Annual Report 2011/12 by NHS Medway

annual report 2011/12

Contents 3.

Foreword

Vision and Priorities

Our Board

10. Clinical decision making 11. Our achievements 14. Our priorities for 2012/13 15. Quality, safety, effectiveness and patient experience 16. How we engage with local people 20. Our staff 22. Complaints 24. Environmental action 26. Information governance 27. Emergency preparedness and response 28. Operating and Financial Review

Foreword The last 12 months have been a period of extraordinary activity in the NHS, in which we have been developing the system to be fit for the future, while at the same time tackling major transformational change in the services we commission. Until 1 June 2011 we were officially still operating as three Primary Care Trusts (PCTs), NHS Eastern and Coastal Kent, NHS West Kent and NHS Medway, although we had already recognised the benefits of working together more closely. When we clustered and became NHS Kent and Medway we were quickly able to adapt our ways of working to reduce duplication in many areas, create greater resilience within the system, and build on the excellent practice in each of our three areas. Meanwhile we have continued to support our Clinical Commissioning Groups, which began as 13, and are now reducing as they merge, share management structures and create federations. This has required considerable commitment from our leading GPs, and significant resources from the PCT to assist them as they prepare to take on their new responsibilities officially from April 2013, and in shadow form from April 2012. Responsibility for public health has started to transfer to Kent County Council and Medway Council, another change heralded by the Health and Social Care Act, while other parts of the system such as the National Commissioning Board have also been established in this period. There will be very few of our staff who have not already been affected by these changes, and during the course of the coming year we will all learn more about the opportunities for us in the future. For many staff this may be with the Commissioning Support Service,

NHS Medway â&#x20AC;&#x201C; Annual Report 2011/12

and much work has taken place on developing this important element of the system. In line with all this change, we have redrawn our governance arrangements, and made changes to our board and committees to reflect the new ways of working. All the time we have maintained our commitment to engage and communicate with our communities, our staff, and key stakeholders such as the Health Overview and Scrutiny Committees of the local authorities.

Colin Tomson, Chairman

So, it has certainly been a busy and challenging year, one in which we have concentrated on building the best possible healthcare services for patients while keeping finances on track, at the same time as helping to create an NHS for the future that we can all be proud of. In this annual report you will find examples of how we have achieved our goals, and see the direction in which we are moving as we work side-by-side with clinicians on the priorities for the next 12 months.

Ann Sutton, Chief Executive

Ann Sutton, Chief Executive Colin Tomson, Chairman Dr Pete Green, Medical Director

Dr Pete Green, Medical Director

NHS Medway â&#x20AC;&#x201C; Annual Report 2011/12

Vision and Priorities Vision When we clustered to become NHS Kent and Medway from 1 June 2011 we created one vision which reflects our commitment to quality and safety, our ambition to do our very best for our residents, and our determination to leave a legacy that will enable future leaders of the NHS in our county to deliver world class healthcare. It states: ‘Our vision is to offer the best healthcare for our population within the resources available, as well as supporting them to live, work and thrive in the best possible health. We will do this by providing more choice, better information, best practice in care and treatment closer to home.’ In order to deliver the NHS Kent and Medway vision we will work with our partners to build a sustainable health and social care system for Kent and

Medway, transforming people’s ability to access the services they need, reducing inequalities, and investing in NHS staff to be the most effective in the country. We will help co-ordinate the work of Health and Wellbeing Boards with local strategies produced by Clinical Commissioning Groups, strategies of our providers, and of Local Authority Adult Social Services and Children’s Services. In all we do in transition we will pursue outcomes that are first class, clinically effective, and value for money. We will support Clinical Commissioning Groups through the authorisation process and as they begin to take on responsibilities.

services for them – for example making best use of technologies; developing a directory of services; helping patients navigate the system; improving care pathways; promoting personal health budgets; ensuring visible performance data from providers; engaging with citizens and effectively using patient feedback. We will help our NHS professionals to become the most effective in the country – for example supporting leadership from Clinical Commissioning Groups and Senate; ensuring staff development; making better use of technology; and developing our offer of commissioning support. We will also work with Trusts to support them as they pursue Foundation Trust status.

We will give priority to transforming people’s ability to access the right

Priorities NHS Medway’s strategic goals for 2011/12 were identified as: ÆÆ improving health and wellbeing

ÆÆ supporting future generations

ÆÆ targeting killer diseases

ÆÆ promoting independence and better quality of life

ÆÆ improving care and choice for patients

NHS Medway – Annual Report 2011/12

ÆÆ improving mental health.

We have made considerable progress in all these areas, and are proud of our achievements, some of which are highlighted in this report.

NHS Medway – Annual Report 2011/12

Our Board The Kent and Medway PCT Cluster represents three primary care trusts – NHS West Kent, NHS Eastern and Coastal Kent and NHS Medway.

Cluster Board Non Executive Directors

Cluster Board Delegation In May 2011 NHS Eastern and Coastal Kent, NHS West Kent and NHS Medway Boards agreed the delegation of PCT functions to the Kent and Medway Cluster Board. The governance arrangements were supported by an Establishment Agreement between the constituent PCT members of the cluster, revised Standing Orders and Standing Financial Instructions and a Scheme of Delegation being adopted by each PCT to delegate authority to newly formed joint committees.

The cluster is committed to commissioning high quality healthcare services for the people of Kent and Medway. We also support Clinical Commissioning Groups as they prepare to take on commissioning responsibilities in the future, as well as maintaining relationships with partner organisations. The board comprises seven part time Non Executive Directors as well as a number of full time Executive

Directors, and is chaired by a Non Executive Director appointed by the NHS Independent Appointments Commission.

Colin Tomson – Chair (appointed 1 April 2011) Graham Mayes (appointed 1 June 2011) David Mayes (appointed 1 June 2011)

Cluster Executive Team* Executive Directors Ann Sutton – Chief Executive Helen Buckingham – Director of Whole Systems Commissioning

Jill Ruddock (appointed 1 June 2011)

Sarah Andrews – Director of Nursing and Quality

Harshad Topiwala (appointed 1 June 2011)

Daryl Robertson – Director of Performance and Assurance

Adrian Hosford (appointed 1 June 2011)

Robert Stewart, Peter Green, James Thallon – Medical Directors

Mike Cosgrove (appointed 1 June 2011)

Bill Jones – Director of Financial Performance and Contracting (from 19 September 2011)

David Lewis (appointed 11 January 2012)

Rod Smith – Director of Financial Strategy and Planning (from 19 September 2011) Jonathan Bates – Director of Financial Stewardship and Governance (from 19 September 2011)

Non Voting Members of the Cluster Executive Team Hazel Carpenter – Director of Commissioning Development and Workforce Stephanie Hood – Director of Communications and Engagement (from 1 May 2011 until 15 August 2011) Jude Mackenzie – Director of Communications and Engagement (from 5 October 2011) Judy Clabby – Assistant Chief Executive Lynne Stuart – Company Secretary *all appointments effective from 1 June 2011 unless otherwise stated

Meradin Peachey – Kent Director of Public Health (voting member since 25 January 2012, previously non voting member)

Board meetings are held bi-monthly at different locations in the area and members of the public are welcome to observe the formal board meetings and ask the board questions. Our board papers are available a week before each meeting on our website.

Alison Barnett – Medway Director of Public Health (voting member since 25 January 2012, previously non voting member)

Further details on the PCT board and cluster board are given in the Annual Governance Statement later in this report.

The Medical Directors together constitute one voting member, the Directors of Finance together constitute one voting member and the Directors of Public Health together constitute one voting member of the cluster board.

NHS Medway – Annual Report 2011/12

Chairman and Non-Executive Directors of the Medway PCT Board During the 2011/12 financial year the Medway Board has been subject to various changes brought about since the publication of the Health and Social Care Bill in July 2010 which subsequently obtained Royal Assent in 2012. In January 2011 the Department of Health published PCT Cluster Implementation Guidance which provided PCTs with flexibility to adopt different board governance models. In April 2011 a workshop involving all Non Executive Directors from the three constituent Cluster PCTs was facilitated by the Chairman, Assistant Chief Executive and Company Secretary to decide on the board model to adopt for the cluster arrangements. The workshop determined to adopt Model 1 and subsequently each PCT in the cluster approved these arrangements. In September 2011 the Department of Health wrote to PCT Chief Executives stating that PCTs were required to adopt the broad principles of Model 2 by December 2011 namely: ÆÆ a single board meeting transacting, as far as is practicable, the board business of all of the constituent PCTs; ÆÆ a single Executive Team with a single Chief Executive; ÆÆ a single individual as Chair of the cluster, therefore excluding shared or rotating arrangements.

NHS Medway – Annual Report 2011/12

As a result of this revised guidance, Non Executive Directors of the PCT, not appointed to the Cluster Board, were required to resign as Directors of the PCT. The cluster PCTs have retained those affected as Board Advisors to continue to service Cluster Committees and to ensure that their expertise and service is retained on an ongoing basis, in particular, providing expertise in a number of the transition work streams to the new NHS architecture. Denise Harker – Chair (resigned 31 May 2011) Colin Tomson - Chair (appointed 1 June 2011) Trevor Cooper (resigned 11 January 2012) David Mayes Graham Mayes Gillian Wells (resigned 11 January 2012) Saba Sadiq (resigned 5 October 2011) Mike Cosgrove (appointed 12 January 2012) Adrian Hosford (appointed 12 January 2012) Jill Ruddock (appointed 12 January 2012) Harshad Topiwala (appointed 12 January 2012)

Executive Directors

Directors’ declarations of Interest

Helen Buckingham, Chief Executive designate (1 April 2011 to 31 May 2011) Director of Whole System Commissioning (from 1 June 2011)

Declarations of relevant and material interests of Board members

Ann Sutton – Chief Executive (from 1 June 2011) Sarah Andrews – Director of Nursing (from 1 June 2011) Peter Green – Medical Director Dr Alison Barnett - Director of Public Health Jonathan Bates - Director of Finance (Director of Financial Stewardship and Governance from 19 September 2011) Wendy Head - Director of HR and Organisational Development (until 31 May 2011) During 2011/12, the NHS Medway Board held three meetings in public and six cluster board meetings were held in public.

Under the NHS Codes of Conduct and Accountability, board members are required to declare any business interests which are relevant and material to the NHS Board of which they are a member. Interests which are regarded as relevant and material are: ÆÆ Directorships, including nonexecutive directorships held in private companies or PLCs (with the exception of those of dormant companies);

ÆÆ Ownership or part-ownership of private companies, businesses or consultancies likely or possibly seeking to do business with the NHS; ÆÆ Majority or controlling share holdings in organisations likely or possibly seeking to do business with the NHS; ÆÆ A position of authority in a charity or voluntary organisation in the field of health and social care;

other organisation contracting for NHS services; ÆÆ Research funding/grants that may be received by an individual or their department; ÆÆ Interests in pooled funds that are under separate management (any relevant company included in this fund that has a potential relationship with the PCT must be declared).

ÆÆ Any connection with a voluntary or

The following Board members have declared interests: David Mayes

Trustee Director of Credit Suisse (UK) Pension Fund

Ann Sutton

Governor, University of Kent

Sarah Andrews

Member and former committee member, Royal College of Nursing Member and former trustee, Action on Elder Abuse Member and former trustee, Marie Curie Cancer Care Member, Clinical Advisory Group, Co-operation and Competition Panel

Jonathan Bates

Non Executive Director, Medway Community Estates Ltd

Peter Green

Director and shareholder of H2H Pharmacy Ltd. GP Partner of The Parks Practice Director and shareholder of PMMR Ltd. Shadow Accountable Officer, Medway Commissioning Group

Gillian Wells

Student and occasional consultant, Canterbury Christ Church University Member of the Ethics and Confidentiality Committee of the National Information Governance Board

Mike Cosgrove

Director, Faversham Consultancy Services Ltd Elected member, Swale Borough Council Chair, Faversham Creek Consortia Trustee Bestel House Charity

Adrian Hosford

Chairman, The Communication Trust Director and Chairman, Moodscope Trustee, “I Can” Charity 16 per cent ownership of Moodscope

David Lewis

Part time Treasurer, Kent Police Authority Vice Chair, Wittersham Parish Council Member of: Weald of Kent Preservation Society, Open Spaces Society and Kent Wildlife Trust

David Lewis (appointed 12 January 2012)

NHS Medway – Annual Report 2011/12

Our achievements Clinical decision making The involvement of clinicians in decision-making has increased greatly during 2011 and early 2012 as they prepare to take on responsibility for the majority of healthcare commissioning.

Over the past year we have made great progress on our priorities areas, which we identified as: ÆÆ Transform life chances for disadvantaged children ÆÆ Tackle the key killers of vascular disease, cancer and respiratory disease ÆÆ Promote well being and good mental health ÆÆ Revolutionise services for older people ÆÆ Break the cycle of inequalities.

