ANNUAL REPORT AND ACCOUNTS 2009|10 · Annual Report and Accounts 2009/2010 3 As well as being one...

ANNUAL REPORT AND ACCOUNTS 2009|10

Guy’s and St Thomas’ NHS Foundation Trust Annual Report and Accounts

Presented to Parliament pursuant to Schedule 7, paragraph 25(4) of the National Health Service Act 2006.

1 Chairman’s statement 4

2 Directors’ report 6

3 Operational and financial review 12

4 Our staff, patients and partners 28

5 Teaching and research and development 36

6 Quality report 40

7 Our organisational structure 44

8 Remuneration report 51

9 Annual accounts 53

contents

Annual Report and Accounts 2009/2010 1

2 Guy’s and St Thomas’ NHS Foundation Trust

Guy’s and St Thomas’ NHS Foundation Trust is part of King’s Health Partners AcademicHealth Sciences Centre (AHSC), a pioneering collaboration between King’s CollegeLondon, and Guy’s and St Thomas’, King’s College Hospital and South London andMaudsley NHS Foundation Trusts.

King’s Health Partners is one of only five AHSCs in the UK and brings together anunrivalled range and depth of clinical and research expertise, spanning both physicaland mental health. Our combined strengths will drive improvements in care for patients,allowing them to benefit from breakthroughs in medical science and receive leadingedge treatment at the earliest possible opportunity.

For more information, visit www.kingshealthpartners.org.


As well as being one of the mostsuccessful Foundation Trusts, we areone of the busiest, with around900,000 patient contacts every year.We provide a full range of services forlocal residents as well as specialistservices for patients from furtherafield, including cancer, cardiothoracicand renal services. The EvelinaChildren’s Hospital at St Thomas’ –designed with the help of its youngpatients – is home to many specialistchildren’s services, while Guy’s is thesite of the largest dental school inEurope.

As part of King’s Health Partners,we are now one of the UK’s first, andlargest Academic Health SciencesCentres and, together with King’sCollege Hospital and South Londonand Maudsley NHS Foundation Trustsand our academic partner King’sCollege London, we bring togetherworld-class teaching, research andclinical services.

We have a long history of clinicaland scientific excellence. Our NationalInstitute for Health Research fundedcomprehensive Biomedical ResearchCentre, established with King’sCollege London, is already ensuringthat translational research drivesbetter treatment for our patients.

Guy’s and St Thomas’ is one of thelargest employers in Lambeth andSouthwark, with almost 11,000 staff.We work hard to reflect the culturaland ethnic diversity of thecommunities we serve and we arestrengthening our partnerships withpatients and local people, as well asneighbouring NHS organisations, localauthorities, GPs and voluntaryorganisations.

We strive to recruit and retain thebest doctors, nurses, therapists andother staff and the dedication of ouremployees is key to our hospitals’success.

Guy’s and St Thomas’ NHS Foundation Trust comprisestwo of London’s best known teaching hospitals withlongstanding reputations for quality and innovation.


Chairman’s statement1King’s Health Partners, our Academic Heath Sciences Centre, has madegood progress during 2009/10. Achieving meaningful collaboration inClinical Academic Groups while maintaining the autonomy and identityof four independent institutions. This has to be based on mutualrespect and confidence and has been enhanced by the appointment ofLord Butler to chair the Partnership Board and Professor Robert Lechleras the Executive Director.

Both the Trust’s main hospital sites haveseen considerable environmentalchange and improvement during recentmonths. The advent of the Shard atLondon Bridge, new hotels at Waterlooand other external changes will havedramatic effects on the local economy.It is clear that both the London Bridgeregeneration zone and the expansion ofother facilities on the South Bank willcreate many additional demands.Maintaining relationships with our localstakeholders, mostly through the SouthBank Partnership, therefore remains animportant responsibility for the TrustBoard. It is within this context that thefirst steps in implementation of ourestates strategy have seen the move ofthe medical toxicology service to Mary

At a time of financial stringency,the Trust Board continues to take itsresponsibilities as stewards of our longterm future very seriously and willensure that the vision of continuingimprovement it has developed isimplemented. We are pleased to havethe continuing help of generousdonors and of Guy’s and St Thomas’Charity under the leadership of SirWilliam Wells and Peter Hewitt as thenewly appointed Chairman and ChiefExecutive respectively.

Ron Kerr, our Chief Executive,continues to inspire the Trust Board to make ambitious plans at the sametime as requiring excellentperformance. The directors aredriving forward important standardsand initiatives, and together form anoutstanding and talented team ofwhich the Trust should be proud.They have been joined this year byHugh Risebrow who, as CommercialDirector, will bring forward innovativeways in which we can develop ourexpertise and facilities to the benefitof the Trust and patients. We werealso pleased to welcome ProfessorFrank Nestle, who replaced ProfessorRobert Lechler as the university’snominee to the Board.

In planning its response toimminent financial and regulatorypressures, the Board is looking to createnew sources of revenue but, moreimportantly, we are eager to offer theclinical and other skills of specialist staff

We plan a future in which trulyoutstanding care remains accessiblefor our local population.

Sheridan House near Guy’s, theopening of Biomedical Research Centrefacilities in the Guy’s Tower, and thetemporary relocation of major non-clinical services from St Thomas’Hospital to York Road, thus enablingessential expansion of the accident andemergency department to begin.

All these plans are shared withGovernors, local community groups,patients, and our electedrepresentatives.


to complement the work of otherproviders, so widening access forpatients.

With the absolute priority that theNHS rightly gives to the safety andquality of patient care, Guy’s and StThomas’ is in a prime position to take alead in providing excellence beyond ourimmediate local boroughs. We plan afuture in which truly outstanding careremains accessible for our localborough populations but whichreaches out to many more patients whoneed highly specialised services. Thisclinical strategy is well aligned withbroader NHS priorities. Much Boardattention has been given to specialistservices at St Thomas’ which sit in theheart of London but are notcomfortably located within a narrowlydefined sector.

In this centenary year of her death,our Showing we care initiativereinforces the example and teaching ofFlorence Nightingale. Her simplemaxims “do no harm” and “treat everypatient as an honoured guest” shouldalways be at the heart of our values.While we are never complacent aboutperformance, we believe that the staffwho look after patients and theirfamilies strive to achieve these aims. Asa leading Foundation Trust we need toset exemplary standards and I am dailygrateful to those who share thisambition.

Showing we careThe Trust has embarked on an attitude-changing initiative this year. TheShowing we care campaign is designed to encourage everyone to thinkabout their behaviour and how it affects patients, visitors and their owncolleagues and, in turn, our services.

A number of schemes are in place to help put these principles intopractice, including In your shoes, which is an opportunity for seniormanagers to get an insight into the daily lives of colleagues. Non-Executive Director Jan Oliver, below, has worked as a cleaner and acatering assistant on the wards and in the kitchen, whilst Chief NurseEileen Sills has worked on the switchboard and as a recruitment assistant.

We are also improving the information we provide to patients,launching a campaign to tell them what they should expect, andcontinuing to roll out new ideas to promote dignity, and respect forpatients.

Patricia MoberlyChairman


Executive was delighted to announcethe first Clinical Academic Groupleaders in March, with a rollingprogramme of appointments nowunderway. A formal partnershipagreement is also expected to besigned shortly.

Work to develop an overarchingclinical strategy is progressing well,involving closer working betweenourselves and King’s College Hospitalin particular, as we develop a broadand shared understanding of the roleof each of our main hospital sites andidentify the areas where we expect tobe world-class. Areas where we wantto grow our collective researchstrength have also been identified andinclude obesity, cancer, liver andvascular disease, as well as publichealth and children’s services.

At the same time, our collectiveeducation agenda is moving forward,building on our success in beingdesignated as the lead organisationfor the Health, Innovation andEducation Cluster for south London.Other strengths include the use of simulation technology, as well asthe development of apprenticeshipschemes and work with local schools to increase access to medical and other health-related careeropportunities.

In terms of external partnerships,there is also much to celebrate,including a revived exchangeprogramme with Johns Hopkins inBaltimore; a new partnership with the

Directors’ report2Guy’s and St Thomas’ continues to deliver excellent patient care, whilstseeking to maintain a strong financial position that will allow us to driveforward quality and service improvements for our patients in the future.That said, striking a balance between quality and service delivery and ahealthy financial position, with surpluses to reinvest, has proved increasinglydifficult as the external financial environment has started to tighten.

It will challenge us to ensure thatservices are provided in the mostappropriate location and enable usto strengthen our workingrelationship with GPs and otherhealth and social care professionals.

There have been significantachievements during the year, despitethe inevitable and growing focus oncost reduction and savings plans.Most notably, we have continued towork with King’s College Hospital andSouth London and Maudsley NHSFoundation Trusts and our sharedacademic partner King’s CollegeLondon to develop King’s HealthPartners as one of the UK’s firstAcademic Health Sciences Centres(AHSCs).

King’s Health PartnersThere have been many successes andimportant milestones as we strive tobring health research, teaching and

education and clinical care together innew and groundbreaking ways thatwill deliver a step change in thebenefits we can realise for ourpatients, local people and the widercommunity.

Clinical Academic Groups form theessential building blocks of the AHSC,and the King’s Health Partners’


University of California in SanFrancisco; and work in both Zambiaand Somaliland that is being drivenforward in collaboration with theTropical Health Education Trust.

Community servicesintegration The Trust, on behalf of King’s HealthPartners, was delighted to be selectedby NHS Lambeth and NHS Southwarkas their preferred partner to managecommunity services in Lambeth andSouthwark from April 2011. Whilststill subject to a period of duediligence, as well as the approval ofour regulators, we believe this newrelationship will bring many benefitsand allow us to improve thehealthcare and well-being services we

provide to local people. It will challenge us to ensure that

services are provided in the mostappropriate location – which will beoutside the hospital setting in manycases – and will also enable us tostrengthen our working relationshipwith GPs and other health and socialcare professionals. In addition, it willhelp us to realise the King’s HealthPartners’ vision to improve the healthof the local population and to extendhealth services research, teaching andeducation out into the community.

