23053 Annual Report - County Durham and Darlington · 2010. 12. 8. · Annual Report and Summary...

3Annual Report and Summary Financial Statements 1 April 2007 - 31 March 2008

Annual Report and Accounts 1 April 2007 - 31 March 2008Presented to Parliament pursuant to Schedule 7,Paragraph 25(4) of the National Health Service Act 2006.

Welcome to the Trust’sannual report for 2007/08.

Our first full year as a Foundation Trustwas a successful one for the Trust.

Waiting times continued to reduce in2007/08. At 31 March the Trust hadexceeded national targets for referral totreatment within 18 weeks. 92% of Trustpatients were admitted within 18 weeks,against a target of 85% and 93% of nonadmitted patients began their treatmentwithin 18 weeks, against a target of 90%.The challenge now is to ensure that thisposition is sustained, and improved upon,throughout 2008/09.

The Trust also ended the year in a strongfinancial position, achieving a surplus of£7.9 million. This is excellent news, as itgives us the financial headroom to invest indeveloping our services.

We improved our performance on hospitalacquired infection and, although with 21cases of MRSA we did not meet our year

end target of 15, this position represents areduction of two thirds compared to theprevious year. Our performance in terms ofcases per 10,000 bed days was also good.The challenge now is to make an impact onthe number of community acquired cases,identified on admission, which make uparound half of the Trust’s cases. In addition,we reduced the impact of ClostridiumDifficile, with the number of cases wellbelow profile.

We are very conscious of the importance ofthese issues, not least to our patients andthe confidence they have in our services.Management of MRSA remains particularlychallenging for the organisation, especiallyas the numbers of cases are small inabsolute terms. Nevertheless, one avoidablecase is a case too many, and the Boardcontinues to pay close attention to thisissue.

In November, we welcomed Stephen Eamesas our new Chief Executive. Stephen has 16years experience as a Chief Executive in arange of NHS organisations. He joined us

4 Annual Report and Summary Financial Statements 1 April 2007 - 31 March 2008

Chairman

Tony WaitesChairman

“Our first full year as aFoundation Trust was asuccessful one for the Trust.”

from Mid-Cheshire Hospitals NHS Trust,which he had successfully led and which wasthe most improved Trust nationally in theHealthcare Commission Annual Healthcheckfor 2006/07.

Stephen has energised the Trust, leading theorganisation into a review of its servicesentitled “Seizing the Future”, to develop acompelling clinical vision for theorganisation and a strategic direction forthe next five years. Work on this importantproject will continue throughout the rest of2008/09.

Within a short period Stephen has alsoinitiated steps to ensure strong andeffective clinical engagement and leadershipwithin the Trust and its management.

I must pay tribute to Louise Robson, ourActing Chief Executive for the six monthsprior to Stephen’s arrival. Louise led theTrust in an exemplary fashion through a keytransitional period. We wish her well in hernew role as Chief Operating Officer forSouth of Tyne PCTs.

In July, the Governors appointed Ian Robsonas Non Executive Director. Dr Robson hasbeen a director of sales, marketing andbusiness development with a background inhealthcare, utilities and environmentalservices. Most recently, he was businessdevelopment director at CELS (Centre ofExcellence for Life Sciences Ltd). Hisexperience has made him a valuableaddition to the Board.

The Governing Council has played anincreasingly important and influential rolein the organisation. During the year therewere 35 meetings of the Council and itscommittees. The Council was closelyinvolved in the appointment of the ChiefExecutive, one Governor sitting on theinterview panel. The Council reappointedone Non Executive Director, Kathryn Larkin-Bramley, and selected one new NonExecutive Director, Dr Ian Robson, andformally appraised my performance asChairman. The Governors’ StrategyCommittee has been closely involved in theannual plan process, and their ClinicalGovernance Committee played a part in theAnnual Health Check declaration.

Our Governors are embedded in the“Seizing the Future” review, representing FTmembers and service users, challenging theclinical experts, leading the programme inthe community and ensuring that serviceoptions are grounded in a high qualitypatient experience.

The Governors are also involved in thegrowth and development of our publicmembership. This stood at 3,360 at the endof the year, and we are committed tofurther growth this year. If you are not amember and would like information onhow to join, this can be found on page 54.

In summary, a successful but verychallenging year. My thanks to the Trust’sdedicated staff who made the successes andmet the challenges.

Tony WaitesChairman


I was delighted to join County Durham andDarlington Foundation Trust as its ChiefExecutive in November 2007.

Over its first five years, this has been aconsistently high performing and successfulorganisation, delivering against targets forshorter waits, twice a three star trust,delivering its financial duties despite hugefinancial challenges and the need to makesavings – while also managing a big changeagenda across its sites.

Thanks for this must go to our frontlinestaff for their hard work and commitment,and to the management team. Particularcredit is due to John Saxby, the Trust’s ChiefExecutive throughout that period for hisleadership during a time of significantchange.

I would also like to thank Louise Robson,who performed the difficult role of ActingChief Executive for six months betweenJohn’s departure and my arrival, for doingso with distinction.

It is now time for the Trust to look aheadto the next five years, to consider thechallenges it faces in the future, in achanging environment.

With waits down to 18 weeks referral totreatment, we now need to focus on thequality of service we provide. This willincreasingly be the determining factor inattracting patients and maintaining thestability and growth of our services. We also need to consider our role inhealthcare locally – are we to remain apredominantly acute provider at a timewhen the market for these services isshrinking, or do we look to offer moreservices outside of hospital and closer toour patients’ homes?

There are also some clinical challenges weneed to address within our organisation,including maximising the use of BishopAuckland General Hospital, the pressuresarising from maintaining three emergencyadmitting centres, and the provision ofchildren’s services on three sites.


ChiefExecutive

Stephen EamesChief Executive

“It is now time for theTrust to look ahead tothe next five years.”

This is why we have begun a major reviewof our services, entitled “Seizing theFuture”.

This is a clinically led review – which meansthat it is about delivering the best servicespossible for the benefit of our patients, ledby our senior doctors, nurses and otherhealthcare staff, involving our Governorsand members as representatives of thepopulations we serve, and finding the rightsolutions for our own particularcircumstances – a five site Trust serving alarge and widespread urban and ruralpopulation.

The “Seizing the Future” review must alsobe seen in the context of our strategicchallenges:-

Sustaining and strengthening our positionas the local provider of choice in the face ofcompetition from other local trusts. Thismeans maintaining and, where possible,building up our presence in thecommunities we serve.

Transforming ourselves from beingrecognised as solely a provider of acute careto being recognised as the provider ofhealthcare to our local communities. Thismeans delivering more services outsidehospital and developing new models ofcare for rural populations.

Collaborating with commissioners,especially GPs and developing carepathways that provide continuity of carefor patients and shift our resources intonew community settings.

Pursuing strategic alliances by retaining ourmembership in wider clinical networks. Thismeans continued co-operation with tertiarycentres to preserve and develop clinicalpathways that improve the experience ofpatients. We should also take opportunitiesto repatriate work from tertiary centreswhere it makes sense in terms of localaccess, patient care and safety.

Harnessing the potential of new andexisting technology to provide swift,convenient access to care and services.

This is in the context of an area wherehealth inequalities are some of the mosttesting in the country with high rates ofsmoking, high teenage pregnancy rates,obesity, alcohol abuse and heart diseaseand where there are significant numbers ofpeople with long–term illness.

Finally, as one of the largest NHSFoundation Trusts in the country, we needto place ourselves in the vanguard ofchange and demonstrate that we cancompete with the best on a national basis.This means working diligently to build ourreputation locally, regionally and nationallyand, wherever possible, promote ourservices and our achievements vigorously.

Following discussions with the Chairmanand members of the Board, and withcolleagues in the organisation, I haveagreed with the Chairman my interimstrategic objectives:


• Deliver and where possible exceed allagreed targets for 2007/8 & 2008/9 –towards which we have made excellentprogress this year

• Establish a robust strategic direction2008-2013 – through Seizing the Future

• Build purposeful external partnerships –within the health and social carecommunity, local strategic partnerships,and increasingly playing our part in thenational picture, for example in thewider Foundation Trust movement

• Improve quality of services – building onour portfolio of nationally recognisedand award winning services, and ourposition in the CHKS top 40 trusts

• Ensure long term financial stability –so that we can invest in the developmentof our services and our facilities

Our aspiration is to be the best FoundationTrust in the country. By delivering theseobjectives I believe we can move closer tothat goal.

Stephen EamesChief Executive


“Are we to remain a predominantly acuteprovider at a time when the market forthese services is shrinking, or do we lookto offer more services outside of hospitaland closer to our patients’ homes?”