Over the 12 months we have moved from clinicians sitting on PCT Clinical Executive Teams, to GPs beginning to take over the reins of 70 per cent of commissioning, with all that entails. For over a year the PCTs, clustered as NHS Kent and Medway since June 2011, have been working with emerging Clinical Commissioning Groups (CCGs) across the county to understand what the reforms will mean for them, and for patients. Originally there were 13 CCGs, each with a leading GP acting as a shadow accountable officer. Over time some of these have merged, so that there are now eight, four of which will work together as a federation, with some sharing management structures and some decision making. While getting the structures and governance in place has been important, what is equally essential, and potentially more transformational

NHS Medway – Annual Report 2011/12

in terms of healthcare, is the principle of getting the decision making closer to patients.

in Kent and Medway, as well as local authorities, out of hours services, hospices and others.

GPs understand what their communities need and this lies at the heart of the NHS reforms. By working with Health and Wellbeing Boards, local authorities, and the Integrated Plan Board they will be able to influence policy across the whole health and social care system.

This is an innovative and forward looking group, the first of its kind in the country, which will take on some of the roles of the Clinical Executive Team but with a much broader focus agreeing broad principles but recognising local decision making. Other roles will be undertaken by the emerging Clinical Commissioning Groups which became committees of the Cluster Board.

Already there has been excellent clinical engagement on clinical policy, such as a more joined-up approach to Independent Funding Requests, and GP appraisals aimed at improving the standard of primary care in a consistent way. CCG leads are also now exercising their leadership role through the Kent and Medway Clinical Leadership Group which was launched in March 2012. The group includes medical and nursing directors from all NHS organisations

There are many examples highlighted on our websites. Meanwhile here are a few highlights from the year 

Top priority for clinical leaders over the next year, and for years to come, will be improving care for the growing number of people with long term conditions. As has been identified nationally, this is in the interests of everyone, system leaders, GPs, and, importantly patients and their carers.

NHS Medway – Annual Report 2011/12

Our achievements Transform life chances for disadvantaged children

are given out by sexual health clinics, pharmacies, youth schemes and some school nurses. The card can be used 20 times before an appointment is needed to re-register for a new card.

Scheme to cut teenage pregnancies goes mobile

When youngsters register for the card they will be told about the app and given a ‘quick response’ code that they can scan immediately to download the app free of charge. It can also be downloaded by searching for ‘Kent C Card’ in the app store.

A new mobile phone app was launched to help the drive to improve sexual health and reduce unplanned teenage pregnancies in Kent. The Kent C Card iPhone app was designed to give teenagers aged 19 and under the information they need on how and where to get free condoms using their C Card – a successful community-based contraception scheme set up in 2007. The app uses active maps to direct teenagers to the nearest outlet offering free condoms to anyone registered with the scheme. It also offers advice on how to register for the card, where to get contraception in an emergency, and information about getting treatment for sexually transmitted infections. Anyone who wants to register with the scheme must attend an appointment with a trained advisor. The condoms

The app was initially developed for iPhones, with Android and Blackberry versions being launched in spring 2012.

Promote well being and good mental health Innovative new mental health website A website to promote good mental health in Kent and Medway won praise from people who use the services and from health and social care professionals.

The Live It Well site, www.liveitwell.org. uk, promotes positive messages about mental health and brings together practical information – including a postcode search – to help people stay well, and get the right support if they need it. It was developed to support the fiveyear mental health strategy for people in Kent and Medway, also called Live It Well which, among other things, is committed to reducing stigma and discrimination, improving the way organisations work together, and ensuring that people in a crisis get the care they need. Rather than being run by one organisation, the website has been developed as a community resource, with funding from local authorities and the NHS. It is hosted by Sevenoaks Area Mind. People can search for their local services, including community mental health teams, resource centres, supported housing, and volunteering opportunities. There is the opportunity to contribute directly to local pages about mental health and to find out how to connect with other people in your area.

Tackle the key killers of vascular disease, cancer and respiratory disease High-tech healthcare to help more patients across Kent An initiative piloted in Kent to bring the benefits of telehealth and telecare to people with long-term conditions is to be rolled out across the country. An evaluation of the project has showed that, if used correctly, this technology can support a 15 per cent reduction in accident and emergency visits, a 20 per cent reduction in emergency admissions and a 14 per cent reduction in planned admissions to hospital. As a result the Government has pledged to bring the benefits of telehealth and telecare to three million people in England with long-term conditions. This will include elsewhere within Kent and Medway, where we are looking to roll-out home-based technology to other patients to help them improve their quality of life and stay healthy, preventing unnecessary hospital admissions. Telehealth technology uses electronic equipment to monitor patients’ health and send readings remotely to health professionals; helping patients manage their conditions at home and stay independent, while ensuring access to treatment should they need it.

Revolutionise services for older people Helping older people keep warm and well A pilot scheme designed to reduce the numbers of elderly people dying due to cold temperatures was introduced in one of the most deprived parts of the county.

NHS Medway – Annual Report 2011/12

Enjoying the smoothie bike at the launch of the Beats and Breathes campaign

The ‘keep warm, keep well’ scheme, funded by NHS Kent and Medway and Kent Fire and Rescue Service, offered extra support to those most at risk during the winter. Residents in parts of Thanet received a home visit from the local Kent County Council Community Warden and were given a free room thermometer to keep an eye on the temperature in their homes. The aim was to raise awareness of the health risk of living in a cold home environment and give advice on staying healthy during the winter months. Residents were also referred to other services that can offer further support on issues such as minor home repairs – for example Age UK – and given advice on how to claim benefits to help them to heat their homes if they were not already doing so. If the pilot is shown to be successful in reducing the number of deaths related to winter weather it will be rolled out to other parts of Kent.

Break the cycle of inequalities

A campaign called Beats and Breathes is aiming to cut the number of premature deaths from heart and lung disease by encouraging people to monitor their health regularly and offering them support to make simple lifestyle changes, which can help reduce their risk of disease. GPs in two Kent towns are already supporting the campaign by inviting those people at risk of the diseases and those already diagnosed for regular checks, reviewing their medication and giving advice and support. At the launch of the campaign NHS teams took to the streets with blood pressure monitors, stethoscopes, scales and cholesterol and lung function testing kits, offering a free ‘while you wait’ health MOT. Many people enlisted the help of the NHS Stop Smoking Service and also Kent Community Health NHS Trust’s health trainers, who offer six free sessions of tailored support to help you towards your goal, whether it’s getting fitter, eating healthier or losing weight. It is hoped the campaign will spread across Kent and Medway if successful.

Beats and Breathes offers lifesaving checks

NHS Medway – Annual Report 2011/12

Our priorities for 2012/13 The NHS in Kent and Medway is committed to ensuring the delivery of high quality care in a personalised and proactive manner, eliminating waste and improving both outcomes and experience for patients. Our priorities are described within our vision (see page 4), and are consistent with the Annual Operating Frameworks published by the Department of Health and by NHS South of England. The planning intentions developed by clinical commissioning groups across the cluster envisage a significant shift in emphasis to support provided through community and primary care based services. We have already achieved considerable change within Kent and Medway. Working with partners we have established strong clinical leadership across organisations which are taking control of the change agenda. We have worked with Kent County Council and Medway Council to establish robust shadow Health and Wellbeing Boards, and we have agreed a number of system-wide priorities with all organisations. These include a strong focus on the radical redesign of care for people with long term conditions, including dementia. Our position as a Telehealth and Telecare pilot site will enable us to roll out the use of assistive technology at

NHS Medway – Annual Report 2011/12

scale and pace. We are already seeing the impact of CCGs on referral rates into secondary care and changes in pathways, and we are seeing the impact that better use of rup-to-theminute data can have on the urgent care system. Our intention is that by 2014/15: ÆÆ People will have clarity about how their services are delivered, and will receive proactive support and care when they need it, without needing to repeat their ‘story’ to a number of professionals ÆÆ We will be commissioning integrated community based services with live specialist input. Locally based health and social services will be working as a single resource centred on the GP practice ÆÆ Patients and their carers will feel supported as individuals ÆÆ There will be fewer in-patient admissions and shorter lengths of stay for those requiring hospital admission ÆÆ Where best clinical practice demands it, more specialist services

will be delivered by networks of providers working in collaboration, removing duplication and focusing scarce resources on delivering the best outcomes for patients. Our expectation is that change in Kent and Medway will be clinically led, and that organisations will work together in line with the Concordat which has been formally agreed by all partners. The overarching leadership groups are the Integrated Plan Board, bringing together Chief Executives and Chairs across the health and social care system, and the Clinical Leadership Group which brings together Medical Directors, CCG Chairs and leaders from all other health and social care professional groups. These groups are supported by local Whole System Delivery Boards and working groups, the operation of which is currently being reviewed to ensure strong CCG and other clinical engagement.

Quality, safety, effectiveness and patient experience We continuously strive to improve the quality of service provision and deliver improved outcomes for the prevention, diagnosis and treatment of illness. We have applied national, regional and local quality measures and metrics to our commissioned services across Kent and Medway, and benchmarked quality and performance to further drive up safety and deliver a more positive experience of care. We continue to listen and take into account the views of patients and our public to further improve services and deliver consistently high quality care that improves effectiveness, safety and patient experience. Our focus on continuous improvement in patient outcomes is aligned to our quality, innovation, productivity and prevention (QIPP), Safe Care and Compassion programme, and our Quality in Transition Plan (QiT) Our Quality in Transition plan describes the quality agenda, aligned to the following quality workstreams: ÆÆ HCAI Programme ÆÆ Safeguarding Programme ÆÆ Safe Workforce Programme ÆÆ Safe Care and Compassion Programme: inclusive of Experience of Care ÆÆ Effectiveness Programme ÆÆ Governance of Service Providers Programme: inclusive of CQUINs and Quality Accounts.

To support delivery of the QiT plan we are: ÆÆ Ensuring Quality in Transition and associated workstreams is integral to our Annual Operating Plan ÆÆ Leading and engaging in the South East Coast Strategic Health Authority (SHA) Enhancing Quality Programme at Board, regional and local levels ÆÆ Benchmarking with others to drive up quality ÆÆ Working collaboratively with partners across Kent and Medway. The delivery of the QiT Plan is overseen by Kent and Medway Quality Committee which provides comprehensive assurance and performance reports to the board. During the last year we have: ÆÆ Included within our service contracts, Commissioning for Quality and Innovation (CQUINs) schedules, that drive up quality across care pathways, and reflect national, regional and local priorities ÆÆ Determined quality performance indicators and metrics for clinical effectiveness, safety, and patient experience that are included in our service contracts ÆÆ Determined patient centred outcome measures and goals which require the delivery of stretching quality improvements

ÆÆ Improved patient safety by reducing the number of healthcare associated infections in hospital, in care homes and in the community ÆÆ Improved the experience of care for patients by the elimination of mixed sex accommodation ÆÆ Improved patient safety as a result of investigating and learning from incidents, national inquiries and Ombudsmen reports ÆÆ Ensured the patients’ voice was heard, listened to and acted upon by responding to complaints and compliments ÆÆ Improved safeguarding outcomes for vulnerable children and adults across the health sector ÆÆ Ensured continuous improvement in the quality and safety of patient care through the use of best available evidence and national guidance ÆÆ Worked with providers to ensure the delivery of safe care ÆÆ Worked with providers to ensure the use of medicines is safe, cost effective, evidence-based and appropriate for the patient for whom medicines are prescribed ÆÆ Increased reporting of medication errors and disseminated the learning across commissioned services.

NHS Medway – Annual Report 2011/12

How we engage with local people All three primary care trusts within NHS Kent and Medway have well established means to listen to their local communities from using their patient and citizen networks, to using their websites, social media and local press. We have many ways to listen, record and act upon what local people want in the design, delivery and quality of care they receive. We would like to thank all those individuals and organisations who have contributed their views – we rely on you when organisations and services are changing, to make sure we deliver high quality care and make the most of our services and staff. Since combining as a cluster the citizen engagement and patient experience

teams have combined their talents and expertise to ensure that patients’ experience and local community views have influenced all aspects of the commissioning cycle. We are also supporting clinical commissioning groups and individual GP practices to help them meet their new obligations as commissioners.

has been developed, and each CCG is assessing its readiness and how they might work with their patients, local partners and communities in future. Communications and engagement strategies are being produced with each CCG, taking into account their commissioning priorities, and the needs of their communities.

Strategic and operational staff work with CCGs to offer advice and practical support, a dedicated resource pack

Patient Participation Groups Patient Participation Groups (PPGs) are a way of involving patients in improving the health and wellbeing of their neighbourhood. They offer an immediate way for patients to have a say in the way their GP practice delivers services. They can fulfil a number of functions, such as: gathering patient experience and feedback which is used to improve their surgery and the care offered; establishing better

information systems; raising funds and purchasing new equipment; creating local networks or supporting carers; and producing newsletters or setting up volunteer schemes to help out with flu vaccinations. NHS Kent and Medway is currently working with 65 GP practices in partnership with Kent and Medway Local Involvement Networks (see table

below) in offering a programme of support including: understanding the community profile, marketing materials, targeted promotions and community development to reach everyone within their local community; meeting papers (developed by patients); running ‘expression of interest’ meetings and establishing the first formal meetings.

