/Outcome MeasuresReduce hospital mortality rates from 103 to 73 by 2011/12PatientSafetyReducing infection rates by 50% by 2011/12Reducing avoidable harms through the following strands of work:− Global Trigger Tool to be used to measure adverse events and reduce incidentswhich may cause harm to our patients− Falls reduction project− Reducing Medication errors by 50% by 2011/12Conformance to best practice through application of the following interventionsto improve patient outcomes:ClinicalEffectivenessPhase 1 site for the North West Advancing Quality initiative that seeks compliancewith best practice in five clinical areas:− Acute Myocardial Infarction (Heart Attack)− Hip & Knee Surgery− Cardio by-pass Surgery− Heart Failure− Community Acquired PneumoniaImplementing 100,000 Lives and Saving Lives Programme. This initiative has beenadopted by the Trust with the aim of reducing patient harm.Identifying measurable indicators of best practice resulting in reduced mortalityand improved patient experiencePatientExperience• Improving the patient experience which will be measured through animprovement in the Patient Satisfaction rating for the quality of services• Improving local patient experience survey results• Customer care programme launched to improve performance and customersatisfaction• Nursing care indicators used to assess and measure standards of clinical careand patient experience• Seeking patients’ views to improve End of Life CareAnnual Report and Accounts April 1st 2009 to March 31st 2010 93

2.1 Progress of Performance onQuality Improvement Prioritiesagainst 2009/10The Trust has continued to work throughout theyear to embed a culture of patient safety and hasmade considerable progress and improvementsin key quality measures through a number ofprogrammes to improve quality during 2009/10.A programme of work has been establishedthat corresponds to each of the four areas weare targeting. Each individual scheme withinthe programme will contribute to one, ormore, of the overall performance targets wehave set i.e. improved hospital mortality rates,reducing avoidable harms, conformance tobest practice and improving patient quality.Improvements will be delivered through theuse of The Blackpool Way, which is the Trust’sorganisational development programme andthis will be achieved by engaging with staff andsupporting them to implement changes thatwill have a positive impact on patient care. Thequality improvement priorities will continue to bemonitored and reported to the Board of Directorsas part of the Board Performance BusinessMonitoring Report and to the Committee of theBoard where appropriate.The following information provides an overviewof the quality of care provided by the Trust basedon performance in 2009/10 against the indicatorsfor patient safety; clinical effectiveness andpatient experience.2.1.1 Patient SafetyReduced Hospital Mortality RatesThe Trust received negative publicity around thepublication of the Dr Foster’s reports on mortality.Since its publication we have made furtherimprovements to our mortality rates as outlinedbelow.The Trust has worked with an independentbenchmarking company over the last five yearsto track hospital mortality rates and take actionwhere rates have been seen as high. In October2008 the Trust had a Risk Adjusted MortalityIndex (RAMI) score of 103. The graph belowidentifies the Trust now has a RAMI of 79. Webelieve that we can improve on this and achieve a10-point reduction in our RAMI, year on year forthe next three years. We therefore set ourselvesthe goal of delivering a RAMI of 73 by thefinancial year 2011/12. Based on 2007/08 RAMIdata achieving our goal will result in 573 fewerdeaths occurring in hospital per year. The Trustis well on the way to delivery of its goal with a22-point reduction in the RAMI from the October2008 baseline as identified in graph 1 below.The reduction in RAMI was achieved byidentifying those schemes which would enhancepatient safety by improving the management ofthe deteriorating patient and by implementingharm reduction strategies such as reducingmedical outliers, hospital acquired infections andmedication errors. Progress on all those objectiveshas been reported to the Board on a regularbasis. The emphasis has been on improvingprocesses so that the improvements are local,measurable and immediate and are owned by theteam providing the care.Graph 1Mortality Trending1210RiskRating080604020April 08May 08June 08July 08Aug 08Sept 08Oct 08Nov 08Dec 08Jan 09Feb 09March 09April 09May 09June 09July 09Aug 09Sept 09Oct 09Nov 09Dec 09Jan 10Feb 10March 10HSMRLinear HSMR94Blackpool, Fylde and Wyre Hospitals

Reducing Infection RatesMethicillin Resistant Staphylococcus Aureus(MRSA)Following the significant reductions inMethicillin Resistant Staphylococcus Aureus(MRSA) Bacteraemia (78%) in 2008/2009,the Trust has continued to embed InfectionPrevention principles across the organisation toensure that the risk of acquiring an infection forpatients is further reduced. The Department ofHealth continues to monitor MRSA bacteraemiarates; the agreed trajectory target for 2009/2010is 26, although the Trust has adopted a localtrajectory target of 13.MRSA Bacteraemia rates continue to fall andfrom April 2009 – March 2010 there have beeneight MRSA Bacteraemias, only three of whichare attributed to the Acute Trust. The remainingfive are attributed to the relevant PrimaryCare Trusts as an infection that developed inthe community as opposed to occurring inthe hospital. During the same time period in2008/2009 there had been eight cases of MRSABacteraemia which demonstrates a reduction in2009/10 as shown in graph 2 below.Clostridium DifficileClostridium Difficile is an organism which maybe present in the faecal flora of asymptomaticcarriers. Clostridium Difficile is found inapproximately 2% of normal adults. Thispercentage rises with age and the elderly havecolonisation rates of 10-20%, depending onrecent antibiotic exposure and time spent inan institution. Symptomatic patients are thosewhose stools contain both the organism and thetoxins which it produces, and have diarrhoea.Those patients who are most at risk of acquiringClostridium Difficile diarrhoea are the elderly,those on antibiotic therapy and surgicalpatients. Antibiotic administration is the mostimportant risk factor for Clostridium Difficilediarrhoea, which is also known as AntibioticAssociated Diarrhoea. The clinical features ofClostridium Difficile infection can range fromdiarrhoea alone, to diarrhoea accompaniedby abdominal pain and pyrexia to pseudomembranouscolitis (PMC) with toxic megacolon,electrolyte imbalance and perforationFollowing the significant reductions inClostridium Difficile Infection (33%) in2008/2009, the Trust has continued to embedmeasures to reduce levels further withinthe organisation. There were 241 cases ofClostridium Difficile Infection (CDI) betweenApril 2009 and March 2010, in comparisonto 315 in the same period last year. Thisdemonstrates a percentage reduction of 24%which is above the 17% yearly reductionincorporated into the three-year plantrajectories. Of the 241 cases for 2009/10, 134have been attributed to the Acute Trust. TheTrust is required to achieve a 52% reduction inCDI rates from the 2007 level, by 2011.Graph 23MRSANumber ofBacteraemias210April 08May 08June 08July 08Aug 08Sept 08Oct 08Nov 08Dec 08Jan 09Feb 09March 09April 09May 09June 09July 09Aug 09Sept 09Oct 09Nov 09Dec 09Jan 10Feb 10March 10MonthsMRSA Bacteraemia Linear (MRSA) BacteraemiaAnnual Report and Accounts April 1st 2009 to March 31st 2010 95

Graph 3Clostridium DifficileNumber ofClostridiumDifficile454035302520151050April 08May 08June 08July 08Aug 08Sept 08Oct 08Nov 08Dec 08Jan 09Feb 09March 09April 09May 09June 09July 09Aug 09Sept 09Oct 09Nov 09Dec 09Jan 10Feb 10March 10MonthsC.DiffLinear (C.Diff)Global Trigger ToolTraditionally the Trust’s efforts to detect anddeal with adverse events have focused onreporting and tracking of errors. However,research published by the Institute for HealthcareImprovement has shown that only 10 to 20% oferrors are reported and of those, 90 to 95% causeno harm to patients. The Trust has thereforedecided to adopt the IHI Global Trigger Tool tomeasure adverse events. The Global Trigger Toolis a method to measure events of harm thatmay happen to a patient during their admissionand stay in an acute hospital. This is an easy-tousemethod for accurately identifying eventsthat cause harm to patients and measuringthe rate at which they occur. It also providesinformation on whether changes being made,in response to adverse incidents, are improvingsafety. Data collection commenced in February2009 therefore no annual comparative data isyet available, however, graph 4 and 5 identifiesthe data available of the total number of harmsfrom February 2009 – March 2010. We haveimplemented a monthly review of 20 sets of casenotes using the Global Trigger Tool. We now havean effective way to identify events that do causeharm to patients in order to quantify the degreeand severity of the harm, and to select andtest changes to reduce them. To date we havereviewed over 300 sets of case notes. A quarterlyreport is produced and submitted to the Boardfor monitoring.Graph 4Total Harms2018Number of Harms1510501148379 61143 26 6FebMarAprilMayJuneJulyAugSeptOct2009 through 2010NovDecJanFebMarTotal HarmsPoly. (Total Harms)The purple curves are 12 month trend lines and show a steadydecrease in harms per thousand bed days over the year96Blackpool, Fylde and Wyre Hospitals

Graph 5Harms per 1000 bed days0.600.500.400.300.200.100.000.450.150.310.130.30 0.300.180.540.030.100.450.060.19 0.19FebMarAprilMayJuneJulyAugSept2009 through 2010OctNovDecJanFebMarharms per 1000 bed daysPoly. (Harms per 1000 bed days)Falls Reduction ProjectA patient falling in hospital is the most commonpatient safety incident reported to the NationalPatient Safety Agency. Although the majorityof falls cause no harm, even falls without injurycan lead to poor mobility and lack of confidencefor the patient. Between April 2008 and April2009, 2,888 patients experienced a slip, trip orfall while in hospital. There are many initiativeswithin the Trust to assist in the prevention andreduction of patient falls and the table belowshows a comparison of the slips, trips andfalls between 2008/09 and 2009/10. The dataidentifies an overall reduction in slips, trips andfalls for each consecutive month apart from themonths in April, May and August 2009, whichdemonstrated a slight increase. A number ofpatient falls initiatives have contributed to thereduction in in-patient falls as identified ingraph 6 below:• Intensive support and training has beengiven to a particular ward within theMedical Division to raise awareness of fallsprevention. This has resulted in a 44%reduction in the number of falls from 25 to11 in a five month period June – October2009 compared to the same period last year.This intensive support is being rolled outacross other areas within the Trust.• The Medical Division has introducedmovement sensors both on the acute wardsand in the community hospitals for patientswho are identified to be at high risk offalling. The sensors are discreet and can beplaced either under the mattress of the bed,or on the chair if the patient is sat out. Thesensors alert the nurses via a pager systemif a patient attempts to get out of bedunaided. The sensors have already helpedprevent potential injury to patients as thenursing staff have been alerted swiftly andassistance can be given.Graph 6 Slips, Trips and Falls2008/20092009/2010350300250200150100500AprilMayJuneJulyAugSeptOctNovDecJanFebMarchAnnual Report and Accounts April 1st 2009 to March 31st 2010 97

Reducing Medication errors by 50% by2011/12Incidents involving medicines were the thirdlargest group (9%) of all incidents reported to theNational Reporting and Learning Service (NRLS)after patient accidents (35%) and treatment /procedure (9%) from a total of 811,746 incidentsof all types reported during 2007.Much work has been undertaken withinPharmacy to improve the safety of Medicineswithin the Trust. As stated in the previous year’sQuality Report we have continued to workwithin clinical professions encouraging a culturethrough which medication incidents are reportedin a timely manner. The number of medicationincidents that are reported is increasing asidentified in graph 7 below, thus acknowledgingthe increased awareness and commitment of staffto ensure that patient safety and professionalaccountability is maximised with the safemanagement of medicines within the Trust.Graph 7 Medication Errors2008/20092009/201070605040303651415226573850463937503563344550 494231 34 36554320100AprilMayJuneJulyAugSeptOctNovDecJanFebMarchIncreased trainingThe Practice Development Sister has reviewed andupdated both the Administration of Medicinesand the Intravenous Administration of MedicinesTraining packages. These now include newprofessional standards, and reflect currentchanges in legislation and organisational policies.The training sessions have been increased tofurther engage professionals with the NationalPatient Safety Agency Alerts and the impact onensuring the safe delivery of medicines to inpatientsand outpatients.To ensure a collaborative and standardisedapproach to the safer management of medicinesthe training packages are now designed to meetthe needs of other Allied Health Professionals, andtraining is now provided for radiographers andphysiotherapists who administer medicines as partof their duties. This has developed a very interprofessionalapproach to medicines managementat all stages of the patients journey.The number of training sessions has beenincreased to monthly to allow access to theincreasing number of professional staff who areinvolved in medicines and to ensure that staffare equipped with the knowledge and skills thatensure medicines are administered to patientssafely.In response to the Nursing and Midwifery Council(NMC) requirements regarding Pre-registrationstudent nurses, training is provided at 1st 2ndand 3rd year stages of the students’ progressionthroughout the course. The Practice DevelopmentSister has ensured that the contents of thetraining packages not only reflect the learningoutcomes of the Higher Education Institution ateach key stage, but also ensure that at point ofregistration the student has met the essential skillsclusters and is prepared for practice.Medicines Management Training is given to allFY1 and FY2 Doctors as part of their InductionTraining on commencement with the Trust.The Administration of Medicines/MedicinesManagement Training has now becomeMandatory for nurses and allied healthprofessionals within the Trust.98Blackpool, Fylde and Wyre Hospitals

Bulletin Safety alerts involving medicinesAll safety alerts are cascaded to clinical areasthrough designated Medicines ManagementLiaison Link Nurses in the form of MedicinesMatter Bulletins. This ensures that informationregarding high-risk medicines or practice isdisseminated at point of care.Introduction of new products to improvepatient safetyThe introduction of pre-filled saline medicaldevices is being rolled out across all clinicalareas. This device will reduce the risks associatedwith the preparation of an injectable medicineand the risk of microbial contaminationassociated with this procedure. This will alsoreduce the use of needles being used andtherefore, the risk of needlestick injuries tostaff. This meets best practice guidelines asidentified in the National Patient Safety Agency(NPSA) Safer Use of Injectable Medicines.Medicine Audits• A Controlled Drugs audit has beenundertaken on a three monthly basis.• Prescribing Audit. Undertaken annuallyto ensure compliance with policies andprocedures and to ensure that safety withinprescribing is maximised.All audit results are presented through theMedicines Management Committee Meetingsand then disseminated to each Division alongwith requests for action plans to address anyissues or concerns. These are then reviewedat the following Medicines ManagementCommittee meeting to ensure improvements aremade.Information resourcesIncreased resources have been made availablevia the Medicines Management Intranet site;these include updates, National Patient SafetyAgency (NPSA) alerts and Medusa which is anelectronic version of the Injectable MedicinesGuide.Current audits that have been undertaken byMedicines Management are:-• All National Patient Safety Agency (NPSA)alerts are audited annually to demonstratesustained compliance with all alerts.• Omission of medicines was initiated last yearand will be audited again in response to theNPSA alert for omitted or delayed medicines.• The General Medicines Management Auditis undertaken on an annual basis andincludes the safe storage of medicines andthe competencies of staff administeringmedicines within the Trust.Annual Report and Accounts April 1st 2009 to March 31st 2010 99

100Audit ImprovementFor all prescribed drugs, omission without reasonor appropriate action should be avoided. Allefforts should be made to ensure patients receiveall medicines as prescribed to ensure that theefficacy and safety of their care is maximised. Itis apparent from the outcome of the audit thatthe correct omission codes are not being utilisedwithin clinical practice. This practice increases thepotential for medication errors to occur withinour wards causing potential harm to our patients.Medication errors have serious consequencesto the wellbeing and recovery of our patients.Documenting an incorrect code is a medicationerror, which should be reported via usualUntoward Incident Reporting Systems.Documenting a code without ascertainingthe facts e.g. recording a code 6 which is inrelation to when the patient is unable to selfadminister or when the patient does not have themedication is not only an error but a falsificationof patient records.Despite this, the results highlight that there issome room for improvement. All staff involvedin medicines administration are encouraged toreflect on current practice and identify areas forimprovement.All Divisions have been supplied with electronicaudit results for individual wards, it is anticipatedthe audit will be repeated within an agreed time.The PD Sister is available to all wards that requireadvice, support or educational sessions.The importance of correct documentationand omission coding is included in trainingpackages at induction and ongoing professionaldevelopment for Trust employees.A future Medicines Matters bulletin is plannedto highlight the correct documentation processesrequired to provide safe medicines administrationand management within the Trust.This will be disseminated to all areas viaMedicines Management Liaison Links and generaldistribution lists.This practice was reviewed and practice auditedprior to the introduction of a National PatientSafety Alert issued in Feb 2010 RRR009 Reducingharm from omitted and delayed medicines inhospital, which reflects the findings of the audititself.Action has already been taken in the provision ofTraining and Clinical Support for staff in clinicalareas as the Trust continues to improve patientsafety in relation to safer medicines managementwithin the Trust.Blackpool, Fylde and Wyre Hospitals2.1.2 Clinical EffectivenessNorth West Advancing Quality InitiativeThe Trust is one of the first sites to assist in thedevelopment of the North West Strategic HealthAuthority Advancing Quality Programme, whichfocuses on delivery of a range of interventionsfor each of the following conditions examples ofthe interventions can be found in the followinginformation and tables:• Acute Myocardial Infarction (Heart Attack)• Hip and Knee Replacements• Coronary Artery Bypass Graft• Heart Failure• Community Acquired PneumoniaResearch has shown that consistent applicationof these interventions has substantially improvedpatient outcomes resulting in fewer deaths, fewerhospital readmissions and shorter hospital lengthsof stay.Applying all the interventions will support ourgoals of reducing hospital mortality, reducingpreventable harms and improving patientoutcomes, thereby improving the quality of theirexperience. The Trust is on track to achieve top25% performance for Acute Myocardial InfarctionMeasures and top 50% performance for Hip andKnee. Work is ongoing to improve and implementmeasures and achieve top 25% performanceacross all conditions. Approximately 2,700patients a year will benefit from this programme.The Patient Experience aspect of the AdvancingQuality programme is now being measured. Assoon as robust data is available the Trust willidentify and implement any actions required toimprove the patient experience.Comparison of DataFor each of the key areas (a series of appropriatepatient care measures have been determinedwhich are known as Composite of Score (CQS).Data is collected to demonstrate if thesemeasures are being met and a composite qualityscore for each key area is derived for everyTrust in the programme. From this data theperformance thresholds for top 25% and 50%performance are identified and applied to eachTrusts performance).Trusts in the top 25% performer group willreceive an incentive payment of 4% of tariff,whilst Trusts in the top 50% performer group(who are not in top 25% group) will receive anincentive payment of 2% to be used to improvepatient care.

A Trust’s score must exceed the threshold inorder to receive payment.Trust on track for top 25% paymentTrust on track for top 50% paymentNot on Track for paymentTrust performance against each of the five keyareas is detailed below. A Clinical Lead andOperational Manager have been identified foreach key area and meetings are held to identifythe actions required to improve scores achievedto date.Acute Myocardial InfarctionAcute Myocardial InfarctionReviewThe performance of the Cardiologists in treatingthe Acute Myocardial Infarction patients isexcellent. There will always be a number ofpatients who will be unable to receive Aspirinand Beta-Blockers. The Cardiac Division willendeavour to improve on the counselling ofpeople to stop smoking.Trust PerformanceMeasureOct 08 -Dec 08Oct 08 –Mar 09Oct 08 –June 09Oct 08 –Sept 09Aspirin at arrival 100.00% 100.00% 100.00% 100.00%Aspirin prescribed at discharge 100.00% 98.97% 99.20% 99.40%ACEI or ARB for LVSD 100.00% 100.00% 100.00% 100.00%Adult smoking cessation advice/counselling 100.00% 95.45% 96.00% 92.86%Beta Blocker prescribed at discharge 100.00% 97.73% 97.35% 98.03%Beta Blocker at arrival 100.00% 100.00% 99.07% 99.07%Fibrinolytic therapy received within 30 minutes of hospitalarrivalPrimary Coronary Intervention (PCI) received within 90minutes of hospital arrival100.00% 100.00% 100.00% 100.00%100.00% 100.00% 100.00% 100.00%Survival Index 96.00% 96.76%Acute Myocardial Infarction (AMI) Composite QualityScore (CQS)100.00% 98.99% 98.47% 98.55%Top 25% CQS Threshold 95.82% 96.33% 96.79% 97.02%Top 50% CQS Threshold 93.1% 92.74% 92.82% 94.40%Trusts in top 25% performer group will receive an incentive payment of 4%Trusts in top 50% performer group (who are not in top 25% group) will receive an incentivepayment of 2%A Trusts score must exceed the threshold in order to receive payment.Trust on track for top 25% paymentTrust on track for top 50% paymentNot on Track for paymentAnnual Report and Accounts April 1st 2009 to March 31st 2010 101

Coronary Artery Bypass GraftSurgery (CABG)ReviewThe management of patientsundergoing Coronary Artery BypassGraft surgery is excellent; however,the discontinuation of antibioticswithin 24 hours is low. Our practisepreviously has been to prescribethe antibiotics without a stop date.These prophylactic antibiotics arenow only prescribed for one day. Ifthe antibiotics have to be continuedfor a longer period, the prescriptionhas to be re-written and the reasonfor this has to be documented inthe patient’s notes. The Directorateis optimistic that this will see animprovement in this parameter.Coronary Artery Bypass Graft (CABG) SurgeryMeasureOct 08 -Dec 08Trust PerformanceOct 08 –Mar 09Oct 08 –June 09Oct 08 –Sept 09Aspirin prescribed at discharge 98.19% 99.08% 99.38% 99.53%Prophylactic antibiotic received within 1 hour prior tosurgical incision93.64% 95.29% 95.26% 94.71%Prophylactic antibiotic selection for surgical patients 96.70% 97.21% 97.74% 98.14%Prophylactic antibiotics discontinued within 24 (48) hrsafter surgery end time82.14% 82.93% 81.57% 82.15%CABG Composite Quality Score (CQS) 92.74% 93.71% 93.60% 93.77%Top 25% CQS Threshold 95.63% 97.56% 98.35% 98.71%Top 50% CQS Threshold 92.74% 93.71% 94.65% 95.01%Trusts in top 25% performer group will receive an incentive payment of 4%Trusts in top 50% performer group (who are not in top 25% group) will receive an incentive paymentof 2%A Trust’s score must exceed the threshold in order to receive payment.Trust on track for top 25% paymentTrust on track for top 50% paymentNot on Track for paymentAnnual Report and Accounts April 1st 2009 to March 31st 2010 103