Our wider roleAs a Trust, we provide a full range oflocal hospital services to people livingin Lambeth, Southwark andLewisham, as well as a wide range of

specialist services for this localpopulation and patients from furtherafield. We continue to collaboratethrough King’s Health Partners andwith organisations across south eastLondon and the capital, as well asnationally and internationally, tosupport and enhance service delivery,research, teaching and training.

We play an active role in the southeast London cancer and cardiacnetworks, and we continue to workwith both specialist commissioninggroups and NHS London to supportwider change which is being driven bythe need to maintain quality andexcellence and to develop sustainableservice models for the future.

This has created disappointment,such as the failure to designate St Thomas’ as a hyper acute strokeunit, but also opportunities, and weare currently working collaborativelyto ensure optimal patient care inspecialties ranging from specialistchildren’s surgery and cardiac servicesto adult vascular services and cancercare.

We have devoted significant effortthis year, with input from NHSLondon, our local commissioners andothers, to explore and betterunderstand the role our hospitals playin the wider health system. Webelieve this will enable us to respondto change in ways that protect andenhance their unique position.

St Thomas’ provides a huge rangeof very specialist services and sub-specialties, as well as one of thelargest intensive care units in the UK.To protect these regional and national centres of excellence, it isessential to understand their complexinter-relationship with our majorcardiac centre, vascular services andcomprehensive range of women’s andchildren’s services, co-located on asingle site.

GSTS celebrates its first year The Trust’s joint venture with Serco Group plc to deliver pathologyservices celebrated its first full year in business in February 2010.Pathology services are absolutely crucial to the delivery of patient careand GSTS Pathology has already delivered real improvements, forexample, halving waiting times for cervical screening and reducing theaverage waiting time for blood to be taken to just nine minutes. Thejoint venture has also enabled us to develop innovative ways ofworking which benefit not just our own hospitals, but otherorganisations such as Bedford Hospital where GSTS is now providing alocal pathology service.


Many services at Guy’s also serve awide population across south eastEngland, either from central Londonor through a growing network ofoutreach clinics and satellite facilities.As well as renal services and complexsurgery, cancer services at Guy’s are akey strategic priority for the Trust andfor the wider cancer network.

Research funded comprehensiveBiomedical Research Centre, which isdescribed on page 38.

Working with commercialpartnersThe Trust has a long tradition ofinnovation, ranging from medicalbreakthroughs and translationalresearch to a commitment to broadercommercial opportunities that willgenerate additional income to supportthe delivery of NHS services.

This year, a number of initiativesreflect this, including:

• our pathology joint venture, GSTSPathology, with Serco Group plc,which has celebrated its firstsuccessful year of operations;

• our partnership with Quintiles,the world’s largest first-in-manclinical trials organisation whichnow occupies state-of-the-artaccommodation in the Guy’sTower alongside our own researchand trials facilities;

• the appointment of the Trust’sfirst board-level CommercialDirector.

We also continue with our existingportfolio of commercial activity,including our long standing contractwith the Ministry of Defence toprovide healthcare to British forcesand their families in Northern Europe.In addition, we have recently beenshort-listed as the preferred bidder tohost the South West London SharedServices Partnership delivering a rangeof facilities management services tofive Primary Care Trusts in south westLondon.

Business reviewGuy’s and St Thomas’ has againperformed well financially in 2009/10,despite a toughening economicenvironment. The Trust has declared a

Director’s report

Cancer services at Guy’s are a keystrategic priority for the Trust andfor the wider cancer network.

£15,000,000has been spent on improving thehospital environment over three years

These services also have afundamental inter-dependency with the health schools and biomedicalsciences at King’s College London, andunderpin our shared and longstandingreputation for world-class clinical andbiomedical research.

This continues to be enhanced byour National Institute for Health

surplus of £1.8 million for the financialyear after accounting for an impairmentof £5.1 million due to the revaluation ofthe Trust’s fixed assets (equivalent to a£6.9 million surplus excluding theimpairment). Although less than thesurplus we originally planned for, webelieve this is a good performance at atime when efficiency savings haveproved increasingly difficult to achievewithout impacting adversely on patientcare.

Pressures such as high levels ofinfection in the community, adverseweather conditions and the need toplan for an anticipated flu pandemichave added to operational challengesduring the year. Pressing operationalneeds have necessarily taken priorityat times, and the launch of our Trust-wide transformation programmeis in part a response to this –recognising that we require additionalfocus and structures in place to deliverthe level of efficiencies that will beneeded in future.

This year’s surplus will add tothose achieved in previous years, andwe are currently undertaking afinancial and strategic review toidentify prudent levels of investmentin service development and our estatein support of our strategic vision overthe coming years.

We have identified the key driversof change which we believe presentboth challenges and opportunities forour future operation. These are:

• a change of government,bringing with it new policies anda changing financial picture;

• the changes to commissioningintentions for clinical servicesincluding the new arrangementsfor the delivery of communityservices;

• the ongoing development ofKing’s Health Partners, includingthe Clinical Academic Groups;

• savings and activity plans;

• our transformation programme;

• the NHS Constitution includingnew rights for patients;

• commercial opportunities.

The Trust continues to focus onmanaging the risks associated withthe drivers of change which arepotential challenges, and on ensuringthat it is in a strong position to takeadvantage of any potentialopportunities.

We have a well establishedfinancial and performance reportingmodel that includes detailed monthlyscore card reporting of national andTrust performance targets to both theBoard of Directors and TrustManagement Executive. In addition,Board sub-committees havedeveloped a range of key performanceindicators, and local performanceindicators are well developedthroughout the organisation.

As a result, when there was asignificant dip in performance againstthe four hour access target in accidentand emergency, the Trust carried outan immediate audit of operationalpractices and data assurance.Following discussions with Monitorand other stakeholders, an action planwas implemented which includedexternal advice and support.

Closer to homeWe continue to deliver majorimprovements to our estate as part ofa comprehensive strategy to improvethe fabric of our buildings andtransform the way patients movethrough the hospital. Comprehensiveward refurbishments, improvementsto circulation and waiting areas, liftrefurbishments and the redevelopmentof the main entrance at St Thomas’have all helped to improve access andthe experience of patients, visitors and


18,000members of our Foundation Trusthelp us to better understand theneeds of our local communities

staff. Investment of £15 million overthree years in these environmentalimprovement schemes provides a solidplatform from which to take forwardour longer term estates strategy,which we are calling our 2020 vision.

These longer term plans, whichwill be refined as business cases aredeveloped and available resourcesbecome clearer, include:

• essential work to repair andrefurbish the Guy’s Tower;

• repairs and improvements bothinternally and externally to theEast Wing at St Thomas’;

• plans for a new cancer facility onthe Guy’s site, initially for a rangeof ‘ambulatory care’ fromdiagnosis to outpatient and daycare treatment and support, withco-located space for research.

Our estates plans support andunderpin our clinical services strategyand also the major transformationprogramme that we launched thisyear to drive efficiency and costreduction, whilst improving qualityand patient focus. The initial areas oftransformation work are theemergency, outpatient and electivepatient pathways and technologysupport for patient care. Strongclinical engagement will be critical tosuccess and this work will be a majororganisational priority over thecoming year.

It is complemented by theShowing we care campaign which welaunched in summer 2009 to focus onorganisational culture and behaviours,and in particular how these can be aforce for good in supporting ourefforts to improve every aspect of thepatient experience. Our staff are ourmost important asset and werecognise and celebrate theircontribution, for example through anannual ceremony and a new monthly

33%reduction in the numberof cases of MRSA bloodinfections last year


recognition scheme – the CARE awards.However, we also acknowledge theneed to set even more ambitiousstandards so that all our patientsreceive exceptional care all of the time.

Sustaining operational performanceagainst a wide range of national andlocal targets, as well as ensuring thedelivery of high quality and clinicallysafe care to around 900,000 patientcontacts each year remains anenormous challenge. It requiresconsiderable and sustained effortfrom frontline staff and managers,and we work hard to support them,for example through our successfulclinical Fridays and also a new weeklymanagers’ forum.

We were delighted to receive verypositive feedback following ourunannounced hygiene inspection insummer 2009. We continue to haveconsiderable success in reducinghospital infection rates and we werepleased to report back on our firstquality accounts last year. Goingforward, we are developing a range ofmeasures that will form our qualityaccounts in future, aligned closelywith the national, regional and localrequirements of the Commissioningfor Quality and Innovation scheme.

Corporate social responsibilityThe Trust is delighted to havepublished its first social accounts aswe take our responsibilities to thelocal community, regeneration andthe environment very seriously. Weare proud of our achievements, whilstalso recognising the need to gofurther.

Our initial priorities focused onthree areas: reducing ourenvironmental impact, including CO2emissions; local recruitment; and localprocurement initiatives. The Trustcontinues to be an NHS leader when itcomes to environmental issues andhighlights this year included openingCombined Heat and Power facilitieson both sites, joining the Mayor ofLondon’s Green500 of leading privateand public sector companies and

We set ambitious targets so thatall our patients receive exceptionalcare all of the time.

Combined Heat and Power unitsIn September 2009, we became one of the first Trusts in London toproduce our own electricity. The Combined Heat and Power units, oneon each site, use a gas engine to produce enough electricity to meethalf our requirements. The waste heat generated by this process, inthe form of steam and hot water, is collected and used for heating andhot water around the hospitals.

The units will reduce our CO2 emissions by almost 11,300 tonnes ayear and will save us more than £1.5 million in energy costs.

Performance and inspectionsIn October 2009, the Trust was verypleased to achieve the highest possiblerating from the Care QualityCommission in its annual healthcheck – rated as ‘excellent’ for thequality of services and ‘excellent’ forthe quality of financial management ona scale of excellent, good, fair or weak.


signing up to the national 10:10campaign.