PCT Area

Number of Practices

Number of practices supported in developing a PPG as at 1 April 2011

Number of practices supported in developing a PPG at 1 April 2012

East Kent

113

Medway

West Kent

NB We do not hold data for practices that have not responded to help from the PCT/LINk or who have decided not to take part in the DES (directed enhanced service) incentives.

NHS Medway – Annual Report 2011/12

Strategic planning NHS Kent and Medway involves people in every aspect of commissioning and service improvement including strategic planning. The cluster supported Medway Commissioning Group and Medway Local Involvement Network (LINk) to gain patients input into the Annual Operating Plan and the Joint Strategic Needs Assessment (JSNA). In November 2011 a joint community engagement event was held at the Corn Exchange, Rochester, with Medway LINk. More than 110 people attended and there were more than 30 voluntary organisations represented and delegates broadly reflected Medway’s diverse population. Information collected was used to inform our Annual Operating Plan and the JSNA. Both documents prioritise areas to be focused on in coming years. South Kent Coast Clinical Commissioning group held similar events in March and other CCGs have plans they wish to discuss with their local communities in the near future.

Other key pieces of engagement work have included: Patients and carers help improve prescribing guidance All aspects of the healthcare system use medicines. The medicines management team advises clinicians and pharmacists which medicines are safe, evidence based and cost effective. Recommendations and based on national guidance or new trials. We have established a virtual reference group (recruited from a range of patient and carer groups) so that they can alert the medicines management team to any concerns patients or carers

NHS Medway – Annual Report 2011/12

might have if changes are introduced into how medications are prescribed, or the way new medicines are licensed replacing more familiar medications. This way the clinical evidence is tested with local patients first before wider guidance is issued to clinicians and pharmacists.

various town locations during the consultation period. A representative from NHS Medway also attended the Luton and Wayfield Partnership Group meeting, which is a multi-agency group supporting residents in Luton and Wayfield, a deprived area in Chatham close to both Chatham and Luton.

If patients have any significant concerns then this is discussed with a wider group of patients and carers before new guidance is issued.

The Medway Health Network, Medway LINk, local GPs, children’s centres and voluntary and community organisations were encouraged to respond to and publicise the consultation.

So far six medications and their guidance have been considered. The views of the panel were then fed back to the clinical team.

Estates Rationalisation: Elm House and Kings Road As part of a national programme of work to rationalise estates across the NHS and improve the overall standard of the buildings where we provide health services, NHS Medway ran a consultation on the relocation of Elm House and Kings Road clinics. Both sites were very energy inefficient and did not meet disability requirements. Planned relocations meant that services delivered at Elm House and Kings Road would be delivered in more suitable accommodation. With support from Medway Health Overview and Scrutiny Committee, NHS Medway consulted patients at both sites around the plans from August to September 2011. Clinicians at both sites handed out the consultation document to service users. This encouraged a good response, from young girls especially who are high users of the contraceptive and sexual health services at both sites. To target a wider range of young people, the sexual health team handed the documents to young people at

Feedback indicated that 64 per cent of all respondents thought the most important factor for them was the location of the service, with the remaining 36 per cent commenting that keeping the same session times and dates was the priority. These views were taken into account when relocating, meaning that services continue to be provided locally and kept clinics at the same times and dates as they are now.

Influencing service design and contract for the procurement of child and adult mental health services (CAMHS) in the community A focus group of young people across Kent and Medway met to discuss their experience of using either CAMHS or a similar service. They were asked about CAMHS appointment times; places where they were seen; the staff; confidentiality; feeling involved in decisions about their care; good and bad points of CAMHS; rating the service; their opinions of how children and young people should be involved in how CAMHS is run; and the best way to involve them in the development of the service.

Their views have been used by the contracting and procurement teams to influence the service specifications when the Children and Adolescent Mental Health Services are retendered for Tier Two and Three community support services. This includes specialist CAMHS support; early intervention/ primary care services; improved access to psychological therapies for children; services for 17 to 18-year-olds; outof-hours intervention; developing mental health services for children and young people incorporating shared care arrangements with community paediatricians; and learning disabilities services. Some of the children and young people may go further to work side by side with staff who are assessing the providers so their influence is carried through to the final decision on which organisation provides the services. Then they will follow up monitoring of the delivery of the services will check young people’s experience of the new service in comparison to their experience of the previous service, to see if it has improved in line with young people’s aspirations.

well as adults. Service users and their relatives and carers have been asked about their experiences of the service and the changes they would make. Their comments have been used to make improvements to the service specification. They will also be involved in scoring and assessing the tendered bids.

Medway My Wishes end of life register A multi-partner project designed to improve end of life care in Medway and empower residents to actively participate with their end of life decisions has set up a secure, webbased register called My Wishes.

The register was rolled out to GP practices and other relevant health care services within Medway from June 2011. Practices are being supported by training to use the system. This will help reduce the stigma and taboo around talking about death and dying. Work is underway to promote My Wishes, both internally and externally. More than 4,000 emergency contact detail cards have been designed and printed for patients who are placed on the register.

It contains patients’ preferences of care, which is accessible for all relevant healthcare professionals, to view and edit care panning information (including preferred place of care) for people approaching end of life.

Wheelchair Service Review and Procurement Wheelchair services in Kent and Medway are under review and the service is being procured. The new service will separate adult and children’s services and will be run across the whole of Kent and Medway. The children’s service will be provided by the same provider across Kent and Medway and will treat children and young people up to their 26th birthday; the adult service will cover all those aged 26 and older. The engagement team has worked with commissioners to listen to service users, children and young people as

NHS Medway – Annual Report 2011/12

Staff are supported in their personal development with a range of programmes from local training through to relevant degree and post graduate studies. The appointment of a Learning and Development Manager has ensured that training continues to be focused across the cluster to ensure staff have the best possible opportunity of a successful transfer into the new NHS structure.

Our staff The most important asset in NHS Kent and Medway is our staff. It is through them we are able to improve health services for local people. This has been a year of significant change for all staff employed by the PCTs in Kent and Medway, with the three PCTs clustering to form NHS Kent and Medway. The cluster employed 1,126 employees as at 1 April 2011. The cluster is providing a stepping stone towards the emerging future commissioning arrangements that will be introduced on 1 April 2013. The arrangement has ensured resilience by providing people to support both local emerging clinical commissioning groups as well as the opportunity to work at scale across Kent and Medway, doing things once, to the highest standards. With a single Executive Team spanning Kent and Medway, roles and functions and staff have been re-aligned to enable the cluster to deliver its main priorities and focus: ÆÆ Clear accountability, PCT statutory Cluster duties, quality, safety, finance, performance, integrated plan and NHS Constitution to 2013 ÆÆ Providing space for emerging GP commissioning groups to operate effectively. ÆÆ Developing commissioning support arrangements and solutions for commissioning groups

NHS Medway – Annual Report 2011/12

ÆÆ Developing new arrangements with local authorities particularly Health and Wellbeing Boards ÆÆ Transfer staff to new roles in NHS Commissioning Board, clinical commissioning groups, local authorities and commissioning support arrangements, minimising the needs for any redundancy. ÆÆ Supporting provider reform, especially with Foundation Trust pipeline through commissioning plans. These principles, along with adherence to the NHS Staff constitution pledges,

are ensuring that staff are integral to these aims by having: ÆÆ Clear roles and responsibilities and rewarding jobs that make a difference to patients, their families and carers and communities. ÆÆ All staff have clear work objectives through a cluster appraisal process with Job descriptions reviewed to reflect cluster-wide working arrangements.

These development programmes include management and leadership, customer services and personal development. Building resilience and engaging with change are also covered, as well as education and training specific to particular professions. We have put in place support and opportunities for staff to maintain their health, wellbeing and safety. There is an active health and wellbeing forum. The forum has followed best public health practice basing its activity on a staff needs assessment. The cluster has become a mindful employer striving

to support the mental wellbeing of our staff. A number of staff, are now trained as Mental Health Champions, providing support to staff when required. A Health and Wellbeing Fair was held at our staff conference in September 2011, where staff had the opportunity to find out more about improving their physical and mental health and to take part in taster activity sessions. Sickness absence levels have remained at around two per cent.

representatives. The three Staff Engagement Groups join together to form the bi-monthly Staff Consultation Committee, chaired by the Chief Executive and this committee is the mechanism for formal consultation.

We have been engaging staff in decisions that affect them, individually, through representative organisations and through local partnership arrangements.

Engagement with staff, in the final quarter of the year, has centred on the future commissioning arrangements and the likely future destination of our staff. The main receiving organisations will be the National Commissioning Board, Kent County Council and Medway Council, the Clinical Commissioning Groups and a Commissioning Support Service.

Staff have been encouraged to be fully involved in the cluster’s development. Monthly Staff Engagement Groups are fully established in the three main cluster sites, where information can be shared and views sought on national, organisational and local issues. The groups comprise both trade union and non-affiliated local staff

Other Staff engagement has ranged from live video team briefs led by the Chief Executive to a staff conference attended by staff from across the cluster.

The transfer of staff into the new NHS organisations is being managed locally, using national guidance and processes wherever possible to ensure consistency.

ÆÆ Personal development, access to appropriate training for their jobs and line management support to succeed.

Any other ethnic group Asian or Asian British Black or Black British Chinese Mixed Unknown White

Our staff: Background by ethnic group.

NHS Kent and Medway staff at their conference in 2011

NHS Medway – Annual Report 2011/12

During the period the three Customer Services teams based across the cluster have worked closely together harmonising local processes and standards. In particular there is now a single Kent and Medway Complaints Handling Policy and Procedures which was approved by the board on 30 November 2011. The Customer Services Team deals with all enquiries and complaints that are received from members of the public and MPs. The Patient Advice and Liaison Services (PALS) can often provide a quick resolution or point people in the right direction. If the complaint is serious and requires investigation and a written response, then the matter is allocated to a Customer Services Case Manager. The Case Manager will contact the complainant or enquirer and agree with them how best to handle their issue. If the complaint is solely about the provision of a service, then it is often best for the provider of that service to investigate and respond to the issue. The Customer Services Team will liaise with the provider and will ask to see a

NHS Medway – Annual Report 2011/12

copy of the provider’s response to the complaint. Where appropriate, the response is shared with the relevant commissioner and/or a clinical adviser. This, in combination with reports to various committees, ensures a mechanism for the organisation to learn from complaints. If the issue being raised concerns the way in which a service is commissioned, the Customer Services Team will request a response from a senior commissioner.

How we monitor and learn from complaints In order to improve the patient experience it is essential that the organisation learns from complaints. Listening to feedback about our local services can uncover new ideas to help improve the way we do things. We ensure any complainant is informed when changes to a service are made. Our complaints are monitored through reports to the Quality Committee and also at regular meetings held between the Chief Executive and Kent MPs. Clinical issues are examined by the Independent Contractors Office.

Practice Nurse

Surgery closures

A disabled patient was unable to find a disabled space in which to park. There was a coned off area by the front door, from which he had just seen a car depart so he parked there and was unhappy to find a note on his car on return.

The PCT worked closely with patients who had raised concerns about the competence and skills of a member of staff within primary care. Patients were reassured about their treatment and procedures for recruitment and monitoring of registered practitioners was strengthened.

Three GP practices ceased across Kent and Medway resulting in the allocation and of patients to alternative surgeries. A co-ordinated approach was taken by the complaints/PALS department, working closely with Primary Care to ensure patients’ concerns were responded to on matters of medical records, access and continuity of care issues.

The coned off area had been used by a nurse who had popped in quickly, but the area was designated for a lorry delivery. Staff members were reminded not to use cones and the complainant received an explanation and an apology.

Complaints The role of the Customer Services Team

Parking Problems

Service Improvements across Kent and Medway

Complaints and enquiries in Medway Complaints received

Number well founded (at the time of reporting 27 cases are still being investigated)

Number of cases referred to the Ombudsman

PALS enquiries

1317

The examples that follow show some of the changes that have resulted from complaints or concerns being raised by members of the public.

Medway Maritime Hospital

Emergency Dental Service

Other local NHS Trusts (including Kent Community Health and KMPT)

A complaint was received from a patient who had not been able to access emergency dental treatment over Christmas. The subsequent investigation revealed that there were an unprecedented number of calls over the period in question and all the appointments were filled quickly. Ways of rectifying this were examined which will improve the situation and allow better management during exceptional peaks.

GPs

120

GP Out of Hours Services

Dentists

Prison Health Services

Other small providers

Total Complaints and Enquiries handled

1547

Estates Management A registered blind patient nearly fell down the steps outside the front entrance of a local NHS facility, because the steps were not adequately marked. Despite reporting this at the time, the patient noted that no alterations had been made more than a month later. The step was repainted and the patient was assured that its condition will be regularly monitored.

Complaints received about NHS providers that were referred to provider for response

Subject matter of complaints The main issues were: Access to Services

Complaints ranged from criteria for funding and Individual Funding Request approval for services.

Medication

While the changes in gluten-free products on prescription continued to be a major topic, there were also issues concerning 28-day prescribing and changes in the provision of unlicensed drugs.

Communication

Most issues relate to the lack of information, or lack of clarity of information supplied to patients.

Treatment

These complaints concerned services which had been commissioned by NHS Kent and Medway.