Heart FailureReviewHeart Failure management is one of fiveareas highlighted by the Advancing Qualityprogramme. It is entirely deserving of suchattention. Nationally and in our own Trust,Heart Failure is responsible for approximately10 hospital admissions per week, each lastingon average eight days. These patients are athigh risk of in hospital mortality and followingdischarge are at ongoing risk of readmission orother serious event. Over recent years advancesin pharmacological and non-pharmacologicaltreatments, including simple education andlifestyle changes, offer significant improvementin prognosis and symptom control for thesepatients. Such benefits also translate intofinancial benefits for the NHS as a whole;hospital admission for patients with heart failureis responsible for 2% of the total NHS budget.Unfortunately the uptake of these treatments,not only locally but also nationally has been verypoor. This is clearly evidenced on a National levelby recent analysis of the National Heart FailureDatabase.In this Trust, improvement in the managementof in-patients with Heart Failure is only partof our Heart Failure Strategy. Over the lasttwelve months we have developed a service tomanage patients from pre-diagnosis that are atrisk or with symptoms in primary care, througheducation, increase of a new medication ofmedical therapy and surveillance. Our approachaims to meet all of the patient care measureshighlighted by the Advancing Quality agenda,not only for in-patients but also for thosecurrently at home and otherwise at risk ofadmission. Although our service is only in itsinfancy the systems we have in place are alreadybeginning to offer benefit to large numbersof patients. Unfortunately this is not yet beingreflected in the Advancing Quality data.The poor performance figures highlight thefact that we are not engaging with individualpatients. Only less than 70% are having theirdiagnosis confirmed by echocardiogram. Whilethe majority of those with formal diagnosis doreceive appropriate medical therapy (AngiotensinConverting Enzyme Inibitors ), it is not allpatients. The lack of education and lifestyleadvice, the lack of specialist follow up is almostcertainly contributing to the high readmissionrate that we know exists. If a patient is identifiedas having, or being at risk of having, heart failureduring their admission and their basic details arepassed to our team we have systems in place toensure that Advancing Quality Care measures aremet• We have expanded the role of the CardiacRehabilitation Team such that all patients willbe assessed; receive educational materials andadvice before discharge.• Our Specialist Nursing Team will ensureechocardiogram is performed duringadmission• That all patients have Angiotensin ConvertingEnzyme Inibitors and beta blocker therapyinitiated before discharge unless contraindicated. This will be monitored as an outpatientthrough specialist follow up, either inhospital or in the community depending onindividual need.• Levels of surveillance will be arrangedto minimise readmission rate and bettersupporting management of the majority ofpatients at home.Unfortunately symptoms and signs of HeartFailure are neither specific to, or sensitive of thediagnosis. Identification of the condition requiresexpertise and specialist investigation. Thesepatients present largely to General Physiciansand they often have complex co-morbidities,which not only complicate but also often maskthe diagnosis. Our greatest challenge is bringingall patients with heart failure as a cause of theiradmission to the attention of our specialist teambefore discharge. We have recently put thefollowing systems in place:• Planned daily attendance on the ClinicalDecision Unit to identify patients with heartfailure or with significant risk of Heart Failure.• A Heart Failure Integrated Care Pathway isin print – highlighting best practice in themanagement of heart failure from admissionto discharge and the need for referral of all toour team.• Request of all medical ward nursing andmedical staff to refer all other patients withheart failure to our team.• Retrospective monthly audit of all patientscoded as heart failure – highlighting wardsfrom which patients are not referred.104Blackpool, Fylde and Wyre Hospitals

Heart FailureMeasureOct 08 -Dec 08Trust PerformanceOct 08 –Mar 09Oct 08 –June 09Oct 08 –Sept 09Discharge instructions 2.70% 1.27% 2.21% 7.33%Evaluation of LVS Function 59.46% 66.46% 68.72% 70.20%ACEI or ARB for LVSD 100.00% 80.00% 76.92% 76.06%Adult smoking cessation advice/counselling 25.00% 28.57% 33.33% 27.78%Heart Failure Composite Quality Score (CQS) 32.69% 36.44% 38.72% 42.40%Top 25% CQS Threshold 70.37% 73.91% 75.67% 74.65%Top 50% CQS Threshold 57.94% 55.94% 57.50% 59.60%Trusts in top 25% performer group will receive an incentive payment of 4%Trusts in top 50% performer group (who are not in top 25% group) will receive an incentivepayment of 2%A Trust’s score must exceed the threshold in order to receive payment.Trust on track for top 25% paymentTrust on track for top 50% paymentNot on Track for paymentAnnual Report and Accounts April 1st 2009 to March 31st 2010 105

Community Acquired PneumoniaReviewValidated data is now available until August 2009according to which the Trust is under-performingin all five-quality parameters.A review of case notes and previous auditshighlighted three areas of improvement inrelation to: coding, documentation and process ofcare. Since patients with pneumonia move acrossvarious departments in two Divisions, close andcollaborative working is essential.To address these issues the following actions havebeen taken so far:• Establishment of a project team, which hasrepresentation from Clinical Support Servicesand Medicine. This team includes clinicians,nursing staff and managers and meets on amonthly basis.• A clear action plan identified below has beenagreed and progress is followed regularly.The following tasks have been completed so far:• Introduction of clear clinical guidelines andposters.• Establishment of an educational program toincrease awareness among front line staff.• Weekly meeting with coder to review notesand ensure accuracy.• Introduction of a clearly visible sticker to alertstaff and improve documentation of all fivemarkers.• Introduction of stop smoking stickers to beused in medical wards and stop smokingtraining for staff in conjunction with publichealth services.The challenge now is to ensure that theseinitiatives are implemented at the front lineand lead to improvement in care with activeparticipation and engagement of the staff.We are now collecting real time data to betterinform all those involved in the project and hopethat regular feedback will provide a stimulusfor improvement. Figures from December 2009indicate some improvement as identified in thegraph below. We do however, realise that furtherwork needs to be done to fulfil our aspiration ofbeing in the top 25% of trusts.Community Acquired PneumoniaMeasureOct 08 -Dec 08Trust PerformanceOct 08 –Mar 09Oct 08 –June 09Oct 08 –Sept 09Oxygenation Assessment 94.38% 94.64% 96.00% 96.89%Blood cultures performed in Accident and Emergencyprior to initial antibiotics received in hospital26.09% 21.13% 16.22% 17.09%Adult smoking cessation advice/counselling 25.00% 15.52% 11.25% 10.20%Initial antibiotic received within 6 hours of hospital arrival 52.00% 63.71% 62.65% 54.21%Initial antibiotic selection for Community AcquiredPneumonia (CAP) in immuno competent patients80.77% 52.05% 52.78% 67.13%Pneumonia Composite Quality Score (CQS) 70.43% 62.76% 61.05% 62.08%Top 25% CQS Threshold 81.18% 81.30% 81.93% 82.11%Top 50% CQS Threshold 78.26% 74.63% 74.40% 74.77%Trusts in top 25% performer group will receive an incentive payment of 4%Trusts in top 50% performer group (who are not in top 25% group) will receive an incentivepayment of 2%A Trust’s score must exceed the threshold in order to receive payment.Trust on track for top 25% paymentTrust on track for top 50% paymentNot on Track for payment106Blackpool, Fylde and Wyre Hospitals

Table 2 identifies actions to be taken to improve the management of patients with pneumonia.Table 2ISSUE ACTION BY WHENLimited awareness ofAdvancing Quality (AQ)within the Trust / Divisions.No suitable doctors atpresent to identify ClinicalChampion on ClinicalDecision Unit (CDU).Collation of baseline dataData Collection and Premierreports 3-6 months inarrears, which prevent realtime improvements.Poor use of Pink CAPidentification stickers inpatients admitted throughA&E and CDU.X-ray marker / diagnosisresults not identified anddocumented in A&E andCDU.Blood cultures notperformed in A&E and CDUprior to administrationof antibiotics and / ordocumented with time.Oxygen saturationassessment not performedand/or documented onadmission in A&E and CDU.Antibiotics not receivedwithin 6 hours of hospitalarrival for every patient.Training Plan to be populated for the year to captureall medical staff within Clinical Support Services Divisionand the Medical Divisions.Pneumonia posters to be developed and displayed inAccident and Emergency (A&E) and Clinical DecisionUnit (CDU).Guidance to be put online in the resource centre andposters to be displayed in clinical areas.Training for nursing staff on CDU/A&EIdentify clinical champion following upcominginterviews and interim solution.Allocate Medical Registrar to carry out retrospectiveaudit to identify baseline for comparison of 5 markersplus mortality and length of stay.Real time data week on week to be obtained from theinformation department and circulated to all the team.Reports to be analysed for areas where improvementsneed to be made to improve performance against 5markers and solutions implemented.Monthly data from Premier to be validated prior tosubmission.Pink Community Acquired Pneumonia (CAP) stickers tobe inserted into notes at triage in A&E and on admissionin CDU for all patients with respiratory problems.Improved training of medical staff in A&E and CDU reAQ, documentation requirements and use of pink CAPstickers as an aide memoir.Improved training of medical staff in A&E and CDUre AQ, documentation requirements and use of pinkstickers as aide memoir.Improved training of nursing staff in A&E and CDU reAQ, documentation requirements and use of pink CAPstickers as aide memoir.Improved training of nursing and medical staff in A&Eand CDU re AQ, documentation requirements and useof pink stickers as aide memoir.End January2010End January2010EndDecember2009OngoingEnd January2010End January2010 due toworkload /AL.OngoingOngoingOngoingEnd JanuaryOngoingOngoingOngoingOngoingCONTINUED OVERLEAFAnnual Report and Accounts April 1st 2009 to March 31st 2010 107

Table 2ISSUE ACTION BY WHENInitial antibiotic selectionfor CAP immuno-competentpatients not appropriate forevery patient.Smokers or ex-smokers notalways identified in medicalor nursing notes.Improved training of medical staff in A&E and CDUre AQ, documentation requirements, use of pink CAPstickers and antimicrobial formulary as aide memoir.Improved training of nursing and medical staff inA&E, CDU and medical wards re AQ, documentationrequirements and use of green smoking Cessationstickers as aide memoir.OngoingOngoingSmoking cessation advicenot given to all smokers orthose who have given up inlast 12 months.Identify smoking cessation champion for each medicalward and provide training.Incorporate smoking cessation awareness and includeweekly audit into the role of identified Band 5.End January2010End January2010Staff unaware of adviceavailable for smokingcessation.Stop Smoking Training for all A&E/CDU staff.OngoingPatients with CAP notalways admitted torespiratory wards.Bed Managers bleep 877 to ensure Pneumonia patientsare admitted to the Respiratory Wards whereverpossible.Patients with Community Acquire Pneumonia to beidentified on whiteboards on each medical ward.OngoingEnd January2010Lead Respiratory Nurse to identify patients admitted in24-hour period from CDU each day and flagged up.OngoingImplementing 100,000 Lives and SavingLives ProgrammeThis initiative, which was launched by theInstitute for Healthcare Improvement andDepartment of Health, has been adopted by theTrust. As with the Advancing Quality Programmethey deploy evidence-based interventions withthe aim of reducing patient harm. The outcomefrom implementing these measures will be:• Improving outcomes for patients who havesuffered a heart attack.• Reducing the incidence of surgical siteinfection.• Early identification and treatment of patientswith worsening conditions.• Reduced infection due to central lineinsertion.• Reduced surgical infections.• Elimination of ventilator associatedpneumonias in critical care.• Reducing the risk of microbial contamination.• Reducing the incidence of catheter relatedbloodstream infection.All patients will benefit from these changes.We have put in place mechanisms to auditboth compliance and impact on patient care ofimplementing these two initiatives and we willbe monitoring their contribution to reducingmortality rates and reducing preventable harm.In addition to the above the Trust will beseeking to continue to implement best practiceas set out in the ‘Map of Medicine’ and NationalInstitute for Health and Clinical Excellence (NICE)guidelines.The first two outcomes have been reported onin this report as detailed below, however, theTrust anticipates having further data availableand all outcomes will be reported in the nextfinancial year.108Blackpool, Fylde and Wyre Hospitals

Improving Outcomes For Patients WhoHave Suffered A Heart Attack RapidResponse Team - Reducing CardiacArrest CallsThe Trust provides data regarding in-hospitalcardiac arrest calls to the Care of the AcutelyIll Group/Resuscitation Committee everymeeting (two monthly) and provides a detailedpresentation every six months.We also discuss action plans for reducing inhospitalcardiac arrests and embedding Do NotAttempt Resuscitation (DNAR) principles at eachmeeting.The number of in-hospital cardiac arrests for theperiod 1st April 2009 – 31st March 2010 is 263.This is represented in Graph 8 below.The following information provides an overviewof some of the initiatives that the Trust hasundertaken to reduce the number of in-hospitalcardiac arrests from April 2009 to March 2010:• Advanced Life Support education has beenincreased.• Immediate Life Support education has beenincreased.• Early Warning Score and Do Not AttemptResuscitation (DNAR) education has beenincreased.• DNAR focus groups have commenced• Critical Care Outreach Service has beenimplemented.Reducing the Incidence of Surgical SiteInfectionMandatory Orthopaedic surveillance and arolling programme of Divisional Surgical Siteinfections has been conducted to monitor thelevels of infections. Issues highlighted fromsurveillance will be utilised to improve practiceacross the Trust.A random sample of 160 patients were auditedto comply with the mandatory surveillance.From the audit two patients acquired infectionswhilst in-patients, this may have occurred due tothe patients self interference with their wounddue to their confused mental state.The Divisional surgical site surveillance onlystarted mid 2009 and will be reported in thenext financial year 2010 / 2011.Identifying measurable indicatorsof best practice resulting in reducedmortality and improved patientexperienceWork is on-going with our clinical teams toidentify measures considered to be indicators ofbest practice across a range of focus areas. Thesewill be monitored and reported to the Board ofDirectors, with results expected to show reducedmortality and improved patient outcomes andprovide assurance that the Trust is deliveringBest in NHS care.Graph 8In-Hospital Adult Cardiac Arrest Calls per MonthApril 2009-March 2010 Cardiac Arrest Figures302520Total151050AprilMayJuneJulyAugSeptOctNovDecJanFebMarchApril - MarchAreaAnnual Report and Accounts April 1st 2009 to March 31st 2010 109

2.1.3 Patient ExperienceImproving the National In-PatientExperience Survey ResultsThe National In-Patient Experience Survey isundertaken on an annual basis. The followinginformation provides comparison of data takenfrom The National In-Patient Experience Surveyresults in relation to the following three indicatorsin which the results for 2008 in comparison to2009 is identified in Table 3 below.The four questions were chosen as Privacy andDignity and Respect is high on the Trust agendaand so is the cleanliness and hygiene of thehospital. The questions in relation to noise atnight and hospital food were chosen followingconsultation with the public. The Trust wantsto ensure that these areas improve year on yearand an action plan has been developed to ensureimprovements are made.Table 3 - National In-Patient Experience SurveyIndicator 2008 Result 2009 ResultIn your opinion, how clean wasthe hospital room or ward thatyou were in?Very clean - 70% of patientsstated that the hospital or roomwas very clean (national averagewas 60%)Very clean - 72% of patientsstated that the hospital or roomwas very clean (national averagewas 65%)Were you given enough privacywhen being examined ortreated?Overall, did you feel you weretreated with respect anddignity while you were in thehospital?Were you bothered by noise atnight fromOther Patients:Were you bothered by noise atnight fromHospital StaffHow would you rate thehospital food ?Yes always - 89% of patientsstated that they were alwaysgiven enough privacy when beingexamined (National average was89%)Yes always - 81% of our patientsfelt they were treated withrespect and dignity whilst theywere in hospital. (Nationalaverage 80%)Yes - 38% of our patients didexperience noise at night due toother patients.Yes - 19% of our patients didexperience noise at night due tohospital staff.The majority of our patients ratedthe food highly with 36% rating itas very good and 38% as good.Yes always - 91% of patientsstated that they were alwaysgiven enough privacy when beingexamined (National average was89%)Yes always - 81% of our patientsfelt they were treated withrespect and dignity whilst theywere in hospital. (Nationalaverage 80%)Yes – 37% of our patients didexperience noise at night due toother patients(National average was 39%)Yes – 24% of our patients didexperience noise at night due tohospital staff(National average was 22%)The majority of our patients ratedthe food highly with 34% ratingit as very good and 40% as good.(National average was 21% verygood and 36% good.110Blackpool, Fylde and Wyre Hospitals

Improving Local Patient ExperienceSurvey ResultsThe local In Patient Experience Surveys areconducted monthly as a measure of whatour patients feel about their experience inour hospital wards. The questionnaires arecompleted whilst patients are still an inpatientensuring that we have real time feedback abouthow our services can be improved and what weare doing well. The results of the surveys arepresented to the Board and are shared with theClinical Divisions.The In-Patient Survey comprises of questionstaken from a sample of questions from thenational surveys. The questions are in fourdomains:1. The Ward Environment and InfectionProtection2. The Staff at the Hospital3. Your Care and Treatment4. Leaving the HospitalThe results of the survey are shown in Table 4and 5 below.Table 4 - Local In-Patient SurveyDomain April – June 09The ward environment and infection protection 95%The staff at the hospital 90%Your care and treatment 94%Leaving the hospital 96%Table 5 - Local In-Patient SurveyJul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10The ward environmentand infection protection94% 95% 95% 94% 95% 94% 95% 94% 95%The staff at the hospital 89% 90% 88% 87% 88% 87% 86% 87% 86%Your care and treatment 90% 91% 91% 90% 91% 91% 92% 91% 92%Leaving the hospital 83% 96% 96% 94% 96% 96% 96% 96% 96%The above percentage relates to positive responses to questions.The surveys have been conducted since April 2009, initially on a three monthly basis and since July 2009on a monthly basis as shown in Graph 9 and Graph 10 below.Graph 9Local In Patient Experience Survey 3 Monthly98%96%92%90%88%86%84%82%April - June 09July - Sept 09Oct - Dec 09Jan 10 - Mar 10The wardenvironment andinfection protectionThe staff atthe hospitalYour careand treatmentLeaving thehospitalAnnual Report and Accounts April 1st 2009 to March 31st 2010 111

Graph 10Local In Patient Experience Survey Monthly100%95%90%85%80%75%Jul-09Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-09 Feb-09 Mar-09The wardenvironment andinfection protectionThe staff at thehospitalYour care andtreatmentLeaving thehospitalThe Trust has consistently maintained a stablepercentage of between 90% and 92%. Thequestion “Leaving the hospital” has beenconsistently the highest domain between 92%and 96%. This survey has been used to measureour compliance with delivering the single sexaccommodation agenda, and will continue to do so.More work needs to be done around the quantityof forms being completed and Senior Nurses aretasked within their Divisions to find ways in whichto improve this, and to address areas wherefurther improvement is indicated.It has been noted that forms that are currentlybeing completed is increasing on each survey.Customer care programme launchedto improve performance and customersatisfactionOver the last few years the Trust has beencommitted to improving the patient experience,of our patients. We invested heavily in a “BeingWith Patients” programme to improve customerservice to patients, with a message aboutcaring for them how they want to be caredfor, not how we want to do it. This includedeffective communication methods, and physicalapproach. We commissioned a company calledPurple Monster to take the messages furtherbetween staff and to develop some customer carechampions across the organisations.In 2010 we are developing this further withmore training and action learning sets and this issupported by our recent staff survey results, theachievement of Investors in People Gold status,and recognition as the 49th Best Place to Work inthe Public Sector.Customer care qualities in our staff are alsoassessed during appraisals as part of ‘Being theBlackpool Person’.Nursing Care IndicatorsThe Nursing Care Indicators are used to assess andmeasure standards of clinical care and patientexperience. The framework for the nursingcare indicators is designed to support nurses inpractice to understand how they deliver care,identify what works well and where furtherimprovements are needed.We have been monitoring nursing care usingthe ‘nursing care indicators’ tool for the lastyear. The nursing care indicators are completelynursing focused. The process involves inspectionof documentation, ward environments andnursing care delivered on a monthly basis, withresults being fed back to senior nurse managersfor action, reporting on specific issues whererequired. Key themes for measurement wereidentified from complaints, the patients’ surveyand results from the Trust documentation audit,the benchmarks held within the essence of carebenchmarking tool, and assessments against Trustnursing practice standards. The following themesare measured monthly:1. Patient Observations2. Pain Management3. Falls Assessment4. Tissue Viability5. Nutritional Assessment6. Medication Assessment7. Infection Control8. Privacy & Dignity (Added September 2009)For the first time we have been able to agreea standard and benchmark properly at bothward and Divisional level. We have expandedthe indicators into other clinical areas to includetheatres, maternity and paediatrics. The nursingcare indictors are subject to internal review andwe are in the process of adding to the suite ofindicators in line with changing standards andrequirements.112Blackpool, Fylde and Wyre Hospitals

Graph 11Overall Trust NCI Performance100Percentage Score95909286.689.891.692.48992.4 92.491.890.8 91.3 91.585April 09May 09June 09July 09Aug 09Sept 09Oct 092009 through 2010Nov 09Dec 09Jan 10Feb 10March 10Care of the Dying indicators have already beenwritten and plans are in place to trial theseat the next data collection. Results generatemeaningful information to enable and motivatenurses to change their practice to improvepatient outcomes.Graph 11 shows the overall Trust performance,expressed as an average percentage of all eightindicators, over the preceding 12 months. Thecurve is a 12 month trend line and shows thatperformance dipped in January, when thehospital was busier than normal and copingwith unusually bad weather conditions. SinceJanuary there has been a month on monthimprovement in the overall performance.End of Life CareIn order to enhance and develop our servicesfurther it is essential that we gather the viewsof patients and carers around end of lifecare in our hospitals. As part of this we haverecruited two patient/carer representatives tosit alongside senior representatives from ourpartner organisations on the Trust’s End of LifeBoard.Additionally the Patient Experience work stream(which reports to the End of Life Board) willobtain feedback about quality of services andareas for further improvement over the nextyear.Annual Report and Accounts April 1st 2009 to March 31st 2010 113

2.1.4 Statement of Assurance fromthe Board relating to Quality ofNHS ServicesInformation on the Review of Services in2009/10During 2009/10 the Blackpool, Fylde and WyreHospitals NHS Foundation Trust provided 76services based on the number of specialities.The Blackpool, Fylde and Wyre Hospitals NHSFoundation Trust has reviewed all the dataavailable to them on the quality of care in all ofthe five Clinical Divisions providing healthcare.The income generated by the NHS servicesreviewed in 2009/10 represents approximately 4.5per cent of the total income generated from theprovision of NHS services by the Blackpool, Fyldeand Wyre Hospitals NHS Foundation Trust for2009/10.The Trust has scrutinised and monitored thequality of its services by way of effective riskmanagement systems. Issues around quality ofcare identified by the Global Trigger Tool or bythe reporting of adverse events are reflectedin the risk register of each clinical Division.The mitigation of high and moderate risks aremonitored by both the Divisional Board and theTrust Board.The Board has used the results of this review todevelop a plan for improving the quality of theTrust’s services. Across 2008/09 and 2009/10, theTrust reviewed the quality of its services acrossthe five clinical divisions through the ‘Fit forFoundation’ programme. The criteria used forthis assessment were developed in conjunctionwith the Board of Directors, and cover seven keyareas:1. Financial management2. Access to services and use of operationalresources3. Governance and quality4. Workforce5. The Blackpool Way (The Trust’s organisationaldevelopment programme)6. Management capacity and processes7. Key strategic and planning tools.Areas 2 and 3 are particularly relevant to qualityperformance, with criteria relating to:• 18-week pathways• Cancer pathways• A&E 4-hour operational standard• Cancelled operations• Theatre utilisation• Day case rates• Length of stay• Hospital Community Acquired Infection (HCAI)rates• Mortality• Complaints• Patient experience• Quality of nursing care• Patient falls• Medication errorsEach of these criteria has a stretch targetassociated with it, deliberately chosen to be agreater achievement than the national target,designed to encourage clinical divisions to strivetowards ‘best in NHS care’ as stated in the Trust’svision.The initial assessment was undertaken in February2008, and the results presented to the Boardof Directors. Following this, areas for furtherdevelopment were identified and divisionalaction plans created to ensure that demonstrableimprovements were made within 6 months. Inaddition, gaps in the criteria were identified – inparticular in relation to patient experience andthe quality of nursing care. As a result, a localpatient experience survey has been developedto gather monthly feedback from each wardarea. The Trust has also developed Nursing CareIndicators, which are used to review the quality ofcare provided across all wards each month.An interim assessment was undertaken inOctober 2008 to review progress, and the finalassessment in February 2009. The final assessmentincluded a face-to-face review with the divisionalmanagement team and the Board of Directors, toafford the opportunity for the Board to explore indetail the areas of concern and the demonstrableimprovements. This will be replicated on anannual basis.Information on Participation in ClinicalAudits in 2009/10During 2009/10, 34 national clinical audits andfive national confidential enquiries covered NHSservices that Blackpool, Fylde and Wyre HospitalsNHS Foundation Trust provides.During 2009/10 Blackpool, Fylde and WyreHospitals NHS Foundation Trust participated in65% national clinical audits and 100% nationalconfidential enquiries of the national clinicalaudits and national confidential enquiries whichit was eligible to participate in.114Blackpool, Fylde and Wyre Hospitals