County Durham and Darlington AcuteHospitals NHS Trust was established on1 October 2002.

This was the result of a merger of the twopredecessor organisations, North DurhamHealth Care NHS Trust and South DurhamHealth Care NHS Trust, following an acuteservices review.

On 1 February 2007, the Trust wasauthorised as a Foundation Trust, underSection 6 of the Health and Social Care(Community Health and Standards) Act2003.

The Trust provides secondary care hospitalservices from three main sites:

• Bishop Auckland General Hospital

• Darlington Memorial Hospital

• University Hospital of North Durham

The Trust also runs community hospitals inShotley Bridge and Chester-le-Street andprovides outpatient, community andoutreach services from several other sites.

The Trust has around 4,700 whole timeequivalent staff and 1,200 beds. It providessecondary care district general hospitalservices to a population of around 500,000in County Durham and Darlington, and intoNorth Yorkshire, with sub-regional servicesreaching into the South of Tyne area,serving a population of 1.2m.

The Trust provides services to thepopulations of the Primary Care Trusts(PCTs) in County Durham and Darlingtonand also to other PCTs outside the patch.


About the Trust

2007/08 was a successful year for the Trustwhich saw us build upon achievement ofFoundation Status from 1 February 2007.

Particular highlights were the achievementof a significant financial surplus anddelivery of the March 2008 national accessmilestones towards the 18 week referral totreatment (RTT) target, while still providinghigh quality clinical services.

Operational performance

2007/08 was an excellent year inperformance terms, with the Trustachieving all of its main performancetargets, with the exception of numbers ofcases of MRSA.

The national waiting times targets that theTrust had to achieve in 2007/08 were:

• 26 week wait for inpatients – to beachieved throughout 2007/08;

• 13 week wait for outpatients – to beachieved throughout 2007/08;

• 6 week wait for diagnostic tests – to beachieved by 31 March 2008;

• 85% of admitted patient pathways tobe completed within 18 weeks (referralto treatment or RTT) – to be achievedfor the month of March 2008;

• 90% of non-admitted patient pathwaysto be completed within 18 weeks(referral to treatment or RTT) – to beachieved for the month of March 2008.


Directors’ Reportand Operating andFinancial Review


As at the end of March 2008, theTrust’s performance against theseindicators was:

• no breaches of the 26 week inpatienttarget;

• no breaches of the 13 week outpatienttarget;

• 15 patients were waiting more than6 weeks for diagnostic tests (13 inradiology and 2 in audiology). Althoughwe did not achieve this target, thisrepresents a massive improvement in ayear, as in April 2007 there were 4,548patients in audiology alone waitinglonger than 6 weeks;

• 92.6% of admitted patient pathwayswere completed within 18 weeks, whichis above the national target of 85%;

• 92.9% of non-admitted patient pathwayswere completed within 18 weeks, whichwas above the national target of 90%.

During March, the Trust achieved for thefirst time the March 2008 national targetthat 100% of patients should be offered anappointment to be seen in a genitourinarymedicine clinic within 48 hours. This is asignificant achievement, and reflects acombination of hard work by the teamcoupled with investment in additionalcapacity

Cancer performance as at the endof March 2008 was as follows:

• 100% of patients waited less than14 days for a first outpatientappointment following urgent GPreferral with suspected cancer, comparedto a national target of 100%;

• 100% of patients were treated within31 days of diagnosis, compared to anational target of 98%;

• 100% of patients were treated within62 days of urgent GP referral comparedto a national target of 95%.

“Particular highlights were theachievement of a significant financialsurplus and delivery of the March 2008national access milestones towards the18 week referral to treatment target.”

Coronary heart disease performance as atthe end of March 2008 was as follows:

• 100% of eligible patients were seenin a rapid access chest pain clinic within2 weeks of GP referral, compared to anational target of 100%;

• 57.1% of eligible patients receivedthrombolysis treatment within60 minutes of calling for help(call-to- needle), against a nationaltarget of 69%;

• But 100% of patients receivedthrombolysis treatment within30 needle), against a national target of 75%.

Healthcare acquired infection remains achallenge for the Trust and is a key risk area.

The Director of Nursing is leading aprogramme of work to tackle MRSA andClostridium Difficile and provides detailedreports to the Trust Board.

Although the Trust reduced the numberof MRSA bacteraemias cases by two thirds,with 21 cases we did not achieve our targetmaximum number of cases of 15.

The Trust was also required to reduceClostridium Difficile infections to amaximum locally agreed target of 444 forthe whole of 2007/08. During 2007/08 therewere 316 infections, significantly below thetarget number.

The Trust is striving to drive downMRSA numbers, and to ensure measurespreviously agreed with the Strategic HealthAuthority and Department of HealthRecovery Support Unit are rigorouslyfollowed by all clinical departments. We arealso working with the Primary Care Truststo address the pressure resulting fromcommunity acquired MRSA infection whichis already present on admission to hospital,but which is still included in the Trust’sfigures. Of the 21 cases of MRSA recordedin 2007/08, 9 of these were on admission.


“The Director of Nursing is leading aprogramme of work to tackle MRSA andClostridium Difficile and provides detailedreports to the Trust Board.”

Action taken to reduce the impact ofhealthcare acquired infection includes:

• Replacement of all mattresses andcommodes

• Establishing a central equipment loanlibrary, alongside an equipmentdecontamination unit

• IV teams established on all sites tomanage the risk associated withintravenous infusions

• Standardising all IV pumps

• Reviewing staffing on wards

• Introducing additional matrons

• Auditing practice using high impactinterventions

• Screening of high risk patients inorthopaedics, vascular, intensive care andhigh dependency admissions, patientsfrom nursing homes and with carepackages in the community

• Taking part in the national “Clean yourhands” campaign and the NHS NorthEast “Scrub up well” campaign

• Introducing a “bare below the elbows”policy for all clinical staff when in contactwith patients

The Board’s concern around healthcareacquired infection is such that we havedeclared, in signing off our annual plan,that we cannot ensure compliance with therelevant targets in 2007/08.

Performance risks

Early performance in 2008/09 suggests thathealthcare acquired infection will remainthe Trust’s biggest single challenge this year.We need to work with our partners to makean impact on the number of communityacquired cases, identified on admission,which make up around half of the Trust’scases.

The other area where performance hasbeen below expectations is in relation tothe call-to-needle target for administeringthrombolysis to heart attack patients. Thishas been due to the challenges in gettingpatients from rural areas to hospital withinthe 30 minute call-to-door standard.Progress has been made in 2007/08including remote telemetry which allowsambulance crews to communicate with theTrust’s cardiology department en-route tohospital. From May 2008 thrombolysis willbe superseded as best practice treatment byprimary angioplasty (PPCI) which can onlybe performed at the major tertiary centresat Middlesbrough and Newcastle.

Although the Trust’s performance inrelation to 18 week RTT performanceresulted in us achieving the March 2008milestones, the challenge now is to ensurethat this performance is sustainable on amonth by month basis.


Financial Performance

The Trust faced a challenging financialagenda in 2007/08, which demandeddecisive and active management. The Boardagreed a range of measures to reduce costs,improve efficiency and maximise income.

These measures, in conjunction with arange of non-recurring financial benefits,have enabled the Trust to deliver a largerthan planned surplus of £7.9 million whilesuccessfully delivering a cost improvementtarget of £16.1 million.

This increased our ability to invest inservices and the Board was able to bringforward planned investment of up to £1mto improve the patient and workingenvironment before the end of the year.This included new beds and mattresses,new staff uniforms and refurbishment workto improve the main entrance and A&E atDMH and the entrance at UHND to improvethe environment and the welcome patientsreceive on entering the hospitals.

However, the outlook for 2008/09 willcontinue to be challenging. The Trustremains above national reference costs(2006/07) which indicates that furtherefficiencies can be made, but we will lose afurther £5 million of payment by resultstransitional relief. This is in addition to the3% cash releasing efficiency gain requiredthrough the PBR tariff.

The Board has identified measures toachieve further cost efficiencies this year, sothat we can continue to generate thesurpluses we need to reinvest in ourservices. This will be particularly importantover the next few years. The Darlington

Memorial Hospital site will requiresignificant investment in its infrastructureso that it remains fit for purpose for thenext thirty years. We expect that we willalso need to invest capital in our sites todeliver the clinical outcomes of Seizing theFuture.

Summary Performance

The Trust delivered a strong financialperformance during 2007-08 ending theyear with a surplus of £7.9 million, havingsecured cost improvements during the yearof some £16 million. Underlyingperformance was even stronger as the £7.9million surplus was net of exceptional itemsand fixed asset impairments totaling £7.5million.