Others

The remainder of complaints related to a variety of issues dental charging.

NHS Medway – Annual Report 2011/12

Environmental Action NHS Kent and Medway has recognised the strong connections between the health of the environment and the health of the population and has chosen to underpin its approach to providing excellent healthcare using the principles of environmental sustainability. The clustering of three PCTs has created an opportunity to build on the successes of each to tackle the threat of climate change and resource depletion. A Sustainable Development Board has been formed to ensure a coordinated approach to reduce NHS carbon emissions, procure sustainable health services and be resilient in the face of climate related emergencies.

The cluster has made significant progress on the national good Corporate Citizenship Assessment Framework with a 21 per cent increase in score compared with the previous year. It is a self-assessment tool to help organisations think about how they can contribute to sustainable development by considering the following overarching themes:

ÆÆ Save money – through energy efficiency, waste reduction and careful use of resources

This board is working closely with local authorities and with the developing health and wellbeing boards to maximise the public health benefits which can result from a more sustainable approach. Examples include tackling fuel poverty and the associated risks from cardiovascular and respiratory disease by providing free insulation for vulnerable people, encouraging active transport to improve wellbeing and reduce obesity and promoting locally sourced fresh fruit and vegetables as part of a healthy diet. We have also joined the Local Nature Partnership to ensure we contribute to improving biodiversity and the Kent Climate Change Network as well as the new cross county partnership to implement the Green Deal.

ÆÆ Putting social, economic and environmental considerations at the heart of decision making;

A new initiative has been developed to encourage GP practices to become more sustainable and aware of their environmental responsibilities. The Sustainable Surgeries Award Scheme is the first of its kind in the country and following a successful pilot has been rolled out and is now available to all practices. The scheme is designed to engage staff and patients in a wide variety of simple changes which will help reduce carbon emissions and improve health. A number of PCT Carbon Champions have been trained to deliver the programme.

NHS Medway – Annual Report 2011/12

ÆÆ Ensuring day to day activities support, rather than hinder, progress with sustainable development; ÆÆ Using the organisation’s purchasing power, influence and resources to help deliver strong, healthy and sustainable communities. Acting as a Good Corporate Citizen will help an organisation: ÆÆ Achieve many health benefits for service users and populations – helping to tackle health inequalities and to move from treatment to prevention

ÆÆ Engage with staff and the community, and lead by example

on sustainability. A rolling programme of initiatives have tackled energy saving, promotion of walking and cycling, healthy low carbon diets, recycling and water saving. A clinical sustainability network has been established so ideas can be shared and transmitted across the NHS.

The PCT cluster has exceeded its initial aims with regard to reduction of direct carbon emissions and is now focussing attention on indirect emissions and a whole NHS approach so that collectively we will be on track to contribute to the national target of 10 per cent reduction in total NHS carbon footprint by 2015.

Progress has continued on the carbon management plans of all three PCTs with the installation of low energy lighting schemes, double glazing and insulation, server virtualisation and voltage optimisation schemes and estates rationalisation. All staff have been encouraged to use videoconferencing and telephones as far as possible to avoid needless travel and the chief executive has shown strong leadership on this. In addition flexible working wherever possible from home or from the nearest base has been encouraged.

The year was concluded by a successful range of contributions to the NHS Sustainability Day of Action. These included a sustainable lunch for all staff, the premier of a film made across the NHS in Kent and Medway and the relaunch of the Sustainable Surgery Scheme.

GPs bike to work as part of the sustainable surgeries scheme

ÆÆ Contribute to UK climate change targets – 80 per cent reduction in carbon emissions by 2050, compared to 1990 levels.

The carbon communications collaborative programme has further developed over the year ensuring a consistent approach to NHS messaging

NHS Medway – Annual Report 2011/12

Emergency preparedness and response NHS Kent and Medway helps to protect the public by having planned and practised systems for coordinating the response of the health service to incidents and emergencies across the county. We work with all NHS organisations including hospitals and community services to ensure that effective plans and response arrangements are in place, and liaise with key partner organisations, including Kent Police, Kent Fire and Rescue and South East Coast Ambulance Service through the Kent Resilience Forum (KRF).

Information governance

The overall aim of the KRF is to ensure that there is an appropriate level of preparedness to enable an effective multi-agency response to emergencies which may have a significant impact on the communities of Kent and Medway.

During 2011 NHS Kent and Medway took part in a wide range of emergency planning exercises and events and begun our preparedness for the 2012 Olympic Games. Our wide ranging exercise programme has included participation in exercises to test the health services’ response to incidents in the Channel Tunnel and at Dungeness Power Station, and contribution to exercise Watermark, a national exercise that explored a scenario involving significant flooding across large parts of the county.

Our preparations for the 2012 Olympics have included participation in a large number of multi-agency planning groups and exercises that have explored the plans and response arrangements at events including the Torch Relay and Paralympic cycling event at Brands Hatch. NHS Kent and Medway has an ongoing emergency response training programme including involvement in a wide range of NHS and multi-agency exercises designed to test our response to major incidents including flooding and dealing with mass casualties.

The Information Governance function across Kent and Medway acted early to form a cluster-wide team in the autumn of 2011 bringing swift efficiencies and improvements. Processes such as incident management and responding to requests for data made under the Freedom of Information Act and the Data Protection Act were natural candidates for crossPCT management and compliance with legislation has been maintained at high levels as a result. The cluster has recorded a compliant score for the national Information Governance Toolkit assessment. Training 95 per cent of the workforce on Information Governance was a challenging target but essential in reducing the risk of information breaches.

NHS Medway – Annual Report 2011/12

The Records Management Legacy project has operated throughout the second half of the year ensuring that key organisational data is appropriately marshalled to facilitate the new, postPCT working forms. The project team engaged with estates colleagues to ensure that corporate and personal data is suitably protected during a period of increased office re-configuration. Public sector organisations are expected to make information available in the public interest either free or at low cost. NHS Medway provides details of its services and how to access healthcare through the internet and a newsletter delivered to all households, partly

subsidised by advertising. For these services, there is no charge. The PCT does not supply information to other parties, for example for research or publication by third parties. It therefore complies with the Treasury’s guidance on setting charges for information.

NHS Medway did not experience any Information Governance serious incidents during 2011/12.

NHS Medway – Annual Report 2011/12

Operating and Financial Review All PCTs have to meet the same statutory and financial duties

Revenue Resource Limit Capital Charges

External Audit

Contain expenditure within the revenue resource limit set by the Department of Health.

External Auditors, appointed by the Audit Commission, provide assurance to the Trust Board and external stakeholders on internal control mechanisms and overall probity. The Annual Accounts are also subject to scrutiny by the External Auditors. For Medway PCT, the External Auditors are PKF (UK). The cost of audit services in the year is set out below:

Capital Resource Limit Contain expenditure within the capital resource limit set by the Department of Health.

Cash Limit A statutory duty not to spend more than the cash allocated to them. PCTs have a combined cash limit for both revenue and capital.

A requirement to pay capital charges on their assets. These include a depreciation charge to reflect the use of fixed assets (other than land) and a 3.5 per cent cost of capital charge on net relevant assets. Medway PCT met its financial duties for 2011/12 and in line with annual plans, achieved target savings of £4.5 million. This surplus will be carried forward and be available for investment in patient services during 2012/13. The following tables set out the Summary Financial Statements. These financial statements might not contain sufficient information for a full understanding of the PCT’s financial position and performance. The full Annual Accounts are available on our website.

Accounts and Governance

£120,000

Use of Resources (including risk based work)

£31,650

Review of redundancy cases (required by DH)

£0

Total

NHS Medway – Annual Report 2011/12

£151,650

NHS Medway – Annual Report 2011/12

y Acute hospitals Community health services

Primary care MH and LD services Medicines Public Health Ambulance services Operational management

Your money We had £450.4 million to spend on healthcare between 1 April 2011 and 31 March 2012: this means that for each man, woman and child in Medway, we spent £1,657.

The PCT continues to monitor expenditure in all these areas. The main differences between what we expected to spend and what we actually spent were the result of:

The chart above illustrates how, of every £100:

ÆÆ more patients than expected being treated in acute hospitals such as Medway Maritime Hospital, and some of these treatments are becoming more complex and expensive

ÆÆ £48 was spent on acute hospitals (of which £32 went on services provided by Medway Foundation Trust Trust) ÆÆ £14 was spent on community health services (mostly on services provided by Medway Community Healthcare) ÆÆ £11 was spent on primary care (GPs, pharmacies, dentistry, optometry) ÆÆ £8 was spent on mental health and learning disability services (of which £6 went on services provided by Kent and Medway NHS and Social Care Partnership Trust) ÆÆ £12 was spent on medicines

ÆÆ rising costs of the continuing care of patients in the community ÆÆ prescribing costs rising ÆÆ savings arising from the reduction in running the organisation, which allowed additional investment in frontline services. In total, we spent £445.9 million of our revenue budget, giving a surplus of £4.5 million. We also spent £1.9 million on capital costs, including:

ÆÆ £1 was spent on our public health team and healthy living services

ÆÆ £1.1million on maintenance of capital stock, and

ÆÆ £2 was spent on ambulance services

ÆÆ £0.4 million on grants to GP and dental practices.

ÆÆ £4 was spent on operational and management costs.

NHS Medway – Annual Report 2011/12

Summary Financial Statements The summary financial statements and remuneration report are appended to this report. Reporting bodies are required to disclose the relationship between the remuneration of the highestpaid director in their organisation and the median remuneration of the organisation’s workforce.

Medway PCT became part of the Kent and Medway Cluster in 2011/12. This allowed some posts to be shared across PCTs to provide greater efficiency. A number of Director and Non Executive Director posts were shared, and these were recharged based on the relative weighted populations. The Remuneration Report details these posts: the cost of the posts falling to Medway PCT is shown in Section A of the report, and Section B shows the gross costs of these posts where posts are shared.

31 March 2012 by the District Valuer. LIFT assets were revalued at fair value; all other assets were revalued on the Modern Equivalent Asset basis. Consequently, there was no difference between the carrying amount and market value of interests in land.

Pension Scheme Past and present employees are covered by the provisions of the NHS Pensions Scheme. The scheme is an unfunded, defined benefit scheme that covers NHS employers, general practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales.

The banded remuneration of the highest paid director in Medway PCT in the financial year 2011/12 was £135,000 - £140,000 (2010/11, £135,000 - £140,000). This was 6.06 times (2010/11, 6.31 times) the median remuneration of the workforce, which was £22,676 (2010/11, £21,798).

Valuation of Assets

In 2011/12, zero (2010/11, zero) employees received remuneration in excess of the highest-paid director. Remuneration ranged from salary bands of £10,000 – £15,000 to £135,000 - £140,000 (2010/11 salary bands ranged from £10,000 – £15,000 to £135,000 - £140,000)

Better Payment Practice Code

Total remuneration includes salary, non-consolidated performancerelated pay, benefits-in-kind as well as severance payments. It does not include employer pension contributions and the cash equivalent transfer value of pensions. The relationship between the remuneration of the highest-paid director in their organisation and the median remuneration of the organisation’s workforce (the “pay multiplier”) shows a reduction between 2010/11 and 2011/12. This reflects an 8 per cent reduction in the workforce numbers as at 31 March in each year, whereas the number of staff being paid less than £20,000 reduced by 19 per cent. This had the effect of increasing the median pay of the workforce, thereby reducing the pay multiple.

Property assets were revalued as at

The scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the scheme is accounted for as if it were a defined contribution scheme: the cost to the NHS body of participating in the scheme is taken as equal to the contributions payable to the scheme for the accounting period. For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full amount of the liability for the additional costs is charged to expenditure at the time the PCT commits itself to the retirement, regardless of the method of payment.

The Better Payment Practice Code requires the PCT to aim to pay all valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later. The performance of the PCT is set out in the table below:

2011-12 2011-12 2010-11 2010-11 Number £000 Number £000

Non-NHS Payables Total Non-NHS Trade Invoices Paid in the Year Total Non-NHS Trade Invoices Paid Within Target Percentage of Non-NHS Trade Invoices Paid Within Target

13,811 111,889 22,835 84,978 12,778 108.146 20,305 75,997 92.59% 96.65% 88.92% 89.41%

NHS Payables Total NHS Trade Invoices Paid in the Year Total NHS Trade Invoices Paid Within Target Percentage of NHS Trade Invoices Paid Within Target

4,700 288,095 4,455 270,767 3,901 283,804 3,511 263,257 83.00% 98.51% 78.81% 97.23%

NHS Medway – Annual Report 2011/12

Forward look Looking forward, the PCT has received an increase of 2.8 per cent on its recurrent revenue resource limit for 2012/13. It is working with the emergent Clinical Commissioning Groups to look at how it can use its funding most effectively, and it has prepared a Quality, Innovation, Productivity and Prevention (QIPP) programme, designed to ensure that each pound spent is used to bring maximum benefit and quality of care to patients. Total savings of £20 million per year are planned for reinvestment in patient care by improving services to patients and introducing innovation and technology to deliver better services.