The national clinical audits and nationalconfidential enquiries that Blackpool, Fyldeand Wyre Hospitals NHS Foundation Trust waseligible to participate in during 2009/10 areidentified in Table 6 below:Table 6National Audits Status National Audits StatusAdult cardiac intervention (BCIS / PCI)Adult Cardiac Surgery (SCTS)Bowel Cancer Audit (NBOCAP)Carotid InterventionsCongenital Heart DiseaseEpilepsy 12Head and neck cancer (DAHNO)Heart rhythm management (pacing and implantable cardiac defibrillators(ICDS)Heavy Menstrual BleedingIntensive Care National Audit Research Centre (ICNARC)National Lung Cancer AuditNational Neonatal AuditNational Kidney Care AuditNational Joint RegistryNational Sentinel Stroke AuditOesophago-gastric (stomach cancer)Royal College of Physicians audit to assess and improve service for peoplewith inflammatory bowel diseaseMastectomy and breast reconstructionMINAPNational Audit of Continence Care 2010National Audit of Services for Falls and Bone Health in Older PeopleNational Audits of Occupational Health management of NHS staff with lowerback pain and depressionNational Comparative Audit of Blood TransfusionNational Dementia AuditNational Diabetes AuditNational head and neck cancer auditOngoingOngoing – to becompleted by May 10OngoingOngoingOngoingUnknownUnknownUnknownUnknownUnknownUnknownUnknownUnknownUnknownOngoingUnknownUnknownOngoingUnknownCompletedOngoingInformed Cons whomay not wish toparticipateOngoingOngoingOngoingContinued overleafAnnual Report and Accounts April 1st 2009 to March 31st 2010 115

Table 6 - ContinuedNational Audits Status National Audits StatusNational Hip fracture databaseServices for people who have fallenPain Database Improvement ProgrammePacingPaediatric intensive care network (PICANET)The National Service Framework for Coronary Heart DiseaseTranscatheter Aortic Valve Implantation (TAVI)The National COPD AuditTARNContinually ongoingUnknownUnknownUnknownUnknownUnknownOngoingUnknownContinually ongoingNCEPOD StudiesParenteral NutritionSurgery in childrenCosmetic SurgeryElective and Emergency Surgery in the ElderlyPeri-operative careOngoingOngoingCompletedOngoingOngoingThe national clinical audits and nationalconfidential enquiries that Blackpool, Fylde andWyre Hospitals NHS Foundation Trust participatedin, and for which data collection was completedduring 2009/10, are listed below alongsidethe number of cases submitted to each auditor enquiry as a percentage of the number ofregistered cases required by the terms of thataudit or enquiry.Completed National Audits/NCEPODNational Audit of ContinenceCare 2010Percentages98%Cosmetic Surgery 100%The reports of one national clinical auditwas reviewed by the provider in 2009/10 andBlackpool, Fylde and Wyre Hospitals NHSFoundation Trust intends to take the followingactions to improve the quality of healthcareprovided. Each National Audit has its own actionplan which is monitored at relevant DivisionalBoard meetings.The reports of 87 local clinical audits werereviewed by the provider in 2009/10 andBlackpool, Fylde and Wyre Hospitals NHSFoundation Trust intends to take the followingactions to improve the quality of healthcareprovided.The lead author for clinical audits are requestedto produce an action plan which is monitoredby the relevant committee within the corporategovernance structure for monitoring andensuring changes in practice occur.The Trust has a Clinical Audit Department whichsupports clinicians undertaking clinical auditand has a very full audit calendar arising fromthe Trust’s quality framework, NHS LitigationAuthority requirements and audits of careagainst National Institute for Health and ClinicalExcellence (NICE) standards.There is also a comprehensive local auditagenda, which is reported through the ClinicalImprovement Committee to the Board.116Blackpool, Fylde and Wyre Hospitals

The Clinical Audit Committee is proposing usingthe Healthcare Quality Improvement Partnershiptools to support Audit, including a prioritisationtool for annual forward planning and approvalof audits which will ensure that all audit workundertaken will be aligned to Board, National,Clinical and Risk priorities for the Trust eachyear. The team are working on ensuring thataudit is multi-disciplinary in nature, patientfocused and can demonstrate improvements inclinical care.Information on Participation in ClinicalResearchThe number of patients receiving NHS servicesprovided or sub-contracted by our Trust in2008/09 that were recruited during that periodto participate in research approved by a researchethics committee was 715 of which the numberof patients recruited to National Institute ofHealth Research (NIHR) Portfolio Studies was602.The number of patients receiving NHS servicesprovided or sub-contracted by our Trust in2009/10 that were recruited during that periodto participate in research approved by a researchethics committee was 857 of which the numberof patients recruited to NIHR Portfolio Studieswas 736*.The NIHR Portfolio studies are high qualityresearch that has had rigorous peer reviewconducted in the NHS. These studies formpart of the NIHR Portfolio Database whichis a national data resource of studies thatmeet specific eligibility criteria. In Englandstudies included in the NIHR Portfolio haveaccess to infrastructure support via the NIHRComprehensive Clinical Research Network.This support covers study promotion, set up,recruitment and follow up by Network staff.Graph 12 below demonstrates patients receivingNHS Services provided or sub-contracted by ourTrust in 2008/09 and 2009/10.This increasing level of participation in clinicalresearch demonstrates Blackpool, Fyldeand Wyre Hospitals NHS Foundation Trust’scommitment to improving the quality of care weoffer and to making our contribution to widerhealth improvement.The number of patients recruited to NIHRPortfolio Studies by speciality group was:Speciality 2008/9 2009/10*Cancer 120 140Cardiovascular 240 192Gastrointestinal 14 47Generic Relevance & CrossCutting Themes0 34Infection 1 3Inflammatory and Immune 0 7Medicines for Children 0 30Musculoskeletal 34 9Renal and Urogenital(co-adopted by Infection)Reproductive Health &Childbirth0 11453 73Respiratory 0 3Stroke 140 84TOTAL 602 736Graph 12Participation in Clinical ResearchNo. Patients required90080070060050040030020010002008/9Year2009/10NIHR PortflioNon PortfolioAnnual Report and Accounts April 1st 2009 to March 31st 2010 117

Graph 13 demonstrates the number of specialitiesthat have participated in Clinical research for2008/09 and 2009/10.* It should be noted that 2009/10 NIHR PortfolioStudy data is not signed off nationally untilJune 30th 2010. We therefore estimate the totalpatient recruitment total to be higher thancurrently reported (as at April 14th 2010).Graph 13Participation in Clinical Research by SpecialityNo. PatientsRecruited3002502001501005002008/092009/10*CancerCardiovascularGastrointestinalGeneric RelevanceInfectionInflammatory an..SpecialityMedicines for ChildrenMusculoskeletalRenal and Urogenit..Reproductive HealthRespiratoryStrokeInformation on the Commissioningfor Quality and Innovation (CQUIN)FrameworkThe Commissioning for Quality and Innovation(CQUIN) payment framework aims to supportthe cultural shift towards making quality theorganising principle of NHS services. In particular,it aims to ensure that local quality improvementpriorities are discussed and agreed at board levelwithin and between organisations. The CQUINpayment framework is intended to embed qualityat the heart of commissioner-provider discussionsby making a small proportion of providerpayment conditional on locally agreed goalsaround quality improvement and innovation.A proportion of the Blackpool, Fylde and WyreHospitals NHS Foundation Trust’s contractedincome in 2009/10 was conditional on achievingquality improvement and innovation goalsagreed between Blackpool, Fylde and WyreHospitals NHS Foundation Trust and any personor body they entered into a contract agreementor arrangement with, for the provision of NHSservices, through the Commissioning for QualityImprovement Payment Framework.The payment mechanism in 2009/10 was thatContracted Commissioners paid 90% of theCQUIN value through block contracts followedby the remaining 10% upon the Trust successfullyachieving the agreed goals. The values ofthese payments are £995,449 and £110,602and therefore the total monetary total for theassociated payments is £1,106,051.Further details of the agreed goals for 2009/10and new agreed goals for the following 12months (2010/11) is available on request from theDirector of Operations 01253 655550.Information Relating to Registrationwith the Care Quality Commission andPeriodic/Special ReviewsBlackpool, Fylde and Wyre Hospitals NHSFoundation Trust is required to register withthe Care Quality Commission and its currentregistration status is compliant with noconditions. The Care Quality Commission has nottaken enforcement action against Blackpool,Fylde and Wyre Hospitals NHS Foundation during2009/10.Blackpool, Fylde and Wyre Hospitals NHSFoundation Trust is subject to periodic reviews bythe Care Quality Commission and the last reviewwas carried out in October 2009 which was theOfsted/ Care Quality Commission joint inspection.118Blackpool, Fylde and Wyre Hospitals

Following the Care Quality Commission’sassessment the Inspectors noted:• Staff in the Accident and EmergencyDepartment pay good attention to thepossible risks to children attending fortreatment posed by adults visiting thedepartment.• A strong embedded safeguarding culture inthe Accident and Emergency Department.• An appropriate awareness of the CommonAssessment Framework which is wellembedded and well regarded by health staff.• The inspection team noted a good exampleof the ‘alert system’ within the Accident andEmergency Department.• The Victoria Safeguarding Centre was seenas a good example of partnership working toimprove both the services and experience ofchildren and young people.Although there were no actions for healthin the combined report the Care QualityCommission has produced a separate report andhave added the following recommendations andmade the following conclusions:• To further develop systems that will identifyoutcomes and evaluation of servicesefficiently.• To monitor performance in regard totimeliness, quality and interventions in healthassessments for Looked After Children (LAC).In view of this Blackpool, Fylde and WyreHospitals NHS Foundation Trust has made thefollowing progress on implementing the aboverecommendations.• The Trust has developed a SafeguardingChildren and Young People Work Planto include Audit to support the Trust toevaluate the service (The work plan alsoincludes training, child protection supervisionand policy development). The ongoing workplan will take into consideration the RevisedWorking Together guide (March 2010).Blackpool, Fylde and Wyre Hospitals NHSFoundation Trust has made the followingprogress by March 31st 2010 in takingsuch action. Contribution to BlackpoolLocal Safeguarding Children’s Board (LSCB)section 11 audits, actions agreed includeidentifying the Named Midwife as theCommon Assessment Framework Lead forthe Trust, Safe Recruitment training forrecruiting managers and improvements havebeen made to the recording of SafeguardingChildren training.• Blackpool, Fylde and Wyre Hospitals NHSFoundation Trust has taken part in the ChildHealth Mapping special review by the CQCin February 2010. The Trust is awaiting thefindings from that review. In the meantime,the Trust has developed an action plan basedon a self-assessment of improvement to bemade.The Trust also participated in an assessment ofperformance by the Care Quality Commissionagainst national standards in relation toHealthcare Associated infections on theNovember 25th 2009. We received no conditionson our registration. The Care QualityCommission has not taken enforcement actionagainst us since the start of the reporting yearfrom April 1st 2009.The Trust retained Clinical Negligence Schemefor Trusts (CNST) Maternity Level 1 on theFebruary 26th 2010 but unfortunately narrowlydid not reach the requirements to meet CNSTMaternity Level 2. The Trust failed on threecriterias to achieve the overall pass rate of 40. Inview of this the Trust has developed an actionplan to achieve Level 2.The Trust has not been required to participate inany special reviews or investigations by the CareQuality Commission during the reported period.A Statement for the Local InvolvementNetworks, Local Authority Overviewand Scrutiny Committee andCommissioning PCTs on their view ofthe Quality ReportThe statements supplied by the abovestakeholders in relation to their comments onthe information contained within the QualityReport can be found on page 125.The Quality Report was discussed with theCouncil of Governors which acts as a linkbetween the Trust, its staff and the localcommunity who have contributed to thedevelopment of the Quality Report.Annual Report and Accounts April 1st 2009 to March 31st 2010 119

Information on the Quality of DataNHS Number and General Medical Practice CodeValidityBlackpool, Fylde and Wyre Hospitals NHSFoundation Trust submitted records during2009/10 to the Secondary Uses System (SUS) forinclusion in Hospital Episode Statistics (HES),which are included in the latest published data.The percentage of records in the published data- which included the Patient’s valid NHS Numberwas 99.2% for Admitted Patient Care; 99.4% forOutpatient care; and 94.6% for Accident andEmergency Care.- which included the Patient’s valid GeneralPractitioners Registration Code was: 99.9% forAdmitted Patient Care; 100% for OutpatientCare; and 99.7% for Accident and EmergencyCare.‘In records submitted to the Secondary UsesSystem (SUS) for inclusion in Hospital EpisodeStatistics (HES), the percentage of recordsincluding the valid patient’s General PractitionerRegistration Code was 2009/10 Admitted PatientCare to date 99.2%’.Information Governance Toolkitattainment levelsBlackpool, Fylde and Wyre Hospitals NHSFoundation Trust’s score for 2009/10 forInformation Quality and Records Management,assessed using the Information GovernanceToolkit was 87%.Clinical Coding Error RateBlackpool, Fylde and Wyre Hospitals NHSFoundation Trust was subject to the Payment byResults clinical coding audit during the reportingperiod by the Audit Commission and the errorrates reported in the latest published auditfor that period for diagnoses and treatmentcoding (clinical coding) were 10.7% and 5.9%respectively as shown in Table 8.The results should not be extrapolated furtherthan the actual sample audited. The followingservices were included in the sample as shown inTable 7 below.Table 7 - Data sampledArea auditedSpecialty/ Sub-chapter/ HealthcareResource GroupSample sizeReason for selectionTheme General Medicine 100 National ThemeSpecialty Accident & Emergency 100Sub-chapter HB: Orthopaedic Non Trauma Procedures 70HealthcareResourceGroup (HRG)JD042: Minor Skin Disorders category 3without Clinical Condition (CC)30Chosen by PCT and agreedby the Trust following localdiscussionsSelected from benchmarkingmain recommendationsTable 8 - Data Published by the Audit CommissionClinical CodingPercentagesPrimary Diagnoses Incorrect 10.70%Secondary Diagnoses Incorrect 10.30%Primary Procedures Incorrect 5.90%Secondary Procedures Incorrect 5.10%120Blackpool, Fylde and Wyre Hospitals

Part 3 QualityImprovement Priorities for2010/11The Trust aims to achieve excellence ineverything it does and its aspirations for qualityimprovement are identified in the QualityStrategy which sets ambitious targets for thenext three years in relation to direct patientcare, as set out below:• Improve our hospital standardised mortalityrate from 103 (100 being the average) to 73by 2011/12.• Conform to best practice by fullyimplementing Advancing Quality, 100,000Lives and Saving Lives interventions.• Reduce avoidable harms by 50% by year2011/12.• Improve the patient experience, evidenced byimproving our rating in the national patientsatisfaction survey by five points per year,over the next three years.After consultation at Board level the Trustconfirmed the top quality improvementpriorities for 2010/11 which would havemaximum benefits for our patients and arereflected in the Trust’s Corporate Objectives.These are detailed in Table 9 below.Table 9 - Quality Improvement Priority 2010/2011Quality ImprovementPriorities 2010/11Quality Improvement Performance/Outcome MeasuresContinue to reduce the Trust’s hospital mortality ratePatient SafetyContinue to reduce MRSA and Clostridium Difficile infection rates asreflected by national targetsReducing avoidable harms through the following strands of work:− Global Trigger Tool to be used to measure adverse events− Reduction of Falls by 30%− Reducing Medication errors by 50% by 2011/12Conformance to best practice through application of the followinginterventions to improve patient outcomes:Clinical EffectivenessPhase 1 site for the North West Advancing Quality initiative that seekscompliance with best practice in five clinical areas:− Acute Myocardial Infarction− Hip and Knee Surgery− Cardio by-pass Surgery− Heart Failure− PneumoniaImplementing 100,000 lives and Saving Lives Programme:− Rapid Response Team - Reducing Cardiac Arrest calls− Reducing the incidence of Surgical Site Infections− Embed implementation of Venous Thrombo Embolism (VTE) guidelineNursing care indicators used to assess and measure standards of clinical careand patient experienceContinued overleafAnnual Report and Accounts April 1st 2009 to March 31st 2010 121

Table 9 - Quality Improvement Priority 2010/2011 - ContinuedQuality ImprovementPriorities 2010/11Quality Improvement Performance/Outcome MeasuresImproving the patient experience which will be measured through animprovement in the National In-Patient Survey results in the following threeareas;− In your opinion, how clean was the hospital room or ward that you were in?− Were you given enough privacy when being examined or treated?− Overall, did you feel you were treated with respect and dignity while youwere in the hospital?Patient ExperienceTo improve National Out-Patient Survey results in the following four key areaswhere the need for improvement was identified:− No copies of GP letters to patients− Poor information− Poor communication – staff not introducing themselves / Lack of informationregarding waiting times and delays in clinic− Lack of time to discuss health issuesLiverpool End of Life Care Pathway− Seeking patients and carers’ views to improve End of Life CarePatient Environment Action Team (PEAT) Survey− To improve PEAT Survey results/standardsEnsure single sex accommodation to provide privacy and dignity for patientsThe quality improvements priorities identifiedin 2009/2010 will continue to be monitoredin 2010/2011 to enable progress towardsachievement to be demonstrated. Additionalindicators have been identified to meet nationalhealthcare directives and current local qualityimprovement priorities for 2010/11 with theexpectation of reporting on these in the nextAnnual Report.The additional quality improvement priorities for2010/11 are listed below:• Embed Implementation of Venous ThromboEmbolism (VTE) guideline• To improving National Out-patient Surveyresults in the following four key areas:- No copies of GP letters to patients- Poor information- Poor communication – staff not introducingthemselves/lack of information regardingwaiting times and delays in clinic.- Lack time to discuss health issues• Liverpool End of Life Care Pathway- Seeking patients and carers’ views toimprove End of Life Care• Patient Environment Action team (PEAT)Survey- To improve PEAT Survey results/standards• Ensure single sex accommodation to provideprivacy and dignity for patientsThe quality improvement priorities will continueto be monitored and measured and progressreported to the Board of Directors as part of themonthly Board Performance Business MonitoringReport. The quality improvement priorities willalso be monitored via way of the AssuranceFramework, the Risk Register process and by theSub-Committees of the Board where appropriate.122Blackpool, Fylde and Wyre Hospitals

3.1 Overview of Performanceof the Trust against Key NationalPriorities and the Core StandardsAn overview of the quality of care offeredby Blackpool, Fylde and Wyre Hospitals NHSFoundation Trust based on performance in2009/10 against indicators selected by theBoard in consultation with stakeholders, withan explanation of the underlying reason(s) forselection is shown in table 10 below:The Board of Directors monitor complianceagainst performance against the key nationalpriorities from the Department of Health’sOperating Framework and against theDepartment of Health’s Core Standards on amonthly basis. The table below provides anoverview of performance for each of the qualitystandards for the last two reporting periods:Table 10 - Performance against Key National Priorities and Core StandardsQuality Standard 2008/09 2009/10 Self Assessment18 week referral to treatmenttimesAll cancers: one month diagnosisto treatment (including newcancer strategy commitment)All cancers: two month GPurgent referral to treatment(including new cancer strategycommitment)Maintained greater than 90%of admitted and 95% of nonadmittedpatients being treatedwithin 18 weeks.100%Qtr 1 – 97%Qtr 2 – 98%Qtr 3 – 98%Qtr 4 – 87% (revised operationalstandards)Maintained the standard forboth admitted and non-admittedcare across the Trust. Achievedthe standard across all Treatmentfunctions from July 09 foradmitted and September 09 fornon-admitted pathways.First Treatment 99% (target96%)Subsequent Treatment: Drugs99% (target 98%)Surgery 100% (target 94%)62 day classic 85% (target 85%)62 day screening 75.5% (target90%)62 day upgrade 90% (target tobe confirmed)All cancers: two week wait 100% (target 100%) 94% (target 93%)Time to reperfusion for patientswho have had a heart attackAchieved 92.98% of patientstreated within 60 minutes ofcalling for helpAchievedIncidence of MRSA Bacteraemia 9 cases (target

Table 10 - Performance against Key National Priorities and Core Standards - ContinuedQuality Standard 2008/09 2009/10 Self AssessmentOutpatients waiting longer thanthe 13 week standardPatients waiting longer thanthree months (13 weeks) forrevascularisationWaiting times for Rapid AccessChest Pain Clinic24 National Core StandardsAccess to healthcare for peoplewith a learning disabilityAchieved – 0 patients waiting inexcess of 13 weeksAchieved – 0 patients waiting inexcess of 13 weeksAchieved – 0 patients waiting inexcess of 2 weeksThe Trust was fully compliantwith the 24 core standards forbetter health.N/AAchieved – 0 patients waiting inexcess of 13 weeksAchieved – 0 patients waiting inexcess of 13 weeksAchieved – 0 patients waiting inexcess of 2 weeksThe Trust is fully compliant withthe 24 core standards for betterhealth.AchievedCancelled operations Achieved AchievedPatient Experience Achieved AchievedStaff satisfaction Achieved AchievedParticipation in heart diseaseauditsQuality of Stroke careUnderachievedUnderachievedParticipation in heart diseaseaudits was 100% achieved andchecked on a regular basis.Under review, possibleunderachievementEthnic coding data quality Achieved AchievedEngagement in clinical audits Achieved AchievedSmoking during pregnancy andbreast feeding initiation ratesFailedUnderachievedMaternity data quality Failed Achieved3.2 Quality Report ProductionWe are very grateful to all contributors who havehad a major involvement in the production of thisQuality Report.The Trust welcomes any comments you may haveand asks you to help shape next year’s QualityReport by sharing your views and contacting theChief Executive Department via:3.3 Quality Report AvailabilityIf you require this Quality Report in Braille, largeprint, audiotape, CD or translation into a foreignlanguage, please request one of these versions bytelephoning 01253 655632.Additional copies can also be downloaded fromthe Trust website: www.bfwhospitals.nhs.ukTelephone 01253 655520Email mary.aubrey@bfwhospitals.nhs.ukAssociate Director of Corporate AffairsBlackpool, Fylde and Wyre Hospitals NHSFoundation TrustTrust Headquarters, Whinney Heys Road,Blackpool, FY3 8NR124Blackpool, Fylde and Wyre Hospitals