We are the largest employer inLambeth and Southwark and arecommitted to recruiting locally, bothto ensure our workforce reflects theneeds of the ethnically and culturallydiverse communities we serve, butalso to maximise the employment,education and training opportunitieswe can provide to local people. Inaddition, we have made considerableeffort to procure goods and serviceslocally in support of local businessesand regeneration for mutual benefitand also in support of environmentalsustainability.

Board of DirectorsThe Board of Directors bring a widerange of experience and expertise totheir stewardship of the Trust andcontinue to demonstrate the vision,oversight and encouragementrequired to enable it to thrive. In2009/10, its membership consisted ofthe following Executive Directors:

Chief Executive, Ron Kerr; Director of Finance, Martin Shaw;Medical Director, Edward Baker; Chief Nurse /Chief Operating Officer,Eileen Sills; Director of Capital, Estatesand Facilities, Steve McGuire; Directorof Workforce and OrganisationalDevelopment, Ann Macintyre; and,from January 2010, CommercialDirector, Hugh Risebrow.

And seven Non-Executive Directors:Chairman, Patricia Moberly, and Non-Executive Directors: David Dean,Mike Franklin, Rory Maw, Frank Nestle,Jan Oliver and Diane Summers.Robert Lechler stood down as ViceChairman/Non-Executive Director inApril 2009 and was replaced by RoryMaw as Vice Chairman and FrankNestle as Non-Executive Director inMay 2009.

The Board of Directors is not

aware of any relevant auditinformation that has been withheldfrom the Trust’s auditors, andmembers of the Board take all thenecessary steps to make themselvesaware of relevant information and toensure that this is passed to theexternal auditors where appropriate.

The Board considers the Trust to becompliant with the principles of theNHS Foundation Trust Code ofGovernance, as well as with theprovisions of the Code in all but thefollowing areas where we havealternative arrangements in place:appraisal of the Chairman; thedesignation of independent directorsand a senior independent director;Chief Executive and Executive Directorterms of appointment; informationabout elected governors standing for re-election; and independentprofessional advice for Non-ExecutiveDirectors. Further details can be foundin the full compliance statement whichis available on the Trust website.

During the year, and to coincidewith the fifth anniversary of ourauthorisation as an NHS FoundationTrust, we took the opportunity toreview our Constitution, and aremaking a number of changes designedto make our Council of Governors evenmore effective and to broaden theconstituencies from which ourmembership is drawn.

Looking aheadGuy’s and St Thomas’, in commonwith the public sector as a whole, isclearly entering a far more demandingoperational and financial environmentand there is an urgent need toincrease efficiency whilst maintaininghigh quality care. We will use ourstrong track record over recent yearsto adapt to this new environment –and we believe the greater freedomswe are afforded as an NHS

Foundation Trust will allow us tocontinue to thrive and to set our ownstrategic direction for the benefit ofthe patients and communities weserve, as well as our staff.

It remains to thank the peoplewho have helped us to achieve somuch in 2009/10 including our staff;our Council of Governors and ourwider membership; Guy’s and StThomas’ Charity for their ongoingsupport and generous investment; ourKing’s Health Partners’ collaborators;and our many external stakeholdersand supporters, in particular our localPrimary Care Trusts and other NHSorganisations in south east Londonwith whom we work closely.

Ron KerrChief ExecutiveOn behalf of the Board of Directors

£1,500,000will be saved each year followingthe installation of Combined Heatand Power units at our hospitals

1,500stroke patients have beenread poetry and stories overthe past decade at St Thomas’

7,000,000medical instruments are deliveredto doctors and nurses by the sterileservices department every year


Operational and financial review3Guy’s and St Thomas’ is one of the largest and busiest Trusts in thecountry. During 2009/10, we saw 604,000 outpatients, 76,000inpatients, 64,000 day case patients and 164,000 accident andemergency attendances. On average, we have 1,110 beds in use atany one time, with 845 at St Thomas’ and 265 at Guy’s, as well as upto 44 specialist baby cots.

Performance ratingsOur overall performance rating ismeasured through the Care QualityCommission’s (CQC) Annual HealthCheck. This assessment measures thequality of our services and how wellwe use our resources. Our mostrecent rating, published in October2009, was ‘excellent’ for both, on ascale of excellent, good, fair or weak.In addition, following anunannounced hygiene inspection bythe CQC in August 2009, the Trustachieved 100 per cent compliancewith no major recommendations forimprovement. These exceptionalresults are evidence of the hard workand dedication of staff across theTrust, and demonstrate our continuedcommitment to high quality care.

Meeting national targetsWe have continued to reduce cases ofMRSA and C.difficile and are wellwithin the national targets set for thehospital. The Trust places greatimportance on reducing hospitalacquired infections and through acontinued drive on cleanliness and azero tolerance approach to poor handhygiene we have achieved a 33 percent reduction in the number of casesof MRSA blood infections (down to 16cases), and 13 per cent reduction inthe number of cases of C.difficile(down to 73 cases) in 2009/10.

The Trust has continued to speedup access to cancer diagnosis andtreatment, and we have achieved allnational targets for waiting timesfollowing considerable effort inmanaging and updating data systemsto support each patient pathway. Ofthose patients referred urgently bytheir GP, 97 per cent were seen withintwo weeks. We have also met thenew requirement to extend themaximum waiting time for breastcancer patients to all referrals, not justurgent cases, with 93 per cent nowseen within two weeks.

For patients with heart conditions,we continue to ensure that no patientwaits longer than three months for acardiac re-vascularisation operation,and that all patients referred to therapid access chest pain clinic are seenwithin two weeks.

These exceptional results areevidence of the hard work anddedication of staff across the Trust.

Furthermore, the Trust has beengranted its licence to provide serviceswith no conditions from the CQC.Under a new, tougher system forregulating standards in the NHS, allTrusts are required by law to beregistered by the CQC by 1 April 2010.In order to do so, they must show theymeet essential standards of qualityand safety; Guy’s and St Thomas’ wasgranted its licence in March.


Apr-Jun2008

Jul-Sep2008

Oct-Dec2008

Jan-Mar2009

Apr-Jun2009

Jul-Sep2009

Oct-Dec2009

Jan-Mar2010

98%

96%

94%

92%

90%

88%

86%

84%

Percentage of patients starting non-admitted treatment within 18 weeks of referral

Percentage startedtreatment within18 weeks of referral

National standard

Apr-Jun2008

Jul-Sep2008

Oct-Dec2008

Jan-Mar2009

Apr-Jun2009

Jul-Sep2009

Oct-Dec2009

Jan-Mar2010

94%

92%

90%

88%

86%

84%

82%

80%

Percentage of patients starting admitted treatment within 18 weeks of referral

National standard

Percentage startedtreatment within18 weeks of referral

100%

95%

90%

85%

80%

75%

70%

65%

Performance against revised cancer access targets

Urgent GP referralsseen within 2 weeks

First treatmentswithin 31 days

Subsequent treatmentswithin 31 days

Treatments within 62 daysof urgent GP referral

Apr-Jun Jul-Sep Oct-Dec

Jan-Mar Nationalstandard

2009-10

Apr-Jun2008

Jul-Sep2008

Oct-Dec2008

Jan-Mar2009

Apr-Jun2009

Jul-Sep2009

Oct-Dec2009

Jan-Mar2010

1.4%

1.2%

1.0%

0.8%

0.6%

0.4%

0.2%

0.0%

Percentage of patients’ operations cancelled on the day

Percentage patients’operations cancelledon the day

National standard

2003-04 2004-05 2005-06 2006-07 2007-08 2008-09 2009-10

100%

98%

96%

94%

92%

90%

88%

86%

Percentage of patients treated within four hours in A&E

Percentage patientstreatment within4 hours

National standard


Operational and financial review

We have continued to work hardto meet the maximum 18 weekwaiting time target, and haveachieved this in all specialties exceptorthopaedics. Despite treating moreorthopaedic patients than ever, thenumber of referrals to the Trust, bothfor very specialist and routineprocedures, is growing at anunprecedented rate. We are workingwith our Primary Care Trusts and NHSLondon to address this.

We have also seen unprecedented

demand for our accident andemergency service and have fallen justshort of the national 98 per centtarget. In 2009/10, 97.6 per cent ofpatients were diagnosed, treated,discharged or admitted within fourhours. There are a number of factorsbehind this, both internally and as aresult of limited alternative provisionlocally, particularly for patients withrelatively minor problems. We areworking hard to address these issues,with help from the Department of

Performance against national targetsNational

Existing commitments standard 2009/10 2008/09 2007/08

A&E access % patients discharged within 4 hours in A&E and MIU >98% 97.6%• 98.2%• 98.3%

Inpatient and Outpatients waiting more than 13 weeks (GP referrals only) <3 / mth 0.0• 0.2• 0.1

outpatient access Inpatients waiting more than 26 weeks <2 / mth 1.8• 2.3• 1.2

Cardiac access Patients seen within 2 weeks for rapid access chest pain >99% 100%• 99.7%• 100.0%

Patients waiting more than 3 months for revascularisation <1% 0%• 0%• 0%

Cancelled % elective operations cancelled on day of operation <0.8% 0.70%• 1.17%• 1.58%

operations % cancellations not re-admitted within 28 days <5% 0.9%• 1.2%• 0.0%

Transfers of care Inpatients with delayed transfer of care (monthly average) <5 2.8• 1.2• 1.8

Health and Patients seen within 48 hours of referral to GUM clinic >99% 100%• 99.8%• 99.5%

well-being Ethnic coding levels of inpatients >90% 91.9%• 91.2%• 88.5%

Clinical quality Call to balloon time for primary angioplasty – % under 150 minutes tba* 58.1% n/a n/a

National priorities

Infection control MRSA bacteraemia reduction (to 30 for 2009/10) <30 16• 24• 46

C.difficile acquisitions in over 2s reduction (to 101 for 2009/10) <101 73• 84• 124