Topslice During the year NHS Medway, together with NHS Eastern and Coastal Kent and NHS West Kent, agreed a funding scheme with Maidstone and Tunbridge Wells NHS Trust. This scheme was designed to enable the Trust to fully fund private finance initiative rentals for the new Tunbridge Wells Hospital over the next five years. As part of the conditions for this scheme, a plan has been agreed with the trust for it to fully fund the PFI rentals from 2016/17. In the early years of this plan, NHS Top Slice monies will be used together with additional money from East Sussex which has patient flows to Tunbridge Wells Hospital. Top Slice funding was non recurrent funding held by the Department of Health which equated to two per cent of total PCT funding allocations. Use of funding was controlled by the Strategic Health Authority and the Department of Health. The Department of Health is expected, subject to formal agreement, to provide recurrent funding of £8million a year and the remaining rental will be paid in full by Maidstone and Tunbridge Wells NHS Trust.

NHS Medway – Annual Report 2011/12

As part of the funding scheme NHS West Kent will make good funding allocations or “lodgements” due to NHS Medway totalling £11million over the four years to 2015/16.

Principal risks and uncertainties We have assessed the principal risks and uncertainties that may affect the PCT over the next few years as we hand over our functions to our successor organisations as being: ÆÆ financial risks: NHS budgets will not be reduced but with demand for NHS services increasing annually, along with the range of services the NHS can offer (such as new drugs and technologies), we have to be very careful about getting value for money

The plans we have put in place for 2012/13 and future years are designed to address these risks and to ensure that the health service in Medway continues to respond to the needs of our population and to deliver value for money to taxpayers.

Statement of the Chief Executive’s responsibilities as the accountable officer of the PCT The Chief Executive of the NHS has designated that the Chief Executive should be the Accountable Officer to the primary care trust. The relevant responsibilities of Accountable Officers are set out in the Accountable Officers Memorandum issued by the Department of Health. These include ensuring that:

ÆÆ the expenditure and income of the primary care trust has been applied to the purposes intended by Parliament and conform to the authorities which govern them;

ÆÆ there are effective management systems in place to safeguard public funds and assets and assist in the implementation of corporate governance;

ÆÆ annual statutory accounts are prepared in a format directed by the Secretary of State with the approval of the Treasury to give a true and fair view of the state of affairs as at the end of the financial year and the net operating cost, recognised gains and losses and cash flows for the year.

ÆÆ value for money is achieved from the resources available to the primary care trust;

ÆÆ effective and sound financial management systems are in place; and

To the best of my knowledge and belief, I have properly discharged the responsibilities set out in my letter of appointment as an Accountable Officer.

Ann Sutton, Chief Executive 1 June 2012

ÆÆ health of our population: growing need for services, falling capacity within the NHS, or an increased focus on Kent-wide services, could result in the PCT being unable to meet the specific health needs of our local population ÆÆ transition risks: at this time of organisational change, there is a risk of key people leaving, resulting in over-stretched systems failing to deliver the local NHS vision ÆÆ whole system risks: different parts of the NHS and social care, in eastern and coastal Kent, Medway, west Kent and beyond, could fail to co-ordinate in every aspect needed to deliver necessary improvements to quality, innovation, productivity and prevention ÆÆ enabling risks: in an era of transformational change, our staff need far greater capacity and flexibility from estates and information technology to support skills which enable that transformation.

NHS Medway – Annual Report 2011/12

ÆÆ The process of Internal and External Audit; ÆÆ The use of the Assurance Framework to manage principal risks associated with key objectives together with a dashboard displaying corporate objective performance.

Governance Statement Scope of responsibility, Ann Sutton The board is accountable for internal control. As Accountable Officer, and Chief Executive of this board, I have responsibility for maintaining a sound system of internal control that supports the achievement of the organisation’s policies, aims and objectives. I also have responsibility for safeguarding the public funds and the organisation’s assets for which I am personally responsible as set out in the Accountable Officer Memorandum.

information and training to exercise their responsibilities effectively. I have ensured that a robust integrated governance framework is embedded within the PCT which is aligned with Department of Health guidance and established best practice. The Memorandum also places responsibility on the Accountable Officer for developing and maintaining key relationships, which include:

In particular the Accountable Officer Memorandum also assigns the Accountable Officer responsibility for:

ÆÆ Local communities through public meetings and the publishing of annual reports and accounts;

ÆÆ The propriety and regularity of NHS finances;

ÆÆ Patients through the PCT’s Local Involvement Networks (LINks) and the Customer Services Team;

ÆÆ The keeping of proper accounting books and records; ÆÆ Prudent, efficient and effective administration; ÆÆ The avoidance of waste and extravagance; ÆÆ The efficient and effective use of all resources within the charge of the Accountable Officer; ÆÆ Ensuring managers at all levels have a clear view of their objectives, the means to assess achievement against those objectives, and the

NHS Medway – Annual Report 2011/12

ÆÆ The South of England Strategic Health Authority through regular meetings and forums; ÆÆ Partners through the Integrated Plan Board and through a range of service and care specific committees and working groups; ÆÆ Local authorities through developing Health and Wellbeing Boards and the appointment of co-opted members from the Local Authority to the Cluster Board;

ÆÆ Other PCT Clusters through joint commissioning arrangements. The context in which risk within the organisation is managed takes into consideration the stakeholders listed above. The Accountable Officer is able to monitor and fulfil the commitments placed on the role by:

Internal audit annually produces an overall opinion on the effectiveness of the systems of internal control. In addition there have been a number of audits carried out on the key functions and systems that directly contribute to their maintenance of the Accountable Officer responsibilities. These audits include: ÆÆ The Board Assurance Framework ÆÆ Risk and Control Framework (including the Risk Management Strategy) ÆÆ Information Governance ÆÆ Core Financial Systems ÆÆ Payroll systems, maintenance and application

ÆÆ Regular reporting to the Board by both clinical and operational management teams;

ÆÆ Landlord Compliance Checks

ÆÆ The Joint Audit Committee;

ÆÆ GP Quality Development Framework.

ÆÆ The Finance and Performance Committee; ÆÆ The implementation of a Risk Management Policy/Strategy agreed by the board which clearly defines roles and responsibilities in relation to risk management at all levels from the Chief Executive to front line staff and addresses both clinical and non-clinical risk; ÆÆ The Health and Safety Committee; ÆÆ The Quality Committee which incorporates Clinical Governance; ÆÆ Regular briefings to the South of England Strategic Health Authority;

ÆÆ Provider Care Quality Commission registration and management

An audit recommendation action list to ensure the learning from these reviews is embedded into any system changes or redesigns is held and reviewed by the Kent and Medway Joint Audit Committee. The Joint Audit Committee is chaired by two alternating Non Executive Directors.

The governance framework of the organisation The operating framework for 2011/12 included a new requirement for all

PCTs in England to form into ‘clusters’. Accordingly, in May 2011, the three boards approved arrangements delegating functions and responsibilities to the Kent and Medway Cluster Board (“the Cluster Board”) which was established as a Joint Committee of the three constituent PCTs in accordance with Regulation 9 of the Primary Care Trusts (Membership, Procedure Administration Arrangements) Regulations 2000, as amended. The governance arrangements were supported by an Establishment Agreement between the constituent PCT members of the cluster, a Scheme of Delegation and revised Standing Orders and Standing Financial Instructions. The PCTs agreed to delegate powers and functions to the Cluster Board in accordance with Regulation 10 of the National Health Service (Functions of Strategic Health Authorities and Primary Care Trusts and Administrative Arrangements) (England) Regulations 2002, as amended. Additionally the PCT Boards approved the establishment of a Joint Remuneration and Terms of Service Committee as a sub committee of the Cluster Board and the establishment of a Joint Audit Committee as a sub committee of the Cluster Board.

The Cluster Board Membership of the Cluster Board initially comprised the Cluster Chair and a further six Cluster Non Executive Directors and six voting Cluster Executive Directors, as follows:ÆÆ Cluster Chair; ÆÆ Six other Cluster Non Executive Directors drawn (two each) from each of the PCT’s acting Chairs or Non Executive Directors ÆÆ The Cluster Chief Executive ÆÆ The Cluster Directors of Finance (together having one vote)

ÆÆ The Medical Director of each of the PCTs (together having one vote) ÆÆ The Cluster Director of Nursing and Quality ÆÆ The Cluster Director of Whole Systems Commissioning ÆÆ The Cluster Director of Performance and Assurance Additionally the following members of the Cluster Executive Team were designated as non voting members of the Cluster Board: ÆÆ The Cluster Director of Commissioning Development and Workforce ÆÆ The Cluster Directors of Public Health ÆÆ The Cluster Director of Communications and Citizen Engagement. The Assistant Chief Executive and Company Secretary are also members of the Cluster Executive Team and attend Board meetings. In January 2012 a further Non Executive Director was appointed to the Cluster Board and, at the same time, the Directors of Public Health became voting members with a single vote. The Cluster Board and PCT Boards now have the same Non Executive and Executive membership with the exception of the Directors of Public Health who continue in Medway (for the Medway PCT Board) and in Kent (for the Eastern and Coastal and West Kent PCT Boards). The Cluster Board meets in public at least bi-monthly. The Cluster Board focuses on strategic issues while assuring itself of the performance of the whole cluster. It achieves a balance by: ÆÆ Long range board agenda planning – coordinated by the Company Secretary with input from the

NHS Medway – Annual Report 2011/12

Cluster Executive Team and Chairman; ÆÆ Bi-monthly board development sessions to cover key strategic and development issues; ÆÆ Monthly Non Executive Director meetings to discuss key topical and strategic issues chaired by the Chairman with the Chief Executive and Company Secretary in attendance.

Board Committees To support the Cluster Board in carrying out its duties effectively, subcommittees reporting to the Cluster Board have been formally established. The remit and terms of reference of these sub-committees were reviewed during the year as cluster arrangements were put in place to ensure robust governance and assurance. Each subcommittee receives a set of regular reports, as outlined within their terms of reference and provides summary reports to the Cluster Board after each meeting. The main committees of the Cluster Board are: ÆÆ Joint Audit Committee ÆÆ Joint Remuneration and Terms of Service Committee ÆÆ Joint Quality Committee ÆÆ Commissioning Committees (one for each PCT) ÆÆ Finance and Performance Committees (one for each PCT) ÆÆ Commissioning Development and Transition Committee.

Joint Audit Committee The Committee is established as a joint sub-committee of the Cluster Board. The Committee meets at least three times a year and otherwise as required. The Audit Committee’s primary role is to oversee the adequacy and

NHS Medway – Annual Report 2011/12

effective operation of the overall internal control system supporting each PCT in the Cluster. The Audit Committee independently monitors, reviews and reports to the Cluster Board on the process of governance and, where appropriate, facilitates and supports, through its independence, the attainment of effective processes. The Audit Committee is charged with monitoring the effectiveness of internal control systems on behalf of the board and has done so as part of its annual work programme and through reporting to the Cluster Board after each of its meetings. Additionally the committee is required to provide assurance that robust Risk Management arrangements are in place throughout the Trust and that they are working effectively. The membership of the Audit Committee comprises two Chairs and one member from each of the three PCTs. The Cluster Chief Executive is invited to attend the Audit Committee, at least annually, to discuss the process for assurance that supports the Annual Governance Statement. The Director of Finance Stewardship and Governance, Company Secretary and Head of Assurance and Risk will normally be present at each meeting of the Audit Committee, together with representatives from Internal and External Audit and Counter Fraud Services.

Joint Remuneration and Terms of Service Committee In line with the requirements of the NHS Codes of Conduct and Accountability, the PCT is required to constitute a Remuneration Committee. The Committee is established as a joint Non Executive sub-committee of the Cluster Board. The committee meets at least twice a year. The committee’s purpose is to determine the remuneration and conditions of service of the Cluster

Chief Executive, Cluster Executives and other Cluster Directors with board responsibility who report directly to the Chief Executive ensuring that these properly support the objectives of the cluster and/or relevant PCT, represent value for money and comply with statutory requirements. In 2011/12, the membership comprised Colin Tomson, Dr Harshad Topiwala, Jill Ruddock, Graham Mayes and Mike Cosgrove. The Remuneration and Terms of Service Committee follows an annual work programme and reports annually to the Cluster Board.

Quality Committee The purpose of the Quality Committee is to ensure that the Cluster Board delivers its statutory responsibilities for care quality through transition, including the domains of safety, effectiveness and patient experience. The Quality Committee is delegated by the Cluster Board to undertake specific duties and provide assurance to the Cluster Board that: ÆÆ A Quality In Transition Plan is developed and delivered in line with the Shared Cluster Operating Model for PCT Clusters (published August 2011); ÆÆ The services commissioned on behalf of the local community are safe, of a consistently high standard and responsive to patient needs and experiences; ÆÆ The commissioned services meet the necessary standards of quality specified in Care Quality Commission (CQC) registration requirements, standard contracts, professional guidance, the NHS Operating Framework and other relevant sources; ÆÆ The commissioned services, including rebalanced commissioned services maintain quality standards

and drive improvements in health outcomes within available resources; ÆÆ There are robust contract monitoring arrangements for all providers in place, using hard and soft intelligence so that any serious failures are prevented or identified at an early stage and resolved; ÆÆ The CQC, the SHA Cluster and providers themselves are immediately notified where performance monitoring identifies signs of non–compliance with registration requirements; ÆÆ Any unresolved provider performance concerns are comprehensively documented in legacy documents for successor organisations; ÆÆ That providers have good clinical governance (effectiveness) processes, patient safety frameworks and methods to capture and act upon patient experience and feedback; ÆÆ That providers are reporting incidents appropriately and implementing the learning from analysis of incident data; ÆÆ That there is a culture of open and honest cooperation so that staff, patients and the public are pro-actively listened to in order to understand their concerns and the experiences; ÆÆ That there are safe arrangements in place for the provision of a safe and effective system wide workforce; ÆÆ That any concerns with the conduct and professional performance of independent contractors registered on the Cluster PCTs’ Medical, Dental and Optical Performers’ Lists are identified and managed.

