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Annual Report & Accounts

At the forefront of Patient care

The Royal Surrey County HospitalNHS Trust

2007/08

At the forefront of patient careThe Royal County Hospital is going places and everyone is working hard to

ensure that it becomes the patients’ first choice for healthcare in Guildford,

Surrey and beyond.

Our ambitious Patients First programme is focusing on the issues that

really matter to patients such as being treated with compassion, dignity and

respect, high quality clinical care, accessible services and having confidence in

the staff caring for them.

Over the next five years we want to go further and ensure that we can be

responsive to what our patients tell us they want, and to the regional and

national plans for the future delivery of healthcare.

Our current bid for NHS Foundation Trust status underpins all of this work

and means that we will be involving our staff and patients in our plans to

ensure that we make the right changes that lead to the most benefits and

best results.

A meSSAGe FrOm Our CHAirmAN ANd CHieF exeCuTive

THe TruST BOArd OF direCTOrS

Our FiNANCiAl rePOrT ANd ACCOuNTS

Our FuNdrAiSiNG ACHievemeNTS

vAluiNG Our PeOPle

iNvOlviNG ANd liSTeNiNG TO Our PATieNTS ANd lOCAl COmmuNiTieS

Our COmmiTmeNT TO PATieNT SAFeTy

CeleBrATiNG Our SuCCeSSeS

Our PerFOrmANCe

lOOkiNG FOrwArd TO Our FuTure

ABOuT Our HOSPiTAl

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Contents

4 | Royal Surrey Annual Report and Accounts 2007/08 Royal Surrey Annual Report and Accounts 2007/08 | 5

A meSSAGe FrOm Our CHAirmAN ANd CHieF exeCuTive

The finances of the NHS have remained as high profile as ever and we worked very hard to ensure that we delivered high quality services for our patients, whilst prudently managing our finances. This meant that the Trust delivered a surplus of £2.5 million – a significant improvement on last year’s break-even position.

We have continued to positively grow and develop our services to ensure that we maintain our reputation as a leading specialist cancer centre and offer care and treatment over and above that of a standard District General Hospital.

We consolidated specialist head and neck and oesophago-gastric cancer surgery and introduced new chemotherapy regimes and radiotherapy techniques such as Intensity Module Radiotherapy Treatment (IMRT). We also continued with our investment of new equipment and installed an additional linear accelerator.

This year has seen the enhancement of our reputation as an international centre for laparoscopic surgery with the designation as a training centre for laparoscopic colorectal surgery.

In March we had the honour of Health Secretary Alan Johnson officially opening the Southern hub of the National Bowel Cancer Screening Programme, which is based at the Post Graduate Medical Centre.

To ensure that this success continues the Trust made some important strides in putting in place the organisational arrangements and processes that will help us manage our affairs effectively in the future, to the benefit of our patients. We introduced a new organisational structure focused on clinically led specialty business units, strengthened our internal performance management arrangements and piloted new approaches to developing our key managerial and clinical leaders, based on the latest private sector thinking. All of these changes will help to make the hospital a stronger and more effective organisation in the future.

As a result of the Fit for the Future strategic review, the first quarter of the year was an uncertain period for all of us at the Royal Surrey County Hospital and we were once again overwhelmed by the amount of support shown by our staff, patients, local community and beyond.

September’s outcome of the review recognised that the Royal Surrey has a continuing central role to play in the Surrey health system, both as a “full service” district general hospital serving a broad catchment based around Guildford and Waverley; and as a Cancer Centre serving a population of more than 1.2 million people in Surrey, West Sussex and Hampshire.

Following on from this, we were delighted to be given the go-ahead by the Strategic Health Authority NHS South East Coast to begin the application process for Foundation Trust status. We see this as a real vote of confidence in the Trust and allows us to look forward to the future.

We are looking forward to 2008/09, which promises to be one of our most successful and exciting years to date.

The Trust has maintained the highest standards of clinical quality and was recognised nationally as one of the top 30 Trusts with the lowest mortality rates. Once again we were an award winning Trust and scooped four awards at the 2008 South east Coast Best of Health awards and were named as one of the country’s Top 40 hospitals by CHkS, who collate performance data for 75% of NHS Trusts.

Our staff have all worked tirelessly through, what was at times, a particularly demanding year. Despite this we fully met the Government’s targets on reducing waits from GP referral to treatment down to 18 weeks and have been congratulated by the Strategic Health Authority NHS South East Coast for delivering on all of the cancer waiting times targets. Our performance has been consistently strong across the board and, in addition to our 18 weeks achievement, we have maintained our position as one of the highest performing Accident and Emergency departments in the country.

Nick moberly, Chief executive

Alan Howarth, Chairman

we can look back on 2007/08 as a year of real achievement for the Trust.


ABOuT Our HOSPiTAl

The royal Surrey County Hospital is a leading district General Hospital and specialist tertiary centre for cancer, eNT, oral and maxillo-facial surgery and pathology. The hospital serves a population of 320,000 for emergency and general hospital services and is the lead specialist centre for cancer patients in Surrey, west Sussex and Hampshire, serving a population of 1.2 million.

Our annual income is £170 million and we have 528 beds and 14 operating theatres. We employ 2,800 staff, making us the second largest employer in Guildford. We have very close links with the University of Surrey and have an extensive education, training and research portfolio. The trust is a national leader in surgical training and laparoscopic surgery and a national and international training centre for complex, minimal access surgery.

Patients at the Royal Surrey also benefit from state of the art diagnostic equipment and one of the lowest mortality rates in the country.

We see around 250,000 outpatients a year, 55,500 patients are admitted for treatment and over 59,000 patients attend our A&E department.


lOOkiNG FOrwArd TO Our FuTure 2008/09 is likely to be one of the most significant years to date for the Royal Surrey and we move into the New year with a real sense of excitement and purpose. Our aspiration is to continue to develop the hospital both as a district general hospital and a Cancer Centre, working closely and collaboratively with our friends and partners in neighbouring Trusts.

We look forward to pursuing a Foundation Trust application over the coming months, and have every confidence that we will be able to make a strong case both clinically, operationally and financially, to be granted a licence. If we are granted with a licence it will lead to a number of benefits for our organisation and the communities we serve. We will have much more freedom to develop our services in line with the needs and wishes of local people. We will be able to manage our own finances and budgets through legally binding contracts with commissioners, and have the ability to retain any surpluses we generate year on year and reinvest them in services for the benefit of our patients.

The new governance structures associated with Foundation Trust status – which include creating a membership and establishing a Council of Governors – will enable us to form stronger links with local people and ensure that their needs are at the heart of what the organisation does. Our staff will also have a greater opportunity to have their say and be involved in shaping future services.

In parallel, we will be driving forward with ambitious plans to improve our services and ensure that we can establish ourselves as national leaders in the delivery of high quality, safe, compassionate and convenient care. In the summer of 2008 we will be launching an exciting clinical and operational change programme – “Patients First” – which will focus on ensuring that:

• We deliver outstanding patient safety and the best clinical quality and outcomes.

• We offer compassionate, empathetic and respectful care for all our patients and their families.

• Our services are organized in a streamlined and user-friendly fashion so that we can offer unrivalled ease of access and convenience for our patients.

The aims will be delivered through a number of initiatives, projects and changes and we will be involving our patients and staff in the programme to ensure that we make the right changes that lead to the most benefits and best results.

Our vision is to deliver the best possible care, treatment and outcomes for all our patients and to constantly strive to be the patient’s first choice for treatment in Guildford, Surrey and beyond.


Our PerFOrmANCe18 weeksThe Trust has achieved the March 2008 18 week targets of 85% of admitted and 90% of non-admitted patients waiting no more than 18 weeks from GP referral to treatment.

The number of admitted patients who receive their treatment within 18 weeks increased from 35 % in March 2007 to 91% in March 2008. Non-admitted patients rose from 60% in March 2007 to 93%.

Most patients now attend their first outpatient appointments within 5-6 weeks and the majority then spend less than 11 weeks on the waiting list for admission for treatment. This is not the case for orthopaedics, but we have achieved significantly reduced waiting times during the year and expect to meet the 18 week standard by December 2008.

This has all been achieved through sharpening up our administrative processes and new ways of working for many staff with a clear focus on the patient’s journey. Patients will see further improvements during 2008/09.

A&E The Trust has continued to over perform on the A&E target of being seen and treated within four hours and by the end of the year had achieved 99.4%. We treated 59,227 patients in A&E and saw 13,244 patients in the Walk In Centre.

OutpatientsThis year there has been a 17% increase in the number of new outpatients referrals, which amounts to 63,409. Follow-up outpatients rose by 3.8% to 143,183.

day cases27,249 patients were treated as day cases this year, which is a rise of 11.5% on last year.