18 week referral to % admissions within 18 weeks >90% 90.6%• 90.2%• 86.8%

treatment times % non-admissions within 18 weeks >95% 96.2%• 96.1%• 91.4%

% specialties achieving 18 week target (Jan-Mar) tba* 94.1% n/a n/a

Cancer access Urgent GP referrals seen within 2 weeks >93% 97.0%• n/a n/a

Breast symptomatic referrals seen within 2 weeks (Jan-Mar) >93% 93.2%• n/a n/a

Cancer treatments started within 1 month of decision to treat >96% 99.4%• 99.5%• 100%

Cancer treatments started within 2 months of urgent GP referral >85% 85.2%• n/a n/a

Subsequent treatments within 1 month of decision to treat >96% 99.6%• n/a n/a

Treatments started within 2 months of screening programme referrals >90% 99%• n/a n/a

Treatments started within 2 months of consultant upgrade referrals >90% 99%• n/a n/a

Infant health % women smoking during pregnancy <5% 4.8%• 5.0%• n/a

Breastfeeding initiation tba* 87.0% 90.8%• n/a

Clinical quality Stroke care – patients with more than 90% of their stay in a stroke unit tba* 82.1% n/a n/a

Participation in heart disease audit • • n/a

Engagement in clinical audits • • n/a

Maternity statistics – data quality indicator Comparators not available • n/a

Staff satisfaction NHS staff satisfaction – results from National Staff Survey Comparators not available • n/a

Patient experience Results of patient survey – 5 domains Comparators not available • n/a

* New targets in 2009/10 –national standards still tobe advised


Health’s intensive support team, sothat we can provide a sustainableimprovement in performance.

NHS Litigation AuthorityIn December 2009 we were assessedby the NHS Litigation Authorityagainst their Risk ManagementStandards for Acute Trusts, and againachieved a high pass at level 2. Theassessment, which measures oureffectiveness in managing risk, looksat 50 standards covering a wide rangeof activities from information forpatients to mandatory training forstaff. We were also accredited at level2 for the revised maternity standards –a considerable achievement.

Sustainability and climatechange The Trust has developed a leading andambitious environmental sustainabilitystrategy after engaging widely withpatients, staff, visitors and otherstakeholders. As a result, we havemade significant progress in reducingthe environmental impact of ourbusiness and have been awarded theMayor of London’s Green500 PlatinumAward in recognition of our efforts,which makes us a leader in the NHS.

Combined Heat and Power unitshave been installed on both sites andwe continuously make energy savingsby investing in new technologies andupgrading our infrastructure; since2006 we have invested over £2.5million in energy saving equipment.

Everyone in the organisation isencouraged to take responsibility forenergy, water and waste saving, andthere are more than 125 environmentrepresentatives in the Trust who serveas the eyes, ears and voices for savingenergy and resources. We were oneof the first signatories to the Mayor’sRE-FIT Programme and, in August2009, we were awarded the CarbonTrust Standard in recognition of ourproactive and systematic approach tocarbon reduction.

We actively monitor and report oncarbon consumption and other keyperformance indicators to ensure thatwe are consistently reducing ourenvironmental impact. In the lastyear, we have reduced electricityconsumption, carbon emissions andwater consumption, and costs, as wellas increased our proportion ofrecycled waste. We are alsocommitted to buying goods andservices locally where possible.

Looking forward, our priorities forfurther improvement will include:

• waste reduction;

• sustainable procurement solutions;

• continued support of the Mayor’sRE-FIT Programme;

• continued preparation for theCarbon Reduction CommitmentEnergy Efficiency Scheme;

• implementation of oursustainability strategy.

Our progress will continue to bemonitored by the Board of Directors.

Corporate social responsibility The Trust is committed to actingresponsibly in terms of the environment,staff, the local community and thewider population. We have a numberof employment initiatives thatcontribute to our corporate socialresponsibility agenda, and moreinformation about these can be foundon page 30.

The Trust is an active participant inthe vibrant local communities weserve, and supports local regenerationand employment.

We are implementing a web-basedbrokerage service allowing us to select

Performance against local targets

Clinical quality Target 2009/10 2008/09 2007/08

Infection control % clinical staff compliant with hand hygiene (monthly audit) >98% 97.5%• 99.0%• n/a

MRSA acquisitions from clinical specimens <80 28• 67• 74

GRE bacteraemias (per month) <2 / mth 0.4• 0.8• 1.3

Clinical indicators Readmission rate (emergency readmission within 28 days) <4.5% 4.7%• 4.6%• n/a

Standardised mortality ratio <85 82.6• 79.6• n/a

Patient experience

Patient survey Staff not talking as if patient not there >86% 87%• n/a n/a

findings Patients ‘very satisfied’ with involvement in decisions about care >63% 63%• n/a n/a

Patients ‘very satisfied’ that they were listened to and supported >66% 66%• n/a n/a

•Target fully achieved

•Target partially achieved

99%of cancer patients begintreatment within one monthof decision to treat

£2,500,000has been invested in energy savingequipment

100%compliance with anunannounced hygieneinspection



suppliers, including small andmedium-sized enterprises, and makethem more readily aware of tenderingopportunities at the Trust. As part ofthis initiative, we will ensure that weoffer a low cost, easy access methodfor them to bid for contracts. The aimis to open up opportunities beyondestablished suppliers and to increasethe number of local companiesserving the Trust.

In addition, we are participating inSupply Cross River – an initiative led bythe Cross River Partnership (made upof City of London, City of Westminster,Lambeth and Southwark Councils),which provides the Trust with aconsultant one day a week to analyserequests from local suppliers and givetraining and technical support to theprocurement team.

We are proud to have establishedformal links with two African countries,Tanzania and Zambia. We signed amemorandum of understanding withMuhimbili University of Health Sciencesin Tanzania in 2007 to establish a

identify initial areas for collaboration. A number of Trust staff also give up

their time voluntarily to support a widerange of international charitableprojects. For example, at the end of2009, two consultants and a staff nursesupported the charity Project Harar andtravelled to Addis Ababa in Ethiopia totreat children suffering from noma, agangrenous facial disease.

Our strategic visionWe have set four goals as part of ourstrategic vision, and these sit withinour role as an Academic HealthSciences Centre. They are:

• to lead an outstanding localhealthcare system;

• to build on our strength as aprovider of specialist services;

• to make research and educationintegral to innovative patient care;

• to create a workforce and anenvironment that delivers highquality and efficient services.

Information risks The Trust is required to assess andreport information risks and datalosses in a standard format providedby the regulator. The table oppositegives details of four incidents, whichrelate to the loss or theft of electronicequipment or documents.

We take all incidents very seriouslyand these are investigated in the sameway as clinical incidents so that welearn lessons and take action toprevent similar issues occurring.

Sickness absence The Trust is required to report onsickness absence and from 1 January –31 December 2009, the sicknessabsence rate was 3.9 per cent. Thisconsists of 134,905 days of sicknessfrom a total of 3,423,885 workingdays available.

Everyone in the organisation isencouraged to take responsibilityfor energy saving.

programme of cooperation for staffdevelopment in ophthalmology and, in2009, four visits took place betweenour organisations. Work includeddemonstrating paediatric surgery toresident doctors and advice on themanagement of diabetic retinopathy.Funding of around £10,000 a yearfrom Guy’s and St Thomas’ Charity anda livery company support this project.

In addition, we have establishedformal links with two hospitals inNdola, Zambia and a memorandum ofunderstanding is being developed,which will be followed by discussions to

£12,000from Guy’s and St Thomas’ Charitysupports a project to develop globalhealth partnerships in Zambia

21%increase in outpatientattendance and 17% growth ininpatient and day case activity


Area Non-Financial Non-Financial Financial Financial (applicable metric) (applicable metric) Data (£000k) Data (£000k)

2009/10 2008/09 2009/10 2008/09

Waste minimisation High temp disposal 678 tonnes 524 tonnes Total waste cost £1,318 £1,036

and management Landfill disposal 2,524 tonnes 2,597 tonnes

Non-burn treatment 878 tonnes 1,017 tonnes

Waste recovery/recycling 15.6% 11.93%

Finite resources Water 364,000 m3 424,000 m3 Water £331 £345

Electricity 162,000 GJ 234,000 GJ Energy £7,496 £8,825

Gas 534,000 GJ 345,000 GJ

Oil 1,048 GJ 9,151 GJ

400research projects involvingpatients and healthyvolunteers are taking placethis year

Environmental impact performance indicators 2009/10

Category Nature of incident Total

I Loss /theft of inadequately protected electronic equipment, devices or paper documents from secured NHS premises. 3

II Loss /theft of inadequately protected electronic equipment, devices or paper documents from outside secured NHS premises. 1

III Insecure disposal of inadequately protected electronic equipment, devices or paper documents. 0

IV Unauthorised disclosure 0

V Other 0

Summary of personal data related incidents 2009/10


Although the surplus was less than weoriginally planned for, we believe this isa good performance at a time whenefficiency savings have provedincreasingly difficult to achieve withoutimpacting adversely on patient care.The Trust had planned to achieve a£25.7 million efficiency improvement,which would have delivered a £20million surplus in 2009.

exceeded our planned income for thisperiod by £13.3 million, whilstexpenditure was £35.9 million aboveplan – reflecting the additional costs ofdelivering these higher levels of activity,investment in the research anddevelopment network, and the £5.1million impairment on our fixed assets.

The Trust’s depreciation charge,dividend on Public Dividend Capitaland interest receivable/other costswere £4 million, £1.4 million and £1million below plan respectively.

Table 1 compares the 2009/10outturn to the 2009/10 plan.

The increase in actual income,compared with the levels set out in ourplan, was primarily a result of the Trustundertaking additional activity for anumber of Primary Care Trusts, overand above the original contractedlevels. This resulted in increasedincome and expenditure associatedwith delivering this additional work.

