Embed Size (px)
Citation preview
ANNUAL ACCOUNTS
Year Ended 31'' March 2007
INDEX Page
Foreword 1-9
Operating and Financial Review 10-23
Remuneration Report 24-27
Statement of Chief Executive's Responsibilities as Accountable Officer 28
Statement of Health Board Members' Responsibilities in respect of Accounts 29
Statement on Internal Control 30-33
Independent Auditor's report 34-35
Accounts and Notes to the Accounts 36-74
The Accounts were authorised for issue on 27th June 2007.
NHS LOTHIAN
ANNUAL ACCOUNTS AND NOTES FOR YEAR ENDED 31 MARCH 2007
ANNUAL REPORT
FOREWORD
I. Accounting convention
The Annual Accounts and Notes have been prepared under the historical cost convention modified to reflect changes in the value of fixed assets and in accordance with the Financial Reporting Manual (FReM). The Accounts have been prepared under a direction issued by Scottish Ministers, which is reproduced as an appendix to these Accounts.
2. Accounting policies
The statement of the accounting policies, which have been adopted, is shown at Note 1.
From 1 April replacing an reserves on tl
2005, the NHS board has complied with the FreM, with the Operating Cost Statement Income and Expenditure Account and the General .Fund replacing capital and revenue i e Balance Sheet, as previously directed in the Resource Accounting Manual.
3. Appointment of auditors
The Public Finance and Accountability Scotland Act 2000 places personal responsibility on the Auditor General for Scotland to decide who is to undertake the audit of each health body in Scotland. For the financial years 2006107 to 2010111 the Auditor General appointed Gillian Woolman, Assistant Director (Health and Central Government), Audit Scotland to undertake the audit of Lothian Health Board. The general duties of the auditors of health bodies, including their statutory duties, are set out in the Code of Audit Practice issued by Audit Scotland and approved by the Auditor General.
4. Board membership
Under the terms of the Scottish Health Plan, the Health Board is a board of governance whose membership will be conditioned by the functions of the Board. Members of Health Boards are selected on the basis of their position - such as a Chief Executive or Director of Finance - or the particular expertise which enables them to contribute to the decision making process at a strategic level.
The Health Board has collective responsibility for the performance of the local NHS system as a whole, and reflects the partnership approach, which is essential to improving health and health care.
The Board members' responsibilities in relation to the Accounts are set out in a statement following this report.
Chair:
Mr Brian Cavanagh until 15Ih september 2006 Mr Robert Anderson Interim Chair from 25Ih September 2006 to 19Ih ~ ~ r i l 2007 Dr Charles Winstanley Chair from 2oth April 2007
Executive Members:
Professor James Barbour OBE, Chief Executive
Dr Alison McCallum, Director of Public Health and Health Policy
Mr John Matheson. Director of Finance
Mrs Jackie Sansbury. Director of Strategic Planning and Modernisation
Ms Heather Tierney-Moore, OBE, Director of Nursing
Mr Peter Gabbitas, Director of Health & Social Care, City of Edinburgh Council
Mr David Bolton, MBE, Chief Operating Officer, University Hospitals Division
Mr Murray Duncanson, Chief Operating Officer, Primary Care Organisation
Dr Charles Swainson, Medical Director
Mr James T McCaffery, Director of Human Resources
Non-Executive Members:
Mr Robert Anderson until 24'h September 2006
Mr Stuart Smith
Mr Robin Burley MBE
Mr Eddie Egan, Vice Chair and Employee Director
Mrs Pat Murray, Chair, Area Clinical Forum
Dr Ian McKay, Clinical Director, Edinburgh CHP
Professor John Savill
Cllr lain Whyte
Cllr Kingsley Thomas - City of Edinburgh Council
Cllr Graeme Morrice -West Lothian Council
Cllr Ann McCarthy - East Lothian Council
Cllr Daniel Molloy - Midlothian Council until sib February 2007
Mr David Belfall
Mr W Bennett - until loih ~ u n e 2006
Mr David Crichton
Mrs Theresa Douglas from 1" July 2006
Mrs Erica Hughes until 3oih June 2006
Ms Lesley Jamie
Mr Stephen Renwick
Dr Rebecca Strachan from 1" July 2006
Dr Alison Tierney, CBE, from 1" July 2006
5. Corporate governance
The Board meets regularly during the year to progress the business of the Health Board. The Scottish Health Plan established that the following standing committees should exist at board level:
- Clinical governance;
- Audit;
- Staff Governance:
- Ethics: and
- Discipline (for primary care contractors).
Healthcare Governance 8 Risk Management committee
The Healthcare Governance & Risk Management committee of the Health Board has twakey roles:
- Systems assurance - to ensure that clinical governance mechanisms are in place and effective throughout the local NHS system; and
- Public health governance - to ensure that the principles and standards of clinical governance are applied to the health improvement activities of the NHS Board.
The membership of the health governance & risk management committee comprises those listed below and is chaired by Stuart Smith:
Mr Robin Burley, Non-Executive Member
lWrs Theresa Douglas, Non-Executive Member
Mrs Pat Murray, Chair, Area Clinical Forum
Dr Rebecca Strachan, Non-Executive Member
Cllr lain Whyte, Non-Executive Member
Audit committee
The membership of the audit committee comprises those listed below and is chaired by Ms Lesley A. Jamie.