Statement from External Agencies1.1 Statement from NHS BlackpoolNHS Blackpool Trust Board as lead commissionerfor Blackpool, Fylde and Wyre Hospitals NHSFoundation Trust can confirm that a reviewof the Quality Accounts for 2009-10 has beenundertaken. They are considered to be bothrepresentative and comprehensive. The Trust’saims for the coming year are both relevant andachievable.NHS Blackpool would like to take thisopportunity to commend the Trust on its serviceimprovements and care quality achievementsduring 2009/2010.Participation in the internationally recognisedNorth West Advancing Quality initiative isevidence of a hospital-wide commitment to theTrust’s Quality Improvement Plan. This initiativedemonstrates that by promoting best practiceand reducing variations in care, quality can beimproved. The initiative has particularly shownthat excellent care was delivered to patientswho had suffered from a Myocardial Infarction(heart attack). It has also highlighted that thecare given to patients suffering from heartfailure and Community Acquired Pneumoniawill require improvement. The Trust hasacknowledged the need for improvement and istaking active steps to improve care delivery.The Trust’s Quality Improvement Plan alsodemonstrates a focus on improving thepatient experience, patient safety and clinicaleffectiveness of care. The Trust has exceededtargets related to the reduction of HealthCare Associated Infections and we anticipatecontinued achievement in the coming year. Wefully support the improvement plans for end oflife care, reduction in falls and monitoring ofnursing care indicators.To improve services, the Trust will seek patientviews and also engage with staff on qualityissues. NHS Blackpool supports the improvementin the four key areas related to outpatientcare and anticipates improvement in the staffelement of the local inpatient survey. We feelthat an excellent way to improve services isby involving patients, carers and Trust staff,as they have first-hand experience of servicesand can provide real and honest views.The relationships developed with the LocalInvolvement Network and the Health Overviewand Scrutiny Committee will add considerably tothe engagement process.The Trust is fully committed to improving thequality of services and is striving for excellencewith a positive drive for improvementopportunities.1.2 Statement from NHS NorthLancashireThank you for asking NHS North Lancashire tocomment on the draft Quality Account. We feelthis is in itself a helpful sign of an open andreflective culture.1. Do you consider that the draft documentcontains accurate information in relation toNHS services provided by the provider?A. Yes, although the Quality Account is notintended to describe all the services and thatis not our expectation of it.It might be helpful to see a list of peoplewho lead on quality and safety for the Trust.2. Do you consider that any other informationshould be included relevant to the quality ofNHS services provided by the provider?A. We feel it would be sensible to include theDr Foster Report and the excellent responseto it that you produced earlier in the year.Until the HSMR methodology is standardisedas per the ‘Francis Report’, we feel that itwill be sensible to show both CHKS’s and DrFoster’s versions. Indeed, it might be sensiblefor the CEO to make reference to this in theintroduction.The component parts of CQUIN andachievement against them show animportant relationship between theaspirations of the commissioners and theachievements of providers. Therefore, abreakdown of achievement here – as per theAQ indicators – would be welcome.Others it would seem sensible to include:The National Hip Fracture Data Base; TARN,Stroke Sentinel Audit.We would like to see as much information aspossible about patient experience.We feel it would be wise to make thedocument as accessible as possible to allmembers of the public. So, for our purposeswe’d like to see a rather detailed documentbut accept that others may want somethingless intricate.3. Do you consider that the data provided isaccurate when compared with any data youhave been supplied with during the year?A. Yes, mindful of the comments above.Annual Report and Accounts April 1st 2009 to March 31st 2010 125

1.3 Statement from Blackpool LocalInvolvement NetworkBlackpool Local Involvement Network (LINk)welcomes the publication of this report andsees it as a positive step forward. For thefirst time, Blackpool LINk is able to read somecomprehensive information on the quality ofhealth care provided.Members of the Advisory Group have spenta considerable length of time reading andresponding to the two drafts. Thank you forresponding positively to our concerns regardingthe jargon that was used.Please see our recommendations:-• To continue to provide ‘jargon-free’ reportsand glossaries in future years.• To improve ‘Falls Reduction’ by extending theprogramme throughout Blackpool, Fylde &Wyre Hospitals.• The Trust needs to strive to lower medicalerrors as most are higher than the previousyear.• Clear action plans for improving hospitalmortality rate, reducing avoidable harms andimproving the patient experience need to beincluded in the report. We are pleased to seethe recommendations of the detailed actionplan provided for patients with pneumonia.• Blackpool LINk would like to monitor results ofthe Trust, using the Global Trigger Tool.1.4 Statement from BlackpoolHealth Overview and ScrutinyCommitteeBlackpool’s Health Overview and ScrutinyCommittee meeting held on the December 8th2009 identified that the committee would not beproviding a response in relation to the QualityAccounts. However, the committee will be happyto receive a copy of the Trust’s published QualityAccount1.5 Statement from LancashireLocal Involvement NetworkLancashire Local Involvement Network have notprovided a response in relation to the QualityAccounts.1.6 Statement from LancashireHealth Overview and ScrutinyCommitteeLancashire Health Overview and ScrutinyCommittee have not provided a response inrelation to the Quality Accounts.We look forward to receiving the official reportin due course.126Blackpool, Fylde and Wyre Hospitals

Glossary of abbreviationsPage No. Abbreviation Meaning2 CHKSClinical, Accountability, Service, Planning, Evaluation) Healthcare KnowledgeSystems (CHKS). Name of the Company which is used for benchmarking5 RAMI Risk Adjusted Mortality Index5 HSMRThe Hospital Standardised Mortality Ratio (HSMR) is an indicator ofhealthcare quality that measures whether the death rate at a hospital ishigher or lower than you would expect. HSMR compares the expected rateof death in a hospital with the actual rate of death. Dr Foster looks at thosepatients with diagnoses that most commonly result in death for example,heart attacks, strokes or broken hips. For each group of patients we canwork out how often, on average, across the whole country, they survivetheir stay in hospital, and how often they die.Methicillin Resistant Staphylococcus AureusMRSA stands for meticillin-resistant Staphylococcus aureus. It’s a commonskin bacterium that’s resistant to some antibiotics. Media reports sometimesrefer to MRSA as a superbug.6 MRSAStaphylococcus aureus (SA) is a type of bacteria. Many people carry SAbacteria without developing an infection. This is known as being colonisedby the bacteria rather than infected. About one in three people carry SAbacteria in their nose or on the surface of their skin.MRSA bacteraemia – An MRSA bacteraemia means the bacteria haveinfected the body through a break in the skin and multiplied, causingsymptoms. If SA bacteria get into the bloodstream, they can cause moreserious infections, such as blood poisoning.Costridum Difficile InfectionClostridium difficile (C. diff) is a bacterium that is present naturally in thegut of around two thirds of children and 3% of adults.6 CDIC. diff does not cause any problems in healthy people. However, someantibiotics that are used to treat other health conditions can interferewith the balance of ‘good’ bacteria in the gut. When this happens, C. diffbacteria can multiply and produce toxins (poisons), which cause illness suchas diarrhoea and fever. At this point, a person is said to be ‘infected’ with C.diff.7 NRLS National reporting and Learning Service8 NMC Nursing and Midwifery Council8 NPSA National Patient Safety Agency9 Medusa Electronic version of the Injectable Medicines Guide10 PCI Primary Coronary Intervention10 AMI Acute Myocardial Infarction11 VTE Venous Thrombo EmbolismAnnual Report and Accounts April 1st 2009 to March 31st 2010 127

Page No. Abbreviation Meaning12 CABG Coronary Artery Bypass Graft12 CQS Composite Quality Score13 LVS Left Ventricular Systolic Function Assessment13 ACEI Angiotensin Converting Enzyme Inibitors13 ARB Angiotensin Receptor Blocker13 LVSD Left Ventricular Systolic Dysfunction15 CAP Community Acquired Pneumonia17 AQ Advancing Quality17 CDU Clinical Decisions Unit18 NICE National Institute for Health and Clinical Excellence18 DNAR Do not Advance Resuscitation23 HCAI Hospital Community Acquired Infection23 NHSLA NHS Litigation Authority24 NIHR National Institute for Health Research25 CQUIN Commissioning for Quality and Innovation26 LSCB Local Safeguarding Childrens Board26 CQC Care Quality Commission26 LAC Looked after Children26 CNST Clinical Negligence Scheme for Trusts26 SUS Secondary Uses System26 HES Hospital Episode Statistics26 PbR Payment by Results26 HRG Healthcare Resource Group26 CC Clinical Conditions26 PCT Primary Care Trust29 GP General Practitioners29 PEAT Patient Environment Action Team32 GHG Green House Gas32 ERIC Estates Returns Information Collections33 CRC Carbon Reduction Commitment33 CHP Combined Heat and Power128Blackpool, Fylde and Wyre Hospitals

Glossary of TermsPage No. Abbreviation Glossary of meaning“Developed by The Casemix Service, Healthcare Resource Groups (HRGs) arestandard groupings of clinically similar treatments which use common levelsof healthcare resource.Healthcare Resource Groups offer ORGANISATIONS the ability to understandtheir ACTIVITY in terms of the types of PATIENTS they care for and thetreatments they undertake. They enable the comparison of ACTIVITY withinand between different ORGANISATIONS and provide an opportunity tobenchmark treatments and services to support trend analysis over time.26 HRGHealthcare Resource Groups are currently used as a means of determiningfair and equitable reimbursement for care services delivered by Health CareProviders. Their use as consistent ‘units of currency’ supports standardisedhealthcare commissioning across the NHS. They improve the flow of financeswithin - and sometimes beyond - the NHS. HRG4 has been in use forReference Costs since April 2007 (for financial year 2006/7 onwards) and forPayment by Results (PbR) since April 2009 (for financial year 2009 onwards).HRG4 was a major revision that introduced Healthcare Resource Groups tonew clinical areas, to support the Department of Health’s policy of Paymentby Results. It includes a portfolio of new and updated HRG groupingsthat accurately record PATIENTS treatment to reflect current practice andanticipated trends in healthcare.”26 CCJD042: Minor Skin Disorders category 3 without CC“CC” means clinical conditions. Therefore in this context the patient had noother clinical conditions or co-morbidities.Annual Report and Accounts April 1st 2009 to March 31st 2010 129

Annex B: Statement of the Chief Executive’sResponsibilities as the Accounting OfficerThe National Health Service Act 2006 (“2006 Act”)states that the Chief Executive is the AccountingOfficer of the NHS Foundation Trust. The relevantresponsibilities of Accounting Officer, including theirresponsibility for the propriety and regularity of thepublic finances for which they are answerable, andfor the keeping of proper accounts, are set out inthe Accounting Officers’ Memorandum issued by theIndependent Regulator of NHS Foundation Trusts(“Monitor”).Under the 2006 Act, Monitor has directed the Blackpool, Fylde and WyreHospitals NHS Foundation Trust to prepare, for each financial year, astatement of accounts in the form and on the basis set out in the AccountsDirection. The accounts are prepared on an accruals basis and must give a trueand fair view of the state of affairs of Blackpool, Fylde and Wyre HospitalsNHS Foundation Trust and of its income and expenditure, total recognisedgains and losses and cash flows for the financial year.In preparing the accounts, the Accounting Officer is required to comply withthe requirements of the NHS Foundation Trust Financial Reporting Manualand in particular to:• Observe the Accounts Direction issued by Monitor, including the relevantaccounting and disclosure requirements, and apply suitable accountingpolicies on a consistent basis.• Make judgements and estimates on a reasonable basis.• State whether applicable accounting standards as set out in the NHSFoundation Trust Financial reporting Manual have been followed, anddisclose and explain any material departures in the financial statements,and• Prepare the financial statements on a going concern basis.The Accounting Officer is responsible for keeping proper accounting recordswhich disclose with reasonable accuracy at any time the financial positionof the NHS Foundation Trust and to enable him to ensure that the accountscomply with requirements outlined in the above mentioned Act. TheAccounting Officer is also responsible for safeguarding the assets of the NHSFoundation Trust and hence for taking reasonable steps for the preventionand detection of fraud and other irregularities.To the best of my knowledge and belief, I have properly discharged theresponsibilities set out in Monitor’s NHS Foundation Trust Accounting OfficerMemorandum.Signed…………………………………… Date: 01 June 2010Aidan KehoeChief Executive130Blackpool, Fylde and Wyre Hospitals

Annex C: Statement in respect of Internal Control2009/2010Statement On Internal Control 2009/10Blackpool, Fylde And Wyre Hospitals NHS FoundationTrust1. Scope of ResponsibilityAs Accounting Officer, I have responsibility for maintaining a sound systemof internal control that supports the achievement of the Blackpool, Fyldeand Wyre Hospitals NHS Foundation Trust’s policies, aims and objectives,whilst safeguarding the public funds and departmental assets for which Iam personally responsible, in accordance with the responsibilities assignedto me. I am also responsible for ensuring that the NHS Foundation Trust isadministered prudently and economically and that resources are appliedefficiently and effectively. I also acknowledge my responsibilities as set out inthe NHS Foundation Accounting Officer Memorandum.2. The Purpose of the System of Internal ControlThe system of internal control is designed to manage risk to a reasonablelevel rather than to eliminate all risk of failure to achieve policies, aimsand objectives; it can therefore only provide reasonable and not absoluteassurance of effectiveness. The system of internal control is based onan ongoing process designed to identify and prioritise the risks to theachievement of the policies, aims and objectives of Blackpool, Fylde and WyreHospitals NHS Foundation Trust, to evaluate the likelihood of those risksbeing realised and the impact should they be realised, and to manage themefficiently, effectively and economically.The system of internal control has been in place in Blackpool, Fylde and WyreHospitals NHS Foundation Trust for the year ended March 31st 2010 and up tothe date of approval of the Annual Report and Accounts.3. Capacity to Handle Risk3.1 LeadershipAs Accounting Officer, I have overall accountability and responsibility for RiskManagement within the NHS Foundation Trust. I lead the Risk Managementprocess as Chair of the Trust’s Healthcare Governance Committee, whichmeets on a quarterly basis.The Medical Director and the Director of Nursing and Quality provideleadership at Board level for the implementation of Clinical Governanceand Risk Management. The Deputy Chief Executive is designated as theaccountable and responsible officer for managing financial risk in the NHSFoundation Trust. The Trust Risk Management Strategy clearly defines theresponsibilities of individual Executive Directors specifically and generally.The Risk Management Strategy applies to all employees and requires anactive lead from managers at all levels to ensure risk management is afundamental part of the total approach to quality, safety, corporate andclinical governance, performance management and assurance.Annual Report and Accounts April 1st 2009 to March 31st 2010 131

Employees, contractors and agency staffare required to report all adverse incidentsand concerns. The NHS Foundation Trustsupports a learning culture, ensuring that anobjective investigation or review is carriedout to continually learn from incidents, onlyassigning ‘blame’ to individuals where it is clearthat policies and procedures have not beenappropriately followed.The Learning from Incidents and Risks Committeecomprising senior staff, meets on a monthly basisto ensure concerns identified from incidents,claims, and complaints are investigated to ensurethat lessons are learned and as a method ofimprovement and sharing good practice. The NHSFoundation Trust fosters an environment whereindividuals are treated in a fair and just way, andwhere lessons are learned rather than blamebeing attributed.All procedural documents are available to staffon the Trust’s Intranet and there is an annualprogramme for monitoring the working of eachprocedural document with a quarterly review ofaction plans in line with the requirements of theNHSLA Risk Management Standards.3.2 TrainingTo ensure the successful implementation andmaintenance of the NHS Foundation Trust’sapproach to risk management, staff at all levelsare appropriately trained in incident reportingand carrying out a risk assessment. An ongoingRisk Management Training Programme hasbeen developed which includes Health andSafety, Clinical Risk Management, Patient Safety,Fire Safety, Conflict Resolution, Resuscitation,Moving and Handling, Safeguarding Childrenand Vulnerable Adults, Infection Prevention,Information Governance and Equality andDiversity mandatory training for staff asidentified in the training needs analysiswhich complies with the Trust’s Learning andDevelopment Strategy.4. The Risk and Control Framework4.1 Key Elements Of The RiskManagement StrategyThe Risk Management Strategy is validated bythe Healthcare Governance Committee andapproved by the Board of Directors and coversall risks and is subject to an annual review toensure it remains appropriate and current. Staffare both accountable and responsible for riskmanagement to ensure it is clearly identified aswell as implementing the system for identifying,managing, evaluating and controlling individualrisk. Risks are identified from risk assessmentsand from the analysis of untoward incidents. TheRisk Management Strategy is referenced to aseries of related risk management documents, forexample, Patient Safety Strategy; Investigatingan Untoward Incident and Serious IncidentReporting Procedure. The Risk ManagementStrategy is available to all staff via the DocumentLibrary on the Trust Intranet.4.2 Key RisksThe key organisational risks for the year wereidentified from the corporate strategic objectivesfor 2009/10, forming part of the Board AssuranceFramework and included:Key Risks 2009/10• Patients acquiring Clostridium Difficile• Patients acquiring MRSA bacteraemia• Failure to reduce hospital mortality rates• Failure to implement Interim ClinicalInformation System• Recruit sufficient RGN’s to meet basicestablishment needs• Compliance with health and safety regulationsFuture Risks 2010/11• Failure to maintain financial balance• Patients acquiring Clostridium Difficile• Patients acquiring MRSA bacteraemia• Failure to reduce hospital mortality rates• Failure to implement Interim ClinicalInformation System• Recruit sufficient RGN’s to meet basicestablishment needs• Compliance with health and safety regulations4.3 How Risk Management IsEmbedded In The Activity Of TheNHS Foundation TrustRisk Management is embedded in the activityof the organisation through Induction Training,regular Risk Management Training and ad-hoctraining when need is identified. An UntowardIncident and Serious Incident reporting systemis in place and incidents are entered onto adatabase for analysis. Root cause analysis isundertaken and all identified changes in practiceare implemented.Risk Management is embedded within theNHS Foundation Trust through key committeesidentified in the Corporate GovernanceStructure and consists of clinical and non-clinicalcommittees, which report to the HealthcareGovernance Committee on a quarterly basis.132Blackpool, Fylde and Wyre Hospitals

The Audit Committee is a sub-committee of theBoard of Directors and provides independentassurance on aspects of governance, RiskManagement and internal controls. TheHealthcare Governance Committee links to theAudit Committee and the Clinical GovernanceCommittee and also reports direct to the Boardof Directors.4.4 Elements of the AssuranceFrameworkThe Board Assurance Framework has beenfully embedded during 2009/10. The AssuranceFramework:• Covers all of the Trust’s main activities.• Identifies the Trust’s corporate objectives andthe targets the Trust is striving to achieve.• Identifies the risks to the achievement of theobjectives and targets.• Identifies the system of internal control inplace to manage the risks.• Identifies and examines the review andassurance mechanisms, which relate tothe effectiveness of the system of internalcontrol.• Records the actions taken by the Board ofDirectors and Officers of the Trust to addresscontrol and assurance gaps; and• Covers the Core Standards on which the Trusthas declared compliance during 2009/10.The Healthcare Governance Committeeconsiders high/significant risks and ifappropriate, recommends their inclusion on theCorporate Risk Register and/or Board AssuranceFramework. This is presented to the Board ofDirectors for formal ratification.Risk prioritisation and action planning isinformed by the Trust’s corporate objectiveswhich have been derived from internal andexternal sources of risk identified from nationalrequirements and guidance, complaints, claims,incident reports and Internal Audit findings. Thisalso includes any other sources of risk derivedfrom Ward, Departmental, Directorate andDivisional risk assessments, which feed up toDivisional and Corporate level management.Action plans are developed for unresolvedrisks. The rating of risks is adapted from theAustralian Risk Management Process.its risks systematically. The action plan arisingfrom each risk also serves as a work plan forthe NHS Foundation Trust through the LeadManagers to ensure mitigation against risks andclosure of any gaps in control or assurance.The ‘elements’ of the Board AssuranceFramework are monitored and reviewed on aquarterly basis by the Healthcare GovernanceCommittee and the Audit Committee and thenby the Board of Directors. This demonstratesthat the document is live and continuous andprovides evidence to support the Statement onInternal Control.The Finance Director (who also acts as theDeputy Chief Executive), and the AssociateDirector of Corporate Affairs are also membersof the Healthcare Governance Committee andprovide Governance and Risk Managementassurance to the Audit Committee at each ofits meetings, thus ensuring an integrated riskmanagement approach.The Trust intends to manage gaps in assuranceby way of the Audit Committee who will reviewthese gaps and assess the required assurances toreview systems and processes.4.5 How Public Stakeholders areInvolved in Managing RisksPublic Stakeholders, which include NHSBlackpool, NHS North Lancashire, BlackpoolOverview and Scrutiny Committee, LancashireOverview and Scrutiny Committee, BlackpoolLocal Safeguarding Children’s Board, LearningDisability Partnership Board and LocalInvolvement Networks (LINk), are consulted onservice developments and changes.Issues raised through the Trust’s RiskManagement processes that impact on partnerorganisations, for example, NHS Blackpool,NHS North Lancashire, and Lancashire Care NHSFoundation Trust, would be discussed in theappropriate forum so that appropriate actioncan be agreed.An established communications framework isin place in the form of a Major Incident Plan,and cross community emergency planningarrangements are in place.Lead Executive Directors and Lead Managersare identified to address the gaps in control andassurance and are responsible for developingaction plans to address the gaps. The BoardAssurance Framework serves to assure the Boardof Directors that the organisation is addressingAnnual Report and Accounts April 1st 2009 to March 31st 2010 133

4.6 Information Governance andIdentifying and Managing RisksThe Information Governance Committee identifiesand manages information risks, which reportsto the Healthcare Governance Committee. TheDeputy Chief Executive (who is also the nominatedBoard Lead for Information Governance Riskand the Senior Information Risk Owner forthe Trust) chairs the Information GovernanceCommittee. The NHS Foundation Trust achieved87% compliance with the Information GovernanceToolkit (IGT) assessment for 2009/10 and the NHSFoundation Trust plans to maintain this target for2010/11. A review of the IGT carried out as partof the 2009/10 Internal Audit plan reported aSignificant Level of assurance.During the financial year 2009-2010 the NHSFoundation Trust had 28 information securityrelated incidents reported all of which were ratedat a level 0. Whilst the severity rating of theseincidents was rated at 0 all were thoroughlyinvestigated and reported upon.Note: Information Security incidents are rated ona scale from 0-5, incidents classified as a severityrating of 3-5 are reported as a serious untowardincident and reported to Monitor and theInformation Commissioner.Table 1 provides a summary which relates to theseincidents.4.7 Compliance with Equality,Diversity and Human RightsLegislationControl measures are in place to ensure that allTrust obligations under equality, diversity andhuman rights legislation are complied with.4.8 Compliance with the NHSPension Scheme RegulationsAs an employer with staff entitled to membershipof the NHS Pension Scheme, control measuresare in place to ensure all employer obligationscontained within the Scheme regulations arecomplied with. This includes ensuring thatdeductions from salary, employer’s contributionsand payments into the Scheme are in accordancewith the Scheme rules, and that member PensionScheme records are accurately updated inaccordance with the timescales detailed in theRegulations.4.9 Compliance with ClimateAdaptation Requirements underthe Climate Change Act 2008The NHS Foundation Trust has undertaken riskassessments and Carbon Reduction DeliveryPlans are in place in accordance with emergencypreparedness and civil contingency requirements,as based on UKCIP 2009 weather projects, toensure that this organisation’s obligations underthe Climate Change Act and the AdaptationReporting requirements are complied with.4.10 Disclosure of Standards forBetter Health Core StandardsDeclarationThe NHS Foundation Trust is fully compliant withthe Care Quality Commission’s 24 Core Standardsfor Better Health. The Board of Directors achievedSignificant Assurance from Internal Audit over theDeclaration Process in December 2009.All policies incorporate an equality impactassessment prior to ratification by the relevantcommittee. The Trust has an Equality and Diversityand Human Rights Steering Committee whichreports to the Clinical Governance Committee.Table 1: Summary Of Other Personal Data Related Incidents In 2009-10Category Nature of Incident TotalIIIIIILoss of inadequately protected electronic equipment, devices or paperdocuments from secured NHS premises.Loss of inadequately protected electronic equipment, devices or paperdocuments from outside secured NHS premisesInsecure disposal or inadequately protected electronic equipment, devicesor paper documents007IV Unauthorised disclosure 2V Other 19134Blackpool, Fylde and Wyre Hospitals