Emergency cases21,590 patients received emergency procedures during 2007/08.

Critical CareThere were 2,934 adult intensive care bed days – a 30.3% rise on 2006/07 and a 7.2% reduction in Special Care Baby Unit bed days down to 2,763.

AdmissionsWe admitted 55,510 patients to hospital during 2007/08 compared to 52,527 last year.

diagnostic waiting timesWe have successfully met the target of having no patients waiting more than six weeks for diagnostic tests including MRI and CT scans and by the end of the year only 568 patients were waiting more than two weeks.

Cancer waiting times targetsWe successfully achieved 100% for the 31 day cancer target of 98% and exceeded the 62 day cancer waiting times target of 95% and achieved 96%.

Cancelled operationsIn 2007/08, 967 operations were cancelled.


CeleBrATiNG Our SuCCeSSeS

Oncology and Medical PhysicsDeveloping and growing our cancer services for patients in Surrey, West Sussex and Hampshire has continued to be a priority for the Royal Surrey this year. We have recruited three new consultants and further invested in new equipment.

Government funding of £7 million was spent on replacing four existing Linear Accelerators at the St Luke’s Cancer Centre and an additional fifth Linear Accelerator. The additional capacity has reduced waiting times and since November 2007 patients have been offered an innovative treatment known as IMRT (Intensity Module Radiotherapy Treatment). IMRT shapes the radiation beams to closely fit the shape of the cancer and also alters the radiotherapy dose according to the shape. This means that the central part of the cancer receives the highest dose of radiotherapy and a surrounding area of tissue gets lower doses. This treatment is not available in all cancer centres and patients have come from as far afield as Oxford.

One of the new Linear Accelerators has been half funded by the Trust and half by the St Luke’s Cancer Fund and has Image Guided Radiation Therapy (IGRT) capability. IGRT provides extremely accurate information on the position of the tumour and adjacent critical organs. This means that radiotherapy treatment can be administered more accurately and effectively.

We also continue to collaborate with the University of Surrey on a wide range of cancer research projects and are also currently participating in a number of international research projects including work with the International Atomic Energy Authority.

In early autumn 2008 we will open the Surrey NHS Bowel Screening Centre. The centre will be responsible for delivering the National Bowel Screening Programme to a population of 1.2 million across Surrey and Crawley.

We also continue to be the National Coordinating Centre for the Physics of Mammography, which is headed up by Prof Kenneth Young, Acting Director of Research and Development.

General SurgeryGeneral Surgery has continued to build on its reputation as a national and international leader and is now working in partnership with St Mark’s and Colchester hospital to run the National Laparoscopic Training Centre.

During 2007/08 colorectal surgery patients saw reduced lengths of stay and we are now among the best ten hospitals in the country for shortening the length of time spent recovering in hospital. Our patients can expect to leave hospital over three days earlier than the national average and spend 12.17 days recovering compared to 15.9 days.

Bowel resection patients have also seen improvements and there are a number who have spent just 23 hours in hospital following surgery.

Our emergency surgery has some of the lowest mortality rates in the country and we provide a 24 hour service for Oesophago Gastric and Hepatopancreaticobiliary surgery and are part of the Surrey-wide Vascular surgery network.

The Oesophagogastric Unit carried out in excess of 100 major cancer resections, with extremely low mortality rates. This success has attracted increasing an number of patients from other centres.

Working with Histopathology, the Breast Surgery Unit is one of the first to introduce sentinel node biopsy to look at whether the disease has spread into the lymph nodes. This was shortlisted for a 2008 Best of Health award and the consultants have taught surgeons from other hospitals across the country to use the technique. Demand for the service grew throughout the year and the unit has introduced a nurse led clinic for women who have a family history of breast cancer and who are concerned that they are at increased risk of developing the disease.


GynaecologyWe are one of the few centres in

the country providing laparoscopic

surgery specifically for the treatment

of endometriosis and during the year

has treated patients from all over

the country.

This year the Early Pregnancy Unit

almost doubled the number of referrals

received and provided a speedy,

dedicated, and sympathetic service to

women experiencing problems in the

first trimester of pregnancy.

Gynaecological Oncological Surgeons,

Simon Butler-Manuel and Anil Tailor

had a 38% increase in referrals and,

using the very latest techniques,

treated women with gynaecological

cancers from all over Surrey to obtain

the best possible outcomes.

urologyIn January 2008 Urological surgeon

Mr John Davies carried out the first

kidney cancer cryosurgery treatment

laparoscopically. The procedure was

carried out in association with Mr Neil

Barber from Frimley Park Hospital

and a Finnish surgeon. This is a very

new technique in the UK and very few

centres are currently able to carry

it out.

Our Urologists are national leaders

in the treatment of prostate cancer

– brachytherapy, cryotherapy and

High intensity focused ultrasound

(HIFU) and laparascopic radical

prostatectomy. 1,000 patients have now had brachytherapy and 1,000 have undergone a laparoscopic radical prostatectomy. The Royal Surrey is the only hospital in the country that offers all of those treatments.

Maxillo – Facial and Orthodontics The team successfully delivered on the interim 18 weeks target and referrals were up by 11% on the previous year. The department has been expanded to cope with the increased demand and to improve the patient experience. Maxillo-Facial Clinical Director Carrie Newlands and Orthodontics Clinical Director Nigel Taylor acted, and continue to, as the National leads for both of their specialties on the development of the NHS Choices website.

We have seen the expansion of our cleft clinics, as a result of more patients choosing to be treated for this condition at the Royal Surrey and have recruited more dental nurses and doctors to help us treat our patients within 18 weeks.

eNTENT serves a population of 1 million and 30% of our GP referrals in 2007/08 were for this specialty. In audiology we are the only hospital in Surrey who met the six and 18 weeks target, which has led to dramatic improvements for our patients.

Our new Head of Audiology Prof Deepak Prasher is a leading expert in research into Auditory Neuropathy, and Noise Induced Hearing Loss and was a senior lecturer in Audiological Science at University College London.

This year Consultant Rhinologist Julian Rowe-Jones introduced a new technique to England for treating chronic sinusitis called balloon sinuplasty, which has already benefited some Royal Surrey patients.

The new technique is based on angioplasty, which is used to widen the clogged coronary arteries of heart disease patients. A tiny balloon is fed along a wire to the blocked sinus and then the balloon is inflated to displace a fine bone at the sinus junction. The balloon is then deflated and removed.

OphthalmologyThis has been a busy year for Ophthalmology, with GP referrals up by 20% and day surgery increasing by 11%. The department has also been running a series of training and open events for local opticians in order to improve the relationship and communication with our Ophthalmology department. The opticians have received Primary Eyecare Acute Referral Scheme (PEARS) training. Patients who develop sudden eye problems can request a specialised eye examination from an optician and our ophthalmologists are training them on how to carry these out.

Trauma and OrthopaedicsWorking with physiotherapists Katherine Binks and Mia Dunkley, Consultant Orthopaedic Surgeon Chris Coates has set up the award winning Ponseti team. This team has transformed the lives of babies and children born with talipes, which is more commonly known as club foot, by adapting a treatment originally developed by Prof Ignatio Ponseti in the 1940s. Children born with club foot would previously have needed surgery by the age of one and then stretching and strapping of the foot. This treatment starts when the baby is born and the baby’s foot is manipulated and put into a cast. Children treated have pain-free and functional feet and less deformity. The team won the NHS South East Coast 2008 Best of Health Adopt, Adapt and Improve award for their work.

In January 2008 a new consultant was appointed to specialise in lower limb surgery and the Royal Surrey is now an internationally recognised specialist training centre for foot fellows

intensive Care Over the last three years the Royal Surrey County Hospital has invested around £1.5 million in transforming its Intensive care facilities. This significant investment has paid for additional and new equipment and extra consultants.

The admissions have doubled to 750 in the last three years but mortality

rates have fallen by 35%, which

equates to 80 more people leaving

hospital alive every year and is well

below the national average. ICU has

also dramatically reduced the rates of

serious infection by more than 70%.

Acute General medicine This year we separated our critical

care unit from intensive care and

this is now well established on our

cardiac ward. This has provided the

opportunity for cardiology patients to

be managed in a more streamlined

way in one area. If a patient needs

some critical care they can receive it

without being moved and then can

remain in the same area as the level of

required care is reduced.

Our stroke care service has gone from

strength to strength and according to

the National Sentinel Audit for Stroke

is one of the best in the South East

Coast region. At the end of the year,

as recommended in the National

Stroke Strategy, we introduced the

only 24/7 Stroke Thrombolysis service

in the region.

We have also welcomed two new

consultants to our rheumatology and

acute medicine department during the

year – Dr Charles Li and Dr

Catherine Neville.