We continue to focus on improving ourfinancial health through an emphasis onproductivity and cost control. In particular,the service line management work that weundertook in conjunction with Monitor hasenabled us to realise improvements in bothclinical and financial health. In 2008-09 wewill also be concentrating on productivity inoutpatient areas.

In accordance with the previously agreedstrategy for rationalising and improving ourestate, we saw the sale of three premises in2007-08 realising cash receipts in excess of£5m. This cash, in part, has enabled us toagree a number of significant capitalinvestments which we will make over thenext five years, relating to both upgradesof our facilities and the introduction of newtechnology.


The Trust has maintained its liquidity at 42days worth of expenditure during the year,without needing to use its working capitalfacility. It is anticipated that some of thisliquidity will also be used to support themajor capital investment referred to above.

Of the Trust’s healthcare related income of£271.8 million, only £191 thousand wasincome received from providing healthcareto private patients, well below themaximum level of private patient incomethat we are permitted to receive under ourFoundation Trust authorisation.

The Trust’s non healthcare income of £29.8million related to funding received foreducation and training (£8.1million) and forservices the Trust provides to other bodies(£19.3 million).

The Trust revalued its assets as at 1st April2008 and reflected these values in itsbalance sheet as at 31st March 2008, inaccordance with standard accountingpractice. Impairments of £7.3m arose fromthese revaluations and were chargedagainst the Income and Expenditureaccount.

A review of accounting policies resulted inno significant changes during the year.

In 2008-09 the Trust again faces achallenging financial agenda, particularly ascompetition in the healthcare sectorincreases as a result of free choice andturbulence in world commodity markets,particularly oil, causes upward inflationarypressure on the medical supplies we buy.

More detailed information on key aspectsof the Trust’s financial performance isdetailed below.

Going Concern

After making enquiries, the Directors havea reasonable expectation that the NHSFoundation Trust has adequate resources tocontinue in operational existence for theforeseeable future. For this reason, theycontinue to adopt the going concern basisin preparing the accounts.

Director’s Declaration

So far as the Directors are aware, there isno relevant audit information of which theauditors are unaware and the Directorshave taken all steps that they ought to asDirectors in order to make themselvesaware of any relevant information and toensure the auditors were aware of thatinformation.


“The DarlingtonMemorial Hospitalsite will requiresignificant investmentin its infrastructure.”

Key Performance Targets

The Trust achieved its main financial targets for the year to 31st March 2008. The targetsand actual performance are as follows:

EBITDA Margin

Definition : The Net Earnings before Interest, Taxation and Dividends shownas a percentage of total income.

Purpose : This measures the underlying performance of the Trust

Source of data : Trust audited annual financial statements

Target: 4.5%

Result : 9.1%

Return on Assets

Definition : The Trust’s annual dividend payments should provide a 3.5% return on average net assets.

Purpose : A measure of Financial Efficiency

Source of data: Trust audited annual financial statements

Target : 3.5%

Result : 3.0%

Income and Expenditure Surplus Margin

Definition : Net Surplus shown as a percentage of total income.

Purpose : To ensure that the Trust has generated a continued surplus


Target : 0.04%

Result : 2.6%


Liquid Ratio

Definition : Cash plus Trade Debtors plus Unused Working Capital Facility minus (Trade Creditors plus Other Creditors) expressed in the number of days’ operating expenses that could be covered.

Purpose : To ensure that the Trust maintains a healthy liquidity position.


Target : 35 days to qualify for a 5 rating

Result : 66 days

Prudential Borrowing Limit

Definition : A limit to the amount of borrowings that the Trust may take on, setfor each NHS Foundation Trust by the independent regulator guidedby the Prudential Borrowing code.

Purpose : Used to protect the public interest and the financial stability ofindividual NHS Foundation trusts.


Target : Borrowings less than £58m

Result : Borrowings were £nil

Private Patient Cap

Definition : The level of Private Patient income is capped at the level(as a percentage of total patient income) as that in the financial year2002-2003.

Purpose: To ensure that the Trust continues to focus on NHS work.

Source of Data : Trust audited annual financial statements

Target: < 0.23%

Actual: 0.07%


Public Sector Payment Policy

Non NHS Payments

Definition : Unless other terms are agreed, the Trust is required to pay its nonNHS creditors within 30 days of the receipt of goods, or a validinvoice, whichever is the later.

Purpose: To ensure that the Trust complies with the Better Payment PracticeCode.

Source of Data: Trust Audited Financial Statements

Target: 95%

Result by number: 98.5%

Result by value: 97.4%

The Trust achieved this target for non NHS invoices.

A detailed breakdown of the figures is shown below:

Non NHS Trade Creditors Number £000

Total bills paid in the year to 31st March 2008 85,806 87,886

Total bills paid within target 84,553 85,591

Percentage of bills paid within target 98.54% 97.39%


NHS Payments

Definition : Unless other terms are agreed, the Trust is required to pay its NHScreditors within 30 days of the receipt of goods, or a valid invoice,whichever is the later.

Purpose: To ensure that the Trust complies with the Better Payment PracticeCode.

Source of Data: Trust Audited Financial Statements

Target: 95%

Result by number: 94.8%

Result by value: 97.6%

The Trust achieved this target for NHS invoices by number and narrowly failed by value.The relatively low numbers of invoices mean that a single large value invoice paid late canhave a material impact on the results.

A detailed breakdown of the figures is shown below:

NHS Creditors Number £000

Total bills paid in the year to 31st March 2008 3,108 33,339

Total bills paid within target 2,945 32,535

Percentage of bills paid within target 94.77% 97.59%

Late Payment Interest

Legislation is in force which requires Trust’s to pay interest to small companies if paymentis not made within 30 days (Late payment of Commercial Debts (Interest) Act 1998). TheTrusts performance against this criteria is:

Amounts included within Interest Payable arising from claims £000

made by businesses under this legislation 0


ServiceDevelopmentsThere were a number of developmentsduring 2007/08, improving the range andquality of the services we provide.

Bowel Screening - From October 2007the Bishop Auckland site became the basefor a bowel screening service serving thepopulation of County Durham andDarlington, as part of Wave 2 of thenational programme. The new service willhelp detect bowel cancer at an early stagewhen treatment is likely to be moreeffective. Over the next two years, over61,000 men and women aged between60 and 69 will be invited for screening,which they can carry out at home. If furthertests are required, these will then takeplace in Bishop Auckland Hospital.

UHND stroke unit - The Trust has openeda dedicated stroke unit at UHND, providing20 beds solely for the care of strokepatients, offering specialist care to patientsacross the north of the county, andcomplementing the unit that exists inBishop Auckland Hospital. The new hyper-acute unit includes the latest physiologicalmonitoring equipment allowing staff tomonitor patients 24 hours a day, includingthe first critical hours following stroke. Theunit will soon launch a “clot busting”thrombolysis service for appropriate patientswho are admitted within two hours of astroke which reduces long term disability.

Admission on the day of surgery -A pilot scheme was established in GeneralSurgery whereby surgeons admit clinicallyappropriate patients on the day of surgeryto a central admissions area rather thanadmitting them onto a main ward the daybefore surgery. Benefits for patients arethey can stay at home the night beforesurgery, attend one central admission point,and staff on the main wards can dedicatemore time to ‘unwell’ post operativepatients. There are also efficiency benefitsin terms of reduced cancellations andlengths of stay.

Trustwide services - As part of the legacyof our history as separate organisations,there are still services which have beenprovided on one site only, or where, onother sites, these services have beenprovided by other trusts. During the year,we expanded our ENT service, historicallya “South Durham” service to includeUniversity Hospital of North Durham. TheTrust’s ENT service now runs alongside thatprovided by City Hospitals Sunderland NHSFoundation Trust. While dermatology hasbeen one of the Trust’s jewels in the crownin North Durham, as one of our subregional services, until this year, it wasprovided in Darlington by South Tees Trust.This year, the North Durham service hasbeen expanded into Darlington MemorialHospital for the first time.


Immunology service - A 12 month pilotwas established in November 2007 todeliver an outpatient allergy immunologyservice at University of North DurhamHospital. The specialist service handles awide range of allergies and immunologyconditions from initial investigationthrough to treatment and ongoingmanagement of patients. A patient surveyreturned a very high satisfaction ratefollowing the first six months of this servicewith 80% of patients being assessed,diagnosed and managed in one visit. Theservice also provides patients with a greaterchoice for locally based treatment and carehaving only previously been available acrossthe whole of the north east in Newcastle.Having established demand, the team isnow working on ways to take the serviceforward including exploring networkoptions with Newcastle.