4.11 Annual Quality ReportThe Directors are required under the Health Act2009 and the National Health Service (QualityAccounts) Regulations 2010 to prepare QualityAccounts for each financial year. Monitor hasissued guidance to NHS Foundation Trust Boardson the form and content of annual QualityReports which incorporated the above legalrequirements in the NHS Foundation Trust AnnualReporting Manual.The Trust has reviewed its objectives and reemphasisedits commitment to quality, with theaim to achieve excellence in everything it does.Its aspirations for quality improvement in 2009/10were to:• Improve our hospital standardised mortalityrate.• Conform to best practice by fullyimplementing Advancing Quality, 100,000Lives and Saving Lives interventions.• Reduce avoidable harms.• Improve the patient experience.The Trust believes quality should be supported atevery level of the organisation and has ensuredthat all five clinical divisions have implementedthe actions required to meet the qualitystandards. Monitoring was overseen by way of anumber of forums.In preparing the Quality Report, the Board ofDirectors can confirm that it has the appropriatemechanisms in place to prepare its Quality Reportas per Monitor’s guidance and is satisfied that:• The Trust has a designated Executive Directorfor the production of the Quality Report.• The Quality Report has been presented toExecutive Directors on a number of occasions.• The Quality Report presents a balanced pictureof the Foundation Trust’s performance overthe period covered.• Key players have been involved in thedevelopment of the Quality Reportthroughout the organisation and havecontributed in providing the data.The Quality Report has been submitted to keystakeholders – Blackpool and Lancashire LocalInvolvement Networks; NHS Blackpool; NHSNorth Lancashire, Blackpool and LancashireOverview and Scrutiny Committees as perMonitor’s guidance.Review of Effectiveness of Quality ReportThe Trust is provided with external assurance on aselection of the quality data identified within theQuality Report via the Staff Survey results, PatientSurvey results and Information GovernanceToolkit results. Local internal assurance is alsoprovided via the analysis of data followinglocal internal audits in relation to nursing careindicators, analysis of data following incidents inrelation to medication errors and slips, trips andfalls incidents for patients.The Trust has a fully controlled process for theprovision of external information with controlchecks throughout the process. Formal sign offprocedures and key performance indicatorson data is submitted through the InformationManagement Department5. Review of Economy, Efficiencyand Effectiveness of the Use ofResourcesThe NHS Foundation Trust has robustarrangements in place for setting objectivesand targets on a strategic and annual basis.These arrangements include ensuring thefinancial plan is affordable, that the deliveryof Cost Improvement Requirements/Quality,Innovation, Productivity and Prevention (QuIPP)requirements, compliance with the terms ofauthorisation and co-ordination of individualobjectives with corporate objectives are approvedby the Board of Directors. Performance againstobjectives is monitored and actions identifiedthrough a number of channels:• Approval of the annual budgets by the Boardof Directors.• Monthly reporting to the Board of Directorson key performance indicators coveringFinance activity and Human Resource targets.• Weekly reporting to the Executive Team onkey influences on the Trust’s financial positionincluding activity and workforce indicators.• The Divisions play an active part in ongoingreview of financial performance includingCost Improvement Requirements/Quality,Innovation, Productivity and Prevention(QuIPP) delivery.• Monthly performance management ofDivisions by the Executive Team is undertakenfor key areas.• Quarterly reporting to Monitor andcompliance with the terms of authorisation.The NHS Foundation Trust also participates ininitiatives to ensure value for money for example:• Value for money is an important componentof the Internal and External Audit plans thatprovide assurance to the NHS Foundation Trustregarding processes that are in place to ensurethe effective use of resources.• In-year cost pressures are rigorously reviewedand challenged, and mitigating strategies areconsidered.• The NHS Foundation Trust subscribes to anational benchmarking organisation (CHKS).This provides comparative information analysison patient activity and clinical indicators. Thisinforms the risk management process andidentifies where improvements can be made.• The NHS Foundation Trust uses leanmethodology to optimise the efficient andeffective use of resources whilst enhancingand not diluting the patient experience.Annual Report and Accounts April 1st 2009 to March 31st 2010 135

The NHS Foundation Trust has a standardassessment process for future business plansto ensure value for money and to ensure thatfull appraisal processes are employed whenconsidering the effect on the organisation.Procedures are in place to ensure all strategicdecisions are considered by the Board ofDirectors.6. Review of EffectivenessAs Accounting Officer, I have responsibility forreviewing the effectiveness of the system ofinternal control. My review of the effectivenessof the system of internal control is informed bythe work of Internal Audit and the ExecutiveDirectors within the NHS Foundation Trust whohave responsibility for the development andmaintenance of the internal control frameworkand comments made by the External Auditorsin their Management Letter and other reports.I have been advised on the implications of theresult of my review of the effectiveness of thesystem of internal control which is scrutinised bythe Board of Directors, the Audit Committee andthe Healthcare Governance Committee and actionplans are formulated to address weaknesses andensure continuous improvements of the system isin place.In describing the process that has been appliedin maintaining and reviewing the effectivenessof the system of internal control I have detailedbelow some examples of the work undertakenand the role of the Board of Directors, the AuditCommittee, Healthcare Governance Committee,Internal Audit and External Audit in this process.My review has been informed by:• Self-assessment against the Audit Commission’sExternal Auditors Local Evaluation (ALE)criteria.• Internal Audit reviews of the Board AssuranceFramework and the effectiveness of theoverall system of internal control as part ofthe Internal Audit annual plan and agreedby the Deputy Chief Executive and the AuditCommittee.• The Head of Internal Audit Opinion whichgave an overall Significant opinion on thesystem of internal control for 2009/10.• The process of arriving at the Trust’s interimself-assessment declaration of complianceagainst the Care Quality Commission’s 24Core Standards for Better Health, whichdemonstrates continuous improvement againstthe standards. Supporting evidence is availablefor all members of the Board of Directorsto review as a source of assurance and is anessential part of the Trust’s verification for thesystem of internal control.• The NHS Foundation Trust receivingregistration with the Care Quality Commissionwithout any conditions on March 16th 2010.• The Trust’s assessment of 87% compliance withthe Information Governance Toolkit standardsfor 2009/10 which demonstrates continuousimprovement against these standards.• The Annual Risk Management Report and theClinical Governance Reports, which evidenceaction on all aspects of governance including,risk management.• The Board Assurance Framework which itselfprovides the NHS Foundation Trust withevidence of the effectiveness of the systemof internal controls that manage the risks tothe organisation. The Board of Directors alsomonitor and review the effectiveness of theBoard Assurance framework on a quarterlybasis. Internal Audit provided a significantassurance opinion on the Board assuranceprocess• The Board of Directors, Audit Committee,Executive Directors Meeting and theHealthcare Governance Committee haveadvised me on the implications of the result ofmy review of the effectiveness of the systemof internal control. These committees alsoadvise outside agencies and myself on seriousuntoward events.• All of the relevant committees within theCorporate Governance Structure which havea clear timetable of meetings and a clearreporting structure to allow issues to be raised.• The Healthcare Governance Committee whomanage and review the Board AssuranceFramework in conjunction with ExecutiveDirectors. The minutes of the HealthcareGovernance Committee are presented tothe Board of Directors. The HealthcareGovernance Committee produce an annualRisk Management report, which is presentedto the Audit Committee followed by the Boardof Directors and this provides assurance oncontrols.• The Audit Committee who review theestablishment and maintenance of an effectivesystem of Integrated Governance, RiskManagement and internal control across thewhole of the Trust’s activities (both clinical andnon-clinical) that supports the achievementof the overall Trust objectives. The AuditCommittee review the Board AssuranceFramework on a quarterly basis.136Blackpool, Fylde and Wyre Hospitals

• Comments made by External Auditors andother review bodies in their reports. Forexample on November 25th 2009, the NHSFoundation Trust had an assessment ofperformance by the Care Quality Commissionagainst national standards in relation toHealthcare Associated infections and inDecember 2009 received no conditions onour registration.A plan to address weaknesses and ensurecontinuous improvement of the system is inplace. However, there have been no significantinternal control issues or gaps in controlidentified. Internal Audit provided overallSignificant Assurance although areas of LimitedAssurance have been identified. InternalAudit reviews resulted in ‘Limited Assurance’opinions in three areas. Action has beenagreed to improve the systems of control. TheManagement Team have already implementedor are in the process of implementing theseactions in order to improve systems of control inthe areas identified.The NHS Foundation Trust received ‘LimitedAssurance’ from Internal Audit which relatedto the review of Mandatory Training inwhich all recommendations made have beenfully actioned and signed off by the AuditCommittee. In relation to the Ward Level (3),Clinical Audit and Delegated Consent reviews,an action plan has been developed for therecommendations made and work is in progress.Progress is monitored by the Clinical GovernanceCommittee and the Healthcare GovernanceCommittee. The Audit Committee will alsomonitor the implementation of the action plansand progress against the recommendationsmade in order to be provided with assurancethat improvements are made.The NHS Foundation Trust was not successful inachieving Clinical Negligence Scheme for Trusts(CNST) Maternity Level 2 award on the February26th 2010. However, it was awarded Level 1compliance. The Trust has developed an actionplan to maintain Level 1 and achieve Level 2.Progress towards compliance with the clinicalCNST standards will be monitored on a quarterlybasis by the Healthcare Governance Committeeand the Board of Directors. The NHS FoundationTrust achieved NHSLA Level 2 in September2008 and an action plan has been developed toachieve Level 3 in 2011.Clostridium Difficile are monitored by theHospital Infection Prevention and ControlCommittee and the Board of Directors.The NHS Foundation Trust has implementeda number of initiatives to limit hospitalacquiredinfections within the target levelthrough additional investments in screeningand personnel, and through participationin the Safer Patients Initiative, which haselements devoted to reducing infection. TheNHS Foundation Trust has little control wheninfluencing the incidence of ‘Community’acquired infection, however it continues to workwith and support NHS Blackpool and NHS NorthLancashire to try to mitigate this risk. The targetremains achievable although is noted as a highrisk.The NHS Foundation Trust continued tooperate robust finance control in 2009/10and has effectively managed in-year financialrisks. The NHS Foundation Trust has developedprocedures to model forward financial plansincluding understanding its financial risk ratingsfor a minimum of three years.7. ConclusionThere have been no significant internal controlissues identified during the year. My reviewof the effectiveness of the systems of internalcontrol has taken account of the work ofthe Executive Management Team within theorganisation, who have responsibility for thedevelopment and maintenance of the internalcontrol framework within their discreetportfolios. In line with the guidance on thedefinition of the significant control issues, I haveno significant control issues to declare withinthis year’s statement.Signed……………………………………Date: 01 June 2010Aidan KehoeChief ExecutiveThe delivery of the MRSA Bacteraemiaand Clostridium Difficile targets remain anacknowledged high-risk, however the NHSFoundation Trust is currently under trajectoryfor MRSA Bacteraemia and Clostridium Difficile.Monthly levels of MRSA Bacteraemia andAnnual Report and Accounts April 1st 2009 to March 31st 2010 137

Annex D: Independent Auditor’s report to theCouncil of GovernorsAnnex D: IndependentAuditor’s report to the Councilof Governors of Blackpool,Fylde and Wyre Hospitals NHSFoundation TrustWe have audited the financial statementsof Blackpool, Fylde and Wyre Hospitals NHSFoundation Trust for the year ended 31 March 2010which comprise the Statement of ComprehensiveIncome, the Statement of Financial Position, theStatement of Cash Flows, the Statement of Changesin Taxpayers’ Equity and the related notes. Thefinancial reporting framework that has beenapplied in their preparation is the NHS FoundationTrust Annual Reporting Manual issued by theIndependent Regulator of NHS Foundation Trusts(“Monitor”).Respective responsibilities of directors and auditorsAs explained more fully in the Statement of ChiefExecutive’s Responsibilities as the AccountingOfficer, the directors are responsible for thepreparation of the financial statements and forbeing satisfied that they give a true and fairview. Our responsibility is to audit the financialstatements in accordance with relevant statute, theAudit Code for NHS Foundation Trusts issued byMonitor and International Standards on Auditing(UK and Ireland). Those standards require us tocomply with the Auditing Practices Board’s EthicalStandards for Auditors.This report, including the opinions, has beenprepared for and only for the Council of Governorsof Blackpool, Fylde and Wyre Hospitals NHSFoundation Trust in accordance with paragraph24(5) of Schedule 7 of the National Health ServiceAct 2006 and for no other purpose. We donot, in giving these opinions, accept or assumeresponsibility for any other purpose or to any otherperson to whom this report is shown or into whosehands it may come save where expressly agreed byour prior consent in writing.The maintenance and integrity of the Blackpool,Fylde and Wyre Hospitals NHS Foundation Trustwebsite is the responsibility of the directors; thework carried out by the auditors does not involveconsideration of these matters and, accordingly, theauditors accept no responsibility for any changesthat may have occurred to the financial statementssince they were initially presented on the website.Legislation in the United Kingdom governingthe preparation and dissemination of financialstatements may differ from legislation in otherjurisdictions.Scope of the audit of the financial statementsAn audit involves obtaining evidence about theamounts and disclosures in the financial statementssufficient to give reasonable assurance thatthe financial statements are free from materialmisstatement, whether caused by fraud or error.This includes an assessment of: whether theaccounting policies are appropriate to the NHSFoundation Trust’s circumstances and have beenconsistently applied and adequately disclosed; thereasonableness of significant accounting estimatesmade by the NHS Foundation Trust; and the overallpresentation of the financial statements.138Blackpool, Fylde and Wyre Hospitals

• adequate accounting records have not beenkept, or returns adequate for our audit havenot been received from locations not visitedby us; or• the financial statements are not inagreement with the accounting records andreturns; or• we have not received all the information andexplanations we require for our audit; or• the Statement on Internal Control does notmeet the disclosure requirements set out inthe NHS Foundation Trust Annual ReportingManual or is misleading or inconsistent withinformation of which we are aware from ouraudit; orOpinion on financial statementsIn our opinion the financial statements:• give a true and fair view, in accordance withthe NHS Foundation Trust Annual ReportingManual, of the state of the NHS FoundationTrust’s affairs as at 31 March 2010 and of itsincome and expenditure and cash flows forthe year then ended 31 March 2010; and• have been properly prepared in accordancewith the NHS Foundation Trust AnnualReporting Manual.• we have not been able to satisfy ourselvesthat the NHS Foundation Trust has madeproper arrangements for securing economy,efficiency and effectiveness in its use ofresources.CertificateWe certify that we have completed theaudit of the accounts in accordance with therequirements of Chapter 5 of Part 2 to theNational Health Service Act 2006 and the AuditCode for NHS Foundation Trusts issued byMonitor.Opinion on other matters prescribed by theAudit Code for NHS Foundation TrustsIn our opinion• the part of the Directors’ RemunerationReport to be audited has been properlyprepared in accordance with the NHSFoundation Trust Annual Reporting Manual;andPeter Chambers (Senior Statutory Auditor)For and on behalf of PricewaterhouseCoopersLLPChartered Accountants and Statutory AuditorsManchester4th June 2010• the information given in the Directors’Report for the financial year for whichthe financial statements are prepared isconsistent with the financial statements.Matters on which we are required to report byexceptionWe have nothing to report in respect of the followingmatters where the Audit Code for NHSFoundation Trusts requires us to report to you if,in our opinion:Annual Report and Accounts April 1st 2009 to March 31st 2010 139

I was admitted to Ward 37 on 1st February 2010 and I feel I must give feedback on the“excellent care which I received during my stay. The ward was clean, the food excellent andthe doctors and nursing staff went ‘above and beyond’, making my stay (dare I say it!)enjoyable. In particular I would like to mention one of the nurses, I think her name was Liz,for her dedication and ‘nothing was too much trouble’. Following my bypass surgery whichwas performed by Mr Bittar I was admitted to CITU where I was extremely well looked afterby Jacob who was very professional and really helped me to relax. Following that I went toWard 38 and again the nursing staff were very pleasant, professional and more than helpfulplus always had a smile on their faces. “Mr Les Wojarski140Blackpool, Fylde and Wyre Hospitals

Annex E: Accounts for the periodApril 1st 2009 to March 31st 2010STATEMENT OF THE CHIEF EXECUTIVE’S RESPONSIBILITIES ASTHE ACCOUNTING OFFICER OF BLACKPOOL, FYLDE AND WYREHOSPITALS NHS FOUNDATION TRUSTThe National Health Service Act 2006 (“2006 Act”) states that the ChiefExecutive is the Accounting Officer of the NHS Foundation Trust. The relevantresponsibilities of Accounting Officer, including their responsibility for thepropriety and regularity of the public finances for which they are answerable,and for the keeping of proper accounts, are set out in the Accounting Officers’Memorandum issued by the Independent Regulator of NHS Foundation Trusts(“Monitor”).Under the 2006 Act, Monitor has directed the Blackpool, Fylde and WyreHospitals NHS Foundation Trust to prepare, for each financial year, a statementof accounts in the form and on the basis set out in the Accounts Direction. Theaccounts are prepared on an accruals basis and must give a true and fair viewof the state of affairs of Blackpool, Fylde and Wyre Hospitals NHS FoundationTrust and of its income and expenditure, total recognised gains and losses andcash flows for the financial year.In preparing the accounts, the Accounting Officer is required to comply withthe requirements of the NHS Foundation Trust Annual Reporting Manual andin particular to:• observe the Accounts Direction issued by Monitor, including the relevantaccounting and disclosure requirements, and apply suitable accountingpolicies on a consistent basis;• make judgements and estimates on a reasonable basis;• state whether applicable accounting standards as set out in the NHSFoundation Trust Annual Reporting Manual have been followed, anddisclose and explain any material departures in the financial statements,and• prepare the financial statements on a going concern basis.The Accounting Officer is responsible for keeping proper accounting recordswhich disclose with reasonable accuracy at any time the financial positionof the NHS Foundation Trust and to enable him to ensure that the accountscomply with requirements outlined in the above mentioned Act. TheAccounting Officer is also responsible for safeguarding the assets of the NHSFoundation Trust and hence for taking reasonable steps for the prevention anddetection of fraud and other irregularities.To the best of my knowledge and belief, I have properly discharged theresponsibilities set out in Monitor’s NHS Foundation Trust Accounting OfficerMemorandum.Signed: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Date: 1st June 2010Aidan KehoeChief ExecutiveAnnual Report and Accounts April 1st 2009 to March 31st 2010i

FOREWORD TO THE ACCOUNTSBLACKPOOL, FYLDE AND WYRE HOSPITALS NHS FOUNDATION TRUSTThese accounts for the period ended 31st March 2010 have been prepared by the Blackpool, Fylde andWyre Hospitals NHS Foundation Trust in accordance with Schedule 7, sections 24 and 25 of the NationalHealth Services Act 2006.Signed: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Date: 1st June 2010Aidan KehoeChief ExecutiveiiBlackpool, Fylde and Wyre Hospitals

STATEMENT OF COMPREHENSIVE INCOME FOR THE YEAR ENDED31 March 20102009/10 2008/09NOTE £000 £000Income from activities 3 245,172 231,790Other operating income 4 26,037 23,288Operating income from continuing operations 271,209 255,078Operating expenses of continuing operations 5 (270,153) (243,088)OPERATING SURPLUS 1,056 11,990Finance CostsFinance income 8 149 1,154Finance expense 9 (1,131) (1,097)Public Dividend Capital dividends payable (5,786) (7,400)Net Finance Costs (6,768) (7,343)SURPLUS/(DEFICIT) FOR THE FINANCIAL YEAR (5,712) 4,647Other comprehensive income:Revaluation losses on property, plant and equipment 11 (16,003) (6,411)Increase in the donated asset reserve due to receipt of donated 11 263 502assetsReduction in the donated asset reserve in respect of depreciation, (249) (289)impairment, and disposal of donated assetsTOTAL COMPREHENSIVE INCOME AND EXPENSE FOR THE FINANCIAL YEAR (21,701) (1,551)The notes on pages vii to xxxv form part of these accounts.All revenue and expenditure is derived from continuing operations.Annual Report and Accounts April 1st 2009 to March 31st 2010iii

STATEMENT OF FINANCIAL POSITION AS AT 31ST MARCH 201031st March 31st March 1st April2010 2009 2008NOTE £000 £000 £000NON-CURRENT ASSETS:Intangible assets 10 4,611 1,089 715Property, plant and equipment 11 188,916 191,319 198,058Trade and other receivables 14 1,868 1,811 1,481Total non-current assets 195,395 194,219 200,254CURRENT ASSETS:Inventories 13 4,393 4,033 3,865Trade and other receivables 14 9,063 7,712 9,100Other financial assets 15 0 5,000 0Cash and cash equivalents 16 11,698 24,072 23,910Total current assets 25,154 40,817 36,875CURRENT LIABILITIES:Trade and other payables 17 (18,977) (19,995) (23,004)Borrowings 19 (126) (114) (103)Provisions 20 (226) (945) (2,036)Tax payable 17 (3,315) (3,095) (2,887)Other liabilities 18 (1,818) (2,955) (2,477)Total current liabilities (24,462) (27,104) (30,507)NON-CURRENT LIABILITIES:Borrowings 19 (17,860) (7,993) (8,107)Provisions 20 (1,216) (1,227) (1,193)Other liabilities 18 (1,550) (1,550) 0Total non-current liabilities (20,626) (10,770) (9,300)TOTAL ASSETS EMPLOYED 175,461 197,162 197,322TAXPAYERS’ EQUITYPublic dividend capital 141,031 141,031 139,640Revaluation reserve 30,810 46,571 53,252Donated asset reserve 2,823 3,051 2,869Income and expenditure reserve 797 6,509 1,561TOTAL TAXPAYERS’ EQUITY 175,461 197,162 197,322The financial statements on pages vii to xxxv were approved by the Trust Board on 1st June 2010 and aresigned on its behalf by:Signed: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Date: 1st June 2010ivBlackpool, Fylde and Wyre Hospitals

STATEMENT OF CHANGES IN TAXPAYERS’ EQUITY AT 31st March 2010Total Public Revaluation Donated IncomeDividend reserve Asset andCapitalreserve ExpenditurereserveNOTE £000 £000 £000 £000 £000Taxpayers’ equity at 1 April 2009 197,162 141,031 46,571 3,051 6,509Total Comprehensive Income for theyear:Retained deficit for the year (5,712) 0 0 0 (5,712)Impairment of property, plant & 11 (16,003) 0 (15,761) (242) 0equipmentReceipt of donated assets 11 263 0 0 263 0Reduction in the donated asset 4 (249) 0 0 (249) 0reserve in respect of depreciationand impairment of donated assetsTaxpayers’ equity at 31 March 2010 175,461 141,031 30,810 2,823 797Taxpayers’ equity at 1 April 2008 197,322 139,640 53,252 2,869 1,561Total Comprehensive Income for theyear:Retained surplus for the year 4,647 0 0 0 4,647Impairment of property, plant & 11 (6,411) 0 (6,411) 0 0equipmentReceipt of donated assets 11 502 0 0 502 0Reduction in the donated asset 4 (289) 0 0 (289) 0reserve in respect of depreciation,impairment and disposal of donatedassetsPublic Dividend Capital received 1,391 1,391 0 0 0Transfer of residual balances for prior 0 0 (270) (31) 301year asset disposals between reservesTaxpayers’ equity at 31 March 2009 197,162 141,031 46,571 3,051 6,509The notes on pages vii to xxxv form part of these accounts.Annual Report and Accounts April 1st 2009 to March 31st 2010v