MaternityOur maternity services have continued

to maintain very high standards and

the unit is the only one in the South East Coast region to have Clinical Negligence Scheme for Trusts Level 3. This signifies a high level of commitment to risk management and evidence of robust research based policies and protocols. We have also been awarded the coveted UNICEF Baby Friendly award for our excellence in preparing and supporting women initiating breast feeding.

We are also proud of the fact that we are the only unit in the south east never to shut its doors. Our unit also has the lowest elective caesarean rate in Surrey at 22.8%, which is below the cap set by Surrey PCT of 23.6%.

In the Healthcare Commission’s 2007 review of maternity services, the Royal Surrey received an overall rating of fair performing. But the review highlighted the fact that our care is very safe and we were awarded a Best Performing mark for ensuring that there are very low levels of complications following delivery.

This has been a busy year for Ophthalmology, with GP referrals up by 20% and day surgery increasing by 11%.


PaediatricsThe number of children being referred to Ambulatory care continued to increase and our dedicated children’s ward offers a seven day a week service for GPs to discuss and if appropriate see children sooner than an outpatient appointment.

Our senior nurses are able to give children their chemotherapy, which means that they do not need to wait for a doctor to be available. This has dramatically improved the child’s and their familie’s experience through reduced waiting times and treatment from a familiar member of staff.

Our Epilepsy nurse Vicky Rimmer was Surrey’s Nurse of the Year at the Best of Health awards in 2007 and this service continues to go from strength to strength. Vicky is the only Paediatric Roald Dahl Epilepsy nurse specialist in the county and trains schools and community organizations on how to give buccal Midazolam which is used to manage acute episodes.

A&EOur A&E department have once again delivered an outstanding performance and have cemented their position as one of the best performing A&E’s in the country for patients being seen and treated within four hours. We have improved the patient experience by integrating our Walk In Centre and minors’ unit, which means that we can quickly decide where best to treat

patients and streamline their journey through A&E. The department is looking to make further improvements to the service in the coming year.

Medical Outpatient SpecialtiesThis department has seen a 30% increase in new referrals over the course of the financial year, with the biggest growth in cardiology and neurology. To help cope with a growing demand, Rheumatology has recruited two new consultants. The Respiratory department is running an award winning Chronic Pulmonary Obstructive Disease (COPD) scheme .

We run the only Growth Hormone Deficiency (GHD) centre for adults with diabetes in Surrey and are one of the largest Insulin pump centres.

The Cardiology diagnostics team scooped a South East Coast Best of Health 2008 award for its joint project with Surrey PCT. The team redesigned the service to improve diagnosis and waiting times for patients. A one stop shop carries out same day investigations and this has drastically reduced waiting times for tests – down from 13 to two weeks.

PharmacyThis year has seen the start of a major refurbishment in the pharmacy department. The building of a new Aseptic Unit, pharmacy dispensary and store was well underway by the

end of the year. This will provide more space to deal with the ever increasing workload. The new pharmacy also has a ‘robot to help improve efficiency and the service for both inpatients and outpatients and free up staff to run the St. Luke’s Cancer Centre Pharmacy all day.

Activity has increased by 5% and during 2007/08 £13,08,402 worth of medicines was dispensed. The oncology pharmacy service has successfully developed a pharmacist prescriber who works in a joint clinic

with nurse prescribers.

TherapiesThe physiotherapy department boasts both members of the award winning Ponseti team and the 2008 South East Coast Health and Social Care Professional of the Year.

Katherine Binks is the region’s Health Professional of the Year and was appointed as the hospital’s first ever Paediatric Physiotherapist in 2002 and since then has helped numerous children and their families to manage and cope with a variety of conditions. Katherine won the award for going above and beyond the call of duty and constantly looking for new ways of improving the care the children receive from her. She also raises money to buy specialist equipment such as buggies and car seats for

children with deformities that parents

can borrow during the sometimes

lengthy treatment.

PathologyThe pathology service has had an

exciting year with the opening of

the South of England Bowel Cancer

Screening Hub by Health Secretary

Alan Johnson. The laboratory has also

been a national pilot site for the review

of pathology by Lord Carter of Coles

and the output from the pilot was very

favourable for the service.

Breast Surgery and Histopathology

were the Surrey finalist for the

Innovative Health and Social Care

Technology award at Best of Health

2008. The team are using a one step

diagnostic test on patients undergoing

surgery for breast cancer. The test

checks if the cancer has already spread

to the lymph nodes and if it is has they

can be removed in the same operation.

This means that these women do not

have to undergo a second operation.

The department looks forward

to the introduction of robotics in

Microbiology and the new build of a

third floor for Cellular Pathology in the

new financial year.

RadiologyThe Radiology Department has had

a very successful year. In September

2007 a new 64 slice CT scanner was

installed, which provides much clearer

images and better diagnosis and is

being used particularly for cardiology

patients. The department also built a

new interventional suite.

Four new consultants have been appointed to strengthen the support to the Cancer Centre.

The department has improved its access times and has exceeded the targets set by the Department of Health on diagnostic wait times.

Our A&E department have once again delivered an outstanding performance and have cemented their position as one of the best performing A&e’s in the country for patients being seen and treated within four hours. we have improved the patient experience by integrating our walk in Centre and minors unit.

Royal Surrey Annual Report and Accounts 2007/08 | 1918 | Royal Surrey Annual Report and Accounts 2007/08

Our COmmiTmeNT TO PATieNT SAFeTy

>> TACkliNG iNFeCTiON

This last year saw even more national attention focused on infection control and cleanliness and we have maintained and built on our commitment to tackling this issue.

During 2007/08 we have revised our health and safety training programmes to provide more support for staff managing safety and risk issues. We have also extended the number staff receiving training.

The number of incidents that are reportable to the Health and Safety Executive has decreased for the third year in succession and this is down to the improvements we have made to health and safety management.

>> HeAlTH ANd SAFeTy

The safety of our patients is the Trust’s top priority and in the coming year we will be launching a number of initiatives under the Patients First programme, to address issues such as falls and medication errors.

We successfully completed a deep clean of the hospital by 31st March 2008 and have seen falls in the rates of C difficile and MRSA, compared to 2006/07.

In 2007/08, we successfully reduced our MRSA bacteraemias by 27% from 33 in 2006/07 to 24 this year. We have also achieved some of the lowest C difficile rates in the South East Coast region.

This has been achieved through the investment of £246,000 of Dept of Health money on deep cleaning the hospital, upgrading our toilets and commodes and buying new mattresses and other equipment.

All of the entrances to clinical areas are very clearly marked with signs informing everyone to clean their hands and we have and continue to audit and train staff on following the correct hand washing procedures.

This year also saw the launch and enforcement of a new antibiotic prescribing policy and we have changed the skin cleansing solution used to take blood, which will help to bring down the number of MRSA infections. All patients who are at risk of contracting MRSA are screened.

In February we successfully implemented a ‘Bare Below the Elbows’ policy for all non-uniformed clinical staff when they are dealing with patients. Staff also have to remove wristwatches and keep long hair tied up.

During 2008/09 we are continuing to work hard to drive down our rates of infection through ensuring adherence to correct hand cleansing by all staff and visitors, thorough cleaning of the hospital site, monitoring catheters and intravenous lines and expanding our decolonisation programme for ‘at risk’ patients.


iNvOlviNG ANd liSTeNiNG TO Our PATieNTS ANd lOCAl COmmuNiTieS

in the coming year we are very much looking forward to working much more closely with our patients and local communities to help shape our services and deliver our Patients First change programme. we will also be looking for the local community to support our Foundation Trust application by becoming a member of the Trust or by standing for election as a Governor.

We are also carrying out some research with recent patients and local communities on the service we provide, what we do well and where we could make improvements.

As part of our commitment to putting our patients first and responding to their needs, in 2008/09 we will be launching a new exit survey for patients to complete when they are discharged. We intend to regularly report the results and highlight where we have made changes in response to comments in the exit survey.

Patient and Public involvement Forum2007/08 was the last year that the Royal Surrey had a dedicated PPI forum and they have provided a huge amount of support throughout the Fit for the Future process and also on a range of issues affecting the hospital – particularly infection control and cleanliness.

Their report to the Healthcare Commission, which will form part of the 2007/08 Annual Health Check, praised the Trust on our efforts to reduce infection and the considerable improvement in cleanliness. The forum has been carrying out inspections of wards and we have dealt quickly with any issues raised following those inspections. It also praised the quality of food provided for patients, the commitment to single sex wards and our PALS organisation.

The forum has continued to spend time in the hospital and has provided useful feedback throughout the year. Members of the forum took part in ‘Cleanwatch’ and paid monitoring visits to inpatient wards where they checked and reported back on cleanliness and hygiene standards. We are keen to maintain a relationship

with the forum members and are

looking forward to working with the

new Surrey-wide Local Involvement

Network.