Commissioning Committee The purpose of this committee is to ensure that the PCT is able to deliver its strategic commissioning objectives by specifically ensuring that: ÆÆ The goals and initiatives outlined in the PCT’s Strategic Commissioning Plan are developed and delivered in accordance with the Operating Framework and the four key strategic drivers outlined in the White Paper: Equity and Excellence: Liberating the NHS namely: ÆÆ Putting patients and public first ÆÆ Improving healthcare outcomes ÆÆ Autonomy, accountability and democratic legitimacy ÆÆ Cutting bureaucracy and improving efficiency The committee works with other committees of the cluster board to achieve high quality, financially viable services meeting all quality, innovation, productivity and prevention challenges (QIPP). In undertaking this work the committee ensures that it has oversight of risks to delivery of the Operational Plan, the Strategic Commissioning Plan and the Cluster’s strategic objectives. This committee reports specific assurances determined in the Assurance Framework. The committee is responsible for the governance and clinical leadership through transition to Clinical Commissioning Groups including organisational development, role design and staffing to ensure delivery of the Operational Plan during and after transition including strategic development within the financial resources available.

Finance and Performance Committee The Finance and Performance Committee provides the Cluster Board with assurance that all financial and performance issues are being

identified, progressed regularly and that appropriate actions are in place to deliver the standards required. Specifically, the committee monitors delivery of Clinical Commissioning Group workstream plans and progress against the integrated plan for the PCT including the QIPP programme.

Commissioning Development and Transition Committee The purpose of the Commissioning Development and Transition Committee is to ensure that the Cluster delivers its Commissioning Development Plan (CDP) across the Cluster and to provide assurance to the Cluster Board in this respect. The Committee has responsibility for: ÆÆ Coordinating and facilitating the links between the Commissioning Development work streams, the Strategic Health Authority Cluster, Local Authorities and other stakeholders and ensure alignment and convergence of local, regional and national workstreams; ÆÆ Coordinating and facilitating the links between commissioning delivery and developmental new commissioning architecture to enable safe transition to Clinical Commissioning Groups by March 2013; ÆÆ Reviewing monthly updates and guidance from the SHA Regional Commissioning Development Board and Local Government Association ensuring that the controls and mitigations to managing transition risks are in place and adequate; ÆÆ Reviewing monthly delivery and performance from each work programme through reporting from the Programme Management Office (who have responsibility for tracking delivery of the CDP).

NHS Medway – Annual Report 2011/12

Clinical Commissioning Groups (CCGs) The delegation of commissioning was a key indicator of reform in the NHS Operating Framework 2011/12 and a key step on the journey from clinical engagement to full authorisation of CCGs. A single measure ‘the percentage of PCT commissioning spend delegated to GP practices’ was determined to monitor how emerging CCGs (eCCGs) are progressing their development supported by PCT Clusters. In September 2011 the SHA issued its SHA cluster approach. A number of criteria were set out in order to maintain statutory requirements for the delegation of PCT functions including: ÆÆ Pathfinder and eCCGs were required to be established as

committees or subcommittees of the PCT board in line with NHS regulations;

ÆÆ Ashford

Corporate Governance

ÆÆ Canterbury and Coastal (C4G)

The UK Corporate Governance Code is a guide to a number of key components of effective Board practice. It is based on the underlying principles of all good governance: accountability, transparency, probity and focus on the sustainable success of an entity over the longer term. The PCT and Cluster adhere to the principles set out in the UK Corporate Governance Code in the following ways.

ÆÆ Dartford, Gravesham and Swanley

ÆÆ The proceedings of these committees or sub-committees would be subject to any applicable standing orders adopted by the PCT;

ÆÆ Medway

ÆÆ Members of the committees or subcommittees would be required to comply with the rules on financial interests as defined in regulation 11 of the Membership, Procedure and Administration Arrangements Regulations.

ÆÆ Thanet

On 25 January 2012 the Cluster PCT Boards approved the establishment of emerging Clinical Commissioning Groups as committees of the relevant PCT Board for the following areas[1]:-

ÆÆ South Kent Coast (Deal, Dover and Shepway) ÆÆ South West Kent (Maidstone and Malling and West Kent)

Terms of Reference for each CCG, a Memorandum of Understanding and a detailed Scheme of Delegation have also been approved by the PCT Boards creating the governance required for full delegation of commissioning budgets, required nationally by April 2012, to allow a full year of shadow operation for emerging CCGs. [1] After

the year end Swale CCG was established as a formal committee of the Board.

Attendance at the Cluster Board and Committee meetings Committee

Average attendance of members

Cluster Board

90%

Joint Audit Committee

93%

Joint Remuneration Committee

71%

Joint Quality Committee

78%

Commissioning Committee

67%

Finance and Performance Committee

68%

Commissioning Development and Transition Committee

66%

Leadership – The PCT and cluster is headed by an effective board which is collectively responsible for the long-term success of the PCT and cluster. There is a clear division of responsibilities between the running of the board and the executive responsibility for the running of the Cluster and PCT’s business. No one individual has unfettered powers of decision and decision making powers are clearly governed by the PCT’s Standing Orders and Standing Financial Instructions, Terms of Reference of individual committees and schemes of delegation. The Chairman is independently appointed by the Appointments Commission and is responsible for leadership of the Board and ensuring its effectiveness on all aspects of its role. As part of their role as members of a unitary board, Non Executive Directors constructively challenge and help develop proposals on strategy. Effectiveness – The Board and its committees have the appropriate balance of skills, experience, independence and knowledge to enable them to discharge their respective duties and responsibilities effectively. There is a formal, rigorous and transparent procedure for the appointment of new directors to the Board which is managed independently for Non Executive Directors by the Appointments Commission. Non Executive Directors’ and Board

NHS Medway – Annual Report 2011/12

Advisors’ portfolios of committee memberships are carefully managed by the Chairman to reflect their areas of special interest and expertise and to ensure that they are able to allocate sufficient time to discharge their responsibilities effectively. All directors receive a programme of induction on joining the board and regularly update and refresh their skills and knowledge through a formal process of appraisal and identification of training and personal development needs. Board papers are supplied in a timely manner, with minimum timescales for receipt of papers set out in the PCT’s Standing Orders. Board papers are prepared with information in a form and of a quality appropriate to enable the Board to discharge its duties. During the 2011/12 financial year the PCT Board has been subject to various changes brought about since the publication of the Health and Social Care Bill in July 2010 which subsequently obtained Royal Assent in 2012. In January 2011 the Department of Health published PCT Cluster Implementation Guidance which provided PCTs with flexibility to adopt different Board governance models. In April 2011 a workshop involving all Non Executive Directors from the three constituent Cluster PCTs was facilitated by the Chairman, Assistant Chief Executive and Company Secretary to decide on the Board model to adopt for the Cluster arrangements. The workshop determined to adopt Model 1 and subsequently each PCT in the cluster approved these arrangements. In September 2011 the Department of Health wrote to PCT Chief Executives stating that PCTs were required to adopt the broad principles of Model 2 by December 2011 namely: ÆÆ a single board meeting transacting, as far as is practicable, the Board business of all of the constituent PCTs; ÆÆ a single Executive Team with a single Chief Executive;

ÆÆ a single individual as Chair of the cluster, therefore excluding shared or rotating arrangements. As a result of this revised guidance, Non Executive Directors of the PCT, not appointed to the cluster board, were required to resign as Directors of the PCT. The Cluster PCTs have retained those affected as Board Advisors to continue to service Cluster Committees and to ensure that their expertise and service is retained on an ongoing basis, in particular, providing expertise in a number of the transition workstreams to the new NHS architecture. In view of various board changes brought about by the guidance issued by the Department of Health and the formation of a new cluster board, which first met in July 2011, it has not been appropriate or timely to undertake a formal and rigorous annual evaluation of Board and committee performance. The Board does, however, review the effectiveness of each Board meeting every time it meets and feedback is used for purposes of continuous improvement. All Directors are subject to annual performance review. Non Executive Directors are subject to re-appointment processes every three years subject to continued satisfactory performance. Accountability – The board considers that it presents a balanced and understandable assessment of the PCT’s position and prospects. The board is responsible for determining the nature and extent of the significant risks it is willing to take in achieving its strategic objectives. The board maintains sound risk management and internal control systems. The board has established formal and transparent arrangements for considering how they should apply risk management and internal control principles and for maintaining an appropriate relationship with the PCT’s auditor.

NHS Medway – Annual Report 2011/12

Remuneration – Remuneration for all Directors is set by reference to national pay rates. No Director is involved in deciding his or her remuneration.

Risk assessment The organisation has developed in 2011/12 an integrated Risk Management Strategy to ensure there is a systematic and consistent approach to risk management throughout the organisation. It is important to ensure that risks are identified, assessed, controlled and dealt with at the appropriate management level. The organisation recognises that risk management has to function in an environment in which the risk appetite and type are defined and this has shaped the development of the risk management model. Following risk identification and assessment, risks are then categorised by their type of risk or the key business driver that may affect the delivery of an objective(s). An individual risk appetite exists for each category and these along with the risk profile for the organisation were set following consultation with the Executive Team and the Non Executive Directors. The organisation expects to see risk management in all parts of the

organisation’s operation and the absence of risk is not considered to be positive.

The risk and control framework The risk management process is designed to identify the principal risks to the achievement of the organisation’s objectives; to evaluate the nature and extent of those risks and determine the organisation’s appetite for those risks; and to manage them efficiently, effectively and economically. The PCT’s risk management system covers six types of risks and controls: 1. Patient Safety/Quality/Prevention risks – Covered by the quality Committee report to the Board and recorded in the Quality risk register. Executive accountability for clinical risk management resides with the Director of Nursing and Quality. 2. Compliance and Legislation risks – Covered by the annual report on risk management and recorded in the Assurance Framework, and Corporate Objectives report. Executive accountability for organisational risks rests ultimately with the Chief Executive. 3. Financial risks - Covered by the

IDENTIFY RISKS

ASSESS RISKS ANALYSE RISKS

EVALUATE AND RANK RISKS

MONITOR AND REVIEW

COMMUNICATION AND CONSULTATION

ESTABLISH

annual report on risk management and recorded in the Assurance Framework and Corporate Objectives report. Financial Risks are also reported in Finance Reports to the Board, the Finance and Performance Committee and the Joint Audit Committee. Executive accountability for financial risk management rests with the Director of Finance Stewardship and Governance. 4. Risks to the delivery of the operating plan- (risks which will impact on the achievement of corporate objectives) – Covered by the annual report on risk management and the Annual Governance Statements. These risks are also recorded in the Assurance Framework. Risk assessment forms part of all strategic policy decisions. 5. Transition/Cluster risks – (risks which will impact on the achievement of the national transition programme). These risks are recorded in the Corporate Risk Register and form part of the organisational development and transfer role of the cluster. 6. Performance risks – Covered by the annual report on risk management and monthly performance reports to both the board and the Joint Audit Committee. These risks are recorded in the Corporate Risk Register and form part of the strategic planning and commissioning decisions. Risks in all these areas are recorded in directorate risk registers and feed into the corporate risk register. Using the reports detailed above, and regular performance update reports, these risk areas are monitored regularly by: ÆÆ The Board

TREAT RISKS

RISK REGISTER

NHS Medway – Annual Report 2011/12

ÆÆ The Joint Audit Committee ÆÆ The Finance and Performance

Committee ÆÆ The Quality Committee ÆÆ The Executive Team ÆÆ The Commissioning Development and Transition Committee ÆÆ The Commissioning Committee. Risk management awareness and the purpose of assessment and monitoring of risk and the organisation’s appetite for the risk categories are embedded in the activity of the organisation at all levels through: ÆÆ Including risk and residual risk rating in business cases, Board reports/papers relating to all development proposals and all performance reports, corporate and team objectives; ÆÆ The development of directorate risk registers in all services and sites informed by risk assessments carried out by staff trained and competent to assess both physical and geographical risks posed by location and client group; The development of action plans to address risks identified and monitoring mechanisms to ensure key controls are effective.