Mr W Bennett, Non-Executive Member (Until loth ~ u n e 2006)
Dr Alison Tierney, Non-Executive Member
Mr Stephen Renwick, Non-Executive Member
Cllr lain Whyte, Non-Executive Member
Mr Robert Anderson was also a member as chair of the Primary Care Organisation Audit Sub-committee. During the period 25" September 2006 and 1 gth April 2007 Mr Anderson acted as interim chair of Lothian NHS Board and his membership of the Audit Committee ceased. His position was taken up by Mrs Theresa Douglas.
The audit committee meets 6 times per year to deal with strategic audit matters across NHS tothian which could have a material impact on the overall performance of NHS Lothian and its operations.
Staff governance committee
The committee has an important role in ensuring consistency of policy and equity of treatment of staff across the local NHS system, including remuneration issues, where they are not already covered by existing arrangements at national level.
The membership of the staff governance committee comprises those detailed below and is chaired by Mr Eddie Egan:
Brian Cavanagh Until 15 September Mr R Burley Non-Executive Member Mr R Anderson Interim Chair, from 2sth September 2006 Prof J Barbour Chief Executive Mr ,I McCaffery Director of Human Resources
Ethics committee
The principal function of the committees is to provide independent advice as to whether a given piece of research is ethical, and whether the dignity, rights, safety and wellbeing of individual research subjects are adequately protected. The membership of the ethics committees, which comprise both clinical and lay members. is as listed below:
Lothian Research Ethics Committee 1
Lothian Research Ethics Committee 2
Mr N Grier (Chair) Professor P Hayes (Chair)
Dr J Walker Mrs A Tod Mr W J Farquhar Mr B P Carey Mrs A Harvey Dr G Steele Mrs M Dewar Dr W Jack Dr H Wallace Dr E Hare Dr S Moussa Dr N Malden Dr K D Smith Dr D Semple Dr L Phillip
Mrs 0 M A Chiswick Dr C MacKellar Mr A Neustein Rev D Stephen Mr W 0 D Walker Mrs V Prosser Miss S Cameron Dr S Mackenzie Mr L Murray Mr J Oliphant Ms T Rye Professor G Siann Mr T Russell Mrs E Richmond Ms L Ellis
-.Lothian Research Ethics Committee 3
Lothian Research Ethics Committee 4
Dr C West (Chair)
Mrs F Petrie Mrs M Granger Dr M MacMillan Mr N G Masterton Mr H J Olson Prof L Sawyer b r J Andrews Dr B Agrawal Dr F Barry Miss B Ellis Dr C Greig Mr Y Maidment Dr H Ward Mrs H Vandore
Dr M Logan (Chair)
Mr A S J Farrow Mr W B Taylor Dr A lnnes Mrs Elizabeth Hartley Dr Y Freer Mr Sandy McAfee Mr Vipin Zamvar Miss C Murray Dr A Nimmo Dr L Schweizer Dr R A Burt Ms P Perry Dr H Drewitt Mr R Forbes Dr G Howat
6. Board members' and senior managers' interests
Professor James J Barbour OBE, Executive Member Non-Executive Director, NHS National Services Board Honorary Professor, Queen Margaret University College Member, First Division Association Member of the University of Edinburgh Court
Dr'Alison McCallum, Executive Member Member, British Medical Association Member, Medical Practitioners' Union
John Matheson, Executive Member Member of the Board of Management at Edinburgh's Telford College Wife is the Fundraising Manager at St Columba's Hospice. Member, First Division Association
Jackie Sansbury, Executive Member No interests to declare
Heather Tierney-Moore, OBE, Executive Member Member, Royal College of Nursing Member, Faculty Board, Faculty Health Informatics, Royal College of Surgeons, Edinburgh
Peter Gabbitas, Executive Member Member, City of Edinburgh Council Senior Management Team Board Member, Capital City Homes
David Bolton, MBE, Executive Member Member, MSFIAmicus Trade Union
Murray Duncanson, Executive Member Trustee, Elizabeth Fitzroy Support, a national charity based only in England and Wales for people with learning disabilities (unpaid) Wife is employed as HR Director for NHS National Services Scotland
2 Member, Institute of Health Service Managers h Member, Managers in Partnership d
<!
-Dr€+lcs-Swainsbn,mfiVeM em ber Occasional medico-legal work as expert advisorlwitness Honorary Senior Lecturer, University of Edinburgh (Teaching) Fellow, Royal College of Physicians of Edinburgh and Faculty of Public Health Medicine Member, British Medical Association and elected Member to the Clinical and Medical Director Sub- committee of the Central Consultants and Specialist committee. Member, British Association of Medical Managers
Jatnes T McCaffery, Executive Member Non-Executive Director - Skills for Hea1th:Honorarium payment PARC Craigmillar Limited - Community Representative
Brian Cavanagh, Chair and Non-Executive Member until 1 5 ' ~ September 2006 Director of Clifden Consultancy Ltd which specialises in social policy & consultancy advice; organises conferences and seminars
Robert Anderson, Interim Chair and Non-Executive Member Shareholder in Melville Housing Association Ltd Member of the Management Committee of Melville Housing Association Ltd Member, Alzheimer Scotland Action on Dementia
Dr C J Winstanley, Chair Chair, General Medical Council Fitness to Practice Panel Judicial office holder, Asylum and Immigration Tribunal Justice of the Peace (England) Council Member, National Consumer Council for Postal Services Non-executive Director, Norfolk and Norwich University Hospital NHS Trust
Stuart Hunter Smith, Non-Executive Member Non-Executive Member of NHS 24 Member, Stories in the air - Registered Charity for Deaf Children
Robin Burley MBE, Non-Executive Member Chair, Built Environment Forum Scotland Non-Executive Membcr. Margaret Blackwood Housing Association Ltd Non-Executive Member, Edinburgh World Heritage Trust
Eddie Egan, Non-Executive Member Member, UNISON Member, Scottish Labour Party Member, Cooperative Party
Pat Murray, Non-Executive Member No interests to declare.