Ophthalmology wet AMD (Lucentis) -A new service was developed to deliverLucentis - a new treatment for an eyecondition known as wet age-relatedmacular degeneration or wet AMD. AMDcauses progressive loss of central vision inolder people and is the most common causeof blindness in the UK. There are currentlyaround 258,000 people in the UK with wetAMD and about 26,000 new cases eachyear. Initially, this care was offered topatients who only had vision remaining inone eye, however the service continues toexpand as further protocol is developedand care is now also being delivered forfirst eye treatments.

Physiotherapy - The Trust successfullynegotiated a contract to provide amusculoskeletal physiotherapy service toDarlington Borough Council. This hasincluded the development of a dedicatedphysiotherapy service for Council employeeswhich provides benefits and care for staffwith standard response to the Council’sOccupational Health referral within fivedays.

Cardiology - During the year, the Trustestablished a new direct access diagnosticservice for GPs covering echocardiography,palpitations and arrhythmias. This meansthat patients can have be referred for testswithout having a consultant appointmentfirst, improving access and reducing waitingtimes.

Radiology services - During the year,investment has been agreed to deliver theTrust’s radiology strategy. This includesmodernising our laboratories andintroducing a new IT system which willoffer an improved and more responsiveservice for patients and staff includingswifter reporting of test results.


“From October 2007the Bishop Auckland sitebecame the base for abowel screening service.”

Recognitionfor our servicesPutting the patient at the centre ofeverything we do is absolutely core to ourbusiness. During 2007/08 we have beenrecognised for the high standard of ourservices and for improving the patientexperience.

CHKS 40 Top Hospitals - The Trustreceived a highly commended award at theCHKS 40 Top Hospitals Awards. The Trustwas one of six organisations internationallyto be shortlisted for the QualityImprovement Award, which recognisessignificant improvements to patient careand experience. The Trust was named oneof the 40 Top Hospitals for the first timesince it was established in 2002.

HQS accreditation - Following a 20 monthassessment process culminating in on siteservice reviews by a team of peer reviewersand external observers the Trust becamethe first NHS organisation in England to beawarded full Health Quality Service (HQS)Accreditation since more rigorous standardswere produced.

Accreditation is valid for three years andwill run until January 2010. As part of theaward process the Trust will be visited inJune 2008 to ensure we are continuing tomeet the standards.

HQS is a charitable non-profit makingorganisation that assists health care providersto assess themselves against quality-focusedstandards that reflect national health carestandards and initiatives.

The key to the assessment programme isbeing able to show that our patients are atthe centre of care provision and that theTrust can demonstrate we have patientfocussed systems in place that are supportedby up to date and effective evidence basedpolicies, procedures and guidelines.

Recognition for Maternity Services -The Healthcare Commission's 'Review ofMaternity Services 2007' rated the Trust’smaternity care “best performing”.

The review looked at 25 different areas ofcare including women's views on cleanlinessof delivery and postnatal areas, choice inlabour, staffing levels and the quality ofsupport in caring for babies after discharge.These were then grouped under threethemes - clinical focus, women centred careand efficiency and capability. The Trustreceived a rating of 'excellent' in each ofthe three themes covered.

Across the region, the Trust received thehighest score for delivering women centredcare and was ranked third overall out ofthe eight hospital trusts providingmaternity care in the North East.

The top rating complements the CharterMark which was awarded to the MaternityService this year. Charter Mark is theGovernment’s national standard forexcellence and Maternity Services wentthrough detailed assessments beforegaining the status. The award is made allthe more impressive as it covers all four ofthe Trust’s main sites and means there isquality of care throughout the county.


Procurement Charter Mark - The CountyDurham Procurement Consortium, hosted bythe Trust, also achieved Charter Mark statusduring the year, the first department of itskind to receive the plaudit. The Consortiumhas helped the Trust, and other local NHSorganisations, achieve significant financialsavings and efficiencies since it wasestablished in 2000. The assessment teamcommented that it was ‘evident that there isa genuine commitment to customer care andcontinuous improvement’.

Pharmaceutical Care Awards - The Trustwon two awards at the Pharmaceutical CareAwards. The Pharmacy won an award forthe MERIT project which aims to reducemedication errors when patients transferbetween care settings and which hasreduced medication errors following hospitaldischarge from 72% to 2%. The palliativecare team won an award for a toolkit forclinicians, produced with Macmillan, to helpreduce the impact of cachexia (weight loss)among cancer patients.

Cancer peer reviews - The Trust hasreceived excellent reviews for our cancerservices with visits by the National CancerPeer Team in late 2007 and early 2008. Thereviewers were particularly impressed withthe Trust's achievement against the nationalcancer waiting times targets andcommitment to service improvement tobenefit the patient experience. In additionthey highlighted strong clinical leadershipand patient centred cancer services withgood practice commended specifically forthe Durham cachexia toolkit (which haswon a national pharmaceutical award), theseamless tracking of patients through theirpathways, a dedicated head and neck lumpclinic, robust internal referral processes andthe pharmacy led oncology clinic project.

Anita Roddick Award - the Hepatitis CService received the inaugural ‘AnitaRoddick Award’ for best practice in HepatitisC, for joint work between the HealthProtection Agency, the Trust and the PCT.

Bright Ideas in Health - Two of the Trust’sintensive care nurses, Pat Hogg and BarbaraJameson, received second prize in the BrightIdeas in Health Awards for an improvedcannula dressing which allows a line to beclearly identifiable and secure, whileallowing the inspection and assessment ofthe site which is vital for infection control.

Arthritis Award - Lynda Gettings, a clinicalnurse specialist in rheumatology received a‘Patients in Focus Award’ from the NationalRheumatoid Arthritis Society for her work oncognitive behaviour therapy as a psycho-social treatment for rheumatoid arthritis.

Hospital Chefs of the Year - Two hospitalchefs, Carolyn Marshall and Jill McLean fromDarlington Memorial Hospital, wereawarded the Gold Award First in Class andthe Hospital Caterers’ Association HospitalChefs of the Year 2008.

ISO 9001:2000 - Facilities achieved the ISO9001:2000 quality standard in Housekeeping/ Catering / Portering & Domestic Servicesdepartments, and maintained the standardin Clinical Engineering / Capital Projects /Sterile Services and Estates departments.Facilities are now looking to achieve thestandard across all of their services. TheSterile Services Department at UHNDachieved Medical Device Compliance in theSterile Services Department, which hasalready been achieved at DarlingtonMemorial Hospital.


Seizing the FutureLooking forward to the next five years, theTrust must ensure that it responds to keynational policies aimed at driving upstandards such as increased choice,competition between providers, the newpayment regime, reduced waiting timesand lengths of stay.

Crucially, the Trust needs to consider thefuture shape of services in the light of:

• Our NHS, Our Future - Lord Darzi’snational review of the NHS

• The NHS North East vision for localimplementation, published on 22 May 2008

• PCT commissioning intentions, includingthe implications of world classcommissioning for improved standards

In December 2007, the Chief Executivelaunched “Seizing the Future”, a majorclinical service review to develop ourstrategic direction for the next five years.

Seizing the Future includes:

• an examination of current services,including addressing some pressingclinical issues such as maximising theusage of BAGH, the pressures arisingfrom maintaining three emergencyadmitting centres, and the provision ofchildren’s services on three sites

• an assessment of how our services adhereto best practice in clinical outcomes

• a review of achievement of nationalstandards across all services thedevelopment of future service options

Seizing the Future is a clinically led process,with support from our elected Governors toimprove services for patients.

The Trust completed a scoping study inJanuary 2008, and since then, four servicestrategy groups, led by clinicians andsupported by the public elected Governors,have been working through future serviceoptions which will meet national standardsand best practice.

The four service strategy groups are:

• Medicine

• Surgery

• Women and Children

• Diagnostics and Clinical Support

The service strategy groups include doctors,nurses and other clinical staff, and alsoinclude elected Governor representativesfrom the Governing Council.

The Trust expects formal consultation onproposals to begin later in the year.


“Seizing the Futureis a clinically ledprocess, with supportfrom our electedGovernors to improveservices for patients.”

Patient and PublicInvolvement

It is the Trust’s policy to involve users in thedevelopment and improvement of services.The Trust’s patient and public involvementmanager supports staff in the organisationof surveys, focus groups and other PPIactivities. The Trust carries out around 60separate exercises each year.