In 2009/10 the Trust was the hostfor the London (South) ComprehensiveLocal Research Network. This increasedthe Trust’s income and expenditure by£15.5 million. Payments made forresearch activities at other Truststotalling £11 million are thereforereflected under establishment costs inthe accounts.

The income and expenditurefigures also include the impact of thePathology Joint Venture with SercoGroup plc, both in the surplus, asstated above, and in the growth inincome and expenditure of £25 million.

Guy’s and St Thomas’ has again performed well financially in 2009/10,despite a toughening economic environment. The Trust has declared asurplus of £1.8 million for the financial year after accounting for animpairment of £5.1 million due to the revaluation of the Trust’s buildings(equivalent to a £6.9 million surplus excluding the impairment).

The annual accounts reflect notonly the performance of the Trust butalso the consolidated results of itswholly owned subsidiaries, GSTEnterprises, GTI Forces HealthcareLimited, Pathology Services Limited,an associate company SSAFA GSTTCare Limited Liability Partnership, andjoint venture GSTS Pathology LimitedLiability Partnership.

The year end surplus reflects thefact that the Trust delivered a significantprogramme of cost reduction andincreased efficiency, whilst continuingto improve services and achieving thekey NHS targets which are expected ofus. The Trust’s income position

Table 1 Plan Actual2009/10 2009/10 Variance

£ millions £ millions £ millions

Total income 916.7 930.0 13.3

Expenses (832.7) (868.6) (35.9)

Operating surplus 84.0 61.4 (22.6)

Depreciation (43.9) (39.9) 4.0

Public Dividend Capital (21.6) (20.2) 1.4

Interest receivable /other 1.5 0.5 (1.0)

Retained Surplus 20.0 1.8 (18.2)


Our financial performance


Financial performance 2008/09and 2009/10For the financial year 2009/10,following government policy, the NHShas adopted International FinancialReporting Standards (IFRS) as the basisfor preparing financial accounts.

IFRS requires a number of changesto the way that financial performanceis calculated. The impact of thesechanges on the Trust is minor. The2008/09 accounts have been restatedto IFRS in order to allow for a validcomparison between years. Thedetails of the changes to the 2008/9accounts are set out in note 34 onpage 80 of the annual accounts. Thecomparator figures for 2008/09 setout in the following sections are therestated IFRS accounts.

Table 2 shows the Trust’s financialperformance for 2008/9 and 2009/10.

part of our plan to meet anticipatedfinancial risks and to deliver surpluseswhich we can reinvest in servicedevelopments and our estate insupport of the Trust’s strategic vision.

Trends in activity, income andexpenditure Charts 1 to 5 on page 21 show activityand income and expenditure growthover a five year period from 2005/06to 2009/10.

Activity trendsCharts 1 to 3 show the growth ininpatient and day case activity(measured as completed patientspells) – up by 17 per cent, andgrowth in outpatient attendances –up by 21 per cent.

Table 2 Actual Actual2009/10 2008/09

£ millions £ millions

Income 930.0 844.5

Expenditure (908.5) (813.7)(including depreciation)

Operating surplus 21.5 30.8

Public Dividend Capital (20.2) (17.6)

Interest etc 0.5 5.8

Retained surplus 1.8 19.0

• the successful delivery of asignificant cost improvementprogramme;

• the implementation of supplystock cabinets; and

• the unexpected recovery of prioryear income.

These ‘gains’ have been partially offsetby:

• the increase in costs associatedwith providing increased activityfor Primary Care Trusts; and

• the cost of meeting nationalwaiting time targets.

The Trust developed efficiencyproposals of £25.7 million to deliver in2009/10, and we will also continue todrive down costs in future years as

Transformation We recognise that real efficiency gains and service improvements canonly be achieved by changing our business processes and the Trust hasa dedicated Change Team which leads on transformation work,overseen by a new Transformation Board.

The adult spine service at St Thomas’ is just one of our successstories. The multidisciplinary team was taken out of clinical practice fora week to analyse their referrals process with some expert help. Afterimplementing a series of changes, including recruiting an appointmentcentre officer to manage bookings, doctors are now seeing a 42 percent increase in patients each week, allowing the service to generateextra income to be reinvested in services.

The Trust made a £19 millionsurplus (£25.5 million prior torestatement) in 2008/9 and achieved asurplus of £1.8 million in 2009/10 afteraccounting for the £5.1 million fixedasset impairment (equivalent to a £6.9million surplus excluding the fixed assetimpairment). These surpluses havebeen allocated to further develop ourservices and to implement the Trust’sambitious estates strategy.

These surpluses are primarily dueto the following positive factors:

• additional activity which hasresulted in increased income fromPrimary Care Trusts;



The growth in inpatient and daycase activity relates to increaseddemand for specialist (tertiary) servicesand the increased activity purchasedby Primary Care Trusts to achievenational waiting times targets. The

six per cent in 2009/10, compared to2008/09, although total attendancesare up by less than two per cent overthe five year period.

Chart 4 shows the growth inincome over the five year period fromApril 2005 to March 2010. Incomehas grown at approximately 10 percent a year over the period. Theincrease in income, above inflation, ismainly as a result of Primary CareTrusts purchasing additional activity(as described above), but also specificfunding for quality improvements insome areas.

The Department of Healthincreased the funding we received tosupport the provision of research by£17 million in 2009/10, comparedwith the funding received in 2008/09.

Chart 5 shows the growth inexpenditure over the five year period.Expenditure has also grown at anaverage rate of 10 per cent a year overthe period. This is primarily as a resultof the additional staff and non-paycosts associated with deliveringadditional activity. In addition to thegrowth in permanent staff, use oftemporary staff has increased.However, it is important to note that in2009/10 the rate of growth inexpenditure has increased significantlyabove trend due to a number ofspecific factors including increasedcosts of research and development,and also increased costs in clinicalsupplies and services, in part due to thearrangements for managing pathologyservices through the joint venture.

Cash flow and balance sheetThere have been a number ofsignificant changes in the Trust’sbalance sheet and working capitalduring the year.

The Trust ended the year with£111.9 million cash in the bank,against a plan of £125.5 million. This

The Trust developed efficiencyproposals of £25.7 million todeliver in 2009/10, and we willalso continue to drive down costsin future years.

majority of the activity growth overthe period relates to day case activity.

Total outpatient activity has grownby 21 per cent (new outpatientreferrals increased by 22 per cent andfollow-up referrals increased by 21 percent) over the period.

Accident and emergencyattendances have increased by nearly

Chart 5: Expenditure £000s1,000,000

900,000

800,000

700,000

600,000

500,000

400,000

300,000

200,000

100,000

02005/06 2006/07 2007/08 2008/09 2009/10

Chart 4: Income £000s1,000,000

900,000

800,000

700,000

600,000

500,000

400,000

300,000

200,000

100,000

02005/06 2006/07 2007/08 2008/09 2009/10

Chart 3: A&E attendances166,000

164,000

162,000

160,000

158,000

156,000

154,000

152,000

150,0002005/06 2007/08 2008/09 2009/102006/07

Chart 2: Outpatient attendances700,000

600,000

500,000

400,000

300,000

200,000

100,000

02005/06 2007/08 2008/09 2009/102006/07

Follow-up New

Chart 1: Completed patient spells

2005/06 2006/07 2007/08 2008/09 2009/10

Non-electiveinpatients

Daycases

Electiveinpatients

140,000

120,000

100,000

80,000

60,000

40,000

20,000

0


was a decrease in cash of £13.6 millioncompared to plan, and of £43.1 millionwhen compared with the £155 millionposition at the end of 2008/09. Thereduction in cash against plan is largelydue to the Trust’s lower than plannedsurplus of £6.9 million, prior to theimpairment charge.

The Trust had a projected capitalspend of £78.8 million for the year.During the year, the Trust received£3.7 million of Public DividendCapital, which was drawn down in fullduring the year. The actual capitalexpenditure during the year was £91 million, including £4.1 millionfrom charitable funds.

The Trust’s land and buildings weresubject to a revaluation in 2009/10 to reflect fair value and this wascompleted as a depreciated

replacement cost valuation. Landvalues remains unchanged from thevaluation as at 1 April 2009. Buildingvalues (including plant and machinery)have decreased in value by a total of£22.1 million. £5.1 million of this hasbeen charged against the income andexpenditure account and £17 millioncharged against the revaluation reserveaccount.

There has been no change to theTrust’s schedule of protected and non-protected assets during the year. In2009/10 the Trust relinquished itslease with Lewisham Primary CareTrust for the remaining parts of theNew Cross Hospital site and Trustservices occupying the site wererelocated to other parts of the Trust’sestate. In 2009/10 the Trust took outleases on Mary Sheridan House and

4,000members of staff werevaccinated againstseasonal flu

Table 3 NHS Funded Donated

£ millions £ millions

Buildings 35.5 0.4

Assets under 25.1 1.8 construction

Plant and 11.6 1.6 machinery

Information 3.6 0.0 technology (IT)

Furniture 0.0 0.0 and fittings

Software 11 0.3 licences etc

Total 86.8 4.1

16thfloor of Guy’s Tower is hometo the state-of-the-art researchand development department

£1,000,000of funding was awarded to lead anew south London HealthInnovation and Education cluster



75 York Road in order to facilitate theTrust’s estate strategy.

Charitable fundingThe Trust is fortunate to be supportedby Guy’s and St Thomas’ Charity. Allthe charitable funds that benefit theTrust are administered by this separatecharity. In 2009/10, the Trust spent£3.7 million from charitable grants oncapital projects and also received £5.2million in charitable contributionstowards revenue expenditure.

Capital expenditureCapital expenditure during 2009/10was focused on protected assets andincluded backlog maintenance, theprovision of medical equipment andinvestment in IT projects. Table 3below shows a breakdown of thedifferent sources of the capital andhow this has been spent.