Patient Advocacy and liaison Service (PAlS)During the year our PALS office

received 615 referrals, which

represents a 10% increase on the

previous year. PALS deals with a very

wide range of concerns and requests

for information from patients and the

public and throughout the year have

strived to successfully deal with

as many as possible. The most

common issues raised include

problems with appointments,

admissions and waiting times and

general communications issues.

Dealing with individual queries kept

PALS very busy during 2007/08,

but alongside that the team also

relaunched the Comment Card system

for visitors to the hospital and focused

it in parts of the hospital experiencing

the most ‘ through traffic’ such as

outpatients and A&E. PALS also

coordinated the 2007 Healthcare

Commission Inpatient and Emergency

Dept surveys and the implementation

of the Mental Capacity Act.

Looking to the future, the PALS

Service will be working closely

with communications to launch an

inpatient exit survey. The survey will

be launched in early summer 2008

and will form part of a commitment to

listen to and respond to our patients.

Healthcare Commission inpatient Survey The results of our 2007 inpatient

survey show that overall patient

satisfaction with the hospital has

increased compared with the 2006

survey. There were particular improvements in the communication with patients undergoing an operation or procedure, privacy and the communication between the Royal Surrey and GPs following discharge. We are in the top 20% of trusts for not having to share bathrooms or sleeping areas with the opposite sex, providing clear information about medication and receiving information about your condition in A&E.

ComplaintsPatients are our eyes and ears and we greatly welcome feedback from patients both positive and negative. Complaints in particular allow us to take immediate action on any issues that are raised as we are committed to continually improving the service we provide for patients and their families and friends. As a result of issues raised, during the last year we have supported and promoted further infection control and hand washing hygiene to ensure that best practice is delivered and staff have received additional training on completing patient records and effective communication.

During 2007/08 we received 306 formal complaints and the great majority of these were resolved under Local Resolution and complainants received written apologies and explanations.

There were a small number where it was more appropriate for staff to meet with the patient face to face in order to go through the issues in more detail and provide a thorough explanation.


vAluiNG Our PeOPle

>> OrGANiSATiONAl develOPmeNT

in January 2008, we re-structured the Trust to provide greater focus on the pathways that our patients go through and to improve the overall experience of our patients. we now have 13 Specialty Business units that are led by a Clinical director.

These units report to the Executive Team every month on their performance and to raise any issues and are now directly involved in helping to set the strategic direction and vision of the Trust over the next five years. The new units are:

• Ear, Nose and Throat

• General Surgery

• Gynaecology

• Maxillo facial/Orthodontics

• Ophthalmology

• Trauma and Orthopaedics

• Urology

• A&E

• Acute General Medicine and Geriatrics

• Medical Outpatient Specialties

• Paediatrics

• Obstetrics

• Oncology and Medical Physics


The survey also highlighted that fewer staff were receiving well structured appraisals and personal development plans and we have already taken action to address this with the introduction of the new national appraisal system and a three month push at the beginning of 2008/09 on getting up to date with all staff appraisals. We have also looked at how the appraisals are conducted as we need to ensure that staff benefit from them and they support their ongoing learning and development.

developing our nurses and midwivesTrainingStatutory obligations require annual updates for all staff on certain clinical practices. The ‘Joint Update’ was revamped in September 2007 with a further review beginning 2008. The Joint update now runs three times a month with attendance recorded manually and data entries into OLM retrospectively.

Health Care Assistants / NvQ CentreThe NVQ Centre continues to be a success. Since April 2007 the NVQ Centre had 11 candidates attain NVQ Level 2 and four candidates attained level 3. Nine candidates are progressing through level 2 and seven through level 3 currently. A Strategy for developing Health Care Assistants in the Trust is currently being developed. A review of the service and the two posts in this small team has led to them being placed in the Practice Development Team but to lead on Health care assistant training.

visiting TimesNew visiting times were introduced in February 2008. These formed part of a new visitors’ charter, which was drawn up by our matrons to improve the information about visiting and to ensure that our visiting times support our commitment to tackling infection. This was supported by the Patient and Public Involvement Forum.

Non medical PrescribingThe Non Medical Prescribing Policy has now been in place for nearly a year and during this time we have seen great developments within this area. We currently have 10 qualified prescribers (9 nurses and 1 pharmacist) with two more in the process of qualifying and two more starting the January course (one of these being a physio) Nursing and Pharmacy are continuing to work together in supporting these staff as they take on this new role. Feedback from those actively using this new skill is that it has increased the smooth running of clinics, the timely pain relief for patients and enabled a more holistic approach to supportive therapy especially for oncology patients.

These units are supported by Radiology, Pathology, Anaesthetics, Theatres and ICU, pharmacy, therapies and outpatients.

We have also launched a Trust balanced scorecard so that clinical teams can ensure efficient and effective use of staff within the organisation.

This year we implemented an equality and diversity approach within the organisation, through the Single Equality Scheme, and undertook impact assessments and supported the formation of related network groups.

The HR team was restructured to work more closely with the new specialty business units. We have also reviewed our recruitment processes to ensure we are attracting the best talent which, together with a review of our employment policies, offers an attractive environment for current and prospective staff.

Staff bankThe Trust has taken the organisation and administration of the staff bank for nursing flexible workers back in-house to allow us to respond to changing operational needs. We also offer excellent staff benefits to those employees who choose to work on flexible contracts.

Junior doctors recruitmentIn spite of the challenges at national level arising from Modernising Medical Careers, we maintained good staffing at junior doctor level and continue to be a hospital of choice for trainees.

improving staff performance and developmentA new clinical skills room has been established in our Education Centre for multidisciplinary ‘hands on’ clinical teaching to improve the quality of care provided to patients. Staff also have better access to high quality and up-to-date learning materials as a result of the achievement of a national Library accreditation.

To harness the future potential of our staff, we established a talent management scheme to provide development for staff and succession planning within the organisation. Alongside this we have improved our management development programme, introduced a team leader development course and a specialty team development programme to support the new Trust structure.

We also introduced the on-line national appraisal system for all non-medical staff and that is being rolled out across the organisation.

NHS staff surveyThe 2007 NHS Staff Survey shows that we have improved in a number of areas compared to the 2006 results. It is very encouraging that fewer staff are intending to move jobs, staff feel more supported by their managers and hand washing materials are more readily available. However, the results do show that there is still further work to do and we are focusing our attentions on making sure that the Royal Surrey is an excellent employer and an attractive place to work.

A new clinical skills room has been established in our Education Centre for multidisciplinary ‘hands on’ clinical teaching to improve the quality of care provided to patients.


Our FuNdrAiSiNG ACHievemeNTS

We smashed our target of £40,000 by nearly £20,000 and the money raised was for six of the charities involved in the raffle and which are part of the Combined Charities Group. St Luke’s Cancer Fund, G.U.T.S, GRACE, The Fountain Centre, Dr Topham’s Research Fund and HASTE. As well as raising money, the raffle helped us raise the public’s awareness of the hospital, particularly St Luke’s, and some of the groundbreaking work carried out in the different cancer disciplines plus the need for charitable support.

Once again people’s support has been tremendous. We have also received a number of very generous legacies this year. The money raised during the year is for replacing and updating equipment and facilities mainly within the St Luke’s Cancer Centre.

The Fundraising department continues to work closely with the other charities supporting the Trust. Mr Geoffrey Lawson the first Chairman of the Coordinating Charities Council has retired and Mr Robert Stedall has taken over as the new Chairman. The Charities and Trustees are very grateful to Mr Lawson for the time and commitment he gave to setting up the Council. Without his wisdom and experience, it would not be the success it is today. The Council meets twice a year to ensure that good communications and a closer working relationship exists between the charities directly supporting the hospital and the Trust.

As in previous years the St Luke’s Cancer Fund has received charitable income through the valuable support of the local community such as schools, companies,

churches and various community groups, many of which have very original ways of raising money. Many local Rotary Clubs and other community groups including Horsham Amateur Dramatic Society gave up their weekends to help with the Mini raffle and support St Luke’s.

We organised one charity trek in the year to the very popular Great Wall of China. The trek was in a remote part of Inner Mongolia and is a tough challenge but all our trekkers completed the trek and raised their sponsorship. This year we have two treks organised in the Autumn to Mt Kilimanjaro and Machu Picchu, Peru.

The fundraising department organises a Christmas Fair and Raffle for the Wards and Departments each year and raised a record amount of £4,200, with the raffle raising a further £1,600.

Through the hard work of our supporters, staff, fundraising volunteers and the generosity and kindness of our donors – whether individuals, schools, community groups or trusts – plus many more, we achieved a great deal this year. On behalf of everyone at the Royal Surrey, thank you.