The Trust has recently introduced newmenu cards at Darlington MemorialHospital which incorporate a patientsatisfaction questionnaire. This provides“real time” information on the patientexperience, allowing a more rapid responseto patients’ issues. The menu cards are nowto be rolled out Trust wide.

Patient Councils - The Trust has twopatient councils, members of which aredrawn from PPI forums and other voluntaryorganisations. The councils are active inmany areas of the Trust’s work, for examplethey participate in patient environmentaction team visits.

PPI Forum - The Trust continued to workclosely with the PPI Forum during its finalyear. The Forum continued its interest instroke services, holding two conferences onthe subject which stimulated interest anddebate amongst staff, service users andcarers, the voluntary sector and overviewand scrutiny. We look forward to buildinga similarly successful relationship with thenew Local Involvement Networks (LINks).

National Inpatient Survey - The Trustperformed well in the 2007 HealthcareCommission Acute Inpatient Survey. 47% ofthose surveyed felt the overall care theyhad received from the Trust was ‘excellent’with a further 35% rating it ‘very good’.

The Trust was in the top 20% (Green) forover half the questions answered byrespondents, and received no scores withinthe worst 20% (Red) of hospitals.

The Trust scored particularly well on privacy,with 93% of patients being admitted tosingle sex accommodation. Otherimprovements since the 2006 survey includepatients having quicker access to a bedonce admitted, choice of admission dates,help eating meals and being offered achoice of food.

We are pleased with the results of thesurvey which have provided valuablefeedback and we are now working ondetailed action plans to enable us tocontinue making improvements.

Consultation - Although the Trust wasnot involved in any formal consultationprocesses this year, we continued to buildon our relationships with the healthscrutiny committees at Durham CountyCouncil and Darlington Borough Council.We are keeping both committees wellbriefed about the Seizing the Futurereview.


Complaints - The Trust received 483formal complaints during the year. Thisis a relatively low figure compared to thenumber of patients seen and treated andthe many thousands of marks ofappreciation received in the formof letters, cards and small gifts.

All but one complaint was respondedto within the required 25 working daytimescale, making the Trust’s performance99.2% against a national average of80-85%.

The Trust prides itself on learning frompatient experiences and a number ofchanges have been made as a directresult of complaints. These include:

• Increased hours for breastfeedingco-ordinators who focus on helpingnew mothers and their babies developbreastfeeding techniques, whilst stillin hospital. They also train midwiferycolleagues so that they can also assistnew parents.

• Additional capacity in the hearing aidclinics to reduce the waiting times forpatients in need of digital hearing aids.

• Improved communication with patientsattending some of the Trust's one-stopclinics regarding their appointments.

• One stop clinics offer patients a chanceto be seen by several specialists involvedin the management of their conditionand also the chance to undergo anumber of investigations, all at thesame appointment.


“We continued to build on ourrelationships with the health scrutinycommittees at Durham County Counciland Darlington Borough Council.“

Workforce

Over the last year the Trust workforce hascontinued to reduce in line with ourworkforce strategy, and the proportion offixed term employees has increased toallow flexibility and increase protection ofour long term skilled employees duringtime of change. Overall our workforcereduced by 4?%, with substantiveemployees reducing by 7%. Sicknessabsence rates remain contained below theNHS average with absence averaging 4.16%during the year, and ending the year at 4%.

Equal opportunities - We are committedto equality of opportunity for all patientsand staff, and for everyone who hasinvolvement with the Trust. Wecontinue to have a positive and proactiveapproach to the employment and retentionof disabled employees and meet the fivecommitments of the disability symbolincluding interviewing all prospectivedisabled employees meeting the minimumcriteria for any post, and working with alldisabled employees to develop and usetheir abilities for our mutual benefit.

Under the Equality Act, all publicauthorities are obliged to eliminateunlawful discrimination and harassmentwith regard to gender and promoteequality. This applies to employees andpatients. The Trust has a Disability EqualityScheme, Race Equality Scheme, and GenderEquality Scheme which have been publishedand following wide consultation hasrecently finalised a Single Equality Schemewhich enabled us to set out our equality ofopportunity approach in one cleardocument. This is now published on theTrust’s internet site.

Staff Survey Results - The results of theannual NHS Staff Survey were published bythe HealthCare Commission in April. Resultsof the staff survey feed into the annualHealthcare Commission health check.

For the most part this year’s results arebroadly comparable to previous years. Thesurvey results reflect the position of theTrust in October 2007 and 850 staff wererandomly sampled, the response rate being46% against a national average responserate of 54%.

• The Trust was in the highest 20%,compared to other acute Trusts inEngland for staff reporting errors, nearmisses or incidents (97% up from 89%)and for the availability of hand washingmaterials

• Staff experiencing work related stress hasreduced (30% down from 34%)

• A slight reduction in the number ofstaff experiencing physical violence frompatients and relatives in the previous12 months (12% down from 13% theprevious year)

• A slight reduction in the number of staffexperiencing bullying or harassment orabuse from other staff (20% down from21%)

• A slight reduction in staff using flexibleworking options (69% down from 71%)

• An increase in staff having health andsafety training in the previous 12 months(79% up from 77%)


Model Employer Group - The Trust strivesto be a good place to work and is flexiblein its approach to supporting employeeswho want to balance the demands offamily and work life. The Trust has a modelemployer group which leads on issuesaround improving the working lives ofstaff. The group will analyse the results ofthe staff survey and identify key areas ofaction. The group also supports otherinitiatives for staff. For example, during theyear, the Trust launched a new voucherscheme to help reduce the cost of childcarefor parents, offering them savings worthhundreds of pounds a year.

Communications and consultation -Within the Trust we operate a variety ofnegotiation, consultation, and informationstrategies. Information is circulatedthrough the Trust Newsletter, summaries ofissues discussed at the Trust ExecutiveDirector Group and regular email Bulletins.Team Briefing operates after each TrustBoard commencing with a specific Heads ofDepartment briefing on the morning aftereach Board meeting. Involvement and

consultation with employees overall isundertaken through these and open staffmeetings, and staff representatives areincluded within formal meetings of theJoint Consultative Committees and TrustMedical Negotiating Committees. Toenhance involvement and communicationstaff representatives are included inworking groups determining Truststrategies and policies, for example thetheatre strategy group and hospitalchanges group.

Lead Employer Trust and NorthernDeanery - From early 2007 the Trust hasbeen the Lead Employer Trust (LET) withresponsibility for the employment of 2,000doctors in training in hospitals and thecommunity across the north east ofEngland. In August 2007 the Trust alsobecame the employer of the NorthernDeanery staff who are responsible for theorganisation and delivery of thatpostgraduate training to doctors anddentists.


“The Trust held its fifth annual staff awardsin November 2007. The event celebrates theachievements of staff and promoteslearning and professional development.”

Training and Development - Trainingand development of staff is key toensuring the Trust meets its strategic aimsand objectives. Influences shaping the stafftraining agenda included patient safety,modernising medical and nursing careers,assessment and accreditation requirementssuch as the Healthcare Commissionstandards, legislation including the Freedomof Information and Health and Safety Actsand profession specific development toensure staff are fit to practise.

Staff awards - The Trust held its fifthannual staff awards in November 2007.The event celebrates the achievementsof staff and promotes learning andprofessional development.

• Deborah Grimes, sister in thechemotherapy unit at UHND waspresented with the “making you feelbetter” award. Deborah was nominatedby patients and relatives for her workwith cancer patients.

• Joan James, cancer specialist nursereceived the award for “Delivery of aFirst Class Service”. The chemotherapyunit at University Hospital of NorthDurham is to be renamed in Joan’shonour, following her retirement. Sadly,Joan died before this could take place.

• Karen Pearson, medical secretaryreceived the “Above and Beyond theCall of Duty Award” for her support tochildren with diabetes and their families.

• Joy Standley and Pauline Mole, sisterson ward 13 at UHND, were awardedfor streamlining the handover processbetween shifts and the contribution thishas made to Improving Patient Safety.

• The “Chairman’s Quality Award” waswon by the Durham Cachexia Team.Their work has also been recognisednationally in the Pharmaceutical CareAwards, earlier this year.

• The “Service Modernisation Award” waswon by the Termination of PregnancyTeam.

• The “Chief Executive’s Team Award” waswon by the National Care Record ServiceProject Team.

Congratulations to the individuals andteams for their achievements.


Management andorganisational development

Clinical divisional structure

The successful management of the Trustdepends on a close partnership betweenmanagers and clinical staff. In March, theBoard agreed changes to its managementarrangements for clinical services tostrengthen and empower clinical leadershipand engagement and increase clinicalrepresentation in the Trust ExecutiveDirectors Group.