Dr Ian McKay, Non-Executive Member Partner, Rose Garden Medical Centre Clinical Director, Edinburgh CHP
Professor John Savill, Non-Executive Member Vice-Principal and Head of the College of Medicine and Veterinary Medicine Member of the Medical Research Council Governor of the Health Foundation Fellow of the Academy of Medical Sciences Fellow of the Royal College of Physicians of London Fellow of the Royal College of Physicians of Edinburgh Fellow of the Royal Society of Edinburgh Member, UK Renal Association Member, American Society of Nephrology Member, Society of Leukocyte Biology Member, Medical Research Society Member, Association of Physicians
-- --- ---
Cllr lain Whyte, Non-Executive Member Elected Member, City of Edinburgh Council Governor, Fettes Trust Director, Edinburgh Leisure Ltd Director, ElCC Ltd
Cllr Kingsley Thomas, JP, Non-Executive Member Manager - Criminal applications, Scottish Legal Aid Board Councillor for Dalry and Executive Member for Health and Social Work, City of Edinburgh Council. Member, Labour Party Member, GMB Trade Union
Cllr Graeme Morrice, Non-Executive Member Member, West Lothian Council Member, Scottish Labour Party Member, Transport 8, General Workers Union Member, Co-operative Party Director, Broxburn Family & Community Development Centre Director, West Lothian Housing Partnership
Cllr Ann McCarthy, Non-Executive Member Elected member, East ~othian Council Cabinet Member with responsibility for Joint Future & Community Care Director and Chair, Homes for Life Partnership (unremunerated) Member, Scottish Labour Party
Cllr Daniel Francis Molloy, Non-Executive Member (until 5'h February 2007) Elected member of Midlothian Council Chair, Garvald Glenesk Ltd Chair, Dalkeith Old People's Welfare Committee Member, Dalkeith Citizen's Advice Bureau Board Member, Energy Efficiency Centre (resigned February 2007) Member, Scottish Labour Party (Dalkeith branch) Member, Transpnrt R General Workers Union Member, Co-operative Party
David Belfall, Non-Executive Member Member, Scottish Criminal Cases Review Commission Member, Policy Committee of the Scottish Council for Voluntary Organisations Member, Shadow Board of the Abbeyfield Scotland Housing Association
Stephen Renwick, Non-Executive Member Managing Director of an Edinburgh based consultancy specialising in public sector consultancy Trustee, Novum Trust - small Edinburgh based charity
Lesley Jamie, Non-Executive Member Business Consultant, Scott-Moncrieff, Chartered Accountants
Erica Hughes, Non-Executive Member (until 3ofh June 2006) Director, Into Work, a charity that supports people with Asperger's syndrome into employment
David Crichton, Non-Executive Member Director and Chief Executive, Confederation of Forest Industries (UK) Ltd Director, Wood for Good Ltd
Theresa Douglas, Non-Executive Member TMD Associates NHS Education Scotland short term contracts from August 2006 -continuing Garth Associates from December 2006 -Associate Facilitation of Action Learning for NHS Lothian, ongoing from January 2006 to July 2007
Dr. Alison Tierney, CBE, Non-Executive Member Adjunct Professor of Clinical Nursing, University of Adelaide Editor-in-Chief of Journal of Advanced Nursing, (Blackwell Publishing UK honorarium) Contract work, for universities, CSO (SEHD) and other organisations Fellow of the Royal College of Nursing
Dr Rebecca Strachan, Non-Executive member Member, Action for Sick Children (Scotland) Trustee, Scottish Child Law Centre
David Fraser Kelly, Director, West Lothian CHCP Paid 5050 by West Lothian CouncillNHS Board
David White, General Manager, East Lothian CHP Wife undertakes short-term contract work for NHSiL, Local Authorities & Voluntary sector
Gerry Power, General Manager, Midlothian CHP Honorary research contract (NHS Lothian) in Podiatry
David Small, General Manager, Edinburgh CHP No interests to declare.
All members of Lothian NHS Board are Trustees of NHS Lothian Endowment Funds.
The accounting policy note for pensions is provided in Note 1 and disclosure of the costs is shown within Note 26 and the remuneration report.
8. Remuneration for Non Audit Work
During the year 2006107 our auditors received no fees in relation to non audit work.
9. Human Resources
As an equal opportunities employer, the Health Board welcomes applications for employment from disabled persons and actively seeks to provide an environment where they and any employees who become disabled can continue to contribute to the work of the board..