CASH FLOW STATEMENT FOR THE YEAR ENDED 31st March 2010Year ended Year ended31st March 31st March2010 2009NOTE £000 £000Cash flows from operationsTotal operating surplus/(deficit) 1,056 11,990Adjusted for:Depreciation 11 5,935 7,060Amortisation 10 162 109Impairments 11 8,484 2,472Transfer from the donated asset reserve 4 (249) (289)(Increase)/decrease in trade and other receivables (1,232) 1,293(Increase)/decrease in inventories (360) (168)Increase/(decrease) in trade and other payables (3,277) (52)Increase/(decrease) in other liabilities (1,137) 2,028Increase/(decrease) in provisions (753) (1,085)Other movements in operating cash flows 0 (1,496)Net cash generated from/(used in) operations 8,629 21,862Cash flows from investing activitiesInterest received 380 917(Purchase)/Sale of financial assets 5,000 (5,000)Purchase of property, plant and equipment (25,298) (11,444)Proceeds from the sale of property, plant and equipment 0 1,496Purchase of intangible assets (3,662) (488)Net cash generated from/(used in) investing activities (23,580) (14,519)Cash flows from financing activitiesPublic Dividend Capital received 0 1,391Loans received 10,000 0Capital element of on-statement of financial position PFI repaid (121) (103)Interest paid (52) 0Interest paid in respect of on-statement of financial position PFI (1,058) (1,069)Public Dividend Capital dividends paid (6,192) (7,400)Net cash generated from/(used in) financing activities 2,577 (7,181)Increase/(decrease) in cash and cash equivalents (12,374) 162Cash and cash equivalents at the beginning of the financial year 24,072 23,910Cash and cash equivalents at the end of the financial year 16 11,698 24,072viBlackpool, Fylde and Wyre Hospitals

1. Accounting policies and otherinformationMonitor has directed that the financialstatements of NHS Foundation Trusts shallmeet the accounting requirements of the NHSFoundation Trust Annual Reporting Manualwhich has been agreed with HM Treasury.Consequently, the following financial statementshave been prepared in accordance with the2009/10 NHS Foundation Trust Annual ReportingManual issued by Monitor, on a going concernbasis under the historical cost convention asmodified by the revaluation of certain fixedassets. The accounting policies contained in thatmanual follow International Financial ReportingStandards (IFRS) and HM Treasury’s FinancialReporting Manual (the “FReM”) to the extentthat they are meaningful and appropriate toNHS Foundation Trusts. The accounting policieshave been applied consistently in dealing withitems considered material in relation to theaccounts.1.1 IncomeIncome in respect of goods and servicesprovided is recognised when, and to the extentthat, performance occurs and is measured at thefair value of the consideration receivable. Themain source of income for the Trust is contractswith commissioners in respect of healthcareservices. Where income is received for a specificactivity which is to be delivered in the followingfinancial year, that income is deferred.Income from the sale of non-current assets isrecognised only when all material conditions ofsale have been met, and is measured as the sumsdue under the sale contract less the carryingamount of the asset sold.1.2 Expenditure on Employee BenefitsShort-term Employee BenefitsSalaries, wages and employment-relatedpayments are recognised in the period in whichthe service is received from employees. The costof annual leave entitlement earned but nottaken by employees at the end of the periodis recognised in the financial statements to theextent that employees are permitted to carryforwardleave into the following period.Pension CostsNHS pension SchemePast and present employees are covered bythe provisions of the NHS Pensions Scheme.The scheme is an unfunded, defined benefitscheme that covers NHS employers, generalpractices and other bodies, allowed under theSecretary of State, in England and Wales. It isnot possible for the Trust to identify its shareof the underlying scheme liabilities. Therefore,the scheme is accounted for as a definedcontribution scheme.Employers pension cost contributions arecharged to operating expenses as and whenthey become due.Additional pension liabilities arising from earlyretirements are not funded by the schemeexcept where the retirement is due to illhealth.The full amount of the liability for theadditional costs is charged to the operatingexpenses at the time the Trust commits itselfto the retirement, regardless of the method ofpayment.1.3 Expenditure on other goods and servicesExpenditure on goods and services is recognisedwhen, and to the extent that they have beenreceived, and is measured at the fair valueof those goods and services. Expenditure isrecognised in operating expenses except whereit results in the creation of a non-current assetsuch as property, plant and equipment.1.4 Property, Plant and EquipmentRecognitionProperty, plant and equipment is capitalisedwhere:• it is held for use in delivering services, or foradministrative purposes;• it is probable that future economic benefitswill flow to, or service potential be providedto, the Trust;• it is expected to be used for more than onefinancial year; and• the cost of the item can be measuredreliably.Additionally, for items of property, plant andequipment to be capitalised they:• individually have a cost of at least £5,000;or• form a group of assets which collectivelyhave a cost of at least £5,000, where theassets are functionally interdependent, theyhad broadly simultaneous purchase dates,are anticipated to have simultaneous disposaldates and are under single managerialcontrol; or• form part of the initial setting-up cost of anew building or refurbishment of a wardor unit, irrespective of their individual orcollective cost.Annual Report and Accounts April 1st 2009 to March 31st 2010vii

MeasurementValuationAll property, plant and equipment assets aremeasured initially at cost, representing thecosts directly attributable to acquiring orconstructing the asset and bringing it to thelocation and condition necessary for it to becapable of operating in the manner intendedby management. Land and buildings aresubsequently measured at fair value based onperiodic valuations less subsequent depreciationand impairment losses.The valuations are carried out by professionallyqualified valuers in accordance with the RoyalInstitute of Chartered Surveyors (RICS) Appraisaland Valuation Manual, and performed withsufficient regularity to ensure that the carryingvalue is not materially different from fairvalue at the balance sheet date. Fair values aredetermined as follows:- Specialised operational property - depreciatedreplacement cost- Non specialised property - modern equivalentasset replacement cost- Land - Market value for existing use- Non operational properties including surplusland - open market valueAssets in the course of construction are valuedat cost less any impairment loss. Cost includesprofessional fees but not borrowing costs, whichare recognised as expenses immediately, asallowed by IAS 23 (Borrowing Costs) for assetsheld at fair value. Assets are revalued when theyare brought into use.Operational plant and equipment are carried atdepreciated historic cost as this is not consideredto be materially different to fair value. Plant andequipment surplus to requirements is valued atnet recoverable amount.Subsequent expenditureWhere subsequent expenditure enhances anasset beyond its original specification, the directlyattributable cost is added to the asset’s carryingvalue. Where subsequent expenditure is simplyrestoring the asset to the specification assumedby its economic useful life then the expenditure ischarged to operating expenses.DepreciationItems of property, plant and equipment aredepreciated using the straight line method overtheir estimated useful economic lives as follows:Buildings & DwellingsPlant & MachineryTransport equipmentInformation TechnologyFurniture & Fittings90 years5 to 15 years5 to 10 years5 to 15 years5 to 15 yearsFreehold land is considered to have an infinite lifeand is not depreciated.Management have determined that each buildingwithin the Trust’s estate is one component, thewhole of which is maintained to a standardsuch that the useful economic life of the wholebuilding and the elements within the building isthe same.The assets’ residual values and useful lives arereviewed annually, where significant.Property, plant and equipment which hasbeen reclassified as ‘held for sale’ ceases to bedepreciated upon the reclassification. Assets inthe course of construction are not depreciateduntil the asset is brought into use.Depreciation is charged to operating expensesfrom the first day of the quarter commencing 1April, 1 July, 1 October, or 1 January, followingthe date that the asset becomes available for use.Depreciation is charged in full in the quarter inwhich an asset becomes unavailable for use or issold and then ceases to be charged.Revaluation and impairmentIncreases in asset values arising from revaluationsare recognised in the revaluation reserve, exceptwhere, and to the extent that, they reverse animpairment previously recognised in operatingexpenses, in which case they are recognised inoperating income.Decreases in asset values and impairmentsare charged to the revaluation reserve to theextent that there is an available balance for theasset concerned, and thereafter are charged tooperating expenses.Gains and losses recognised in the revaluationreserve are reported in the Statement ofComprehensive Income as an item of ‘othercomprehensive income’.viiiBlackpool, Fylde and Wyre Hospitals

Held for sale assetsAssets intended for disposal are reclassified as‘held for sale’ once all of the following criteriaare met:• the asset is available for immediate sale in itspresent condition subject only to terms whichare usual and customary for such sales;• the sale must be highly probable i.e.:- management are committed to a plan tosell the asset;- an active programme has begun to find abuyer and complete the sale;- the asset is being actively marketed at areasonable price;- the sale is expected to be completedwithin 12 months of the date ofclassification as ‘held for sale’; and- the actions needed to complete the planindicate it is unlikely that the plan will bedropped or significant changes made to it.Following reclassification, the assets aremeasured at the lower of their existing carryingamount and their ‘fair value less costs to sell’.Depreciation ceases to be charged and theassets are not revalued, except where the ‘fairvalue less costs to sell’ falls below the carryingamount. Assets are de-recognised when allmaterial sale contract conditions have been met.Property, plant and equipment which is tobe scrapped or demolished does not qualifyfor recognition as ‘held for sale’ and insteadis retained as an operational asset and theasset’s economic life is adjusted. The asset isde-recognised when scrapping or demolitionoccurs.Donated assetsDonated non-current assets are capitalisedat their fair value on receipt and this value iscredited to the donated asset reserve. Donatednon-current assets are valued, depreciated andimpaired as described above for purchasedassets. Gains / losses on revaluations are takento the donated asset reserve and, each year, anamount equal to the depreciation charge on theasset is released from the donated asset reserveto the income statement. On sale of donatedassets, the net book value of the donated assetis transferred from the donated asset reserve tothe Income and Expenditure Reserve. Similarly,any impairment on donated assets charged tothe income and expenditure account is matchedby a transfer from the donated asset reserve.NHS rules require that at all times the donatedasset reserve is equal to the net book value ofdonated assets.1.5 LeasesFinance LeasesWhere substantially all risks and rewards ofownership of a leased asset are borne by theTrust, the asset is recorded as Property, Plantand Equipment and a corresponding liabilityis recorded. The value at which both arerecognised is the lower of the fair value of theasset or the present value of the minimum leasepayments, discounted using the interest rateimplicit in the lease. The implicit interest rate isthat which produces a constant periodic rate ofinterest on the outstanding liability.The asset and liability are recognised at theinception of the lease, and are de-recognisedwhen the liability is discharged, cancelled orexpires. The annual rental is split between therepayment of the liability and a finance cost.The annual finance cost is calculated by applyingthe implicit interest rate to the outstandingliability and is charged to Finance Costs in theStatement of Comprehensive Income.Operating LeasesPayments made under operating leases (netof any incentives received from the lessor) arecharged to operating expenses on a straight-linebasis over the period of the lease.Leases of land and buildingsWhere a lease is for land and buildings, theland component is separated from the buildingcomponent and the classification for each isassessed separately. Leased land is treated as anoperating lease.1.6 Private Finance Initiative (PFI) transactionsHM Treasury has determined that governmentbodies shall account for infrastructure PFIschemes where the government body controlsthe use of the infrastructure and the residualinterest in the infrastructure at the endof the arrangement as service concessionarrangements, following the principles of therequirements of IFRIC 12. The Trust thereforerecognises the PFI asset as an item of property,plant and equipment together with a liabilityto pay for it. The services received under thecontract are recorded as operating expenses.The annual unitary payment is separatedinto the following component parts, usingappropriate estimation techniques wherenecessary:a) Payment for the fair value of servicesreceived;b) Payment for the PFI asset, including financecostsAnnual Report and Accounts April 1st 2009 to March 31st 2010ix

Services receivedThe fair value of services received in the year isrecorded under the relevant expenditure headingswithin ‘operating expenses’.PFI AssetThe PFI assets are recognised as property, plant andequipment, when they come into use. The assetsare measured initially at fair value in accordancewith the principles of IAS 17. Subsequently, theassets are measured at fair value, which is kept upto date in accordance with the Trust’s approach foreach relevant class of asset in accordance with theprinciples of IAS 16.PFI liabilityA PFI liability is recognised at the same time as thePFI assets are recognised. It is measured initially atthe same amount as the fair value of the PFI assetsand is subsequently measured as a finance leaseliability in accordance with IAS 17.An annual finance cost is calculated by applyingthe implicit interest rate in the lease to theopening lease liability for the period, and ischarged to ‘Finance Costs’ within the Statement ofComprehensive Income.The element of the annual unitary payment thatis allocated as a finance lease rental is applied tomeet the annual finance cost and to repay thelease liability over the contract term.An element of the annual unitary paymentincrease due to cumulative indexation is allocatedto the finance lease. In accordance with IAS 17,this amount is not included in the minimum leasepayments, but is instead treated as contingentrent and is expensed as incurred. In substance, thisamount is a finance cost in respect of the liabilityand the expense is presented as a contingentfinance cost in the Statement of ComprehensiveIncome.Assets contributed by the Trust to the operator foruse in the schemeAssets contributed for use in the scheme continueto be recognised as items of property, plant andequipment in the Trust’s Statement of FinancialPosition.1.7 Intangible fixed assetsRecognitionIntangible assets are non-monetary assetswithout physical substance which are capable ofbeing sold separately from the rest of the Trust’sbusiness or which arise from contractual or otherlegal rights. They are recognised only where it isprobable that future economic benefits will flowto, or service potential be provided to, the Trustand where the cost of an asset can be measuredreliably, and where the cost is at least £5,000,or form a group of assets which collectivelyhave a cost of at least £5,000, where the assetsare functionally interdependent, had broadlysimultaneous purchase dates, are anticipated tohave simultaneous disposal dates and are undersingle managerial control.Internally generated intangible assetsInternally generated goodwill, brands, mastheads,publishing titles, customer lists and similaritems are not capitalised as intangible assets.Expenditure on research is not capitalised.Expenditure on development is capitalised onlywhere all of the following can be demonstrated:• the project is technically feasible to the point ofcompletion and will result in an intangible assetfor sale or for use;• the Trust intends to complete the asset and sellor use it;• the Trust has the ability to sell or use the asset;• how the intangible asset will generate probablefuture economic service delivery benefits e.g.The presence of a market for it or its output,or, where it is to be used for internal use, theusefulness of the asset.• adequate financial, technical and otherresources are available to the Trust to completethe development and sell or use the asset; and• the Trust can measure reliably the expensesattributable to the asset during development.SoftwareSoftware which is integral to the operation ofhardware e.g. An operating system, is capitalisedas part of the relevant item of property, plant andequipment. Software which is not integral to theoperation of hardware e.g. Application software, iscapitalised as an intangible asset.MeasurementIntangible assets are recognised initially at cost,comprising all directly attributable costs neededto create, produce and prepare the asset to thepoint that it is capable of operating in the mannerintended by management.Intangible assets relate to developmentexpenditure, software and licences and are carriedat amortised cost which management considerto materially equate to fair value and a reviewfor impairment is performed annually. Increasesin asset values arising from impairment reviewsare recognised in the revaluation reserve, exceptwhere, and to the extent that, they reverse animpairment previously recognised in operatingexpenses, in which case they are recognised inoperating income. Decreases in asset values andimpairments are charged to the revaluation reserveto the extent that there is an available balance forthe asset concerned, and thereafter are charged tooperating expenses.xBlackpool, Fylde and Wyre Hospitals

Gains and losses recognised in the revaluationreserve are reported in the Statement ofComprehensive Income as an item of ‘othercomprehensive income’.Intangible assets held for sale are measured atthe lower of their carrying amount or ‘fair valueless costs to sell’.AmortisationIntangible assets are amortised over theirexpected useful economic lives in a mannerconsistent with the consumption of economic orservice delivery benefits, as follows:Development expenditureSoftwareLicences and Trademarks8 years5 to 15 years5 to 15 yearsAmortisation is charged to operating expensesfrom the first day of the quarter commencing 1April, 1 July, 1 October, or 1 January, followingthe date that the asset becomes available foruse. Depreciation is charged in full in thequarter in which an asset becomes unavailablefor use or is sold and then ceases to be charged.1.8 Government grantsGovernment grants are grants from Governmentbodies other than income from primary caretrusts or NHS trusts for the provision of services.Grants from the Department of Health areaccounted for as Government grants. Wherethe Government grant is used to fund revenueexpenditure it is taken to the Statementof Comprehensive Income to match thatexpenditure. Where the grant is used to fundcapital expenditure the grant is held as deferredincome and released to operating income overthe life of the asset on a basis consistent withthe depreciation charge for that asset.1.9 Cash and cash equivalentsCash is cash in hand and deposits with anyfinancial institution repayable without penaltyon notice of not more than 24 hours. Cashequivalents are investments that mature in 3months or less from the date of acquisition andthat are readily convertible to known amountsof cash with insignificant risk of change in value.1.10 InventoriesInventories are valued at the lower of cost andnet realisable value using the weighted averagecost method for drugs and the first-in first-outmethod for other inventories, less any provisionsdeemed necessary.1.11 Financial instruments and financialliabilitiesRecognitionFinancial assets and financial liabilities whicharise from contracts for the purchase of nonfinancialitems (such as goods or services), whichare entered into in accordance with the Trust’snormal purchase, sale or usage requirements,are recognised when, and to the extent which,performance occurs i.e. when receipt or deliveryof the goods or services is made.Financial assets or liabilities in respect of assetsacquired or disposed of through finance leasesare recognised and measured in accordancewith the accounting policy for leases describedat note 1.6.All other financial assets and financial liabilitiesare recognised when the Trust becomes a partyto the contractual provisions of the instrument.De-recognitionAll financial assets are de-recognised when therights to receive cash flows from the assets haveexpired or the Trust has transferred substantiallyall of the risks and rewards of ownership.Financial liabilities are de-recognised when theobligation is discharged, cancelled or expires.Classification and measurementFinancial assets are categorised as ‘Loans andreceivables’.Financial liabilities are classified as ‘OtherFinancial Liabilities’.Financial assets and financial liabilities at ‘FairValue through Income and Expenditure’Financial assets and financial liabilities at ‘FairValue through Income and Expenditure’ arefinancial assets or financial liabilities held fortrading. The Trust does not have financial assetsor liabilities classified in this category.Loans and ReceivablesLoans and receivables are non-derivativefinancial assets with fixed or determinablepayments with are not quoted in an activemarket. They are included in current assets.The Trust’s loans and receivables comprise: cashand cash equivalents, NHS debtors, accruedincome and ‘other receivables’.Loans and receivables are recognised initiallyat fair value, net of transactions costs, and aremeasured subsequently at amortised cost, usingthe effective interest method. The effectiveinterest rate is the rate that discounts exactlyestimated future cash receipts through theexpected life of the financial asset or, whenappropriate, a shorter period, to the netcarrying amount of the financial asset.Annual Report and Accounts April 1st 2009 to March 31st 2010xi

At each period end, the Trust reviews tradedebtors for recoverability and makes provisionsto the extent that recovery of specific debts isconsidered to be doubtful.Interest on loans and receivables is calculatedusing the effective interest method and creditedto the Statement of Comprehensive Income.Other financial liabilitiesOther financial liabilities are recognised initiallyat fair value, net of transaction costs incurred,and measured subsequently at amortised costusing the effective interest method. The effectiveinterest rate is the rate that discounts exactlyestimated future cash payments through theexpected life of the financial liability or, whenappropriate, a shorter period, to the net carryingamount of the financial liability.They are included in current liabilities except foramounts payable more than 12 months after thestatement of financial position date, which areclassified as non-current liabilities.Interest on financial liabilities carried at amortisedcost is calculated using the effective interestmethod and charged to Finance Costs. Interest onfinancial liabilities taken out to finance property,plant and equipment or intangible assets is notcapitalised as part of the cost of those assets.Impairment of financial assetsAt the statement of financial position date,the Trust assesses whether any financial assetsare impaired. Financial assets are impaired andimpairment losses are recognised if, and only if,there is objective evidence of impairment as aresult of one or more events which occurred afterthe initial recognition of the asset and which hasan impact on the estimated future cash flows ofthe asset.For financial assets carried at amortised cost, theamount of the impairment loss is measured as thedifference between the asset’s carrying amountand the present value of the revised future cashflows discounted at the asset’s original effectiveinterest rate. The loss is recognised in theStatement of Comprehensive Income through theuse of a bad debt provision.1.12 ProvisionsThe Trust provides for legal or constructiveobligations that are of uncertain timing oramount at the balance sheet date on the basisof the best estimate of the expenditure requiredto settle the obligation. Where the effect of thetime value of money is significant, the estimatedrisk-adjusted cash flows are discounted using HMTreasury’s discount rate of 2.2% in real terms.Clinical negligence costsThe NHS Litigation Authority (NHSLA) operatesa risk pooling scheme under which the Trustpays an annual contribution to the NHSLA,which, in return, settles all clinical negligenceclaims. Although the NHSLA is administrativelyresponsible for all clinical negligence cases, thelegal liability remains with the Trust. The totalvalue of clinical negligence provisions carriedby the NHSLA on behalf of the Trust is disclosedat note 20. A provision is held in the Trust’saccounts for the excess payable by the Trust tothe NHSLA and is disclosed under ‘other legalclaims’ in note 20.Non-clinical risk poolingThe Trust participates in the Liabilities toThird Parties Scheme. This is a risk poolingscheme under which the Trust pays an annualcontribution to the NHS Litigation Authorityand in return receives assistance with the costsof claims arising. The annual membershipcontributions, and any ‘excesses’ payable inrespect of particular claims are charged tooperating expenses when the liability arises.1.13 ContingenciesContingent assets (that is, assets arising from pastevents whose existence will only be confirmedby one or more future events not wholly withinthe entity’s control) are not recognised as assets,but are disclosed in note 22 where an inflow ofeconomic benefits is probable.Contingent liabilities are not recognised, butare disclosed in note 22, unless the probabilityof a transfer of economic benefits is remote.Contingent liabilities are defined as:• Possible obligations arising from past eventswhose existence will be confirmed only by theoccurrence of one or more uncertain futureevents not wholly within the entity’s control;or• Present obligations arising from past eventsbut for which it is not probable that a transferof economic benefits will arise or for which theamount of the obligation cannot be measuredwith sufficient reliability.1.14 Public dividend capitalPublic dividend capital (PDC) is a type of publicsector equity finance based on the excess ofassets over liabilities at the time of establishmentof the predecessor NHS trust. HM Treasury hasdetermined that PDC is not a financial instrumentwithin the meaning of IAS 32.A charge, reflecting the forecast cost of capitalutilised by the Trust, is paid over as a publicdividend capital dividend.xiiBlackpool, Fylde and Wyre Hospitals

The charge is calculated at the real rate set byHM Treasury (currently 3.5%) on the averagerelevant net assets of the Trust. Relevant netassets are calculated as the value of all assets lessthe value of all liabilities, except for donatedassets and cash held with the GovernmentBanking Service. Average relevant net assetsare calculated as a simple mean of opening andclosing relevant net assets.Prior to 2009/10 the dividend was based onforecast average relevant net assets. From1 April 2009 the dividend is based on actualaverage relevant net assets. Any variance fromamounts paid during the year based on forecastoutturn are included in current amountsreceivable or payable. The dividend thuscalculated is not revised should any adjustmentto net assets occur as a result of the audit of theannual accounts.1.15 Value Added TaxMost of the activities of the Trust are outsidethe scope of VAT and, in general, output taxdoes not apply and input tax on purchases isnot recoverable. Irrecoverable VAT is charged tothe relevant expenditure category or includedin the capitalised purchase cost of fixed assets.Where output tax is charged or input VAT isrecoverable, the amounts are stated net of VAT.1.16 Corporation TaxThe Trust is a Health Service Body within themeaning of s519A ICTA 1988 and accordingly isexempt from taxation in respect of income andcapital gains within categories covered by this.There is power for the Treasury to disapply theexemption in relation to specified activities ofa Foundation Trust (s519A (3) to (8) ICTA 1988),Accordingly, the trust is potentially within thescope of corporation tax in respect of activitieswhich are not related to, or ancillary to, theprovision of healthcare, and where the profitstherefrom exceed £50,000 per annum.1.17 Third Party AssetsAssets belonging to third parties (such as moneyheld on behalf of patients) are not recognisedin the accounts since the Trust has no beneficialinterest in them. However, they are disclosed ina separate note to the accounts in accordancewith the requirements of HM Treasury’s FReM.1.18 Foreign currenciesruling on the dates of the transactions. Atthe end of the reporting period, monetaryitems denominated in foreign currencies areretranslated at the spot exchange rate on 31March. Resulting exchange gains and lossesfor either of these are recognised in the Trust’ssurplus/deficit in the period in which they arise.1.19 Losses and Special PaymentsLosses and special payments are items thatParliament would not have contemplated whenit agreed funds for the health service or passedlegislation. By their nature they are items thatideally should not arise. They are thereforesubject to special control procedures comparedwith the generality of payments. They aredivided into different categories, which governthe way that individual cases are handled.Losses and special payments are charged to therelevant functional headings in expenditure onan accruals basis, excluding provisions for futurelosses, but including losses which would havebeen made good through insurance cover hadthe Trust not been bearing its own risks (withinsurance premiums then being included asnormal revenue expenditure).1.20 Accounting standards not adoptedMonitor have directed that Foundation Trustsadopt International Financial ReportingStandards in accordance with the adoptiontimetable set out by the InternationalAccounting Standards Board. The Trust haveadopted all relevant standards as they apply toFoundation Trusts.IAS27, ‘Consolidated and separate financialstatements’: Monitor have issued a dispensationin 2009/10 for NHS Foundation Trusts toconsolidate their Charitable Fund balances intothe Trust’s financial statements where the Trustmeets the “control test” set out within IAS27.1.21 Accounting standards adopted earlyIn line with the IASB’s “Improvements to IFRS”issued in April 2009, and the Foundation Trust’sAnnual Reporting Manual, the Trust has earlyadopted an amendment to IFRS 8 (SegmentalReporting). Consequently the Trust has notdisclosed assets attributable to each operatingsegment as this information is not reported tothe Chief Operating Decision Maker.The Trust’s functional currency andpresentational currency is sterling. Transactionsdenominated in a foreign currency aretranslated into sterling at the exchange rateAnnual Report and Accounts April 1st 2009 to March 31st 2010xiii