Four clinical divisions replace the previousclinical directorate structure as follows:

• Medicine and Emergency Care

• Surgery

• Women and Children

• Clinical and Diagnostic support

Each of these divisions will be led by aDivisional Clinical Director, supported by aDivisional Manager and a Divisional SeniorNurse.

The Divisional Clinical Directors will bemembers of the Executive Team, and willbe part of the weekly Executive Directors’meeting.

Service Line Management (SLM)

The Trust is one of eight sites nationallypiloting service line management. SLM isabout creating effective self-governingunits within the hospital to allow cliniciansand managers the autonomy, accountabilityand capabilities to deliver improvements in

quality and productivity in each specialty.During 2007/08, General Surgery was asuccessful SLM pilot specialty within theTrust and we are now looking to roll outthe approach across the organisation fromthe summer of 2008.

Innovation

The Trust believes innovation is central todelivering success through Seizing theFuture and clinical excellence. In December,the Trust held an innovation day, at whichclinicians presented their ideas fordeveloping new services, and improving theefficiency and effectiveness of existingservices. The day was successful andenergised the Trust and stimulated ideasand discussion amongst clinicians andmanagers. As a consequence, the Trust hasidentified a £2 million innovation fund forinvestment in initiatives during 2008/09,and will be repeating the event later thisyear.

Research and Development

Research and Development is a key growtharea for the Trust, which has a strong trackrecord of clinical research and innovation.In the 2007/8 year the Trust has supported151 active research projects, of which 40 areown-account, 100 non-commercial multi-centre trials, and 11 commerciallysponsored clinical trials. In the last year218 patients have been recruited to NIHR(National Institute of Health Research)approved clinical trials, considerably higherthan other local Trusts of similar size.

Clinicians from the Trust have beensuccessful at bringing in external grantfunding of over £1 million from NIHR


funding sources, including the HealthTechnology Assessment Programme;Research for Patient Benefit; and approvedcharities. The own-account research has ledto a number of high quality peer reviewpublications, together with numerousabstracts and conference presentations.Two doctoral degrees have been awardedin the last year.

Examples of nationally acclaimed workinclude the palliative care team’s work oncancer cachexia which won the NationalCare Award by the Royal PharmaceuticalSociety. Other innovators within the Trusthave filed patents of their innovations,and one of these recently won a BrightIdeas award.

The Trust has a very active R&D committeewhich encourages and monitors research.Small grants are offered bi-annually.Processes of research governance are wellestablished, including a research reviewboard which carefully assesses all projectsproposed.

The Trust has embraced its membership ofthe Durham and Tees Comprehensive LocalResearch Network and is working closelywith local organisations to enhance clinicalresearch activity. This work includes leadroles for specialty network groups inGastroenterology and Dermatology. Topic-specific networks of stroke and diabetesare also well represented within the Trust.Partnerships are also being activelyencouraged with Durham University andthe Durham Medical School, and there arealready a number of fruitful collaborations.


“The successful management of theTrust depends on a close partnershipbetween managers and clinical staff.”

NHS partners - We have close workingrelationships with County Durham andDarlington PCTs as our main commissioners.Changes are taking place in the PCTs asCounty Durham takes the lead oncommissioning across the area andDarlington becomes the provider PCT. Werecently held a Board to Board meetingwith Darlington PCT to examine theimplications and opportunities this changepresents for our two organisations.

With fewer PCTs, we have been able tofocus more on our relationships withindividual GP practices. In the last year,members of the Executive Team offeredvisits to local practices. We were able tohave very helpful discussions about theirperception of the Trust and its services, forwhich we are grateful.

We also work closely with the local mentalhealth trust, Tees Esk and Wear ValleysTrust and the North East AmbulanceService where a continuing priority is theachievement of the 60 minute door-to-needle target for administeringthrombolysis.

Although a foundation trust is notperformance managed by its local SHA,NHS North East remains a key stakeholderin terms of wider NHS strategic concerns.

Our other key stakeholders are the localauthorities, in particular Durham CountyCouncil and Darlington Borough Council,where we work with social services, andhave joint child protection arrangements.


UHND BAGH CLSH

Operator Consort Criterion Robertson Health

Capital Value £114m £49m £10m

Financial Close March 1998 May 1999 May 2002

Operational Date April 2001 June 2002 October 2003

Termination Date March 2028 June 2032 May 2032

Unitary Fee 2006/07 £15.0m £9.6m £1.9m

Indexation Various RPI RPI

Partners and stakeholders

PFI contracts - Three of our hospitals, and the support services within those properties,have been provided under PFI agreements. The arrangements for each site wereindependently negotiated by predecessor organisations with separate PFI consortia andeach is managed and maintained in accordance with the requirements of its own ProjectAgreement.

Our role in the community

One of the Trust’s key aims is to improvethe health and well being of local peopleand to be a major contributor to thesuccess of the local economy.

Around 200 of our staff are involved in anambassadors’ scheme and visit local schoolsto talk to students about working in theNHS, training and qualifications.

The William Harvey Project aims to link thethree hospitals of County Durham andDarlington with eight schools to supportyoung people in realising their potentialand encouraging them to consider thetypes of interesting careers available tothose who have science qualifications,including and especially medicine. Theproject was funded initially for 2 years bytwo charities, the Sutton Trust and theOgden Trust. They have not worked withthe NHS before but are very impressed bythe project’s potential and their intentionis that if the project is successful it will forma pilot for much wider dissemination androll-out.

In addition the Trust actively supportsstudents from local schools by providingquality work experience placements. Thereare a wide range of learning environmentsavailable to young people which cancontribute to them making informedchoices about working in the NHS. Teachersand School Career Advisors are also offeredinformation and advice through organisedevents to help them support students. TheTrust runs a programme entitled ‘I want tobe a doctor’ for young people aspiring togo to medical school and train to becomedoctors. Postgraduate students are alsowelcomed on work experience placementsas part of their college or university

programmes and the Trust also works witha number of organisations seeking torehabilitate adults back into the workforce,providing a limited number of placementsusually in the administration field.

Environment

It is the Trust’s policy to reduce its impacton the environment from its activities andprovide a sustainable environment for thefuture. Following a successful audit of ourenvironmental systems in 2006 where allhospital sites were assessed as performingat a ‘very good’ level, we have continuouslysought to improve this performance to thehighest tier.

As part of its policy objectives,opportunities are being developed toreduce our level of carbon emissions inline with current guidance and therecommendations made in the SternReview. In 2008, the Trust successfullyapplied to participate in the ‘CarbonManagement Programme’ facilitated bythe Carbon Trust. This programme providesa partnering agreement aimed at reducingthe levels of CO2 we generate from our

activities. This will include utilities, wasteand transport.

It is also planned to link with the LocalAuthority and integrate with theirSustainability agenda and the broadersustainable community objectives.

The Trust has a green travel plan. As partof this we ran a ‘Cycle to Work’ schemethrough which staff could lease a bicycle(for 1 year) and then purchase it at adiscount of up to 35%, as long as it wasused for part of their home to workjourney, to reduce impact on theenvironment.


The Board of Directors provides overallleadership and vision for the organisation,decides on its strategy and monitors theimplementation of the strategy. It decideshow the organisation develops its services,and its financial and workforce strategies.The Board ensures that clinical andcorporate governance standards are clearlyunderstood and are being put into practice.

The Board is ultimately and collectivelyresponsible for all aspects of the Trust’sperformance, including clinical and servicequality, financial performance,management and governance.

There is a balance of 5 Executive and 5independent Non Executive Directors onthe Board. The Board is chaired by the NonExecutive Chairman. The different roles ofthe Chief Executive and Chairman and ofthe Executive and Non Executive Directorsare recognised by the Board.

The Non Executive Directors have all beenappointed specifically for theirindependence, skills and experience, whichis outlined on p 36. They are responsible forscrutinising and challenging theperformance of the Trust’s executivemanagement in meeting agreed goals andobjectives. In doing so, they must alsosatisfy themselves as to the integrity offinancial, clinical and other information,and that financial and clinical qualitycontrols and systems of risk management inplace are robust and defensible. They are

also responsible for deciding appropriateremuneration for the Executive Directors.They have a prime role in successionplanning and in appointing and, ifappropriate, removing, the Trust’s ExecutiveDirectors.

Executive and Non Executive Directors arefull and equal members of the Board, andall Directors have joint responsibility forevery decision of the Board of Directorsregardless of their individual skills or status.

Operational decisions are delegated tomanagement by the Executive Directors,in the framework of the Trust's terms ofauthorisation, standing financialinstructions and schemes of delegationand decisions reserved to the Board.