Prudential Borrowing LimitA Prudential Borrowing Limit (PBL) isset by Monitor and is reviewed at leastannually. The total amount that theTrust borrows must be within thislimit. Monitor sets the PBL for eachFoundation Trust with reference tofinancial ratios and the individualTrust’s working capital facility. TheTrust did not renew its working capitalfacility beyond 31 July 2008 asplanned given the healthy cashposition of the Trust.

The Trust had no borrowingagainst the PBL during 2009/10, andthis was in line with expectation. TheTrust’s performance against the PBLindicators is described in note 29 onpage 77 of the annual accounts.

External audit servicesThe Members’ Council agreed thatDeloitte LLP should be the Trust’sexternal auditor for 2009/10. TheTrust incurred £158,664 in auditservices fees in relation to thestatutory audit of the Trust and itssubsidiaries’ accounts to 31 March2010.

Monitoring Trust performanceThe Trust has developed a ‘balancedscore card’ to review and monitorperformance at a Trust-wide,divisional and directorate level.Incorporated within the Trust levelscore card, which is reported monthlyto the Board of Directors, are themetrics used by Monitor to assess thefinancial risk rating of the Trust.

Monitor uses four criteria to assessthe Trust’s financial risk rating:underlying financial performance;achievement of the financial plan;financial efficiency; and liquidity. Atthe end of the financial year the Trustachieved a risk rating of three, in arange of one to five where five is thebest performance.

We have identified the key driversof change which we believe presentboth challenges and opportunitiesto our future operation.

Commercial income andprivate patient capThe Trust has a large commercialportfolio, and much of this income issubject to long term contracts.

In accordance with FoundationTrust legislation, the Trust’s privatepatient income is capped at 2.9 percent of income from patient careactivities based on the Trust’s 2002/03financial outturn. The Trust remainedwithin the private patients cap for2009/10 (see note 3.3 on page 66 ofthe annual accounts). Our futureplans assume that private income willremain constant in real terms, andthat we will therefore remain withinthe required limit.


Identifying potential financialrisks and opportunitiesIn assessing the financial risks faced bythe Trust, we have assessed theexternal factors which are likely toimpact on the organisation. We haveidentified the key drivers of changewhich we believe present bothchallenges and opportunities to ourfuture operation. These are:

• a change of government, bringingnew policies and a changingfinancial picture;

• the ongoing development ofKing’s Health Partners, includingthe Clinical Academic Groups;

• the changes to commissioningintentions for clinical servicesincluding the new arrangementfor the delivery of communityservices;

• savings and activity plans;

• our transformation programme;

• the NHS Constitution includingnew rights for patients;

• commercial opportunities.

The Trust continues to focus onmanaging the risks associated with thedrivers of change which are potentialchallenges, and on ensuring that it is ina position to take advantage of thepotential opportunities.

The development of the AcademicHealth Sciences Centre and extendingour commercial income are primarilyviewed as opportunities. The changedeconomic climate, volatility of thenational tariff and Market Forces Factorunder Payment by Results and ourpurchasers’ commissioning intentions,as well as changes to the levy fundingwe receive for teaching, are majoruncertainties and viewed as threatswhich make future planning difficult.

Responding to potentialfinancial risks andopportunitiesIn responding to these potential risksand opportunities, in particular thechange and uncertainty we face interms of the external environment, theTrust continues to set itselfchallenging financial targets.

The Trust is planning to achieve afurther £31.9 million savings in2010/11 and also aims to deliver asurplus of £5 million, which will be inaddition to the surpluses achieved inprior years. These surpluses will thenbe available to reinvest in servicedevelopments and our estate insupport of the Trust’s strategic vision.

The degree to which these targetsare achieved will determine the levelsof investment that the Trust is able toundertake in future years, and will alsoprovide a financial buffer should thefinancial risks we have identifiedmaterialise.

The following section sets out thekey challenges and opportunities wehave identified in achieving thefinancial targets that we have setourselves, and how these will bemanaged.

Change in government, new policies and financialenvironmentThe recent change in government maylead to significant changes in NHStargets, funding and quality standardsover the next few years. It is difficultto assess the impact of the change onnational health policy at this stage andtherefore the commissioning andfinancial risks set out below are thosewe are currently aware of.

The economic environmentThe global economic downturn hasimpacted significantly on futurefunding likely to be available to theNHS. The Department of Health is

96consultants have 1.5protected days a weekto carry out research

193apprentices have beenrecruited into a varietyof roles across the Trust

£295,000was awarded by Guy’s andSt Thomas’ Charity to fundbuildings and environmentprojects



forecasting savings required of at least£20 billion over the period 2010/11 to2016/17. London is expecting to face afinancial shortfall of £3.8 billion to £5.1billion over this period. This will requireincreased efficiency savings for NHSTrusts of four per cent a year or more.

The Trust will ensure programmesare developed to respond to thefinancial challenges driving furtherimprovements in productivity andefficiency whilst improving the qualityof patient care and the patientexperience. The establishment of ourtransformation programme willunderpin these efforts.

Market Forces Factor income and theremoval of non-recurrent support.The Trust is working with theDepartment of Health and NHSLondon to secure additional fundingfor the excess cost of providingspecialist services covered by thenational tariff, and to minimise theimpact of changes to research anddevelopment funding.

We have successfully implementedservice level reporting. Reports ofprofit and loss by service, consultantand procedure at a patient level arenow available for all the Trust’sservices. The potential for nationaltariff changes to alter the signals fromthese trading accounts remains aconcern, although they are being usedto inform the Trust business planningdecisions and are proving valuable.

Changes to funding forteachingThe Trust did not incur any loss ofteaching income in 2009/10 and doesnot expect any change in 2010/11. Weare aware, however, that the teachinglevy is currently under review and it isexpected that a new funding formulawill apply from April 2011. Earlyindications are that the Trust will see areduction in income of around £16million which will be phased at £4million a year starting in April 2011.We are working with NHS London andthe Department of Health to ensurethat the impact of any proposedchanges are fully understood.

As King’s Health Partners, we areleading the development of theHealth, Innovation and EducationCluster for south London and believewe will be well-placed to respond tochanges in the education agenda.

We aim to provide a full range ofworld-class clinical services,complemented by excellence inteaching and research, for thebenefit of the populations we serve.

The financial regimeUnder Payment by Results, theintroduction of the HealthcareResource Group version 4 andchanges in the Market Forces Factorhave resulted in significant changes tothe tariff structure and values whichhave impacted adversely on the Trust.In 2009/10, these losses of £16million, together with the loss of £2.8million income for High Cost AreaAllowances, have been partiallymitigated by transitional support fromNHS London of £7.5 million on a non-recurrent basis.

The national review of MarketForces Factor has led to a reduction inincome which was capped at two percent in 2009/10 and the Trust expects tolose a further £3.2 million in 2010/11.

We face significant financial risksin 2010/11 with the further loss of


Development of King’s HealthPartners, including ClinicalAcademic GroupsTogether with King’s College Hospitaland South London and Maudsley NHSFoundation Trusts, and our sharedacademic partner King’s CollegeLondon, we have formed an AcademicHealth Sciences Centre (AHSC), King’sHealth Partners. Based on thecomplementary skills of the partnerorganisations, we aim to provide a fullrange of world-class clinical services,combined with excellence in teachingand research, for the benefit of thepopulations we serve.

Opportunities to improve theeffectiveness and quality of our services,and to reduce unnecessary duplicationare being actively explored. We believethe AHSC presents opportunities forservice development, income growthand diversification as well as greaterefficiency.

Expectations are high, and themember organisations will need todevelop capacity and capability todeliver the future vision whilstmaintaining performance againstexisting targets. The development ofClinical Academic Groups, which arecurrently being introduced acrossKing’s Health Partners to bring clinicalservices, research and educationactivities together within a series ofsingle managerial units, will underpinthis work.

Changes in commissioningintentions and the newarrangements for communityservicesThe Trust is working closely with localPrimary Care Trusts as they developtheir commissioning intentions andreferral management and practice-based commissioning proposals for2010/11 and beyond. To date, theeffect of referral management andpractice-based commissioning havebeen relatively minor, although wecontinue to monitor their impact onthe Trust.

As King’s Health Partners, we haveresponded jointly to both theHealthcare for London – A Frameworkfor Action and A Picture of Healthconsultation on the future of servicesin south east London, as well as to theevolving South East London HealthServices Strategy. We have alsoparticipated in discussions about howthe proposals will be taken forward as

the outcomes of consultation areknown.

These proposals, along with anyother plans to rationalise specialistservices, may be reflected in the futurecommissioning intentions of GPs,Primary Care Trusts and otherpurchasing consortia. We are wellplaced to assist in the consolidation ofspecialist services and, if asked, wouldprovide services to an agreedpopulation as part of networkedpathways of care.

Primary Care Trusts are assumingthat significant financial savings canbe achieved through demandmanagement and shifting care fromacute hospitals to communitysettings. Guy’s and St Thomas’, onbehalf of King’s Health Partners, hasbeen selected by NHS Lambeth andNHS Southwark as the preferredpartner to manage communityservices in Lambeth and Southwarkfrom April 2011. This new relationship

90small grants were awardedby Guy’s and St Thomas’Charity to enhance servicesand our environment

£41,000of funding was awarded fromthe London Deanery to runeducation courses for consultants

200articles by staff haveappeared in peer-reviewedjournals



will also support our efforts tostrengthen closer working with GPsand a range of other health and socialcare professionals.

The Trust believes that whilst theintegration of acute and communityservices will be essential to deliveringbetter health care in our local area andmake a significant contribution to thefinancial savings required of the NHS insouth London, the scale of change is ofsuch magnitude that it will require theTrust to work collaboratively withcommissioners and other acuteproviders to ensure a sustainablehealthcare system is maintained.