1.22 Accounting standards not yet effective andnot adopted earlyThe following standards and amendments toexisting standards have been published and aremandatory for the Trust’s accounting periodsbeginning on or after 1 April 2010 or laterperiods, but the Trust has not early adoptedthem:IFRIC 17, ‘Distribution of non-cash assets toowners’ (effective for accounting periodsbeginning on or after 1 July 2009). Thisinterpretation will not impact the Trust.IAS 27 (revised), ‘Consolidated and separatefinancial statements’, (effective for accountingperiods beginning on or after 1 July 2009). Thisrevised standard will not have an impact on theTrust.IFRS 3 (revised), ‘Business combinations’ (effectivefor accounting periods beginning on or after 1July 2009). This revised standard will not have animpact on the Trust.IFRS 2 (amendments), ‘Group cash-settledshare-based payment transactions’ (effectivefor accounting periods beginning on or after 1January 2010). This revised standard will nothave an impact on the Trust.Annual improvements 2010 and 2009. Withthe exception of the amendment to IFRS 8 inrelation to the disclosure of total assets bysegment which has been adopted by the trustin the current financial statements as notedabove, the improvements will apply to the Trustfrom 1 April 2010 and 2011 onwards. Thesefurther improvements are not expected to havea significant impact on the Trust’s financialstatements.IFRIC 19, ‘Extinguishing financial liabilities withequity instruments’. This revised interpretationwill not have an impact on the Trust.1.23 Accounting estimates, judgements andcritical accounting policiesComponent depreciationIAS 16(Property, Plant and Equipment) requiresthat “each part of an item of property, plantand equipment with a cost which is significantin relation to the total cost of the item, shall bedepreciated separately”. The standard also states,“A significant part of an item of PPE may havea useful life and a depreciation method thatare the same as the useful life and depreciationmethod of another significant part of the sameitem. Such parts may be grouped in determiningthe depreciation charge”.The Trust has elected to depreciate eachbuilding and its constituent elements as a singlecomponent on the basis that this more fairlyreflects the way that the Trust’s is managedand maintained. The appropriateness of thistreatment will be reviewed annually.This change in accounting estimate has beenapplied from 1 April 2009 resulting in a reductionto the annual depreciation charge of £1.2m.Revaluation of land, buildings and dwellingsAt 31st March 2010 the Trust’s valuer carried outa revaluation of the land, buildings and dwellingsto reflect the continued economic downturnduring 2009/10. This has resulted in a downwardvaluation of these non-current assets of £24.5million. (see Note 11 for further details)IAS 32, ‘Financial instruments. Presentation onclassification or rights issues’ This revised standardwill not have an impact on the Trust.IAS 39, ‘Eligible hedged items’. This revisedstandard will not have an impact on the Trust.IFRS 9, ‘Financial instruments. The trust will applyIFRS 9 from 1 April 2013. It is not expected tohave a material impact on the Trust’s financialstatements.IFRIC 14, IAS 19 ‘Prepayments of a minimumfunding requirement’. This revised standard andinterpretation will not have an impact on theTrust.”IFRIC 18, ‘Transfer of assets from customers’. Thisrevised standard will not have an impact on theTrust.xivBlackpool, Fylde and Wyre Hospitals

2. Operating segments2009/10 Medicine Surgery Cardiac Women’s Clinical Other Total& SupportChildren’s Services£000 £000 £000 £000 £000 £000 £000Income 72,307 63,170 44,124 25,154 35,639 30,815 271,209Expenditure (69,898) (62,030) (43,462) (24,676) (27,229) (28,277) (255,572)EBITDA 2,409 1,140 662 478 8,410 2,538 15,637Fixed asset impairments (8,484)Depreciation (6,097)Interest receivable 149Interest payable (1,132)PDC dividend (5,785)Deficit for the Financial Year (5,712)2008/09 Medicine Surgery Cardiac Women’s Clinical Other Total& SupportChildren’s Services£000 £000 £000 £000 £000 £000 £000Income 73,383 63,124 45,251 23,468 23,946 25,906 255,078Expenditure (67,737) (60,069) (38,764) (23,818) (18,192) (24,866) (233,446)EBITDA 5,646 3,055 6,487 (350) 5,754 1,040 21,632Fixed asset impairments (2,472)Depreciation (7,169)Interest receivable 1,154Interest payable (1,098)PDC dividend (7,400)Surplus for the Financial Year 4,647Segmental informationFinancial and operational performance data is reviewed by the Trust Board of Directors on a monthlybasis. The Board are responsible for setting financial performance targets for each of the divisionswithin the Trust. The Trust Board of Directors are therefore considered to be the Chief OperatingDecision Maker (CODM).Each of the Trust’s healthcare divisions have been deemed to be a reportable segment under IFRS8(Segmental Reporting). The “Other” segment consists of the Corporate Services and Facilities divisionswhich combined represent 11.3% of operating income.Recharges of indirect activity based costs are recharged between divisions at unit costs. Overheads andfixed costs are apportioned on the floor area, staff numbers or expenditure levels.The majority of the Trust’s revenue is generated from external customers in England, with theexception of the bodies listed below, and transactions between segments are immaterial2009/10 2008/09£000 £000Scottish NHS bodies 409 121Local Health boards in Wales 96 54Northern Ireland Health and Social Care Trusts 68 0The Trust has three external customers which generate income amounting to more than 10% of theTrust’s total income. The values of income from the largest customers are set out in note 26. Theincome from these customers is included in all of the segments reported above.Annual Report and Accounts April 1st 2009 to March 31st 2010xv

3. Income3.1 Income from Activities by categoryYear ended Year ended31st March 31st March2010 2009£000 £000Elective income 57,669 56,203Non elective income 78,554 72,868Outpatient income 32,024 30,434A & E income 7,452 6,973Other NHS Clinical income 68,053 63,799Private patient income 1,420 1,5133.2 Private patient income245,172 231,790Under section 44 of the 2006 Act, the proportion of private patient income to the total of patient relatedincome of the Trust should not exceed the proportion whilst the NHS body was an NHS trust in 2002/03.2009/10 2008/09 2002/03£000 £000 £000Private patient income 1,420 1,513 3,184Total patient related income 245,172 231,790 151,547Proportion (as a percentage) 0.6% 0.7% 2%3.3 Income from activities by sourceYear ended Year ended31st March 31st March2010 2009£000 £000NHS Foundation Trusts 92 83NHS Trusts 25 18Strategic Health Authorities 1,278 807Primary Care Trusts 238,968 223,343Department of Health 93 3,660Local Authorities 197 242Non NHS:- Private patients 1,420 1,513- NHS Injury scheme income 1,176 1,181- Other 1,923 943245,172 231,7903.4 Mandatory and Non Mandatory IncomeUnder the National Health Service Act (2006) the Trust is required to provide health Services inEngland. The mandatory goods and services are listed in Schedule 2 of the Foundation Trust’s Terms ofAuthorisation. Of the total income from activities, £240.1m (2008/09: £227.9m) relates to MandatoryGoods and Services and £5.0m (2008/09: £3.9m) relates to Non Mandatory Goods and Services.xviBlackpool, Fylde and Wyre Hospitals

4. Other Operating IncomeYear ended Year ended31st March 31st March2010 2009£000 £000Research and Development 1,128 1,071Education, training and research * 13,601 10,505Charitable and other contributions to expenditure 83 143Transfers from donated asset reserve 249 289Non-patient care services to other bodies ** 6,559 6,001Profit on disposal of land and buildings 0 1,496Sales of goods and services *** 2,752 2,947Other **** 1,665 83626,037 23,288* Education, training and research income comprises income relating the North West LeadershipAcademy for which the Trust is the host organisation, and funding received from NHS Northwestfor junior doctors training.** Non-patient care services to other bodies includes service level agreement income from otherNHS bodies for estates, IT and payroll services provided by the Trust.*** Sales of goods and services includes income from catering sales, commercial laundry services, staffaccomodation rentals, and car parking.**** Other income includes £264,000 relating to VAT refunds relating to prior years.Annual Report and Accounts April 1st 2009 to March 31st 2010xvii

5. Operating expenses5.1 Operating expenses comprise: Year ended Year ended31st March 31st March2010 2009NOTE £000 £000Services from Foundation Trusts 513 427Services from NHS Trusts 184 39Services from other NHS bodies 943 1,916Purchase of healthcare from non NHS bodies 3,011 1,883Non Executive Directors’ costs 143 140Executive Directors’ costs 6 722 679Employee costs (excluding Executive Directors’ costs) 6 165,445 148,659Drug costs 17,239 15,042Supplies and services - clinical 30,670 29,105Supplies and services - general 8,722 8,367Establishment * 9,014 6,559Transport 1,947 1,741Premises 12,302 13,092Increase / (decrease) in provision for impairment of receivables (1,102) 1,330Depreciation 11 5,935 7,060Amortisation 10 162 109Non-current asset impairments 11 8,484 2,472Audit services - statutory audit 77 86Other auditor’s remuneration 0 45Clinical negligence ** 3,379 1,919Other *** 2,363 2,418270,153 243,088* Establishment costs have increased due to North West Leadership Academy training expenditure.This increase in costs is offset by increased “Education, training and research” income disclosed innote 4.** The Trust’s annual contribution to the NHS Litigation Authority insurance scheme for clinicalnegligence has increased significantly during the year.*** Other expenditure includes costs for external consultancy, internal audit services, and car parksecurity services.5.2 Other auditor’s remuneration Year ended Year ended31st March 31st March2010 2009£000 £000Waiting list management 0 31IFRS Consultancy 0 14TOTAL 0 455.3 Auditor liability limitation agreementsThe audit agreement PricewaterhouseCoopers (PwC) contains a £1million limit on their liability for lossesor damages in connection with the audit contract for their audit work. This limitation does not apply inthe event of losses or damages arising from fraud or dishonesty of PwC.xviiiBlackpool, Fylde and Wyre Hospitals

5.4 Operating leasesAs lessee5.4.1 Payments recognised as an expense Year ended Year ended31st March 31st March2010 2009£000 £000Minimum lease payments 2,194 2,0262,194 2,0265.4.2 Total future minimum lease payments Year ended Year ended31st March 31st March2010 2009£000 £000Not later than one year 15 78Between one and five years 5,838 4,401After five years 920 2,4616,773 6,9405.4.3 Significant leasing arrangementsThe significant operating lease arrangements held by the Trust relate to medical equipment andbuildings and are subject to the following terms:- No transfer of ownership at the end of the lease term.- No option to purchase at a price significantly below fair value at the end of the lease term.- Leases are non-cancellable or must be paid in full.- No secondary period rental or at best market rate.- Lease payments are fixed for the contracted lease term.Significant operating lease arrangements held by the Trust relate to: Annual Leasecommitmentterm£000 Years- Cardiac centre equipment 449 7- Catheter laboratory 1 207 7- Catheter laboratory 2 188 5- Zoo Cark Park 167 5- CT Scanner 155 5- Endoscopy equipment 150 55.4.4 PFI Payments recognised as an expense Year ended Year ended31st March 31st March2010 2009£000 £000Facility Management - Minimum lease payments 1,426 1,3541,426 1,354The Trust is committed to make the following service paymentsduring the next year for the PFI commitment: £000expiring in 15 to 20 years: 1,260The facility management charge was set at the outset of the contract and is uplifted annually from1st April by the increase in the Retail Prices Index as at the preceding February. Costs are charged tooperating expenses.Annual Report and Accounts April 1st 2009 to March 31st 2010xix

6. Employee costs and numbers6.1 Staff costs Year ended Year ended31st March 31st March2010 2009Permanently Other Total Totalemployed£000 £000 £000 £000Salaries and wages 136,346 0 136,346 124,244Social security costs 9,547 0 9,547 8,889Employers contribution to NHS Pension Scheme 14,830 0 14,830 13,580Agency / Contract staff 0 5,444 5,444 2,625Total 160,723 5,444 166,167 149,338Total employee costs above reconciles to the total of Executive Directors’ costs and Employee costs onNote 5.1 Operating expenses.6.2 Average number of persons employed Year ended Year ended31st March 31st March2010 2009Permanently Other Total TotalemployedWTE WTE WTE WTEMedical and Dental 304 25 329 341Administration and estates 977 64 1,041 905Healthcare assistants and other support staff 1,012 0 1,012 919Nursing, midwifery and health visiting staff 1,334 0 1,334 1,279Scientific, therapeutic and technical staff 434 2 436 4156.3 Retirements due to ill health4,061 91 4,152 3,859In the period ended 31st March 2010 there were 7 early retirements from the Trust on the grounds ofill-health. The estimated additional pension liabilities of these ill-health retirements will be £551,787.(2008/09: 9 cases with estimated liability of £896,162) The cost of these ill-health retirements will beborne by the NHS Pension Scheme. Accordingly, no provision is recognised in the Trust’s accounts.6.4 Pension costsPast and present employees are covered by the provisions of the NHS Pensions Scheme. The scheme isan unfunded, defined benefit scheme that covers NHS employers, general practices and other bodies,allowed under the direction of Secretary of State, in England and Wales. The Scheme is not designed tobe run in a way that would enable NHS bodies to identify their share of the underlying scheme assetsand liabilities. Therefore, the scheme is accounted for as a defined contribution scheme: the cost to theTrust of participating in the Scheme is taken as equal to the contributions payable to the Scheme for theaccounting year.The Scheme is subject to a full valuation every four years by the Government Actuary. The last suchinvestigation, on the conclusions of which scheme contribution rates are currently based, had an effectivedate of 31 March 2004 and covered the period from 1 April 1999 to that date. Between the full actuarialvaluations, the Government Actuary provides an annual update of the scheme liabilities for IAS 19purposes. The latest assessment of the liabilities of the Scheme is contained in the Scheme Actuary report,which forms part of the NHS Pension Scheme (England and Wales) Resource Account, published annually.These accounts can be viewed on the Business Service Authority - Pensions Division website at www.pensions.nhsbsa.nhs.uk. Copies can also be obtained from The Stationery Office.The conclusion of the 2004 valuation was that the scheme had accumulated a notional deficit of £3.3billion against the notional assets as at 31 March 2004, and the Scheme continues to operate on a soundfinancial basis. Employer contribution rates are reviewed every four years following the Scheme valuation,on advice from the actuary. Taking into account the changes in the benefit and contribution structureeffective from 1 April 2008, it was recommended that employer contributions should continue at theexisting rate of 14% of pensionable pay. From 1 April 2008, employees pay contributions according to atiered scale from 5% up to 8.5% of their pensionable pay.xxBlackpool, Fylde and Wyre Hospitals

7. Gains/(losses) on disposal of assetsYear ended Year ended31st March 31st March2010 2009£000 £000Gain/(Loss) on disposal of protected assets 0 1,4960 1,496The gain on disposal of assets in 2008/09 related to overage payments received following the sale ofland in previous years. The disposal of property, plant and equipment disposals reported at note 11for 2008/09 arose from the disposal of property, plant and equipment assets at nil net book value, andgenerated no sale proceeds.8. Finance incomeYear ended Year ended31st March 31st March2010 2009£000 £000Interest from bank accounts 149 1,154149 1,1549. Finance expense - financial liabilitiesNOTE Year ended Year ended31st March 31st March2010 2009£000 £000Interest on obligations under on-statement of 793 804financial position PFI schemesContingent rentals under on-statement of financial 264 264position PFI schemesLoans from Foundation Trust financing facility 52 0Unwinding of discount on provisions 20 22 291,131 1,097Annual Report and Accounts April 1st 2009 to March 31st 2010xxi

10. Intangible assetsIntangible assets comprise the following elements:Software Licences & Development TotalLicences Trademarks Expenditure£000 £000 £000 £000Cost or valuation at 1st April 2009 620 515 189 1,324Additions purchased 3,342 342 0 3,684Cost or valuation at 31st March 2010 3,962 857 189 5,008Amortisation at 1st April 2009 92 71 72 235Charged during the year 82 57 23 162Amortisation at 31st March 2010 174 128 95 397Net book value at 31st March 2010 3,788 729 94 4,611Net book valuePurchased at 31st March 2010 3,788 729 94 4,611Total at 31st March 2010 3,788 729 94 4,611Prior year:Cost or valuation at 1st April 2008 364 283 189 836Additions purchased 256 232 0 488Cost or valuation at 31st March 2009 620 515 189 1,324Amortisation at 1st April 2008 33 39 49 121Charged during the year 53 32 24 109Reclassifications 6 0 (1) 5Amortisation at 31st March 2009 92 71 72 235Net book value at 31st March 2009 528 444 117 1,089Net book valuePurchased at 31st March 2009 528 444 117 1,089Total at 31st March 2009 528 444 117 1,089Net book valuePurchased at 1st April 2008 331 244 140 715Total at 1st April 2008 331 244 140 715xxiiBlackpool, Fylde and Wyre Hospitals

11. Property, plant and equipmentProperty, plant and equipment comprises the following elements:Land Buildings Dwellings Assets Plant Transport Information Furniture Totalexcluding under and Equipment Technology & fittingsdwellingsconstruction Machinery£000 £000 £000 £000 £000 £000 £000 £000 £000Cost or valuation at 1st April 2009 9,576 155,325 7,213 3,807 38,886 204 5,344 2,123 222,478Additions purchased 0 3,759 773 19,486 2,012 0 1,661 65 27,756Additions donated 0 0 0 0 257 0 6 0 263Impairment charges to revaluation 0 (14,591) (1,412) 0 0 0 0 0 (16,003)reserveReclassifications 0 350 (350) 0 (9) 0 9 0 0Transfer of depreciation to gross (367) (16,304) (226) 0 0 0 0 0 (16,897)book value following revaluationCost or valuation at 31st March 2010 9,209 128,539 5,998 23,293 41,146 204 7,020 2,188 217,597Depreciation at 1st April 2009 367 5,571 133 0 21,623 179 2,698 588 31,159Charged during the year 0 2,240 102 0 2,790 13 594 196 5,935Impairments recognised in operatingexpenses 0 8,484 0 0 0 0 0 0 8,484Reclassifications 0 9 (9) 0 0 0 0 0 0Transfer of depreciation to grossbook value following revaluation (367) (16,304) (226) 0 0 0 0 0 (16,897)Depreciation at 31st March 2010 0 0 0 0 24,413 192 3,292 784 28,681Net book value at 31st March 2010 9,209 128,539 5,998 23,293 16,733 12 3,728 1,404 188,916Net book valueOwnedPurchased at 31st March 2010 8,870 117,865 5,998 23,293 15,697 12 3,722 1,404 176,861Donated at 31st March 2010 0 1,781 0 0 1,036 0 6 0 2,823Assets under PFI arrangementFinance lease at 31st March 2010 339 8,893 0 0 0 0 0 0 9,232Total at 31st March 2010 9,209 128,539 5,998 23,293 16,733 12 3,728 1,404 188,916Protected statusProtected assets at 31st March 2010 9,209 128,539 0 0 0 0 0 0 137,748Unprotected assets at 31st March 2010 0 0 5,998 23,293 16,733 12 3,728 1,404 51,168Total at 31st March 2010 9,209 128,539 5,998 23,293 16,733 12 3,728 1,404 188,916As at the Balance Sheet date all Land, Buildings and Dwellings are Freehold.Protected assets are those assets required for providing the mandatory goods and services set out in the Trust’sterms of authorisation approved by Monitor, the Independent Regulator of Foundation Trusts. The Trust may notdispose of any protected property without the approval of Monitor.Revaluation of property, plant and equipmentLand and buildings (including dwellings) valuations are carried out by professionally qualified valuers inaccordance with the Royal Institute of Chartered Surveyors (RICS) Appraisal and Valuation Manual. The lastrevaluation took place on 1 April 2008 based on modern replacement cost and was undertaken by Andrew MWilson MRICS of DTZ. At 31 March 2009 and 31 March 2010 desktop valuations were carried out using cost indicesto update land and building asset values.The impact of the revaluation of land and buildings (including dwellings) charged to operating expenses andreserves is as follows:2009/10 2008/09£000 £000Impairments charged to the revaluation reserve 15,761 6,411Impairments charged to the donated asset reserve 242 0Impairments recognised in operating expenses 8,484 2,47224,487 8,883Annual Report and Accounts April 1st 2009 to March 31st 2010xxiii

11. Property, plant and equipment (continued)Land Buildings Dwellings Assets Plant Transport Information Furniture Totalexcluding under and Equipment Technology & fittingsdwellingsconstruction Machinery£000 £000 £000 £000 £000 £000 £000 £000 £000Cost or valuation at 1st April 2008 11,512 156,801 7,468 85 44,772 209 7,792 2,511 231,150Additions purchased 0 2,577 167 3,722 1,663 10 547 11 8,697Additions donated 0 0 0 0 502 0 0 0 502Impairment charges to revaluationreserve (1,936) (4,053) (422) 0 0 0 0 0 (6,411)Reclassifications 0 0 0 0 784 0 (913) 215 86Disposals 0 0 0 0 (8,835) (15) (2,082) (614) (11,546)Cost or valuation at31st March 2009 9,576 155,325 7,213 3,807 38,886 204 5,344 2,123 222,478Depreciation at 1st April 2008 0 0 0 0 27,668 180 4,237 1,007 33,092Charged during the year 0 3,466 133 0 2,710 14 543 194 7,060Impairments recognised in 367 2,105 0 0 0 0 0 0 2,472operating expensesReclassifications 0 0 0 0 80 0 0 1 81Disposals 0 0 0 0 (8,835) (15) (2,082) (614) (11,546)Depreciation at 31st March 2009 367 5,571 133 0 21,623 179 2,698 588 31,159Net book value at 31st March 2009 9,209 149,754 7,080 3,807 17,263 25 2,646 1,535 191,319Net book valueOwnedPurchased at 31st March 2009 8,870 137,382 7,080 3,807 16,261 25 2,646 1,535 177,606Donated at 31st March 2009 0 2,049 0 0 1,002 0 0 0 3,051Assets under PFI arrangementFinance lease at 31st March 2009 339 10,323 0 0 0 0 0 0 10,662Total at 31st March 2009 9,209 149,754 7,080 3,807 17,263 25 2,646 1,535 191,319OwnedPurchased at 1st April 2008 11,089 143,684 7,468 85 16,362 29 3,555 1,504 183,776Donated at 1st April 2008 0 2,181 0 0 742 0 0 0 2,923Assets under PFI arrangementFinance lease at 1st April 2008 423 10,936 0 0 0 0 0 0 11,359Total at 1st April 2008 11,512 156,801 7,468 85 17,104 29 3,555 1,504 198,058Protected statusProtected assets at 31st March 2009 9,209 149,754 0 0 0 0 0 0 158,963Unprotected assets at 31st March 2009 0 0 7,080 3,807 17,263 25 2,646 1,535 32,356Total at 31st March 2009 9,209 149,754 7,080 3,807 17,263 25 2,646 1,535 191,319Protected statusProtected assets at 1st April 2008 11,512 156,801 0 0 0 0 0 0 168,313Unprotected assets at 1st April 2008 0 0 7,468 85 17,104 29 3,555 1,504 29,745Total at 1st April 2008 11,512 156,801 7,468 85 17,104 29 3,555 1,504 198,058xxivBlackpool, Fylde and Wyre Hospitals