The health board provides employees with information on matters of concern to them as employees and consults employees or their representatives so their views are taken into account in decisions affecting their interests.
10. Related Party Transactions
Dr Ian McKay is a non-executive member of NHS Lothian and a partner in Rose Garden Medical Centre, Edinburgh. In 2006-07, NHS Lothian's Family Health Services payments to Rose Garden Medical Centre amounted to £878,000.
As noted in section 6, the wife of Mr John Matheson is employed as a fundraising manager at St Columba's Hospice. During 2006-07, NHS Lothian provided £2,281,000 of revenue funding and £74,000 of capital funding to St Columba's Hospice.
By order of the board
27th June 2007 . . . . . . . .. . . . .. . . . . . . . . . . ... . . . . .Chief Executive
NHS LOTHIAN
ANNUAL ACCOUNTS AND NOTES FOR YEAR ENDED 31 MARCH 2007
OPERATING AND FINANCIAL REVIEW
1. Principal activities and review of the year
The NHS Board was established in 1974 and is responsible for commissioning health care services for the residents of Edinburgh and the Lothians, a total population of 801,310.
In December 2000, the Scottish Executive published "Our National Health: A Plan for Action, A Plan for Change" (the Scottish Health Plan), which recognised the need to simplify, improve and rationalise local decision making arrangements. As a result, from 30 September 2001, 15 single unified NHS boards were established. In the case of the 11 mainland board areas, these new unified NHS boards replaced the separate structures of NHS Boards and Trusts.
These new NHS boards form a local health system, with single governing boards responsible for improving the health of their local populations and delivering the healthcare they require.
The overall purpose of the unified NHS Board is to ensure the efficient, effective and accountable governance of the local NHS system and to provide strategic leadership and direction for the system as a whole.
The role of the unified NHS Board is to:
- improve and protect the health of the local people; - improve health services for local people; - focus clearly on health outcomes and people's experience of their local NHS system; - promote integrated health and community planning by working closely with other local
organisations; and - provide a single focus of accountability for the performance of the local NHS system.
The functions of the unified NHS Board comprise:
- strategy development; - resource allocations; - implementation of the Local Health Plan; and - performance management.
NHS Lothian again met all its financial targets in 2006107 including achieving a reduction in the level of non recurrent support. This outcome was supported by a partnership approach both within NHS Lothian and elsewhere across NHS Scotland in respect of tertiary services.
Other highlights of the year included:
On 12'~ October 2006 the Board reached initial agreement with Consort (operator of the Royal Infirmary of Edinburgh) on outstanding disputed amounts in relation to operation of the PFI contract. This agreement was contained in a supplemental agreement signed on 3oth March 2007. The agreement enabled Consort to proceed with its planned refinancing of its project funding. On 15th March 2007 the Board, acting on independent financial advice, the support of the Scottish Executive and in accordance with the UK Treasury Code of Conduct with the private sector approved the concluding of the refinancing negotiations.
Under the agreement, NHS Lothian is to receive a lump sum of f5.2m out of a total refinancing gain of f18.9m. This has enabled NHS Lothian to make full and final settlement of outstanding sums charged to the Operating Cost Statement in the same period in respect of the contract settlement and construction final accounts. The lump sum gain and final settlements of sums due were completed in May 2007.
In addition, NHS Lothian's facilities usage payments are being reduced by f 1 .1m, at 2006-07 prices, up to the completion of the primary period of the hospital project agreement with Consort.
Cash Releasing Efficiency Savings totalling £25.8 million were achieved in year, including £7.3 million in respect of Efficient Government targets.
The 6 months waiting time target for inpatient and day cases which had been achieved by December 2005 was maintained throughout 2006-07. NHS Lothian also achieved a zero target for inpatients and day cases waiting over 18 weeks in December 2006 - one year ahead of the national target.
The number of patients where discharge was delayed over 6 weeks was 16 by 31" March 2007; a 71% reduction in year.
2. Financial targets
The Scottish Executive set 3 budget limits at health board level on an annual basis. These limits are:
Revenue resource limit - a resource budget for ongoing operations; Capital resource limit - a resource budget for new capital investment; and Cash requirement - a financing requirement to fund the cash consequences of the ongoing operations and the new capital investment.
Health Boards are expected to stay within these limits, and will report on any variation from the limits as set.
3. Financial Performance and Position
Limit as set Actual Outturn Variance by SEHD (0ver)lUnder
1 Revenue Resource limit 1,032,897 1,028,263 4,634
2 Capital Resource limit 42,614 41,977 637
3 Cash Requirement 1 , I 15,030 1,115,030 0
Memorandum for In Year Outturn PO00
Brought forward surplus from previous financial year (1 79 ) Savings against in year revenue resource limit 4,455
Details of NHS Lothian's Net Operating Costs and RRL outturn are set out in notes 4 to 8. Fluctuations against comparatives, at detail level, reflect shifts towards single system working within the organisation.
4. Payment policy
The board endeavours to comply with the principles of the Better Payment Practice code by processing suppliers' invoices for payment without unnecessary delay and by settling them in a timely manner. In 2006107 average credit taken was 37 days (2005106 - 44 days). In 2006107 the Board paid 49.74% (2005106 - 64.44%) by value and 47.1 0% (2005106 - 58.44%) by volume within 30 days.