To make a donation, hold an event or for information about leaving a legacy – please contact the fundraising department on 01483 464146 or email [email protected]

Fundraising activity has continued to support the Trust and over the course of the year we raised around a £1 million. The main event for the year was the major raffle, which ran from April to december. First prize was a new Mini One car donated by a very generous benefactor.


Our FiNANCiAl rePOrT ANd ACCOuNTS

>> FiNANCe review

in 2007/08, the Trust achieved an in-year financial surplus of £2,517k, compared with a surplus of £39k reported for 2006/07. This represents the third consecutive year of achieving a financial surplus, with no financial support received:

Surplus Reported for year

£k

Financial Support

£k

Surplus/(deficit) excl. Financial Support

£k

2004/05 262 6,540 (6,278)

2005/06 1,068 - 1,068

2006/07 39 - 39

2007/08 2,517 - 2,517

The surplus achieved in the year

increases the Trust I&E reserve on the

Balance Sheet to £4,338k.

Whilst achieving a surplus significantly

above the previous year, the Trust

was able to approve non recurrent

expenditure totalling £4.9m to the

benefit of patients and staff through

replacing aged medical equipment

and ward infrastructure. We believe

patients, visitors and staff will notice

and appreciate the improvements.

Total income increased from £151.8m

to £170.1m, a growth of 12.1%.

Operating expenses increased from

£148.0m to £163.4m, a growth of

10.4%. This resulted in an operating

surplus before financing costs and

payment of dividend on public capital

of £6.6m, compared with £3.9m in

2006/07.

Patient referrals to the Trust have

continued to increase, benefiting

from the roll out of Choose and

Book. Combined with the increase

in treatments to meet the national

18 week targets, income from PCTs

increased to £130m, accounting for

76% of the Trust’s overall income.

This included an over-performance

compared with the SLA for Surrey PCT

of £6.8m. 2007/08 marks the end of

the 4 year transition to full Payment

by Results; the income reduction in

2007/08 was a little under £10m for

the Trust.

The increase in patient treatments

enabled the Trust to again improve

productivity by keeping the overall

growth in expenditure below

income. To support a 6% increase

in emergency and elective patient

treatments and an 8% increase in

outpatients, staff levels increased to

2,440. Average elective patient length

of stay reduced to 3.3 days. Patients

undergoing surgery as day cases

increased to 80% as a proportion

of total elective spells. Both these

two measures of efficiency compare

favourably with other Trusts.

The Trust has a duty to meet a number

of financial targets. In 2007/08, the

performance was as follows:

• To break even – the Trust recorded

an in-year surplus of £2,517k

• To remain within the Capital

Resource Limit £8,302k – the

Trust met this target with a slight

underspend of £6k.

• To remain within the External

Financing Limit – the target was set

at £1,811k and the Trust recorded

an undershoot of £66k.

• The target of a 3.5% return on assets

was achieved.

• Trust management costs were 3.5%

of income, within the tolerance set

by the Department of Health.

• To pay non NHS creditors within

30 days – although performance

improved, this target has not been

met, largely as a result of continuing

problems with the e-procurement

system. The results were:

• 73% of bills by number were

paid within 30 days (57% in

2006/07)

• 67% of bills by value were paid

within 30 days (55% in 2006/07)

The Trust has built on the financial

performance achieved in the last three

years to report a stable and growing

surplus. This places us in a good

financial position to start the process

to become a Foundation Trust, with

the resultant benefits to our patients,

community and staff.

Paul Biddle, director of Finance


The full annual accounts can be obtained from the Director of Finance, The Royal Surrey County Hospital NHS Trust, Egerton Road, Guildford,GU2 7XX. These accounts were approved by the Board of Directors on 17 June 2008 and signed on their behalf by Nick Moberly, Chief Executive and Paul Biddle, Director of Finance.

independent Auditor’s report to the directors of the Board of royal Surrey County Hospital NHS TrustWe have examined the summary financial statements for the year ended 31 March 2008 which comprise the Income and Expenditure Account, the Balance Sheet, the Statement of Total Recognised Gains and Losses, the Cash Flow Statement and the related notes. We have also audited the information in the Trust’s Remuneration Report that is described as having been audited.

This report, including the opinion, has been prepared for and only for the Board of Royal Surrey County Hospital NHS Trust in accordance with Part II of the Audit Commission Act 1998 and for no other purpose, as set out in paragraph 36 of the Statement of Responsibilities of Auditors and of Audited Bodies prepared by the Audit Commission. We do not, in giving this opinion, accept or assume responsibility for any other purpose or to any other person to whom this report is shown or into whose hands it may come save where expressly agreed by our prior consent in writing.

respective responsibilities of directors and auditorsThe directors are responsible for preparing the Annual Report, including the Remuneration Report. Our responsibility is to audit the part of the Remuneration Report to be audited and to report to you our opinion on the consistency of the summary financial statements within the Annual Report with the statutory financial statements. We also read the other information contained in the Annual Report and consider the implications for our statement if we become aware of any apparent misstatements or material inconsistencies with the summary financial statements.

Basis of opinionWe conducted our work in accordance with Bulletin 1999/6 ‘The auditor’s statement on the summary financial statements’ issued by the Auditing Practices Board. Our report on the statutory financial statements describes the basis of our audit opinion on those financial statements and on the information in the

Remuneration Report to be audited.

OpinionIn our opinion:

• the summary financial statements are consistent with the statutory financial statements of the Trust for the year ended 31 March 2008; and

• the part of the Remuneration Report to be audited has been properly prepared in accordance with the accounting policies directed by the Secretary of State as being relevant to the National Health Service in England.

Signed by: KPMG LLP, London

>> SummAry FiNANCiAl STATemeNTS 2007/08

These summary financial statements for the year ended 31 march 2008 have been prepared by the royal Surrey County Hospital NHS Trust under the National Health Service Act 2006 in the form which the Secretary of State has, with the approval of the Treasury, directed.


>> STATemeNT OF direCTOrS reSPONSiBiliTy iN reSPeCT OF iNTerNAl CONTrOl

The following is an extract from the full Statement on internal Control which is produced in full in the Trust’s Annual Accounts, a copy of which can be obtained upon request from the director of Finance.

ResponsibilityThe Board is accountable for internal

control. The Chief Executive has

responsibility for maintaining a sound

system of internal control that supports

the achievement of the organisation’s

policies, aims and objectives, and

safeguards the public funds and the

organisation’s assets.

The system of internal control

is designed to manage risk to a

reasonable level rather than to

eliminate all risk of failure to achieve

policies, aims and objectives. The

system of internal control is based on

an ongoing process designed to:

• Identify and prioritise the risks to the

achievement of the organisation’s

polices, aims and objectives.

• Evaluate the likelihood of those

risks being realised and the impact

should they be realised, and to

manage them efficiently, effectively

and economically.

The system of internal control has

been in place in the Royal Surrey

County Hospital for the year ended

31 March 2008.

Responsibility is delegated to Directors

to lead in risk management

• The Director of Nursing and

Operations is the delegated lead

for all risk management including

NHSLA Risk Management

Standards, complaints, Standards

for Better Health, Health & Safety,

clinical and non-clinical legal

claims, IT and for liaising with the

Health Informatics Service.

• The Medical Directors share

responsibility with the Director of

Nursing and Operations for the

Clinical Governance Unit, which

encompasses clinical effectiveness

and research & development.

• The Director of Finance has

delegated responsibility for financial

risk management, the financial

standing instructions and is the lead

for counter fraud. The Director of

Finance is responsible for liaising

with Internal and External Audit.

Risk and Control FrameworkThe Trust’s Risk Management Strategy

is designed to provide a rigorous

organisational framework to co-

ordinate and oversee risk

management activities.

The risk strategy contains the

following:

• A statement on the Trust’s

commitment to ensuring that

clinical and non-clinical risk

management is integrated into the

business process.

• The roles and responsibilities for

managers and members of staff.

• The levels of training members of

staff require enabling them to fulfil

their roles and responsibilities.

• A suitable communication system is

in place to enable staff and external

stakeholders to be informed of

relevant policies, risks etc.

• A Risk Identification Process.

• Roles and responsibilities of specific

risk management lead officers.

A mechanism is in place to monitor

the Trust's performance and report to

the Trust Board either directly, or,

via the Integrated Governance

Committee, the Clinical Governance

Board and the Executive Management

Committee. The tools used to monitor

performance are:

• NHSLA Risk Management Standards.