Risk themes for 2011/2012 Since clustering of PCTs the organisational risks identified can be summarised by the following themes: ÆÆ The ability of the organisation to maintain staff resources especially in key positions due to instability within the NHS; ÆÆ The effect of the transition agenda on achieving PCT and integrated commissioning forecast savings; ÆÆ The achievement of financial balance at year end; ÆÆ The protection of key assets including information assets during the transition phase;

ÆÆ Breaching nationally issued targets on Healthcare Acquired infections; ÆÆ The development of the Commissioning Support Service and its leadership; ÆÆ The ability to develop and support emerging CCGs while delivering PCT objectives; ÆÆ Loss of key skills as Public Health and CCGs evolve through transition. These risks are continually monitored to ensure they are mitigated as far as possible. Additionally, the Board, Joint Audit Committee and the Executive Team review the risks to ensure the internal controls are robust.

Review of the effectiveness of risk management and internal control A review of effectiveness is informed in a number of ways. The Company Secretary and the Director of Finance Stewardship and Governance have responsibility for the overall arrangements for gaining assurance through the Assurance Framework and on controls reviewed as part of the internal audit work. Executive Directors within the organisation also share the responsibility for the development and maintenance of the system of internal control. South Coast Audit is appointed as the internal auditor for the clustered PCTs and were asked to provide an Opinion on the effectiveness of the system for internal control, including the Board Assurance Framework and underpinning risk management processes for the 2011/2012 period.

the Assurance Framework and Risk Management processes and confirm that these processes were effective from an operational perspective. The auditors also assessed if the Board was fulfilling its responsibility to ensure there is an effective system of internal control in place. Owing to significant changes in some areas due to clustering the auditors did not rely on their previous work to give assurance that risk management processes were effective. Following the audit South Coast Audit was able to provide significant assurance that there are effective systems of internal control, including the Board Assurance Framework and underpinning risk management processes in place. The audit did not identify any significant issues and made only minor recommendations relating to the reporting of the progress made against action plans. Other reviews include our information governance toolkit assessment verified by internal audit, clinical audits and “deep dives” carried out by the Director of Nursing and Quality. Reliance upon these indicators has been placed during the reporting period.

Significant Issues There are no significant issues to disclose. My review confirms that the PCT has a generally sound system of internal control that supports the achievement of its policies, aims and objectives. Ann Sutton Chief Executive

The approach taken by the auditors was to complete a high level assessment of the controls and processes that inform

NHS Medway – Annual Report 2011/12

Statement of Comprehensive Net Expenditure for year ended 31 March 2012

2011/12 2010/11 (restated) £000 £000

Administration Costs and Programme Expenditure

Auditor’s Report Independent Auditor’s Report to the directors of NHS Medway. We have examined the summary financial statement for the year ended 31 March 2012 which comprises the Statement of Comprehensive Net Expenditure, the Statement of Financial Position, the Statement of Changes in Taxpayers Equity, the Statement of Cash Flows, Better Payment Practice Code and Auditor remuneration. This report is made solely to the Board of Directors of Medway PCT in accordance with Part II of the Audit Commission Act 1998 and for no other purpose, as set out in paragraph 45 of the Statement of Responsibilities of Auditors and Audited Bodies published by the Audit Commission in March 2010.

Respective responsibilities of directors and auditor The directors are responsible for preparing the Annual Report. Our responsibility is to report to you our opinion on the consistency of the summary financial statement 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 report if we become aware of any apparent misstatements or material inconsistencies with the summary financial statement. We conducted our work in accordance with Bulletin 2008/03 issued by the Auditing Practices Board. Our report on the statutory financial statements describes the basis of our opinion on those financial statements.

NHS Medway – Annual Report 2011/12

Opinion In our opinion the summary financial statement is consistent with the statutory financial statements of Medway PCT for the year ended 31 March 2012. We have not considered the effects of any events between the date on which we signed our report on the statutory financial statements (8 June 2012) and the date of this statement. Robert Grant for and on behalf of PKF (UK) LLP London, UK 18 July 2012

Employee benefits Other costs Income Net operating costs before interest

11,686 55,088 466,868 426,472 (34,324) (39,105) 444,230 442,455

Investment income Other (gains)/losses Finance costs Net operating costs for the financial year of which:

(82) (90) 16 0 1,741 1,556 445,905 443,921

Of which: Administration costs Gross employee benefits Other costs Income Net administration costs before interest

4,933 6,061 (260) 10,734

Investment income Other (gains)/losses Finance costs Net administration costs for the financial year

0 0 0 10,734

Programme Expenditure Gross employee benefits Other costs Income Net programme expenditure costs for the financial year

6,753 460,807 (34,064) 433,496

Investment income Other (gains)/losses Finance costs Net programme expenditure costs for the financial year

(82) 16 1,741 435,171

Within these figures, expenditures have been funded by non recurrent revenue allocations of £330,000 (Administration. £103,000, Programme £230,000) received from the Department of Health within the year relating to deployment within the Health Economy of 2 per cent ‘Top Slice’ funding.

NHS Medway – Annual Report 2011/12

Other comprehensive net expenditure Impairments and reversals put to the Revaluation Reserve Net (gain)/loss on re\aluation of property, plant & equipment Net (gain)/loss on re\aluation of intangibles Net (gain)/loss on re\aluation of financial assets Net (gain)/loss on other reserves Net (gain)/loss on available for sale financial assets Net actuarial (gain)/loss on pension schemes Reclassification adjustment on disposal of available for sale financial assets Total comprehensive net expenditure for the year

Statement of financial position at 31 March 2012

31 March 2012 31 March 2011 Merger 31 March 2011 31 March 2010 restated Adjustments (restated) (restated) £000 £000 £000 £000 £000 Non-current assets: Property, plant and equipment 45,536 47,985 0 47,985 42,943 Intangible assets 185 261 0 261 369 Other financial assets 628 630 0 630 633 Trade and other receivables 1,142 1,096 0 1,096 2,460 Total non-current assets 47,491 49,972 0 49,972 46,405 Current assets: Inventories 0 0 0 0 0 Trade and other receivables 5,641 10,318 0 10,318 11,626 Other financial assets 0 0 0 0 0 Other current assets 0 0 0 0 0 Cash and cash equivalents 81 58 0 58 0 Total current assets 5, 722 10, 376 0 10, 376 11, 626

247 78 (1,636) (1,945) 0 0 0 0 0 0 0 0 0 0 0 0 444,516 442,054

Staff Sickness absence and ill health retirements

Non-current assets held for sale 2011-12 2010-11 Number Number Total current assets Total Days Lost Total Staff Years Average working Days Lost

11,080 1,280 8.66

12,892 1,335 9.66

Total assets

680 6,402 53,893

0 0 0 135 10,376 60,348

0 10,376 11,761 0 60,348 58,166

Current liabilities Trade and other payables (30,568) (30,603) 0 (30,603) (28,039) Other liabilities 0 0 0 0 (85) 2011-12 2010-11 Provisions (514) (657) 0 (657) (890) Number Number Borrowings (629) (573) 0 (573) (459) Number of persons retired early on ill health grounds 1 3 Other financial liabilities 0 0 0 0 0 Total current liabilities (31,711) (31,833) 0 (31,833) (29,473) £000s £000s Non-current assets plus/less net Total additional pensions liabilities accrued in the year 74 156 current assets/liabilities 22,182 28,515 0 28,515 28,693

Non-current liabilities Trade and other payables (1,142) (1,096) 0 (1,096) (2,460) Other liabilities 0 0 0 0 0 Provisions (1,615) (1,721) 0 (1,721) (1,981) Borrowings (19,278) (19,907) 0 (19,907) (16,247) Other financial liabilities 0 0 0 0 0 Total non-current liabilities (22,035) (22,724) 0 (22,724) (20,688)

Total Assets Employed: 147 5,791 0 5,791 8,005 Financed by: taxpayers’ equity General fund (9,758) (3,141) 0 (3,141) 622 Revaluation reserve 9,905 8,932 0 8,932 7,383 Other reserves 0 0 0 0 0 Total Taxpayers’ Equity: 147 5,791 0 5,791 8,005

NHS Medway – Annual Report 2011/12

Statement of changes in taxpayers’ equity

Statement of cash flows For the year ended 31 March 2012

For the year ended 31 March 2012

General fund

Revaluation reserve

Other reserves

Total reserves

£000

(3, 141) 0 0 (3, 141)

8,932 0 0 8,932

0 0 0 0

5,791 0 0 5,791

0 1,636 0 0 0 (247) 0 (416) 0 0 0

0 0 0 0 0 0 0 0 0 0 0

(445,905) 1,636 0 0 0 (247) 0 0 0 0 0

0 973 0 9,905

0 0 0 (444,516) 0 438,872 0 147

Balance at 1 April 2011 Opening balance adjustments Merger adjustments Restated balance at 1 April 2011

Changes in taxpayers' equity for 2011-12 Net operating cost for the year (445,905) Net gain/(loss) on revaluation of property, plant, equipment 0 Net gain/(loss) on revaluation of intangible assets 0 Net gain/(loss) on revaluation of financial assets 0 Net gain/(loss) on revaluation of assets held for sale 0 Impairments and reversals 0 Movements in other reserves 0 Transfers between reserves* 416 Release of reserves to Statement of Comprehensive Net Expenditure 0 Transfers to/(from) other bodies within the group 0 Reclassification adjustment on disposal of available for sale 0 financial assets Net actuarial gain/(loss) on pensions 0 Total recognised income and expense for 2011-12 (445,489) Net Parliamentary funding 438,872 Balance at 31 March 2012 (9, 758)

*including transfers from the revaluation reserve to the general 0 0 0 0 fund in respect of impairments as follows: Changes in taxpayers' equity for 2010-11 Restated balance at 1 April 2010 622 7,383 0 8,005 Net operating cost for the year (443,921) 0 0 (443,921) Net gain/(loss) on revaluation of property, plant, equipment 0 1,945 0 1,945 Net gain/(loss) on revaluation of intangible assets 0 0 0 0 Net gain/(loss) on revaluation of financial assets 0 0 0 0 Net gain/(loss) on revaluation of assets held for sale 0 0 0 0 Impairments and reversals 0 (78) 0 (78) Movements in other reserves 0 0 0 0 Transfers between reserves 318 (318) 0 0 Release of Reserves to Statement of Comprehensive Net Expenditure 0 0 0 0 Transfers to/(from) other bodies within the group 1 0 0 1 Reclassification adjustment on disposal of available for sale financial 0 0 0 0 assets Net actuarial gain/(loss) on pensions 0 0 0 0 Total recognised income and expense for 2010-11 (443,602) 1,549 0 (442,053) Net Parliamentary funding 439,839 0 0 439,839 Balance at 31 March 2011 (3,141) 8,932 0 5,791 *including transfers from the revaluation reserve to the 0 0 general fund in respect of impairments as follows:

NHS Medway – Annual Report 2011/12

Cash Flows from Operating Activities Net Operating Cost Before Interest Depreciation and Amortisation Impairments and Reversals Other Gains I (Losses) on foreign exchange Donated Assets received credited to revenue but non-cash Government Granted Assets received credited to revenue but non-cash Interest Paid Release of PFI/deferred credit (lncrease)/Decrease in Inventories (lncrease)/Decrease in Trade and Other Receivables (lncrease)/Decrease in Other Current Assets lncrease/(Decrease) in Trade and Other Payables (lncrease)/Decrease in Other Current Liabilities Provisions Utilised lncrease/(Decrease) in Provisions Net Cash lnflow/(Outflow) from Operating Activities Cash flows from investing activities Interest Received (Payments) for Property, Plant and Equipment (Payments) for Intangible Assets (Payments) for Other Financial Assets (Payments) for Financial Assets (LIFT) Proceeds of disposal of assets held for sale (PPE) Proceeds of disposal of assets held for sale (Intangible) Proceeds from Disposal of Other Financial Assets Proceeds from the disposal of Financial Assets (LIFT) Loans Made in Respect of LIFT Loans Repaid in Respect of LIFT Rental Revenue Net Cash lnflow/(Outflow) from Investing Activities Net cash inflow/(outflow) before financing

2011-12 £000

2010-11 (restated) £000

(444,230) (442,455) 3,324 3,094 869 0 0 0 0 0 0 0 (1,650) (1,508) 0 0 0 0 4,608 2,672 0 0 43 1,515 0 (85) (341) (661) 1 120 (437,376) (437,308) 82 90 (1,484) (1,999) (8) (134) 0 0 0 0 509 410 0 0 0 0 2 3 0 0 0 0 0 0 (899) (1,630) (438,275)

(438,938)

Cash flows from financing activities Capital Element of Payments in Respect of Finance Leases and On-SoFP PFI and LIFT (574) (839) Net Parliamentary Funding 438,872 439,839 Capital Receipts Surrendered 0 0 Capital grants and other capital receipts 0 0 Cash Transferred (to)/from Other NHS Bodies 0 0 Net Cash lnflow/(Outflow) from Financing Activities 438,298 439,000 Net increase/(decrease) in cash and cash equivalents

Cash and Cash Equivalents (and Bank Overdraft) at Beginning of the Period 58 (4) Opening balance adjustment- TCS transactions 0 0 Restated Cash and Cash Equivalents (and Bank Overdraft) at Beginning of the Period 58 (4) Effect of Exchange Rate Changes in the Balance of Cash Held in Foreign Currencies 0 0 Cash and Cash Equivalents (and Bank Overdraft) at year end 81 58