5. Counter Fraud Services
Through the work undertaken by Counter Fraud Services, a small sample of claims for patient exemption within NHS Lothian has been tested for validity. Based on the level of fraud within the sample, a projected figure of f 1,764,849 (2005106: f 1,533,007) has been identified as being the potential total fraud committed against NHS Lothian in 2006107. Where fraud is known (and detected through the sampling process), recoveries are made wherever possible. For financial year 2006107, a total of f 33,949 (2005106: f 18,381 ) has been recovered.
6. Key Performance Indicators
The Local Delivery Plan process was introduced in 2006107 and replaced the previous Performance Assessment Framework. Performance in relation to key target measures in 2006107 is summarised below.
Key Performance Indicators
NHS Scotland Objective 1:
Health Improvement for the people of Scotland - improving life expectancy and healthy life expectancy.
I - In Lothian there has been an improvement in the CHD rate reducing H.OlT / Reduce health inequalities by increasing the rate of 1 from 104.9 in 2002-04 to 101.1 in 2003-05. improvement for the most deprived communities by
LDP - Key Measure. Performance
Crude CHD rate per 100,000 (<75 yrs) in most
15% across a range of indicators including; CHD, cancer, adult smoking, smoking during pregnancy, teenage pregnancy and suicides in young people: target date 2008.
Lothian is a pilot site for Keep Well (previously Prevention 2010) involving 15 GP practices serving the most deprived population.
deprived areas (using 3 year averages)
I I An AHP Physiotherapy consultant came into post on February 2006. 1 I I
Target Ref No.
A Stroke Hotline has been introduced which allows GPs to speak directly to an on-call stroke specialist at any time for advice and referral to a new rapid access neurovascular clinic.
Other initiatives include the "Body Checkout" project to provide informal health checks in community settings.
Key Performance Targets
Numbers smoking as a % population in the 16-64 years age group
The source for this data is the annual Scottish Household Survey. The average rate in Lothian has been around 27% during 2003 and 2004 surveys. This has improved to 24.8% in the 2005 survey. There is a variation between the figure of 23% for Edinburgh and 27% for the rest of Lothian.
In September 2006 the NHS Lothian Tobacco Strategy was launched. Key areas of work have included streamlining the pathway of care, launching "No Ifs, No Butts", reaching out to hard to engage groups, e.g. people with mental health problems and making services morelocally accessible.
NHS Lothian continues to focus on target groups and with Keep Well (Prevention 2010) funding are tackling smoking in our least affluent communities.
Reduce rate of smoking among adults (16-64 age group) in all social classes to 22%: target date 2009.
The key developments that are expected to have an impact on targets are the smoking ban in public places and any change in the selling of tobacco to 16-1 8 year olds.
MMR uptake rate % at 24 months old
Suicide rates per 100 ,000 population
MMR uptake continues to improve and at 94% (quarter 4 2006) is the highest it has ever been, above the national average and the fourth highest in Scotland.
Over 380 primary healthcare staff attended eight roadshows delivered during summer 2006.
During 2006 Lothian was a pilot in the HPSINES e-Learning programme "Promotirg Effective Immunisation". This is now being embedded within the NHS Lothian workforce education programme.
Progress is being made with local Suicide Prevention action planning as part of Joint Health lmprovement Plans and Community Planning. Numbers for 2005 have decreased in all CHP areas except North Edinburgh.
The Four Choose Life alliances in Edinburgh and the Lothians have supported a range of initiatives - football clubs in West and Midlothian, Arts work in East Lothian, reflecting local priorities and target groups, such as young men who account for 3 out of 4 completed suicides.
NHS Lothian launched the Mental Health lmprovement Network in March 2007 which promotes mainstreaming of mental health improvement.
95% uptake target for all childhood vaccinations (ongoing).
Reduce suicide rate between 2002 and 2013 by 20%.
NHS Scotland Objective 2:
Efficiency and Governance Improvements - continually improve the efficiency and effectiveness of the NHS
LDP - Key Measure.
Forecast Deficit 1 Surplus for YE against total revenue resource limit
Performance
NHS Lothian met all its financial targets in 2006107. This position has been achieved after the Board identified and resolved a short term financial challenge within 2006-07 only. The level of non recurring funding to support recurring expenditure has continued to reduced from 2005106 f 25.6m to f 1 1.3m.
NHS Lothian has, for the second year running, achieved the largest efficiency gain of any Health Board in Scotland of f25.8m.
Target
E.01 T
Key Performance Targets
NHS boards to operate within their revenue resource limit; operate within their capital resource limit; meet their cash requirement.
Sickness Absence Rate: 4% by 31 March 2008. 2.02K - Hours lost due to sickness absences as a % of total hours available (all NHS employees excludes private contractors e.g. GPs and Dentists)
Lothian's sickness absence rate is 5% for the period April - December 2006, When final figures are available absence is expected to be at 4.9% at March 2007.
Monitoring and review of absence levels and progress towards the target will be undertaken with the other key targets and included in the Lothian Management Information System (MIDAS).
The Sickness Absence target is included in all senior manager objectives for 2007108. Further work is being done to classify leave appropriately and to promote other leave policies.
NHS Scotland Objective 3:
Access to Services - recognising patients need for quicker and easier use of NHS services.