• Better Health Care Standards

• NHS high level performance indicators

• Benchmarking activity

• Internal standards

• Risk assessment and action plan monitoring

• Investigation and trend analysis of incidents, complaints and claims

• Patient and staff attitude surveys

• Internal and external audit

• Assurance framework

• Balanced scorecards – Trustwide supported by individual care

groups/SBUs

• Performance reports

• Minutes of all key committees

The Trust has a process for internal

audit to provide an informed opinion

on the assurance framework.

Internal audit's opinion on the Trust's

assurance framework for 2007/08 is

summarised as:

Significant assurance can be given

that there is a generally sound system

of internal control, designed to meet

the organisation’s objectives, and

that controls are generally being

applied consistently. However, some

weakness in the design and application

of controls has been identified with

actions to correct in place.

There is a robust system in place to

identify and prioritise the risks to its

primary objectives aims and polices,

to evaluate the likelihood of those risks

being realised and the consequent

impact on the Trust. The Trust intends

to manage the risks efficiently,

effectively and economically. The

Trust recognises external agencies as

an effective source of risk identification

e.g. The Healthcare Commission,

Medicines & Healthcare Products

Regulatory Agency (MHRA), National

Patients Agency (NPSA), the Health

and Safety Executive (HSE) and Internal

Audit Reviews. Risks are evaluated

using an integrated risk assessment

tool and graded as high, significant,

medium and low. High/significant

risks are included on the strategic risk

register. Measures to treat risks are

applied at higher and lower levels

in the Trust. Risk management is

embedded into the Trust by day to day

activity and acceptance and ownership

by management and staff. This is

underpinned by relevant and effective

training. Stakeholders are involved

via groups for example: - Clinical

Risk Management Group, Infection

Control Committee and the Audit and

Assurance Board.

Healthcare Commission Core StandardsThe Trust has undergone a process

to assess its position in relation to

meeting the core standards and has

received reasonable assurance that

the Trust has met all core standards

without significant lapses.

The Assurance FrameworkThe Assurance Framework provides

assurances that the principal risks

(defined as the risks to the Trust's

objectives) have been identified. The

elements of the Assurance Framework

are: key controls to the risk have been

identified to reduce or mitigate the

risk, assurance of the effectiveness of

the key controls, gaps identified in

the key controls that may reduce their

effectiveness, gaps in assurance that

may have an adverse effect on the

principal risk.

Royal Surrey Annual Report and Accounts 2007/08 | 35

Key areas to note are:

Finance – Once the uncertainty with regard to the application of the SLA with Surrey PCT was settled through quarter one arbitration the Trust has consistently forecast a full year surplus of c. £3 million (month 12 actual £2.5 million surplus) equivalent to 2% of income. Within this surplus non-recurrent spend was approved by the Board in quarter four for the benefit of patients and staff.

Internal Control – The Trust identified weaknesses with the e-proc system provided as part of the service from SBS. As a result of requesting an Internal Audit review, recommendations to address the limited functionality of the system were identified and actioned.

Fit for the Future – The investments to improve specific services committed as part of FFF have been approved by the Board and funded as part of the 2008/09 plan.

NHS Pension Scheme RegulationsAs an employer with staff entitled to membership of the NHS pension scheme, control measures are in place to ensure all employer obligations contained within the scheme regulations are complied with. This includes ensuring deductions from salary, employer’s contributions and payments into the scheme are in accordance with the scheme rules, and that member’s pension scheme records

• The Trust has fulfilled its obligations in relation to patient targets achieving both the admitted and non-admitted target for 18 weeks in March 08.

Consideration of the information provided by external/internal audits, self-assessments, external assessments, investigations, Trust analysis, use of risk assessment and other measures in the above paragraph provides the evidence of Control for the Trust.

SummaryAs the result of achieving consistently high standards the South East Coast SHA Board has agreed to invite RSCH to complete phase one of the SHA FT readiness assessment process which will assess the clinical and financial sustainability to operate as an FT in its own right.

With the improvements the Trust has made towards governance in the last financial year, and the balanced achievement delivered in 2007/08, the Trust has assessed itself as ‘A’ using The South East Coast Strategic Health Authority grading system as a basis.

Nick Moberly Chief Executive

are accurately updated in accordance

with the timescales detailed in the

regulations. Work is ongoing at the

RSCH to ensure pension details of all

our employees held at the Pensions

Agency are brought fully up to date.

Clinical – Whilst benefiting from

productivity improvement the Trust

recognises the potential clinical risk

from operating at full capacity.

MRSA - Incidents although showing

an improvement on 06/07 the overall

outcome is 24 versus the target of

12. Plans to further reduce MRSA

bacteraemias include:

• Focus on eliminating contaminates

and eradicating preventable

bacterium infections and increased

training.

• Closer working with the PCT with

respect to reducing community

acquired infections.

• Reviewed our cleaning procedures

and quality assurance systems.

Other - Increased emergency

admissions has put pressure on

achievement of the emergency bed

day standard.

The following improvements should

be noted that demonstrate improved

governance within the Trust:

• The Trust has reported an in-year

surplus for four consecutive years

resulting in a cumulative surplus at

31/03/08 of £3.2million.


>> iNCOme ANd exPeNdiTure ACCOuNT FOr THe yeAr eNded 31 mArCH 2008

As Restated

2007/08 2006/07

£000 £000

income from activities 149,541 131,497

Other operating income 20,522 20,347

Operating expenses (163,421) (147,951)

Operating surplus 6,642 3,893

loss on disposal of fixed assets (60) (18)

Surplus before interest 6,582 3,875

interest receivable 250 273

interest payable (9) (15)

Other finance costs – unwinding of discount (10) (9)

Surplus for the financial year 6,813 4,124

Public dividend Capital dividends payable (4,296) (4,085)

retained surplus for the year 2,517 39

Staffing 60%

Premises 5%

depreciation & Amortisation 5%

Misscellaneous 2%

Services from NHS Bodies, Trusts & Foundation Trusts 2%

Clinical Supplies 21%

General Supplies, Transport, Establishment & Consultancy Services 5%

Primary Care Trusts 77.5%

department of Health & Strategic Health Authorities 6.4%Healthcare Services provided by NHS Trust 0.6%

Charitable income 0.1%Foundation Trusts 0.5%

injury Cost recovery 0.2%

Private Patient & Overseas visitors income 2.1%

Transfer from donated Asset reserve 0.3%

education, Training & research 4.6%

income Generation 4.4%

Non-patient Care Services 2.0%

Other 1.5%

ANAlySiS OF iNCOmeTotal income for 2007/08 was £170,063,000, broken down into the following categories:

ANAlySiS OF exPeNdiTureTotal expenditure for 2007/08 was £163,421,000, broken down into the following categories:

during 2006/07 the Trust reviewed its accounting policy for the recognition of income in respect of patients that have not been discharged as at 31 march. As at that date the value of work carried out for such patients has been estimated and income accrued, even though it is not yet due to be invoiced.


STAFF COSTSTotal staff costs, including directors’ remuneration for 2007/08 was £100,104,000 made up as follows:

Nursing & midwives 31.8%

Scientific, Therapeutic & Technical 18.6%

Administrative & Clerical 9.4%

Healthcare Assistants 4%

Maintenance & Other Employees 0.4%

Senior Managers 4.7%

Medical 31.1%

>> BAlANCe SHeeT AS AT 31 mArCH 2008

31 march 31 march 2008 2007

£000 £000

Fixed assets intangible assets 274 254 Tangible assets 133,883 123,928

134,157 124,182

Current assets Stocks and work in progress 2,566 2,626 debtors – amounts falling due within one year 18,114 14,724 Cash at bank and in hand 473 446

21,153 17,796

Creditors: Amounts falling due within one year (18,729) (17,022)

Net current assets 2,424 774

Total assets less current liabilities 136,581 124,956

Creditors: Amounts falling due after more than one year (67) (119)

Provisions for liabilities and charges (1,027) (2,344)

Total assets employed 135,487 122,493

Financed by: Capital and reserves Public dividend capital 59,654 57,843 Revaluation reserve 64,624 57,093 donation reserve 6,849 6,129 Other reserves 22 24 income and expenditure reserve 4,338 1,404

Total capital and reserves 135,487 122,493


>> STATemeNT OF TOTAl reCOGNiSed GAiNS ANd lOSSeS FOr THe yeAr eNded 31 mArCH 2008

2007/08 2006/07

£000 £000

Surplus for the financial year before dividend payments 6,813 4,124

unrealised surplus on fixed asset revaluations/indexation 8,376 7,857

increase in the donation reserve due to receipt of donated assets 770 394

Reductions in “other reserves” (2) (2)

Total gains and losses recognised for the financial year 15,957 12,373

Prior period adjustment 0 789

Total gains and losses recognised in the financial year 15,957 13,162

The prior period adjustment of £789k relates to a change in accounting policy for partially treated patients introduced during the 2006/07 financial year.