NHS Medway – Annual Report 2011/12

Salaries and Allowances

A. Net Cost to NHS Medway (Where posts are shared with other PCTs, only the share relevant to Medway PCT is shown below) Benefits in kind relate to the amount paid by the PCT in respect of expenses claims, which is in excess of the amount nationally agreed by the Inland Revenue. Remuneration waived by directors and allowances paid in lieu. £5 - 10,000 (2010-11, £5 - £10,000) remuneration was waived by 1 (2010-11, 1) director. £0 (2010-11, £0) of allowances were paid in lieu to 0 (2010-11, 0) directors. Colin Tomson Denise Harker

Cluster Chairman Chairman Non Executive Director Non Executive Director Non Executive Director Non Executive Director Non Executive Director Non Executive Director Non Executive Director Non Executive Director Non Executive Director Non Executive Director Non Executive Director * Non Executive Director * Non Executive Director * Non Executive Director * Non Executive Director *

2011-12 Contract of service

01.06.11 01.01.10 01.04.10 01.03.10 01.04.10 11.01.12 11.01.12 11.01.12 11.01.12 11.01.12 17.02.03 01.04.10 01.04.10 01.10.06 01.10.06 01.10.06 17.02.03

Date of Leaving

31.05.11

Graham Mayes David Mayes Saba Sadiq 05.10.11 Adrian Hosford Mike Cosgrove Dr Harshad Topiwala Jill Ruddock David Lewis Trevor Cooper Gillian Wells Jackie Bell Dominic Carter Helen Carter Deborah Charnock Rosanne Corben * Not a Non Executive Director of NHS Medway, but held a non executive directorship in one of the Kent and Medway PCTs. Ann Sutton Chief Executive 01.04.11 Helen Buckingham Deputy Chief Executive and Director of Whole Systems 01.03.09 Commissioning Dr Alison Barnett Director of Public Health 03.03.08 Wendy Head Director of OD and Workforce Planning 02.11.09 31.05.11 Dr Peter Green Medical Director (Quality Assurance, Information Inteligence and 13.10.03 Technology) Dr Robert Stewart Medical Director and Director of Clinical Commissioning 01.06.11 Dr James Thallon Medical Director (Primary care) 01.06.11 Jonathan Bates Director of Financial Stewardship and Governance 13.11.06 Bill Jones Director of Financial Performance and Contracting 19.09.11 Rod Smith Director of Financial Strategy and Planning 19.09.11 Daryl Robertson Director of Performance and Assurance 01.06.11 Hazel Carpenter Director of Commissioning Development and Workforce 01.04.11 Sarah Andrews Director of Nursing and Quality 01.04.11 Stephanie Hood * Director of Citizen Engagement and Communications 21.07.11 12.08.11 Jude Mackenzie Director of Citizen Engagement and Communications 05.10.11 * On secondment from South East Coast SHA Band of Highest Paid Director's Total Remuneration (£'000) Median Total £ Remuneration Ratio

NHS Medway – Annual Report 2011/12

2010-11 Salary (bands of £5,000)

Other remuneration (bands of £5,000)

Bonus Payments (bands of £5,000)

Benefits in kind (rounded to the nearest £100)

Salary (bands of £5,000)

Other remuneration (bands of £5,000)

Bonus Payments (bands of £5,000)

Benefits in kind (rounded to the nearest £100)

£000

£00

£000

£00

5 - 10 5 - 10 0-5 0-5 0 0-5 0-5 0-5 0-5 0-5 5 - 10 5 - 10 0-5 0-5 0-5 0-5 0-5

20 - 25

30 - 35 10 - 15 5 - 10 0 5 - 10 5 - 10 -

1 1 1 1 1

15 - 20

100 - 105

135 - 140 10 - 15

4 1

135 - 140 85 - 90

10 - 15

0-5

100 - 105

20 - 25 15 - 20 15 - 20 15 - 20 15 - 20 15 - 20 15 - 20 15 - 20

0-5

0 1 0 -

90 - 95 -

5 - 10 135 - 140 £22,676 6.06

0-5

0-5 -

135 - 140 £21,798 6.31

NHS Medway – Annual Report 2011/12

Salaries and Allowances B. Gross Cost of posts. Where posts are shared with other PCTs, the full cost of the post is shown below. No posts were shared in 2010/11.

2011-12 Posts are shared NHS Eastern and Coastal Kent 46.24 per cent, NHS Medway 15.86 per cent and NHS West Kent 37.90 per cent

Colin Tomson

Contract of service

Date of Leaving

Chairman 01.06.11 Graham Mayes Non Executive Director 01.04.10 David Mayes Non Executive Director 01.03.10 Saba Sadiq Non Executive Director 01.04.10 05.10.11 Adrian Hosford Non Executive Director 11.01.12 Mike Cosgrove Non Executive Director 11.01.12 Dr Harshad Topiwala Non Executive Director 11.01.12 Jill Ruddock Non Executive Director 11.01.12 David Lewis Non Executive Director 11.01.12 Trevor Cooper Non Executive Director 17.02.03 Gillian Wells Non Executive Director 01.04.10 Jackie Bell Non Executive Director * 01.04.10 Dominic Carter Non Executive Director * 01.10.06 Helen Carter Non Executive Director * 01.10.06 Deborah Charnock Non Executive Director * 01.10.06 Rosanne Corben Non Executive Director * 17.02.03 * Not a Non Executive Director of NHS Medway, but held a non executive directorship in one of the Kent and Medway PCTs. Ann Sutton Chief Executive 01.04.11 Helen Buckingham Deputy Chief Executive and Director of Whole Systems 01.03.09 Commissioning Dr Peter Green Medical Director (Quality Assurance, Information Inteligence and 13.10.03 Technology) Dr Robert Stewart Medical Director and Director of Clinical Commissioning 01.06.11 Dr James Thallon Medical Director (Primary care) 01.06.11 Jonathan Bates Director of Financial Stewardship and Governance 13.11.06 Bill Jones Director of Financial Performance and Contracting 19.09.11 Rod Smith Director of Financial Strategy and Planning 19.09.11 Daryl Robertson Director of Performance and Assurance 01.06.11 Hazel Carpenter Director of Commissioning Development and Workforce 01.04.11 Sarah Andrews Director of Nursing and Quality 01.04.11 Stephanie Hood * Director of Citizen Engagement and Communications 21.07.11 12.08.11 Jude Mackenzie Director of Citizen Engagement and Communications 05.10.11 * On secondment from South East Coast SHA Band of Highest Paid Director's Total Remuneration (£'000)

NHS Medway – Annual Report 2011/12

2010-11 Salary (bands of £5,000)

Other remuneration (bands of £5,000)

Bonus Payments (bands of £5,000)

Benefits in kind (rounded to the nearest £100)

Salary (bands of £5,000)

£000

£00

£000

£00

10 - 15 5 - 10 0 -

5 1 3

145 - 150

3 5

5 - 10 5 - 10 -

100 - 105

90 - 95

10 - 15

100 - 105

130 - 135 105 - 110 95 - 100 95 - 100 110 - 115 110 - 115

10 - 15

95 - 100 95 - 100

0-5

12 1

60 - 65

40 - 45 10 - 15 5 - 10 0 5 - 10 5 - 10 10 - 15 5 - 10 10 - 15 5 - 10 5 - 10 5 - 10 5 - 10 5 - 10 5 - 10 5 - 10

135 - 140

5 - 10

0 1 6 4 1 2 1

14 4 0

90 - 95

Benefits in kind Other remuneration Bonus Payments (rounded to the (bands of £5,000) (bands of £5,000) nearest £100)

135 - 140

NHS Medway – Annual Report 2011/12

C. 2011/12 Pension Benefits

Real increase in pension at age 60 (bands of £2,500)

Ann Sutton Helen Buckingham

Chief Executive Deputy Chief Executive and Director of Whole Systems Commissioning Dr Alison Barnett Director of Public Health Wendy Head * Director of OD and Workforce Planning Jonathan Bates Director of Financial Stewardship and Governance Bill Jones Director of Financial Performance and Contracting Rod Smith Director of Financial Strategy and Planning Daryl Robertson Director of Performance and Assurance Hazel Carpenter Director of Commissioning Development and Workforce Sarah Andrews Director of Nursing and Quality Jude Mackenzie * Director of Citizen Engagement and Communications * Wendy Head and Jude Mackenzie are not members of the NHS Pension Scheme

Real increase in lump Sum at 60 (bands of £2,500)

0 - 2.5 0 - 2.5 (0 - 2.5)

2.5 - 5 2.5 - 5 (0 - 2.5)

0 - 2.5 (0 - 2.5) 0 - 2.5 0 - 2.5 2.5 - 5 2.5 - 5

0 - 2.5 (5 - 7.5) 0 - 2.5 2.5 - 5 10 - 12.5 7.5 - 10

Total accrued pension at age 60 at 31 March 2012 (bands of £5,000)

60 - 65 25 - 30 35 - 40 20 - 25 20 - 25 35 - 40 35 - 40 25 - 30 30 - 35

Lump sum at age 60 related to accrued pension at 31 March 2012 (bands of £5,000)

Cash Equivalent Transfer Value at 31 March 2012

Cash Equivalent Transfer Value at 31 March 2011

Real increase in Cash Equivalent Transfer Value

Employer’s contribution to stakeholder pension (rounded to nearest £00)

£000

180 - 185 75 - 80 105 - 110 60 - 65 60 - 65 105 - 110 115 - 120 75 - 80 90 - 95

1,203 352 662 383 464 655 773 377 -

1,076 267 601 332 481 567 685 254 -

93 77 42 41 -32 71 66 115 -

As Non-Executive members do not receive pensionable remuneration, there are no entries in respect of pensions for Non-Executive members.

Cash Equivalent Transfer Values A 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 members’ 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 benefit accrued in their former scheme. The pension figures shown relate to the benefits that the individual has

NHS Medway – Annual Report 2011/12

accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies. The CETV figure, and from 2004-05 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 of pension service in the scheme at their own cost. CETVs are calculated

Real Increase in CETV within the guidelines and framework prescribed by the Institute and Faculty of Actuaries.

This reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation and contributions paid by the employee (including the value of any benefits

transferred from another scheme or arrangement). The CETV at 31 March 2012 has been calculated using the most recent (November 2011) actuarial factors produced by the Government Actuary’s Department. This is a

departure from the NHS Manual for Accounts, which requires common market valuation factors to be used for the start and end of the period.

Policy on the Remuneration of Senior Managers The VSM Pay Framework introduces new arrangements that were implemented in 06/07. The total reward package for very senior managers includes:

ÆÆ Additional payments where appropriate

ÆÆ Basic Pay: A spot rate for the post

ÆÆ No performanace bonuses were given to Exceutive Directors in the last financial year.

ÆÆ An Annual performance bonus scheme

All Senior Managers are on permanent contracts and the notice periods do not exceed six months.

NHS Medway – Annual Report 2011/12

D. Reporting of other compensation schemes - exit packages

Exit package cost band (including any special payment element)

*Cost of compulsory redundancies

Number of other departures agreed

Cost of other departures agreed

Total number of exit packages

Total cost of exit packages

Number of departures where special payments have been made

Cost of special payment element included in exit packages

Number

£000s

Number

£000s

Number

£000s

Number

£000s

0 0 0 0 0 0 0 0.00

0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0.00

0 0 0 0 0 0 0 0

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0.00

0 0 0 0 0 0 0 0

*Cost of compulsory redundancies

Number of other departures agreed

Cost of other departures agreed

Total number of exit packages

Total cost of exit packages

Number of departures where special payments have been made

Cost of special payment element included in exit packages

Number

£000s

Number

£000s

Number

£000s

Number

£000s

5 5 1 3 1 0 0 15.00

28 84 27 203 132 0 0 474

0 0 0 1 0 0 0 1.00

0 0 0 62 0 0 0 62

5.00 5.00 1.00 4.00 1.00 0.00 0.00 16.00

28 84 27 265 132 0 0 536

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0 0 0 0 0 0 0 0

*Number of compulsory redundancies

Less than £10,000 £10,001 - £25,000 £25,001 - £50,000 £50,001 - £100,000 £100,001 - £150,000 £150,001 - £200,000 >£200,000 Total

Reporting of other compensation schemes - exit packages 2010-11 - Revised Banding

Exit package cost band (including any special payment element)

*Number of compulsory redundancies

Less than £10,000 £10,001 - £25,000 £25,001 - £50,000 £50,001 - £100,000 £100,001 - £150,000 £150,001 - £200,000 >£200,000 Total

* This note provides an analysis of Exit Packages agreed during the year

NHS Medway – Annual Report 2011/12

NHS Medway Fifty Pembroke Court Chatham Maritime Chatham Kent ME4 4EL Tel: 01634 335020 Email: itsyournhsmedway@nhs.net Web: www.medwaypct.nhs.uk Designed by NHS Kent and Medway Communications Team

NHS Medway â&#x20AC;&#x201C; Annual Report 2011/12