LDP - Key Measure.
3.01 K - O/O coverage of population, using list sizes for GP practices taking part in Scottish Primary Care Collaborative (SPCC)
3.02K - Oh of aged 0-1 7 years registered w'th an NHS dentist
3.03K - IPlDC waiting over 6 months excluding ASC ( all acute specialities)
3.04K - IPlDC waiting over 18 weeks excluding ASC (all acute specialities)
-
Key Performance Targets
Ensure that anyone contacting their GP surgery has guaranteed access to a GP, nurse or other health care professional within 48 hours from April 2004.
60% of 5 year old children (primary 1) will have no signs of dental disease by 201 0
No patient with a guarantee should wait longer than 6 months for inpatient or day case treatment from 31 December 2005, reducing to 18 weeks from 31 December 2007.
Performance
At the end of April 2006 there was 36% coverage in Lothian using the measure based on practices taking part in SPCC.
Lothian achieved 100% compliance with the 48-hour access target by December 2003 ahead of the national target date.
Lothian has uptake of 71%, which is one of the highest rates of children registered with an NHS Dentist in Scotland and the UK. This position will continue to be maintained.
NHS agreed LDP target is to improve this by 1% per annum. This proxy measure is being revised.
NHS Lothian have introduced nursery toothbrushing programmes and 9 oral health support workers have been recruited to implement the Childsmile programme.
The 6 month wait target was met by December 2005 and has been sustained for 16 months to March 2007.
Lothian met the zero waiting target in December 2006, a year ahead of the national target date.
HEAT Target Ref No.
A.01T
A.02T
A.03T
New OP (GPIGDP referrals) waiting over 26 weeks excluding ASC ( all acute specialities)
New OP (GPIGDP referrals) waiting over 18 weeks excluding ASC (all acute specialities)
% of patients waiting 4 hours or less from arrival to transfer or discharge
Lothian met its 6-month target by December 2005 and this is being maintained
Significant progress towards achieving the 18 week target has been made with patient numbers waiting reduced from 3715 at March 20'06 to 2,401 at March 2007
The performance at March 2007 is 87% across NHS Lothian. This is a 13% increase in compliance with the 4 hour target from March 06 despite a rise in the number and acuity of presentations.
The need to proactively manage inpatient capacity has been important to meet the needs of patients requiring admission. Bed state information for the whole of Lothian is now shared daily on the Lothian intranet.
Improvements to discharge planning have been achieved through ' planning tools.
Work has progressed on alternatives to hospital attendance and admission, including development of a single point of contact for GP emergency referrals.
appointment, reducing to 18 weeks from 31 Oecem ber 2007.
By end 2007 no patient will wait more than 4 hours from arrival to discharge or transfer for accident and emergency treatment.
% of patients from diagnosis to treatment within 31 days
The figures Tor performance to December 2006 have improved to 91 %.
The weekly tracking process, as well as the implementation of the action plan has assisted in improving performance. Building on a recent review into the breast service, which identified areas for improvement such as extended operating days in theatre (now implemented), NHS Lothian, in partnership with General Electric (GE) has scheduled a Kaizen workshop around the breast service to improve performance
Women who have breast cancer and need urgent treatment will get it within one month where appropriate.
1 % of patients urgently referred to treatment within 2 months
- -- - -
Lothian's performance for Lung cancer patients has improved to 90.4% at December 2006. Breast has improved to 96.6%.
Systems for weekly prospective patient tracking, monitoring and reporting for cancer in Lothian are now developing well after their implementation in September 2006. Operational escalation policies have been developed for each Tumour group.
GE Healthcare are taking forward 3 cancer projects, CT scanning, urgent colorectal referrals and a new patient clinic in the Breast Service, to implement required improvements to waiting times in these areas.
The Director of Nursing is taking forward a review of existing cancer Clinical Nurse Specialist services (CNS). This will assist in linking the CNS role closely into prospective patient journey management.
By 31 December 2005 no patient urgently referred for cancer treatment should wait more than 2 months.
3.13K - Angiography patients waiting over 8 weeks
NHS Lothian has continued to meet this target. No patients are waiting more than the 8 week maximum for angiography after seeing a spe~ialist.
A.1OT From June 30 2004 the maximum wait from angiography to surgery or angioplasty will be 18 weeks.
Revascularisation patients waiting over ~ 18 weeks. I
!
NHS Lothian has continued to meet this target. No patients are waiting more than the 18 week maximum wait for surgery or angioplasty following angiography.
A new, whole journey, combined 16 week standard is being introduced.
I
Additional capacity is also required for cardiac surgery and NHS Lothian is liasing with the Golden Jubilee National Hospital to ensure sufficient volume is in place both to bring waiting times down for surgery but also to permit the repatriation of cardiac surgery from Clydebank when the West of Scotland Regional Heart and Lung Centre is established later this year.
I
I
I
,
From June 30 2004 the maximum wait from angiography to surgery or angioplasty will be 18 weeks.
Additional capacity requirements have been assessed to achieve and sustain the revised waiting times targets. An additional Consultant Electrophysiologist has been appointed to provide further ablation capacity. Also further catheter laboratory time for both angiography and angioplasty has been identified.