>> relATed PArTy TrANSACTiONS

Under the requirements of the

accounting standard FRS8 senior staff

are required to declare any material

transactions by themselves or any

related party or any entities owned

by themselves or any related party

and the Trust. During 2007/08 the

Trust received services to the value

of £72,703, inclusive of recoverable

VAT, from a private company

PeterPostPartners Ltd, for project

management consultancy services

in connection with the Electronic

Staff Records project (£68.6k)

and E-Prescribing project (£4.1k).

Sue Lewis, Executive Director for

Nursing and Operations, has a 50%

shareholding in the company. As

at 31st March 2008 £14,614 of this

sum remained unpaid. Disclosure is

also required in relation to a contract

between MC Pathology Ltd, a company

under the control of Professor M

Cook, and the Partnership Pathology

Services, jointly managed by the Royal

Surrey County Hospital NHS Trust and

Frimley Park Hospital NHS Foundation

Trust. The value of this contract was

£43,436. As at 31 March 2008 there

were no outstanding balances.

>> CASH FlOw STATemeNT FOr THe yeAr eNded 31 mArCH 2008

2008 2007

£000 £000

Net cash inflow from operating activities 9,504 12,918 Returns on investments and servicing of finance: interest received 253 270interest element of finance leases (9) (15)

Net cash inflow from returns on investments and servicing of finance 244 255

Capital expenditure: Payments to acquire tangible fixed assets (7,883) (5,887)receipts from sale of tangible fixed assets 11 7Payments to acquire intangible assets (79) (234)

Net cash inflow (outflow) from capital expenditure (7,951) (6,114)

Dividends paid (4,296) (4,085)

Net cash inflow (outflow) before financing (2,499) 2,974

Financing Public dividend capital received 7,311 0Public dividend capital repaid (5,500) (3,268)(not previously accrued) Other capital receipts 770 405Capital element of finance leases (55) (48)

Net cash inflow/(outflow) from financing 2,526 (2,911)

Increase in cash 27 63


>> BeTTer PAymeNT PrACTiCe COde – meASure OF COmPliANCe

2007/08 2006/07

Number £000 Number £000

Total Non-NHS trade invoices paid in the year

42,365 51,993 29,093 35,273

Total Non-NHS trade invoices paid within target

30,802 34,840 16,655 19,336

Percentage of Non-NHS trade invoices paid within target

73% 67% 57% 55%

Total NHS trade invoices paid in the year 1,221 14,638 1,123 9,187

Total NHS trade invoices paid within target 597 7,131 504 3,273

Percentage of NHS trade invoices paid within target

49% 49% 45% 36%

The Better Payment Practice Code requires the Trust to aim to pay all undisputed invoices by the due date or within 30 days of receipt of goods or a valid invoice, whichever is later.

>> mANAGemeNT COSTS

in 2007/08 management Costs were £5,941,000 against income of £170,063,000 compared to £5,634,000 and £150,465,000 in 2006/07.

>> AudiT ServiCeS

The Trust’s external auditor is KPMG. The cost of statutory audit services in 2007/08 was £186,000. A further £15,000 was paid during the course of the year in relation to use of resources work. This use of resources includes the following:

• Auditors’ Local Evaluation – This looks at the key areas in the Trust such as Financial Management, Internal Control, Value for Money, Financial Standing and Financial Reporting.

All matters regarding auditor independence, objectivity and conflicts of interest are reviewed by the Audit and Assurance Board in line with best practice.

>> remuNerATiON rePOrT

This report includes details regarding

“senior managers” remuneration in

accordance with Section 234b and

Schedule 7a of the Companies Act

1985. No director has made a request

to withhold information relating to the

disclosure of their remuneration.

The Trust’s Remuneration Committee

advises and assists the Board in

meeting its responsibilities to ensure

appropriate remuneration and terms

of service for the Chief Executive and

Executive Directors. Membership of

the committee consists of the Trust’s

Chairman and all Non-Executive

Directors. The Chief Executive

and Directors’ remuneration is

determined on the basis of reports to

the Remuneration Committee taking

account of any independent evaluation

of the post, national guidance on

pay rates and market rates. The

Remuneration Committee is advised

on these matters by the Chief Executive

and Director of Organisational

Development and Human Resources

(who also acts as secretary to this

committee). Pay rates for the Chairman

and Non-Executive Directors of the

Trust are determined in accordance

with national guidance.

The Trust has in place performance

related pay for the Chief Executive and

Executive Directors. Both individual

and corporate wide targets are

set annually by the Remuneration

Committee. In view of the financial

pressure on all areas of the Trust

through 2006/07 the Remuneration

Committee decided that no bonus

payments would be made for 2006/07.

Targets established for Executive

Directors for 2007/08 were met and as

a result bonus payments were awarded

to all Executive Directors.

The Chief Executive and all Directors

are on permanent contracts as at

31st March 08, and are subject

to a six month notice period.

Termination arrangements are

applied in accordance with statutory

regulations as modified by national

NHS conditions of service agreements

(specified in Whitley Council/

Agenda for Change), and the NHS

pension scheme. Specific termination

arrangements will vary according to

age, length of service and salary levels. The Remuneration Committee will agree any severance arrangements.

Tables attached show details of salaries, benefits and any other remuneration and pension entitlements of senior managers. No compensation is payable to former senior managers and no amounts included in the above are payable to third parties for the services of senior managers.

Nick Moberly Chief Executive


>> SAlAry ANd PeNSiON eNTiTlemeNTS OF SeNiOr mANAGerS

Name & Title

2007 – 08 2006 – 07

SalaryOther

RemunerationBenefits in kind Salary

Other Remuneration

Benefits in kind

(bands of £5000)

(bands of £5000)

Rounded to the nearest £100

(bands of £5000)

(bands of £5000)

Rounded to the nearest £100

£000 £000 £ £000 £000 £

mr. S Caswell – Non-executive director 5 –10 0 0 5 –10 0 0

mr. A Hendrich – Non-executive director 5 –10 0 0 5 –10 0 0

mrs. d mckenzie – Non executive director 5 –10 0 0 5 –10 0 0

mrs. m Poole – Non-executive director 5 –10 0 0 5 –10 0 0

mrs. S wood – Non-executive director 5 –10 0 0 5 –10 0 0

mr. G layer – medical director (1) 15 – 20 140 –145 0 N/A N/A N/A

dr. C Tibbs – medical director (1) 15 – 20 105 –110 0 N/A N/A N/A

Mr. A Howarth – Chairman 20 – 25 0 0 20 – 25 0 0

ms. e murray – director of Od & Hr 95 –100 0 0 75 – 80 0 0

mr. P Biddle – director of Finance 115 –120 0 0 95 –100 0 0

mrs. S lewis – director of Nursing & Operations 125 –130 0 400 95 –100 0 300

mr. N moberly – Chief executive 160 –165 0 0 120 –125 0 0

(1) The following change in the post of Medical Director occurred during the course of the 2007/08 financial year.

Mr. G Layer and Dr. C Tibbs were appointed jointly to the position on 1st May 2007.

A benefit in kind was provided to Mrs. S Lewis through the provision of a car lease, value disclosed above.

Total remuneration paid to directors in 2007/08 (in their capacity as directors) totalled £584,229.

remuNerATiON


PeNSiON BeNeFiTS

Name & TitleReal increase in

pension at age 60 (bands of £2,500)

Real increase in lump sum at

age 60 (bands of £2,500)

Total accrued pension at age 60 at 31 march 2008 (bands of £5,000)

lump sum at age 60 related to accrued pension

at 31 march 2008 (bands of £5,000)

Cash equivalent Transfer value at 31 march 2008

Cash equivalent Transfer value at 31 march 2007

real increase in Cash equivalent Transfer value

£000s £000s £000s £000s £000s £000s £000s

mr. P Biddle – director of Finance 0.0 – 2.5 5.0 – 7.5 5 –10 20 – 25 N/A N/A N/A

mr. G layer – medical director 2.5 – 5.0 10.0 –12.5 50 – 55 155 –160 898 795 58

mrs. S lewis – director of Nursing & Operations 2.5 – 5.0 12.5 –15.0 35 – 40 115 –120 564 471 57

mr. N moberly – Chief executive 2.5 – 5.0 5.0 – 7.5 20 – 25 60 – 65 273 238 21

ms. e murray – director of Od & Hr 0.0 – 2.5 5.0 – 7.5 15 – 20 45 – 50 163 136 17

dr. C Tibbs – medical director 0.0 – 2.5 2.5 – 5.0 25 – 30 85 – 90 462 417 24

Cash equivalent Transfer valuesA Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member’s accrued benefits and any contingent spouse’s pension payable from the scheme. A CETV is a payment made by a pension scheme, or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits

accrued in their former scheme.