We have a good history of workingwith local PCTs to deliver systemchange within the funding available toall parties. The Trust’s transformationprogramme, potential cost savingsfrom King’s Health Partners and theintegration with community servicesgive us a firm basis from which todeliver significant service redesign andcost reduction.

Although we have set a plan for2010/11 to deliver a surplus of £5million, we will continue to look foropportunities to deliver efficiencysavings, remove waste and reducecosts. Our aim is to over exceed thistarget to maximise the investment wecan make in clinical services and theTrust’s estate strategy.

Transformation programmeThe Trust recognises that real efficiencygains and service improvements canonly be achieved by changing ourbusiness processes, and the Trust has adedicated change team which leads ontransformation work, overseen by anew Transformation Board. Thetransformation programme has beenset a target to save £50 million fromApril 2011.

NHS Constitution and newrights for patients The NHS Constitution gives patientsthe right to be treated within 18weeks or to move to another serviceprovider for their treatment. We haveseen a significant rise in referrals to anumber of clinical services over thelast 12 months and this has led tosome patients waiting longer than thenational maximum waiting times. Ifdemand continues to increase, wemay not be able to meet this level ofactivity in some specialties and somepatients may opt to transfer to otherproviders. However, when patientshave been offered this choice in the

We will continue to look foropportunities to deliver efficiencysavings, remove waste andreduce costs.

Savings and activity plansThe Trust has set itself challengingfinancial targets over the next threeyears in order to deliver the financialsavings required by the NHS and thesurpluses needed to invest in our estate.The Trust is developing plans to reducecosts whilst continuing to provide highquality effective clinical services.

We are also working with localPrimary Care Trusts on a number ofkey productivity improvements anddemand management protocols todeliver overall system sustainability sothat the activity delivered by the Trustis both affordable and can bedelivered within the funding available.

The risk of not meeting thesetargets will be that the Trust and localPCTs will be in financial deficit, whichmay lead to additional reductions inactivity and funding available in futureyears, and adversely impacting on ourestates strategy.


past, most have opted to stay with theTrust and have chosen not to transfer.

The Trust does not believe this tobe a significant financial risk, althoughis it clearly a performance issue if thetargets remain.

Commercial opportunitiesThe Trust benefits from having one ofthe largest and most successfulenterprise units in the NHS. Thecommercial directorate supports anddevelops a range of initiatives todiversify our income base and createadditional financial surpluses, whichare used to invest in NHS patient careand our facilities and equipment.

Commercial opportunities andactivities are subject to scrutiny by theBoard, and aim to create commercialgain from the physical and intellectualassets of the Trust, without incurringsignificant financial or reputational risk.

These include treating private andinternational patients at privatepatient facilities; commercial researchand trials ; commercialisation ofintellectual property; consultancyservices in the UK and internationally,both independently and in conjunctionwith leading consultancies; managementof healthcare facilities forgovernments, military organisationsand other healthcare organisationsinternationally; provision of supportservices to other NHS organisations;and partnering with commercialorganisations who have innovativeproducts and services.

Research developmentsTransplantation is an exciting area of medicine that unites King’s HealthPartners’ clinical innovation, leading-edge research and organisationalexcellence.

King’s Health Partners’ brings together the major clinical transplantservices offered by Guy’s and St Thomas’ and King’s College HospitalNHS Foundation Trusts with King’s College London, which is home tothe Medical Research Council’s only UK Centre for Transplantation.

Our doctors and scientists have studied rare individuals acrossEurope who appear to have developed a natural tolerance to a donatedkidney after transplantation. Usually, this is only revealed when organrejection does not occur after the patient stops taking theirimmunosuppressive drugs for clinical reasons.

Through studying these patients, we have been able to show theseindividuals share a ‘tolerance fingerprint’ – a specific ‘full set’ ofimmunological markers in the blood.

Doctors now hope to be able to screen kidney transplant patientsfor these markers to identify patients who may be able to safely reducetheir use of immunosuppressants.

The commercial directorate supportsa range of initiatives which are usedto invest in NHS patient care.


Our staffWe have almost 11,000 staff, clinicaland non-clinical, who are integral tothe success of the organisation. Theycontinue to provide high quality careand work hard to meet national andlocal targets, and to improve efficiency.

Communicating with our staffThe Trust is committed to involving staffin decision-making and keeping theminformed of changes and developmentsacross the organisation. The Trust’stwo-day corporate inductionprogramme is a valuable source ofinformation for new recruits and theKnowledge and Information Centre at

staff magazine, People. The Trust’sintranet, GTi, is also a central source forpolicies, guidance and online tools.

We work with staff representativesto ensure employees’ voices are heard.The Joint Staff Committee meetsbimonthly, acting as a valuableconsultative forum. Sub-groups havebeen established to look specifically atpolicy and pay issues and topics such asfinancial performance are regularlydiscussed.

Staff throughout the organisationare encouraged to voice opinions andget involved in developing local servicesto drive continuous improvement.

Staff surveyWe participate in the annual NHSnational staff survey and since 2008have invited all eligible staff torespond rather than a smaller selectedsample so that we get the bestpossible insight into the views of ourstaff. Based on the latest results fromthe 2009 survey, Guy’s and StThomas’ is among the top 20 per centof acute Trusts in England for 22 outof the 40 key scores; an increase from13 in 2008.

3,826 members of staff respondedto this year’s survey and the areas ofbest and weakest performance can beseen on the table on page 35.

The Trust uses the results in avariety of ways to address any areas ofconcern. For instance we havedeveloped the In your shoes initiativewhereby senior managers have an

The Trust strives to improve the quality of care and the hospitalenvironment through consultation with our patients, the commitmentand hard work of our staff, and the support of our partners. Thisenables us to deliver treatment and care that meets the needs of thediverse local communities we serve.

Our staff, patientsand partners4

Staff throughout the organisationare encouraged to voice opinionsand get involved in developinglocal services.

St Thomas’ provides email andcomputer access for staff, as well asregular information and trainingsessions.

We work hard to ensure staff areaware of the key priorities and issuesaffecting the organisation, includingthe changing financial and regulatoryenvironment. Our range of well-established communications channelsincludes a monthly team briefing and


opportunity to experience the roles ofother staff for a day, and we held ourfirst ever Trust-wide awards event in2009 to recognise and honour theoutstanding contributions of our staff.

We continue to work with staffside representatives to develop ouraction plans which address issuesraised in the staff surveys.

Equality and diversity The Trust takes an inclusive approachto the six strands of equality – age,disability, ethnicity and race, religionand belief, gender, and sexualorientation. Following a strategicreview in 2009, we developed ourEquality and Human Rights Scheme2010-2013 to proactively promotediversity through key priorities such as:

• robustly addressing discrimination,bullying and harassment;

• ensuring that clinical services arefair and fully accessible;

• providing equality of opportunityfor all our workforce;

• ensuring our staff reflect thecommunities we serve.

In 2009, the Trust appointed its firstDirector of Equality and Diversity whotakes overall responsibility formonitoring our operations againstthese priorities and publishes detailsof our performance.

The Trust continues to use the ‘twotick’ disability symbol on recruitmentmaterials, signifying our positiveattitude towards the recruitment ofdisabled people, and we continue tosupport disabled staff, includinganyone who becomes disabled duringtheir employment. We also workclosely with some specialistorganisations including Remploy, StatusEmployment and the Royal LondonInstitute for the Blind to provide workexperience placements for people withdisabilities.

Aspire, the Trust’s equality anddiversity network, brings togetherstaff, Non-Executive Directors andmembers of the local community toactively support our diverse workforceat all levels.

Looking forward, the Trust iscommitted to taking further positivesteps and has recruited a learning

disability coordinator to help us meetthe recommendations of Healthcarefor all – the independent inquiry led bySir Jonathan Michael to consider howhospitals meet the healthcare needs ofpeople with learning disabilities.

We will also relaunch andstrengthen our Equality ImpactAssessment process to ensure new

Guy’s and St Thomas’ CharityThe Trust is fortunate to be the main beneficiary of Guy’s and StThomas’ Charity and is grateful for the generous support this providesfor a wide range of services, initiatives and research.

The Modernisation Initiative End of Life Care Programme is just oneof these. It is an ambitious project designed to improve services inLambeth and Southwark for people with advanced, progressive, andincurable conditions. It supports them to live and die as well aspossible, and ensures their families and carers are looked after. It is alsodesigned to support healthcare staff and recently launched a pocket-sized guide, What to do after death, for those first to arrive at the sceneof a death. It contains useful contacts, guidance on what to do withmedication, as well as patient considerations, such as how to ensurespiritual beliefs and preferences for after death care are met.

Better breathing for life, is another exciting and innovative schemefunded by the Charity which aims to improve care for patients withchronic obstructive pulmonary disease – severe breathing difficulties –in Lambeth and Southwark. Working with the two local Primary CareTrusts, King’s College Hospital and staff in the community, the projectis helping to identify patients who are at risk of hospital admission,ensuring they are treated at home wherever possible. In 2009, theteam won a national award for service innovation.


service developments and buildingprojects, as well as Trust policies anddecisions, support our commitment todiversity.

Training and developmentThe Trust is committed to the training,career development and promotion ofall staff – see chapter 5 – and offers arange of opportunities to support this,including short courses, managementdevelopment programmes, mandatorytraining, mentoring schemes andaccess to university programmes.

Staff have helped to develop theTrust’s values, which guide how weinteract with patients, visitors andstaff, and these have informed thestandards we expect through ourvalues-based behaviours model. Thisnow underpins the Trust’s appraisalscheme and ensures an emphasis onbehaviour and attitudes, not just onpractical skills. Through appraisals weactively encourage staff to contributeideas to improve the performance ofour services and increase efficiency.

The Trust runs an apprenticeshipscheme to provide work-basedtraining for staff seeking to gain theknowledge and skills required toundertake their role and tasks more

identified covering a diverse range ofareas and include roles in nursing,maternity and administration, as wellas in pharmacy and housekeeping.