NHS Scotland ~bject ivb 4:
Treatment Appropriateito Individuals: ensure patients receive high quality services that meet their needs. I
Patients whose Discharge Delayed over 6 weeks.
I
1 I No. -
I I
LDP - Key Measure
The target set was for a reduction of 5O0/0 from the baseline at April 2006. NHS Lothian have exceed this by dropping from 56 to 16 for dhose delayed over 6 weeks (71% reduction) whilst those delayed in a short stay setting fell from 20 to 4 (80% reduction) at the April 2007 census.
The total number of patients delayed in Lothian Hospitals is now at its lowest since 2000
Performance Indicator
~
The number of patients whose discharge was delayed for over 12 months remains at zero. I I I
We will reduce the number of people waiting to be discharged from hospital into a more appropriate care setting by 20% year on year between 2005 and the end of 2008, cutting to a minimum the number of people waiting more than 6 weeks to be discharged.
2006107 HEAT Target
Patient (65+) admitted, two or more times as an emergency in one calendar year.
Key Performance Targets
i The Lothian Long Term Conditions Management Group is taking an qverall lead on delivery of this target. This group includes all 4 Clothian CHPs and local authority representation.
I
Each local CHP has a draft Action Plan in place with a range of 4t ions in hand. This will be underpinned by the use of SPARRA
I (Scottish Patients At Risk of Readmission and Admission).
By 2008-09, we will reduce the proportion of older people (65+) who are admitted as an emergency inpatient 2 or more times in a single year by 20% compared with 2004105.
Cervical Screening - O/O of 20-60 year olds screened.
' The screening programme continues to exceed the national uptake 1 of 80%, but there continues to be a slight decline in uptake in recent 1 years in iine with the national picture.
Focus placed on implementing the Scottish Cervical Call-Recall System in line with national policy.
i A Good Practice Guide in Cervical Screening for Women with 1 Learning Disabilities has been produced. Guidelines and training I materials will be rolled out to primary care staff in 2007. i
I Work has been initiated with a number of stakeholders to develop an agreed NHS Lothian policy for the introduction of HPV vaccination. I
Cervical screening target 8O0/0, ongoing
Sustainability and Environmental Reporting
NHS Lothian promotes sustainable practice at all levels in the organisation. Sustainability seeks to ensure that finite resources are used in a manner that has zero impact on the ecosystem. NHS Lothian has put in place the means to effectively monitor and target the consumption of utilities, of which fossil fuels and electricity are the major part.
NHS Lothian measures the output of C02 as part of its participation in the EU Carbon Emissions trading scheme, and also as part of good environmental practice. In all environmental activity, the C02 index is the lowest common denominator and reference to this ensures the most efficient use of resources. Overall, NHS Lothian is performing well in managing EU Carbon Emissions allocations and on two of its three participating sites is substantially under these allocations.
NHS Lothian has a track record of success in achieving key national targets for reduction in energy consumption. NHS Lothian consumption has been less than the national targets up to 2006107. Although expenditure on energy has risen from f7.8M in 2004105 to f 12.7M in 2006107, the main rise occurred in 2005106 due to extreme volatility in the energy market. Temperature-adjusted consumption is also showing a reduction in 2006107. The graph below shows that, after a period in 2003104 where double running site costs were incurred, energy consumption in per unit of space is also on a declining trend.
Annual Energy Consumption Compared with National Target
NHS Lothian produced its first Environmental Annual Report in May 2007, coverir~y the year to 31 March 2007. It also established a Steering Group to drive compliance with HDL 2006 (21) and its policies on sustainable development, which were endorsed by the Board in December 2006. . , , . -. . _ ~ _ ~
1400000 7 100
St. John's Hospital has for several years achieved the IS0 standard 140001 - Environmental Management, which includes' relevant energy management content. NHS Lothian's Environmental Strategy outlines the intention to achieve this standard at the Western General Hospital within one year and within 3 years for the rest of NHS Lothian.
-- 95
1300000 -
+Actual Consumption -Target Consumption +GJ1100m3
F es h~ been featured in both the staff newspaper Connections and the regular staff b r E r a i s e employee awareness. NHS Lothian also works closely with the Carbon l rust to undertake energy efficiency surveys, which help to focus capital investment on projects offering the greatest scope for energy consumption improvement.
NHS Lothian has spent in excess of f0.64m during 2006107 on energy efficiency projects, with expected cumulative revenue savings over £200,000 per annum. A further significant programme is being developed for 2007108.
NHS Lothian actively participates in the following national energy management groups:
Health Facilities Scotland - Engineering Technology Advisory Board and its sub-groups National Services Scotland - Commodity -Advisory Panel for Supply of Utilities
The above demonstrates NHS Lothian's organisational commitment to sustainable development. An internal audit, completed in April 2007, found clear evidence of best practice in a significant number of areas and arrangements are in place to address recommendations arising from the audit.
By order of the board
27th ~ u n e 2007 . . . . . . . . . . . . . . . . . . .. . . . . .. . . . . . .Chief Executive
NHS LOTHIAN
ANNUAL ACCOUNTS AND NOTES FOR YEAR ENDED 31 MARCH 2007
REMUNERATION REPORT
I. Board Members' and Senior Employees' Remuneration
Information disclosed in this report relates to the remuneration of Board Members and senior employees. Other disclosures in these accounts provide details of the interests of Board Members and senior managers, and information about related party transactions.