Clinical Directorates provide leadershipand accountability at service level. EachDirectorate is managed by a ClinicalDirector, Clinical Service Manager andMatron who have responsibility forensuring the Directorate functionseffectively both as a service provider andas a business unit.

The Board has agreed changes toleadership arrangements and committeestructures in order to strengthen itsgovernance and clinical engagement andto ensure that we effectively address thechallenges and opportunities of thechanging policy environment for NHSFoundation Trusts.


Board of Directors

In January, the Board agreed revisedportfolios for Executive Directors, bringingtogether under a Director of Finance,Planning and Performance (Deputy ChiefExecutive) accountability for finance, IMTand information, performancemanagement systems and estates andfacilities, and establishing the role ofDirector of Operations and BusinessDevelopment.

Executive accountabilities for this new roleinclude:

• Development and delivery of operationalstrategy

• Access, Booking and Choice, 18 weeks

• Patient services, service development

• Workforce and workforce strategy

Some changes were also made to theportfolios of the Director of Nursing andMedical Director.

In March, the Board also agreed changes toits Committee structure. Four newcommittees (in addition to the AuditCommittee) are being established asfollows:

• Healthcare Governance Committee(replacing Clinical Governance and RiskManagement Committee) – chaired bythe Medical Director

• Business and Infrastructure Committee –chaired by the Director of Finance,Planning and Performance

• Market and Service DevelopmentCommittee – chaired by the Director ofOperations and Business Development

• Quality and Innovation Committee –chaired by the Director of Nursing

The Board committees exist to support theBoard in fulfilling its responsibilities forcorporate and clinical governance and giveassurance to the Board for its individualremit.

The Board operates in accordance with itsstanding orders and has agreed standingfinancial instructions, a scheme ofdelegation and a scheme of decisionsreserved to the Board.

The Board of Directors is accountable to theGoverning Council for its performance.Directors develop an understanding andknowledge of the views of governors andmembers by participating in GoverningCouncil meetings and seminars, and byattending relevant governing councilcommittees. The Board of Directors andGoverning Council also hold a joint meetingannually to support this process.

The Board evaluated collectiveperformance, and the performance ofthe Board Committees, at an away dayon 17 July 2007.

Non Executive Directors’ performanceappraisal was carried out by the Chairman,whose performance appraisal was carriedout by the Nominations Committee, and ledby the Senior Independent Director.

The performance of Executive Directors wascarried out by the Chief Executive, whoseperformance was appraised by the Chairman.


“The Board ofDirectors providesoverall leadershipand vision for theorganisation.”

Tony Waites, from Darlington, was appointed Non Executive Chairman ofCounty Durham and Darlington Acute Hospitals NHS Trust on 1 March 2006for a term of 4 years. In this role he chairs the Governing Council and the Boardof Directors and their respective Nominations and Remuneration Committees.He also chairs the Board of Directors Investment Committee. Mr Waites waspreviously chairman of County Durham and Tees Valley Strategic HealthAuthority, Tees Health Authority and Darlington Memorial NHS Trust. Duringhis career, he held a series of senior board level positions including chairman,managing director and finance director in the UK and abroad. He is also aJustice of the Peace and a member of the Tees Valley Partnership Board.

Declared interests: Trustee of Teesside Hospice Care Foundation and Director,Teesside Hospice Trading Company Ltd, Justice of the Peace.

Tony Wolfe is a retired deputy head teacher from Egglestone. He was aNon Executive Director of County Durham and Darlington Acute Hospitals NHSTrust and its predecessor Trust. He was reappointed for a term of 4 years from14 October 2006. Mr Wolfe is a member of the Trust Board’s Nominations,Remuneration, Investment and Clinical Governance Committees. He is appointedTrust Vice Chairman until 31 March 2009 and, in this role, is the chair of theGoverning Council’s Advisory Committee.

Declared interests: none.

Paul Stewart lives in Durham and is a commercial litigation partner in aNewcastle law firm. He was appointed as a Non Executive Director of CountyDurham and Darlington Acute Hospitals NHS Trust on 1 July 2006 for a termof 4 years. Mr Stewart is a member of the Board’s Nominations and AuditCommittees and is appointed Senior Independent Director until 31 March 2009.

Declared interests: Member of Grey College Senior Common Room, DurhamUniversity, Member of Dickinson Dees LLP.

Kathryn Larkin-Bramley, from Durham is a Fellow of the Institute of CharteredAccountants. She was appointed for a second term of office, for three years,with effect from 1 February 2008, by the Governing Council. Ms Larkin-Bramleyhas been appointed chair of the Board of Directors’ Audit Committee until31 March 2009 and is a member of the Risk Management and NominationsCommittees.

Declared interests: Lay Member of County Durham and Darlington ProbationBoard, Independent Member of Durham Police Authority, Trustee of Children’s’Cancer Fund, Lay Member of North East Children’s’ Malignant Disease Registry,Treasurer of Durham Forum for Health, Co-opted Member of Durham CountyCouncil Audit Committee (non-voting Member) and Consultant FoundationTrust Financing Facility.

Dr Michael Waterston lives in Durham, where he runs an IT consultancy. Hewas appointed as a Non Executive Director of County Durham and DarlingtonAcute Hospitals NHS Trust on 1 July 2006 for a term of 4 years. He is a memberof the Trust’s Audit, Remuneration, Nominations and Risk ManagementCommittees.

Declared interests: Managing Director, Waterstons Ltd, Director of DunelmCourt Ltd and Waterstons Ltd, IT Consulting Organisation – joint shareholdingwith Sally Waterston.


Dr Ian Robson, who lives in Gateshead, has been a director of sales, marketingand business development, most recently in healthcare, utilities andenvironmental services. He was appointed as a Non Executive Director of CountyDurham and Darlington NHS Foundation Trust on 1 June 2007 by the GoverningCouncil for a term of three years. He is a member of the Board of Directors’Remuneration and Nominations Committees.

Declared interests: Independent Consultant operating as ‘Ascendant’,considering equity in Winbus Ltd, Consultant for Specials Clinical Manufacturingand National Steering Group Member of Chemical and Biological WorkingGroup.

Stephen Eames became the Trust’s Chief Executive and Accounting Officer on26 November 2007. He has been an NHS Chief Executive for 16 years, mostrecently at Mid-Cheshire Hospitals NHS Trust.


John Saxby was the Trust’s Chief Executive and Accounting Officer until31 May 2007. Mr Saxby has worked in the NHS since 1974 and has been anNHS Chief Executive since 1994.

Declared interests: Governor of Darlington College of Technology, AuditSurveyor for Health Quality Service, Member of the Advisory Group to TheChildren’s Foundation (Charity), NHS Employer representative to the North EastReserve Forces Association and NHS Confederation Representative on NationalInstitute for Health and Clinical Excellence Interventional Procedures AdvisoryCommittee.

Louise Robson was the Trust’s Director of Planning and Performance until31 May 2007 and Acting Chief Executive from 4 June 2007 until 26 November2007. Ms Robson was appointed in 2003 and has previously held variouspositions at Board level for a number of major NHS organisations and at theDepartment of Health over the last ten years. Ms Robson left the Trust onsecondment in December 2007 and left the Trust permanently on 31 March 2008.


Robert Aitken is the Trust’s Medical Director. He is a consultant gynaecologistand obstetrician who has worked in the NHS since 1993. Mr Aitken waspreviously a medical officer with the Royal Army Medical Corps.


Sue Jacques is the Trust’s Deputy Chief Executive and Director of Finance,Planning and Performance. She is a Fellow of the Chartered Association ofCertified Accountants. Mrs Jacques has worked in the NHS since 1989 and hasbeen an NHS Finance Director for 7 years.


Laura Robson is the Trust’s Director of Nursing. She is a State Registered Nurseand State Certified Midwife. Miss Robson has been an NHS Director of Nursingfor 11 years.


Annual Report and Summary Financial Statements 1 April 2007 - 31 March 2008 37


Tony Waites

Tony Wolfe

Paul Stewart

Kathryn Larkin-Bramley

Michael Waterston

Ian Robson

Stephen Eames

John Saxby

Louise Robson

Robert Aitken

Laura Robson

Sue Jacques

25/0

4/0

7

30/0

5/0

7

08/0

6/0

7

27/0

6/0

7

25/0

7/0

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26/0

9/0

7

24/1

0/0

7

28/1

1/0

7

12/1

2/0

7

30/0

1/0

8

27/0

2/0

8

26/0

3/0

8

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The Board of Directors has a cycle of business and met formally on 12 occasions duringthe year.