12. Capital commitmentsCommitments under capital expenditure contracts at the balance sheet date were £29,042,195.2010/11 2009/10£000 £000Surgical Centre 21,901 37,165Urgent Care Centre 1,166 2,955Reconfiguration of Women & Children services 3,069 11,741Mortuary 2,026 0Other 880 87029,042 52,73113. Inventories31st March 2010 31st March 2009 1st April 2008£000 £000 £000Materials 4,393 4,033 3,865There have been no write-down of inventories or reversal of write-downs during 2009/10.Management have performed a review for obsolete or slow moving stock in order to identify the needfor an inventory provision and do not consider that a provision is required as at 31 March 2010.Inventories charged to operating expenses include drugs £16.808m (2008/09 15.054m) and cardiacconsumables £2.542m(2008/09: £2.048m). The figure reported for drugs in operating expenses includescosts of non-inventory items.Annual Report and Accounts April 1st 2009 to March 31st 2010xxv

14. Trade and other receivables14.1 Trade and other receivables 31st March 31st March 1st April2010 2009 2008£000 £000 £000NHS receivables 5,158 5,776 7,605Other receivables with related parties 872 809 0Provision for impairment of receivables (405) (2,256) (1,375)Prepayments and accrued income 1,656 1,469 947PDC dividend receivable 406 0 0Other receivables 1,376 1,914 1,923Trade and other receivables falling due within one year 9,063 7,712 9,100Other receivables 2,118 2,051 1,680Provision for impairment of receivables (250) (240) (199)Trade and receivables falling due after more than one year 1,868 1,811 1,481Total 10,931 9,523 10,58114.2 Aging of receivables past their due date but not impaired31st March 31st March2010 2009£000 £000By up to three months 532 179By three to six months 254 208By more than six months 6 75792 46214.3 Analysis of provision for impairment of receivablesNHS Debts Non NHS Debts Total£000 £000 £000As at 1st April 2009 1,869 627 2,496Amounts written off during the year as uncollectible (675) (64) (739)Amounts reversed unused during the year (1,189) (118) (1,307)(Decrease)/increase in allowance recognised in operating expenses 164 41 205As at 31st March 2010 169 486 65514.4 Aging of impaired receivables31st March 31st March2010 2009£000 £000By up to three months 62 1,381By three to six months 54 268By more than six months 539 847655 2,496xxviBlackpool, Fylde and Wyre Hospitals

15. Other financial assets31st March 31st March 1st April2010 2009 2008£000 £000 £000Yorkshire Bank deposit 0 5,000 0The rate of interest attached to this deposit was 6.15% and the maturity period at the time of thedeposit was 1 year. Due to the short term nature of the deposit and the fact that the interest rate is notmaterially different than market rates, management did not consider that the fair value of the assetwas materially different to amortised cost. As at 31 March 2010, the deposit has been returned in fullwith nil gain or loss, therefore there is no credit risk for the Trust in respect of the deposit at year end.16. Cash and cash equivalents31st March 31st March 1st April2010 2009 2008£000 £000 £000Balance at beginning of the year 24,072 23,910 13,511Net change in the year (12,374) 162 10,399Balance at 31 March 11,698 24,072 23,910Made up of:Cash with Government Banking Service 11,698 24,072 23,91011,698 24,072 23,91017. Trade and other payables31st March 31st March 1st April2010 2009 2008£000 £000 £000NHS payables 3,904 5,165 3,704Amounts due to other related parties 147 1,750 0Non-NHS trade payables - revenue 5,214 6,214 7,879Non-NHS trade payables - capital 5,278 2,799 5,547Accruals 4,434 4,067 5,874Subtotal 18,977 19,995 23,004Tax & social security costs 3,315 3,095 2,887Trade and other payables falling due within one year 22,292 23,090 25,89118. Other liabilities31st March 31st March 1st April2010 2009 2008£000 £000 £000Deferred income 1,818 2,955 2,477Other liabilities falling due within one year 1,818 2,955 2,477Deferred income* 1,550 1,550 0Other liabilities falling due after more than one year 1,550 1,550 0Total 3,368 4,505 2,477* Non-current deferred income relates to a contribution from Blackpool PCT towards the futureoperating costs of the Urgent Care Centre, due to be commissioned during 2010/11. This income willbe released to income over the life of the asset once it comes into use and is depreciated. In 2008/09this was included in current liabilities, therefore the prior year figures have been restated to reflect thischange of treatment.Annual Report and Accounts April 1st 2009 to March 31st 2010xxvii

19. Borrowings19.1 Borrowings 31st March 31st March 1st April2010 2009 2008£000 £000 £000Obligations under PFI contracts 126 114 103Borrowings falling due within one year 126 114 103Loans from Foundation Trust Financing Facility 10,000 0 0Obligations under PFI contracts 7,860 7,993 8,107Borrowings falling due after more than one year 17,860 7,993 8,107Total borrowings 17,986 8,107 8,210The Foundation Trust Financing Facility loan expires on 30th March 2034 and attracts interest at a fixedrate of 3.7%. The Trust is committed to repaying 2.17% of the balance in each September and Marchwith effect from 30th September 2011. The agreement provides for a total loan of £25m, to be utilised by31st March 2011.19.2 Prudential borrowing limitThe Trust is required to comply and remain within a prudential borrowing limit. This is made up of twoelements:• the maximum cumulative amount of long-term borrowing. This is set by reference to the four ratiotests set out in Monitor’s Prudential Monitoring Code (see table below). The financial risk rating setunder Monitor’s Compliance Framework determines one of the ratios and therefore can impact on thelong term borrowing limit; and• The amount of any working capital facility approved by Monitor.Further information on the NHS Foundation Trust Prudential Borrowing Code and Compliance Frameworkcan be found on the website of Monitor, the Independent Regulator of Foundation Trusts.The Trust performance against approved PBL ratios is as follows :-Financial ratio Actual Approved Actual Approvedratios PBL ratios ratios PBL ratios2009/10 2009/10 2008/09 2008/09Minimum dividend cover 2.5x >1x 2.9x >1xMinimum interest cover 7.8x >3x 10.8x >3xMinimum debt service cover 4.9x >2x 6.7x >2xMaximum debt service to revenue 1.2%

20. Provisions20.1 Provisions analysis 31st March 31st March 1st April2010 2009 2008£000 £000 £000Pensions relating to other staff 18 17 16Permanent Injury Benefit 62 56 56Other legal claims 99 100 100Other 47 772 1,864Provisions falling due within one year 226 945 2,036Pensions relating to other staff 170 166 165Permanent Injury Benefit 1,046 1,028 993Other legal claims 0 33 35Other 0 0 0Provisions falling due after more than one year 1,216 1,227 1,193TOTAL 1,442 2,172 3,22920.2 Provisions in year movement and timing of cash flowsPensions Permanent Other Other Totalrelating to Injury Legalother staff Benefit Claims£000 £000 £000 £000 £000At 1st April 2009 183 1,084 133 772 2,172Change in discount rate 0 0 0 0 0Arising during the year 18 68 96 0 182Utilised during the year (17) (62) (98) (96) (273)Reversed unused 0 0 (32) (629) (661)Unwinding of discount 4 18 0 0 22At 31st March 2010 188 1,108 99 47 1,442Expected timing of cash flows:Within one year 18 62 99 47 226Between one year and five years 68 235 0 0 303After five years 102 811 0 0 913Total 188 1,108 99 47 1,442The provisions for pensions relating to other staff and permanent injury benefit are stated at thepresent value of future amounts estimated as payable using life expectancy tables provided by theOffice of National Statistics. Payments are made on a quarterly basis to the NHS Pension Scheme andNHS Injury Benefit Scheme respectively.Other legal claims represent the amounts payable by the Trust in relation to the excess on claims forclinical negligence and injury to third parties. In return for an annual contribution from the Trust tothe NHS Litigation Authority, the claims are settled by the NHSLA on the Trust’s behalf. £51,387,000 isincluded in the provisions of the NHSLA at 31st March 2010 in respect of clinical negligence liabilities ofthe Trust (2008/09: £32,062,748).Other provisions at 31st March 2010 are in relation to potential decontamination project residual costs.During the year £0.5m of the provision has been reversed unused to operating expenses followingthe Trust’s withdrawal from the decontamination project consortium. Other provisions at 31st March2009 relating to agenda for change appeals and the European working time directive have also beenreversed unused.Annual Report and Accounts April 1st 2009 to March 31st 2010xxix

21. Private Finance Initiative Transactions21.1 PFI schemes deemed to be off-Statement of Financial PositionThe Trust does not have any PFI schemes deemed to be off-balance sheet as at 31 March 2010.21.2 PFI scheme deemed on-Statement of Financial PositionThe Trust has a PFI Partnership Agreement for the provision of facilities for the provision of healthcareservices to the public at Wesham, Rossall and Bispham. The contract runs for 27 years from April 2001.The Trust has title to the freehold land at Wesham and Rossall and the contractor has title to the landat Bispham. At the end of the agreement period the contractor will cease to have any rights, title andinterest in the Wesham and Rossall sites, and the Trust has an option to purchase the Bispham facility atmarket value, which must be exercised not later than 12 months prior to the end of the contract. TheTrust has estimated that the residual value of the Bispham property is £2.4 million.The unitary payment was set at the outset of the contract and is uplifted annually from 1st April by theincrease in the Retail Prices Index as at the preceding February. These inflationary increase are charged tothe statement of comprehensive income as finance expenses.Total obligations for on-Statement of Financial Position PFI contracts due:31st March 31st March 1st April2010 2009 2008Gross PFI liabilities - minimum lease payments: £000 £000 £000Rentals due within one year 908 908 908Rentals due within two to five years 3,632 3,632 3,632Rentals due thereafter 11,803 12,711 13,61916,343 17,251 18,159Future finance charges on PFI agreements (8,357) (9,144) (9,948)Net PFI liabilities 7,986 8,107 8,211Net PFI liabilities are repayable as follows:No later than 1 year 126 114 103Later than 1 year and no later than 5 years 639 579 528Later than 5 years 7,221 7,414 7,5797,986 8,107 8,210During the year the following PFI financing payments have been made to the contractor:31st March 31st March2010 2009£000 £000Repayment of borrowings 114 103Finance expense - Interest 793 804Finance expense - Contingent rent 264 2641,171 1,171The Trust is also committed to make the service payments for facility management which are charged tooperating expenses. These are disclosed at note 5.4.4.xxxBlackpool, Fylde and Wyre Hospitals

22. ContingenciesContingent liabilities 31st March 31st March 1st April2010 2009 2008£000 £000 £000Employer and Occupier Liability 59 65 68This is the maximum potential liability for Staff and Occupiers Liability, which the balance of excesscovered by the NHS Litigation Authority scheme of which the Trust is a member.The Trust has no contingent assets.23. Financial InstrumentsThe Trust does not have any listed capital instruments and is not a financial institution. Due to thenature of the Trust’s current financial assets/liabilities and non current financial liabilities, book valueequates to fair value.All financial assets and liabilities are held in sterling.The Trust’s treasury management operations are carried out by the finance department, withinparameters defined formally within the Trust’s standing financial instructions and policies agreed bythe board of directors. Trust treasury activity is subject to review by the Trust’s internal auditors.Credit RiskThe bulk of the Trusts commissioners are NHS, which minimises the credit risk from theses customers.Non-NHS customers do not represent a large proportion of income and the majority of these relate tobodies which are considered low risk - e.g. universities, local councils, insurance companies, etc.Liquidity RiskThe Trust’s net operating costs are incurred under service agreements with local Primary Care Trusts,which are financed from resources voted annually by Parliament. The Trust largely finances capitalexpenditure through internally generated funds and from loans that can be taken out up to anagreed borrowing limit. The borrowing limit is based upon a risk rating determined by Monitor, theIndependent Regulator for Foundation Trusts and takes account of the Trust’s liquidity. The Trust istherefore not exposed to significant liquidity risk.Market RiskAll of the Trust’s financial liabilities carry nil or fixed rate of interest. In addition the only element ofthe Trust’s financial assets that is currently subject to variable rate is cash held in the Trust’s main bankaccount and therefore the Trust is not exposed to significant interest rate risk.23.1 Financial Assets by category31st March 31st March 1st April2010 2009 2008Loans and Loans and Loans andReceivables Receivables Receivables£000 £000 £000NHS Receivables 4,989 3,907 6,436Accrued Income 66 46 182Other receivables 2,012 2,336 1,717Other financial assets 0 5,000 0Cash and cash equivalents 11,698 24,072 23,910Total Financial Assets 18,765 35,361 32,245Annual Report and Accounts April 1st 2009 to March 31st 2010xxxi

23.2 Other Financial Liabilities by category31st March 31st March 1st April2010 2009 2008£000 £000 £000NHS Payables (3,904) (5,165) (3,704)Other payables (10,639) (10,763) (13,426)Accruals (4,434) (4,067) (5,874)Subtotal - Trade and other payables (18,977) (19,995) (23,004)PFI Obligations (7,986) (8,107) (8,210)Other borrowings (10,000) 0 0Subtotal - Borrowings (17,986) (8,107) (8,210)Total Financial Liabilities (36,963) (28,102) (31,214)The Trust has a loan with the Foundation Trust Financing Facility which is categorised as a non-currentfinancial liability. The carrying value of the liability is considered to approximate to fair value as thearrangement is of a fixed interest rate and equal instalment repayment feature. In addition, the interestrate is not materially different to the discount rate.24. Third party assetsThe Trust held the following cash and cash equivalents on behalf of third parties which have beenexcluded from cash and cash equivalents in the Trust’s statement of financial position:31st March 31st March 1st April2010 2009 2008£000 £000 £000Patients monies 17 15 20Blackpool, Fylde and Wyre Hospitals Charitable Funds 3,492 3,701 3,9863,509 3,716 4,00625. Losses and special paymentsThere were 173 cases of losses and special payments totalling £0.862 million in the accounting period(2008/09: 439 cases totalling £0.452 million).xxxiiBlackpool, Fylde and Wyre Hospitals

26. Related party transactionsBlackpool, Fylde and Wyre Hospitals NHS Foundation Trust is a body corporate established by order ofthe Secretary of State for Health.During the period none of the Department of Health Ministers, Trust Board Members or members ofthe key management staff or parties related to them has undertaken any material transactions withthe Trust.Governing CouncilThe roles and responsibilities of the Governing Council of the Trust are carried out in accordance withthe Trust’s constitution and its terms of authorisation.The Council has specific powers including:- appointment and removal of the Chair and non executive Directors.- approval and appointment of the Chief Executive by the non-executive Directors.- to determine the remuneration and allowances and the other terms and conditions of the nonexecutive Directors.- to appoint the Trust’s external auditors.- to be presented with the annual accounts, annual report and any other report on them by thefinancial auditors.- to provide views to the board of directors relating to the Foundation Trust’s forward planning.The Trust maintains a register of interest for members of the Governing Council.Of the total 33 members of the Council of Governors, 12 represent the interests of other organisationswho the Trust has identified as key partners in the delivery of healthcare with the remainder beingstaff members and members of the public.Members of Council of GovernorsReceivablesPayables31st March 31st March 1st April 31st March 31st March 1st April2010 2009 2008 2010 2009 2008£’000 £’000 £’000 £’000 £’000Blackpool PCT 699 1,414 1,505 176 11 17North Lancashire PCT 1,661 1,369 3,303 112 308 69Blackpool Borough Council 40 55 0 115 6 0Lancashire County Council 7 23 0 0 0 0Lancashire Care Trust 76 82 122 43 80 52UCLAN 55 65 0 9 4 02,538 3,008 4,930 455 409 138IncomeExpenditure2009/10 2008/09 2009/10 2008/09£’000 £’000 £’000 £’000Blackpool PCT 93,846 86,123 219 50North Lancashire PCT 96,523 87,701 1,300 2,616Blackpool Borough Council 295 221 1,197 1,032Lancashire County Council 51 56 1 3Lancashire Care Trust 2,701 2,843 290 270UCLAN 270 142 50 41193,686 177,086 3,057 4,012Other related partiesThe Department of Health is regarded as a related party. During the year the Trust has had a significantnumber of material transactions with the Department, other entities for which the Department isregarded as the parent Department, and other Government departments and Central and LocalGovernment bodies, in addition to members of the Council of Governors list above.Annual Report and Accounts April 1st 2009 to March 31st 2010xxxiii

26. Related party transactions (continued)The Trust has also received revenue and capital payments from Blackpool, Fylde and Wyre HospitalsCharitable Fund. The Charity is registered with the Charity Commissioners (Registered Charity 1051570)and has its own Trustees drawn from the Trust Board.Significant transactions with these other related parties are listed below:ReceivablesPayables31st March 31st March 1st April 31st March 31st March 1st April2010 2009 2008 2010 2009 2008£’000 £’000 £’000 £’000 £’000Department of Health 15 33 1 1 0 63North West SHA 358 0 85 5 47 0Western Cheshire PCT 0 488 24 91 1,207 0Central Lancashire PCT 584 316 730 1 1 4NHS Purchasing and Supply Agency 0 0 0 78 180 273NHS Litigation Authority 0 0 0 0 0 1HM Revenue & Customs 708 645 0 3,315 3,095 2,887NHS Pension Scheme 0 0 0 1,902 1,743 1,572Blackpool, Fylde & Wyre HospitalsCharitable Fund 155 79 148 0 0 01,820 1,561 988 5,393 6,273 4,800IncomeExpenditure2009/10 2008/09 2009/10 2008/09£’000 £’000 £’000 £’000Department of Health 93 3,660 0 0North West SHA 10,202 8,803 9 178Western Cheshire PCT 42,853 45,139 0 0Central Lancashire PCT 3,915 3,347 6 35NHS Purchasing and Supply Agency 0 0 4,390 4,337NHS Litigation Authority 0 0 3,379 1,919HM Revenue & Customs 0 0 9,559 8,889NHS Pension Scheme 0 0 14,830 13,580Blackpool, Fylde & Wyre Hospitals Charitable Fund 263 502 0 057,326 61,451 32,173 28,938All transactions related to the provision of healthcare services and were conducted at arm’s length.Remuneration of key management personnelThe members of the Trust Board are deemed to be the key management personnel. The following tablesummarises the remuneration due to these staff. Further details can be found in the RemunerationReport.AggregateHighest paid directorYear ended Year ended Year ended Year ended31st March 31st March 31st March 31st March2010 2009 2010 2009£000 £000 £000 £000Remuneration 1,068 1,044 190 184Employer contributions to the NHS Pension Scheme 121 124 22 22Accrued pension under NHS Pension Scheme 270 339 64 62Accrued lump sum under NHS Pension Scheme 803 1,016 193 186Number of directors to whom benefits are accruing Number Numberunder the NHS Pension Scheme 7 11None of the key management personnel received an advance from the Trust. The Trust has not enteredinto guarantees of any kind on behalf of key management personnel.xxxivBlackpool, Fylde and Wyre Hospitals

27. Transition to IFRS - first time adoptionIFRS 1 ‘First-time Adoption of International Financial Reporting Standards’ sets out the proceduresthat the Trust must follow when it adopts IFRS for the first time as the basis for preparing its financialstatements. The Trust is required to establish its accounting policies for the year ending 31st March2010 and apply these retrospectively to determine the IFRS opening balance sheet as at its date oftransition, 1st April 2008. The key adjustments made to the financial statements are set out below.a) Capitalisation of Private Finance Initiative (PFI)IFRIC 12 ‘Service concession arrangements’ sets out the general principles on recognising andmeasuring the obligations and related rights under, amongst others, PFI arrangements. The Trusthas a PFI arrangement for the provision of services at Wesham Park, Rossall and Bispham Hospitals,which in compliance with IFRIC 12 have now been capitalised and a corresponding liability created onthe Statement of Financial Position. The assets are revalued and depreciated in accordance with theTrust’s capitalisation policy (see note 1.4), and interest applied to the liability is charged to the Incomestatement.b) Component depreciationIAS 16 ‘Property, plant and equipment’ requires that significant assets are depreciated separately toensure that assets are written down over their expected useful economic lives.Statement of taxpayers’ equity Public Revaluation Donated Income Totaldividend reserve asset andcapitalreserve expenditurereserve£000 £000 £000 £000 £000Taxpayers’ equity at 31 March 2009 underUK GAAP 141,031 43,759 3,070 9,115 196,975Adjustments for IFRS changes:Private Finance Initiative 0 2,821 0 (1,511) 1,310Component Depreciation 0 (9) (19) (1,095) (1,123)Taxpayers’ equity at 31 March 2009under IFRS 141,031 46,571 3,051 6,509 197,162Taxpayers’ equity at 1 April 2008under UK GAAP 139,640 49,912 2,869 2,804 195,225Adjustments for IFRS changes:Private Finance Initiative 0 3,340 0 (1,243) 2,097Taxpayers’ equity at 1 April 2008under IFRS 139,640 53,252 2,869 1,561 197,322Reconciliation of 2008/09 operating surplus £000Surplus/(deficit) for 2008/09 under UK GAAP 6,043Adjustments for:Private Finance Initiative (269)Component Depreciation (1,127)Surplus/(deficit) for 2008/09 under IFRS 4,64728. Events after the reporting periodThere are no events after the reporting period.Annual Report and Accounts April 1st 2009 to March 31st 2010xxxv

Notice of the Trust’s Annual Public Meeting/Annual Members’ MeetingThe Annual Public Meeting/AnnualMembers Meeting of the Blackpool,Fylde and Wyre Hospitals NHSFoundation Trust will be held at 6pmat the De Vere Hotel, Heron’s Reach,Blackpool.Further copies of the Annual Report and Accounts forthe period April 1st 2009 to March 31st 2010 can beobtained by writing to:Miss J A OatesFoundation Trust SecretaryBlackpool, Fylde and Wyre Hospitals NHS FoundationTrustTrust HeadquartersBlackpool Victoria HospitalWhinney Heys RoadBlackpoolFY3 8NRAlternatively they can be downloaded from our websitewww.bfwhospitals.nhs.ukIf you would like to make comments on our AnnualReport or would like any further information, pleasewrite to:Chief ExecutiveBlackpool, Fylde and Wyre Hospitals NHS FoundationTrustTrust HeadquartersBlackpool Victoria HospitalWhinney Heys RoadBlackpoolFY3 8NR176Blackpool, Fylde and Wyre Hospitals

Created by www.marketingforhealth.co.uk (ref 2097-07/10), an ISO9001 Quality and ISO14001 Environmental accredited company.Blackpool, Fylde and Wyre Hospitals NHS Foundation TrustWhinney Heys Road, Blackpool, FY3 8NR01253 300000www.bfwhospitals.nhs.uk