Board Members and senior managers are remunerated in accordance with approved national pay rates. All posts at this level are subject to rigorous job evaluation arrangements and the pay scales applied reflect the outcomes of these processes. All extant policy guidance issued by SEHD has been appropriately applied and agreed by the Remuneration Committee. Determination of individual salary placement on appointment is guided by the terms of circular MEL(2000)25.
All senior manager posts have been evaluated using the HAY methodology and NHS Lothian is an active participant in the Job Evaluation Committee which considers posts at this level. The Board has agreed that the NHS Lothian Board Members should be appointed to the new Executive Cohort in accordance with HDL(2006)23, subject to the requisite processes being completed. The remaining senior manager posts are included in the ongoing work being carried out by the Executive Managers' Review Group who will determine whether they are to be included in Agenda for Change or the Executive Cohort. Once the outcome of this work is known, NHS Lothian will proceed with implementation in line with national guidance.
Details of Board Members' remuneration are disclosed in tables 2a and 2b of the remuneration report and have been subject to audit. 2005-06 information on page 26 for pension cash Equivalent Transfer Values (CETV) has been restated to correct errors in SPPA calculated values for that period.
ANNUAL ACCOUNTS AND NOTES FOR YEAR ENDED 31 MARCH 2007
REMUNERATION REPORT
2(a). Board Members' and Senior Employees' Remuneration - 200612007 Real inaease Total a w e d Cash Cash in pension at pension at Equivalent Equivalent Real inaease
Salary age 60 age 60 at 31 Transfer Transfer in CElV in Benefils in (bands of (Bands of March Value Value year Kind £5.000) fs.oo0) (Bands of (CETV) at 31 (CElV) at 31
f5.000) March 2006 March 2007 f'000 roo0 roo0 f'000
Remuneration of:
Executive Members
prof James J Barbcur. Chief Executive
Dr Alison McCallum. Director of Public Health
Mr John Malheson. Director of Finance
hks J Sansbury. Diredu of Healthcare Planning
Ms Heather lierney-Moore. Diredu of Nursing
Mr Peter Gabbitas, Diredor of Health 8 Social Care'
Mr David A Bolton. Chief Operating OfClcer UHD .
Mr Murray Duncansoo. Chief Operating Officer PC0
Dr Charles P Swainson. Medical Director
Mr James T McCaffery. Director of HR
0 -5
0-5
0 5
0-5
0-5
0-5
0-5
0-5
0-5
0 -5
n la
nla
50-55
0-5
40-45
25-30
0-5
30-35
50-55
40-45
70-75
20-25
nla
nla
868
38
687
402
26
422
947
688
1360
373
nla
nla
Non Executive Members h4 Wan Cavanagh. Chairman until 15/09/06 nla
nla
nla
nla Mr Robert Anderson. Chairman from 25/09/06
Mr Robert Andersoo unLl 15/09/06
Mr Stuarl Smilh. Chairman UHD
Mr Robin Burley. Chairman PC0
h4 Bill Bennett -deceased
Mr Eddie Egan. Employee ~irecto?
hks Pal Murray. Chair of Lolhian Area Clinical F O N ~ '
Dr Ian McUay. Clinical Director. Edinburgh CHP'
Prof John Savill. Head of College of Medicine - UoE
Cllr lain Whyle
Ulr Kingsley Thomas. City of Edinburgh Canal
Cllr Graeme Morrice. West Lothian Coundl
Ulr Ann Mc Carlhy, Easl Lolhian Council
Ulr Daniel Mdloy. Mdlolhian Council
Mr David Belfall
h4 Stephen Renwidc
Ms Lesley Jamie
hks Erica Hughes until 30106106
Mr David Crichlon
Mrs Theresa Douglas from 01/07/06
Dr Alison liemey from 01/07/06
I3 Rebecca Strachan from 01107106
nla
nla
nla
nla
0 5
0 5
5-10
nla
n la
nla
nla
nla
1520
20-25
20-25
nla
nla
nla
nla
nla
314
149
166
nla
nla
nla
nla
nla
nla
-41
0
55
nla
nla
nla
nla
nla
2
2
0
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
343
1 38
98
nla
nla nla
nla
nla
nla
nla nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
n la nla
nla
nla
nla
nla
nla
nla
nla
nla
nla nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
Other Senlor Employees Mr David Kelly. Diredor. West Lothian C H C ~ nla
0 5
0-5
0-5
nla
10-15
15-20
15-20
nla
1 59
226
224
nla
174
- 252 - - -
251
h4 David While. General Manager. East Lothian CHP Mr Geny Power. General Manager. Mdlolhian CHP
Mr David A Small. General Manager. Edinburgh CHP
Total
' - 1 50% of Ule cosls for Peter Gabbitas are charqed to the Citv of Edinburqh Council
? Edd~e Egan's salary ~ndudes f56.000 In resped of non&&rd duties ! Pat Murrav's salarv indudes £ 74.000 in resoect d ~ n - b o a r d dmes ;pr Ian Mci(a/s saiary indudes f89.000 in respect of nm-board dules. vh of the msls for David Kelly are charged by West Lothian Coundl. David Kelly is in the Council Pension Scheme.
25