Governors’ and Directors’ registers of interests

In performing their role, the Governors and Directors must act with integrity andobjectivity and in the best interests of the Trust. Governors and Directors must not usetheir position for personal advantage or seek to gain preferential treatment. Registersare kept to formally record the declared interests of Governors and Directors and areavailable to the public from the Trust’s website at www.cddft.nhs.uk or by requestfrom the Foundation Trust office at [email protected] or 01325 74 3625.

= not a Director at this time

The Trust Board had six committees duringthe year – Audit, Remuneration,Nominations, Investments, RiskManagement and Clinical Governance.

The Audit Committee was chaired byKathryn Larkin-Bramley, one of the NonExecutive Directors; other members were DrMichael Waterston and Paul Stewart. TheAudit Committee met seven times duringthe year on the following dates, with fullattendance on every occasion: 20 April2007; 22 May 2007; 8 June 2007(extraordinary meeting); 25 June 2007; 25September 2007; 23 November 2007; 25January 2008.

The Committee’s responsibilities include:

• review of assurance framework;

• review of annual financial statements;

• review of internal financial andmanagement reporting systems;

• annual review of statement on internalcontrol;

• annual review of standing orders,standing financial instructions andschemes of delegation and decision; and

• monitor internal and external audit workplans.

The Committee met following the year endto review the following before submissionto the Trust Board for approval:

• financial accounts and statements;

• statement of internal control; and

• annual health check declaration.

The Remuneration Committee met threetimes during the year to review the termsand conditions of employment of themembers of the executive team, assessperformance and recommend salarychanges.

The Remuneration Committee is chaired bythe Chairman, Tony Waites, and itsmembers are Tony Wolfe, MichaelWaterston and Ian Robson.

The Committee met on the following dates,with full attendance: 15 May 2007; 9 July2007; 13 November 2007.

It met jointly with the NominationsCommittee on 25 April 2007 with fullattendance and 30 January 2008 withapologies received from Mr Paul Stewart.

The Chief Executive also attendsRemuneration Committee meetings for thatpart of the meeting that concerns themembers of the executive team, but notwhere matters relate to the Chief Executivepost.

The Remuneration Committee annuallyreviews the salary of the members of theexecutive team. The Committee determinesthe salaries of the members of theexecutive team through the assessment ofcorporate performance, individual directorperformance, inflationary increasesawarded to other staff groups andbenchmark data. None of the remunerationis directly performance related.Performance of the Executive Directors isappraised by the Chief Executive, andperformance of the Chief Executive and theNon Executive Directors is appraised by theChairman. The Chairman’s performance isappraised by the Governing CouncilNominations Committee, with the supportof the Senior Executive Director.


The Committees of the Trust Board

The members of the executive team wereappointed on permanent contracts with anotice period of 6 months. The MedicalDirector is appointed for a term of fiveyears, which is due to expire 30 June 2012.There are no special contractualcompensation provisions attached to theearly termination of a member of theexecutive team’s contract of employment.

Early termination by reason of redundancyis subject to the normal provisions of theAgenda for Change: NHS Terms andConditions of Service Handbook (Section16): or, above the minimum retirement age,early termination by reason of redundancy‘in the interest of the efficiency of theservice’ is in accordance with the NHSPension Scheme.

Employees above the minimum retirementage who themselves request termination byreason of early retirement are subject tothe normal provisions of the NHS PensionScheme.

Details of the members of the ExecutiveTeam’s remuneration can be found onpages 70.

The Nominations Committee (of theBoard of Directors) is chaired by the TrustChairman, Mr Tony Waites and has amembership of all the Board’s NonExecutive Directors.

The Committee is responsible foridentifying and nominating suitablecandidates to fill executive directorvacancies as they arise. The Committeemembers and (except in the case of theappointment of a Chief Executive) the ChiefExecutive, are all then responsible formaking the decision on the appointment ofExecutive Directors, as required by thestatute.

The Trust Board’s Nominations Committeemet jointly with the RemunerationCommittee on 25 April 2007 with fullattendance and 30 January 2008 withapologies received from Mr Paul Stewart.

During the year, the Committeecommissioned an external consultancy toidentify candidates for the role of ChiefExecutive, using open advertising andexecutive search.

The Nominations Committee of theGoverning Council is responsible for theappointment of Non Executive Directors.Details are included on p42.

The Clinical Governance Committeeset the agenda for clinical governance,during the year, within the organisation,received reports from internal and externalreviews and monitored compliance againstrequired local and national benchmarks.The Committee was chaired by the MedicalDirector and independent members wereTony Wolfe and Ian Robson. The committeemet nine times during the year on thefollowing dates: 12 March 2007; 12 April2007; 5 July 2007; 19 July 2007; 05September 2007; 11 October 2007; 06December 2007; 12 January 2008 and 20March 2008.

The Risk Management Committeeensured the appropriate management of allorganisational risks and reported them tothe Board during the year. The committeewas chaired by the Chief Executive andindependent members were KathrynLarkin-Bramley and Dr Michael Waterston.The committee met 6 times during the yearon the following dates: 17 May 2007; 12July 2007; 20 September 2007; 22 November2007; 24 January 2008 and 27 March 2008.

The Investments Committee managedthe review, operation and monitoring ofthe Trust’s detailed investment policies andperformance during the year. Thecommittee was chaired by the TrustChairman, Mr Tony Waites. The committeemet on 22 May 2007 with full attendance;23 July 2007 with apologies received fromColin Smith and Lynn Browell; and 19November 2007 with full attendance.


The Trust’s Board of Directors is accountableto the Governing Council for its performance.

During the year, the Council met four timesin public session, and its eight subcommittees also met regularly meaningthat, in total, there were 35 full counciland committee meetings.

The Governing Council committeeswere:

• Advisory

• Audit

• Clinical Governance

• Membership

• Nominations (see below)

• Remuneration (see below)

• Risk Management

• Strategy

All Governors have been elected orappointed for a term of three years.

The Governing Council’s keyresponsibilities are:

• Keeping the Trust’s membersadvised. The Trust produces amembership newsletter, NewsroundExtra, which is sent to all publicmembers. Two editions were producedduring the year. Through themembership committee, the Governorshave begun other initiatives to engagewith members, including “medicine formembers” meetings and “Meet theGovernor” roadshows in localsupermarkets. Since the year end theyhave hosted a series of memberworkshops as part of the “Seizing theFuture” project.

• Overseeing the Trust’s strategicdirection. The Governing Council hasestablished a Strategy Committee as aforum to discuss strategic issues, inparticular the development of the annualplan. Governors are also embedded inthe governance of the “Seizing theFuture” project, with elected governorrepresentatives in each of the servicestrategy groups where future serviceoptions are being considered.


Governing Council

• Guardianship of the Trust’sgovernance arrangements. Anychanges to the Trust constitution must beagreed by the Governing Council, andconstitutional issues are considered by aGoverning Council Advisory Committee,chaired by the Vice Chairman. TheCommittees supported the Council indischarging the following keygovernance responsibilities:

• appointing one new Non Executive, and reappointing an existing Non Executive for a further term. Candidates for the appointment of the new Non Executive Director, were sought by open external advertisement.

• establishing the remuneration for the Chairman and Non-Executive directors.The Remuneration Committee of theGoverning Council commissioned theAppointments Commission to research remuneration levels in similarfoundation trusts before making theirdecision

• approving the appointment of a new Chief Executive

• appraising the performance of the Chairman

• developing the Annual Plan

• the Governing Council AuditCommittee has also begun a trainingand development process ready forthe appointment of a new auditor in2008/09

The Governors are responsible for theappointment and removal of the Chairmanand the Non Executive Directors from theBoard.

Remuneration CommitteeThe Remuneration Committee of theGoverning Council commissioned theAppointments Commission to researchremuneration levels in similar foundationtrusts before setting the remuneration forthe Chairman and non executive directors.

Nominations Committeeof the Governing CouncilThe Nominations Committee of theGoverning Council has the role ofidentifying candidates for non executivedirectors (and chairman) of the Board andmaking recommendations to the GoverningCouncil. Candidates for the appointment ofthe new Non Executive Director weresought by open external advertisement.A member of the Committee also sat onthe interview panel for the Chief Executive.The Nominations Committee also has arole in appraising the Chairman, thisprocess being led by the SeniorIndependent Director.

Appointed Governors representorganisations or groups of organisationswhich the Foundation Trust believes areits most important local partners.

Appointed Governors were appointed bythe organisations they represent.

Elected Governors were elected inaccordance with the election rules includedin the constitution.


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