The pension figures shown relate to

the benefits that the individual has

accrued as a consequence of their

total membership of the pension

scheme, not just their service in a

senior capacity to which the disclosure

applies. The CETV figures and the

other pension details, include the

value of any pension benefits in

another scheme or arrangement which

the individual has transferred to the

NHS pension scheme. They also

include any additional pension benefit

accrued to the member as a result

of their purchasing additional years

As Non-executive members do not receive pensionable remuneration, there will be no entries in respect of pensions for Non-executive members.

of pension service in the scheme at

their own cost. CETVs are calculated

within the guidelines and framework

prescribed by the Institute and Faculty

of Actuaries.

real increase in CeTvThis reflects the increase in CETV

effectively funded by the employer.

It takes account of the increase in

accrued pension due to inflation,

contributions paid by the employee

(including the value of any benefits

transferred from another pension

scheme or arrangement) and uses

common market valuation factors for the start and end of the period.

A CETV is not provided once a scheme member reaches age 60.


THe TruST BOArd OF direCTOrS

The Trust Board consists of the Chairman, five non-executive and six executive directors,

ensuring the required mix of skills, capabilities and experience to meet the needs of the Trust.

The Board is responsible for

determining the long term strategic

direction of the Trust, deciding its

overall policies and governance as

well as overseeing financial viability.

The Chairman and non-executive

directors are appointed by the

Secretary of State for Health for

fixed terms. The Chief Executive and

executive directors are appointed

by a committee of the Trust Board

which comprises the Chairman,

non-executive directors and outside

advisors. The Chief Executive and

executive directors are appointed on

permanent contracts but may tender

their resignations to the Board at any

time. The Chairman of the Consultant

Staff Committee and the Chair of

Staff Representatives also attend

Board meetings.

Reference to statutory requirements under FRS8 is contained in the Finance section of this report.


Alan Howarth Chairman

A former partner in Ernst & Young with over 25 years’ experience as a management consultant. Chairman of Gresham Computing plc, Highams plc, Message Pad Ltd, Adili plc and CRF Inc. He has further non-executive interests in smaller concerns, nationally and internationally.

Melloney Poole vice Chair – Non executive director

A qualified solicitor, a corporate, charity and trust lawyer who is a Deputy Director of the Big Lottery Fund heading up the legal and governance department.

Stephen Caswell Non executive director

A chartered accountant and former partner with PricewaterhouseCoopers in Hong Kong where he spent 22 years specialising in audit, insolvency and business advisory services until his retirement in 2002. He is also Chairman of Guildford College Corporation and a trustee of the Surrey Association for the Visually Impaired.

Alain Hendrich Non executive director

MA, Chartered FCIPD. A Chartered Fellow of the CIPD and former Area Board Member in British Telecom International Division. Alain is an international consultant in human resources, strategy development and project management. A Member of the Institute of Directors, he is also a Non-Executive Director with Dimensions Group which provides support to people with learning difficulties across England and Wales and a Lay Chair with the Judicial Appointments Commission.

deborah mckenzie Non executive director

Currently a Principal at OPM working on Health and Local Government initiatives, Deborah specialises in Organisational Development and Board development. She was previously an Associate Partner at Accenture. Her Community Activities include membership of the Surrey Co-design Group. She was formerly Chair of the Guildford & Waverley Patient & Public Involvement Forum and member of the Royal Surrey’s Patient & Public Involvement Strategy Group.

Suzanne wood Non executive director

An experienced human resources professional having worked in the UK and internationally for pharmaceutical and consumer organisations. She is currently UK HR Director of Basilea Pharmaceuticals Ltd.

Nick moberly Chief executive

A former Director of Strategic Development at King’s College Hospital NHS Trust with experience as an independent strategy consultant having worked for McKinsey & Company and a former First Secretary at the Foreign & Commonwealth Office.

Sue lewis director of Nursing deputy Ce

Sue is a registered nurse and trained at St Barts Hospital and from there spent a number of years in a variety of nursing roles at different organisations. She started her management career at Wexham Park Hospital in the early 90s and joined the Royal Surrey County Hospital in 1995 as General Manager of Surgery. Sue was appointed to the Trust Board in 2003 as Director of Nursing and subsequently took on the Deputy Chief Executive role and, in 2006, further expanded her role to include Operations. Sue has sat on a number of national committees and most recently was part of the National Working Group looking at a review of how public sector inspections are run.


Paul Biddle director of Finance

A Chartered Accountant, formerly Chief Executive of Jarvis Systems & Technologies and Chief Financial Officer for NatWest’s Retail & Commercial Businesses. Previously Finance Director of the UK Business of Digital Equipment & Xerox. A non-executive director of Charteris PLC, W&J Linney Limited and CAF Bank and Hon Treasurer of Action Medical Research.

Eleanor Murray director of Od & Hr

A former Associate Director of HR – OD, Head of Clinical Governance and business manager for surgery and anaesthetics. An Honorary Lecturer in Organisational Behaviour at Imperial College, London.

Christopher Tibbs Joint medical director

Consultant gastroenterologist and physician at the Royal Surrey since 2005, having previously been Consultant at St George’s Hospital and Queen Mary’s Roehampton, with honorary contracts at the Liver Unit, Kings College Hospital and the Royal Marsden. Extensive management experience as Clinical Director at both Queen Mary’s Roehampton and St George’s. Main clinical interest in liver disease and advanced therapeutic endoscopy.

Graham layer Joint medical director

Consultant breast and general surgeon and Professor of Surgical Sciences with previous consultant posts at the Hammersmith, Charing Cross and St Peter’s Hospitals. Has had extensive national experience at Royal College and Specialty Association level as Secretary. Is currently Lead in Professional Development for the Senate and Forum of Surgery of Great Britain and Ireland, Treasurer of the National Confidential Enquiry into Patient Outcome and Death (NCEPOD), Secretary of the Intercollegiate Specialty Examinations Board (FRCS) and Specialty Advisory Committee member for PMETB with responsibility for the Republic of Ireland.

in accordance with the Public Bodies (Admission to meetings) legislation, Board meetings are publicised and members of the public are given access to that part of the meeting that is not considered confidential.

Trust Board meetings will be held on 31 July, 25 September, 30 October and 27 November 2008. Board meetings in 2009 will be held on 29 January, 26 February, 26 march, 30 April, 28 may, 25 June, 30 July, 1 October, 29 October and 26 November. All Board meetings are held in The Education Centre, royal Surrey County Hospital and will start at 9.30 a.m.

The Annual Public Meeting for 2008 will be held at 6pm on Wednesday 24 September 2008 in the Lecture Theatre, Education Centre, Royal Surrey County Hospital. The Annual Public Meeting for 2009 will be held on 30 September 2009.

>> BOArd meeTiNGS

54 | Royal Surrey Annual Report and Accounts 2007/08

Board remuneration and Terms of Service CommitteeThis committee, comprising the Chairman and non executive directors, advises the Board on appropriate remuneration and terms of service for the Chief Executive, executive directors and other Board members. Whilst the Chief Executive and Director of HR attend the meeting in an executive capacity, neither takes any part in determining their own salaries.

The Remuneration and Terms of Service Committee agreed salary increases for the executive team based on performance. The Committee increased the salary ranges taking account of the NHS Executive guidance on senior managers’ pay. The salary range gives the Committee scope to recognise the development of individual experience and expertise over time as well as above average performance identified through appraisal. The Committee also agrees the pay award for employees on Trust Terms and Conditions of Service.

Membership – Chairman and five non-executive directors.

>> COmmiTTeeS OF THe BOArd

The following three committees report to the Board ensuring accountability for public money:

Audit and Assurance BoardThe Audit and Assurance Board provides an independent objective review of the Trust’s financial practices and compliance with national policies, standing orders and standing financial instructions. It brings together responsibilities for overseeing an effective system of internal control for financial areas within the Trust. The Chief Executive, Finance Director, and representatives of the Trust’s internal and external auditors also attend the Audit and Assurance Board. Non-clinical risk is reported to the Integrated Governance Committee.

Membership – three non-executive directors - Stephen Caswell (Chair), Deborah McKenzie, Suzanne Wood.

Clinical Governance BoardThe Trust also had in place a Clinical Governance Board, responsible for the overview of clinical risk. This committee also reported directly to the Board. Both committees actively provide positive risk management initiatives within a fair and just culture.

Membership – Chief Executive, Director of Nursing, Medical Director, Deborah McKenzie, Director of Public Health – Surrey PCT.

The salary range gives the Committee scope to recognise the development of individual experience and expertise over time as well as above average performance identified through appraisal.

The Royal Surrey County Hospital NHS Trust Egerton Road Guildford GU2 7XX

t 01483 571122

www.royalsurrey.nhs.uk

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