In addition, the Trust has recentlyintroduced a cadet scheme to raiseawareness of apprenticeships andwork experience opportunities in localschools and colleges, and with jobseekers. Cadets will spend time in keyservices relating to their areas ofinterest and will be able to undertakeaccredited learning under theguidance of a coach.

VolunteersOur staff benefit greatly from thesupport of a team of more than 300volunteers who contribute anestimated 720 hours a week to theTrust. They provide a range of servicesfrom welcoming patients and visitors,directing or assisting them asnecessary, to working with thespiritual care team and escortingpatients to the MediCinema to watchthe latest films, often in wheelchairsor even in their beds.

Safe working environmentWe place a strong focus on health andsafety to maintain an environmentthat is safe for staff, patients andvisitors. Significant progress has beenmade throughout the year in terms ofaudits, training and incident reportingand our health and safety strategy setsout a three year vision for improvingperformance.

Our occupational health serviceremains one of the largest in thecountry, employing a team of doctors,nurses, counsellors and support staff,which not only serves almost 11,000staff, but has contracts to provideservices for a number of localbusinesses.

Pre-employment screening, work-related health checks and a

Our staff, patientsand partners

The Trust is committed to thetraining, career development andpromotion of all staff and offers a range of opportunities tosupport this.

3,826members of staffresponded to the 2009national staff survey

79%of nurses and midwives wouldrecommend Guy’s and StThomas’ as a place to work

effectively. In response to agovernment commitment to increaseapprenticeship opportunities in thepublic sector, we are providingopportunities for existing staff, schoolleavers and job seekers. As a result,nearly 200 apprenticeships have been


vaccination and immunisationprogramme are just some of theservices offered. This year, followingan extremely successful awarenesscampaign, an unprecedented numberof staff – more than 4,000 – werevaccinated against seasonal flu, andnearly 3,000 against swine flu.

PatientsAround 900,000 patients walk throughour doors each year, and it is theirexperience which is at the heart ofeverything we do. It is only throughlistening to our patients, theirrelatives, carers and visitors that wecan provide the best possible services.

Listening to patientsWe value patient feedback which helpsus monitor and improve services. Theindependent research organisationIpsos MORI conducts a telephonesurvey of around 4,000 patients onbehalf of the Trust twice a year.

We continue to see high levels ofsatisfaction with the services weprovide, with over 90 per cent ofthose surveyed reporting they werevery or fairly satisfied with their visit tothe Trust and the quality of care theyreceived.

The Care Quality Commission’sannual inpatient survey showed that92 per cent of our inpatients rated

their care as good or excellent, whilst96 per cent reported their ward asvery or fairly clean. The commissionalso conducted an outpatient surveythis year, which saw 91 per cent ofrespondents rating their care asexcellent, very good or good, and 82per cent feeling they were treatedwith dignity and respect at all times.

This year, the Trust has relaunchedits comment card scheme andsuggestion boxes have been installedin wards, outpatient clinics andwaiting areas.

These surveys and feedbackfacilities ensure that we continue tomake changes that patients andvisitors want. The results andobservations are fed back to therelevant local teams for action andreported to the Board of Directors andCouncil of Governors’ patientexperience working group. Patientstell us that cleanliness and theappearance of the hospitals are veryimportant to them, and over the lastyear the Trust’s environmentalimprovement programme hasincluded the refurbishment of themain hospital entrances, wards andcorridors on both sites. Patients alsowanted more information about theirtreatment and we have been workinghard to ensure patients see the letterswe send to their GP.

The Trust also takes complaints veryseriously and we strive to learn lessonsso we improve services and better meetthe needs of patients. We have fullyimplemented the new nationalcomplaints framework which aims todeliver a more complainant-focusedapproach and encourages opencommunication between patients andservice providers. We have worked topromote an atmosphere of opennessand respect so that patients or visitorsfeel comfortable raising any concernswith staff directly.

720hours a week arededicated to the Trustby a team of volunteers

NHS ConstitutionThe NHS Constitution was published in January 2009 and bringstogether what patients and the public, as well as staff, can expect fromthe NHS, including hospitals such as Guy’s and St Thomas’.

We are embedding the Constitution into our everyday practice in anumber of ways. Through national programmes such as the dignitycampaign, we are transforming services for patients being treated on thewards. Through local initiatives such as our own Showing we care initiative,we are ensuring that we listen to patients and staff and respond to theirneeds, and that we provide satisfying and rewarding jobs for our staff.

For staff, we offer a range of benefits and facilities including theride-to-work cycle scheme, interest free loans for computers and seasontickets and on-site nurseries, as well as opportunities for flexibleworking to help staff balance their home and working lives.


Patient involvementThe Trust is committed to involvingpatients and the public in thedevelopment and improvement ofservices. This year, we have continuedto implement our patient and publicinvolvement strategy – a three yearvision aimed at embedding a positiveapproach to involvement across theorganisation.

We held a two-day trainingprogramme for staff to give them theskills they need to plan and organiseinvolvement schemes, particularlywhen planning service developmentsor changes. An ‘engagement guide’and new policy have also beendeveloped to assist staff undertakinginvolvement initiatives.

Patient involvement has been a keyfeature of the design work for the newchemotherapy day unit and eventshave been held to gather opinions andshare ideas. As a result, the

conditions and treatments to enablethem to make informed decisionsabout their care. All informationproduced by the Trust is monitoredand approved through a rigorousprocess to ensure that it is evidence-based, meets national standards andhas been reviewed by patients.

During the year, the Trustproduced over 100 new patientpublications, and reviewed existingpublications to ensure accuracy. InSeptember, two of the Trust’s patientinformation leaflets were highlycommended at the British MedicalAssociation Patient InformationAwards. Timmy’s Operation, acartoon which explains to childrenwhat to expect when they have ananaesthetic, and the leaflet,Chemotherapy services at St Thomas’Hospital, were praised by judges.

The Knowledge and InformationCentre at St Thomas’ continues toprovide a welcoming and accessiblelocation for patients and their familiesto enquire about health services, usecomputers and search the internet,and to visit the PALS walk-in service.Last year nearly 80,000 people visitedthe centre and staff responded tonearly 15,000 queries.

The Trust provides a comprehensivelanguage support service to meet theneeds of our diverse population andcan provide interpreters for patientsand their carers. We providetelephone interpreting services inmost common languages and facilitiesexist to translate information,including into formats such as audioor Braille.

PartnersThe Trust benefits from excellentpartnerships with a range oforganisations and these allow us todeliver services which meet the needsof our local and wider patient

Our staff, patientsand partners

The Trust is committed to involving patients and the public in thedevelopment and improvement of services.

100new patient publicationswere produced duringthe year

900,000patients walk throughour doors every year

environment is now designed tomaximise privacy and recognise theneed for personal space whenundergoing treatment.

The Maternity Service LiaisonCommittee is another key source ofuser views and engagement, andtopics of interest over the last yearhave included promotingbreastfeeding, smoking cessation andone-to-one care during labour.

Patient information The Trust is committed to providingpatients with clear, informative,clinically accurate information on


communities, whilst also supportinglocal regeneration and creatingemployment opportunities for localpeople.

Partnerships to improvehealthcareKing’s Health Partners was formallyaccredited in March 2009 and muchwork has been undertaken since thento build the structures and strategiesthat will ensure we deliver our vision tocreate an Academic Health SciencesCentre which combines the best ofbasic and translational research, clinicalexcellence and world-class teaching todeliver ground-breaking advances inphysical and mental health. Moreinformation about King’s HealthPartners can be found on page 6.

ConsultationsIn the Shape of Things to Comeconsultation, Healthcare for Londonacted on behalf of the JointCommittee of Primary Care Trusts todevelop new models of care for strokeand trauma. The aim was to developcentres of excellence to raise clinicalstandards and improve patientoutcomes. Results were published inJune and included designating Guy’sand St Thomas’ as a trauma and astroke unit. As part of King’s HealthPartners we are also supporting King’sCollege Hospital in developing a majortrauma centre.

Developing services with localagenciesThe Trust enjoys long-standing andcollaborative relationships with primaryand community care partners inLambeth and Southwark. Theserelationships will be strengthened in thecoming months by NHS Lambeth andNHS Southwark’s decision to select theTrust as their preferred partner tomanage community services.

4,000patients are surveyedtwice a year by IPSOSMORI

and planned developments at ourhospitals and seek their input andadvice when required.

The Trust works in partnershipwith the South Bank Employers Groupas part of our commitment towidening access to employmentopportunities for the local community,and we now advertise 25 per cent ofjobs for bands one to four throughthe group.

Working with our partnersOur comprehensive Biomedical Research Centre’s stunning new facilities inthe Guy's Tower brings together patients, clinicians and scientists in adedicated space. It is here that they gather for formal meetings and eventsand also make those all-important informal contacts that often drive someof the best research ideas that lead to real benefits for patients.

Whilst admiring spectacular views of the city, Trust staff and theiracademic colleagues are already using the centre to engage with partnerorganisations and industry, and doctors and scientists are regularlyfound in the café discussing potential avenues for their research.

Looking forward, we will use the facilities to engage local people,patients and charities in the research taking place on their doorstep,offering them opportunities to discover and discuss the exciting projectstaking place at our hospitals and other organisations within King’sHealth Partners.

We are confident this new centre is fast becoming a place where wecan explain what we’re doing and inspire local people to get involved.

We continue to work closely withLocal Involvement Networks (LINks) inLambeth and Southwark. For example,Lambeth LINk recently reviewed localservices for deaf and hearing-impairedadults, and both Lambeth andSouthwark LINks helped us to developa policy to support the reimbursementof expenses for people who take part inpatient involvement activities.

We also work closely with Lambethand Southwark Overview and ScrutinyCommittees. We regularly updatethem about proposed service changes


Our staff, patients and partners

Guy’s and St Thomas’ CharityThe Trust is grateful for the continuedand generous support of Guy’s and StThomas’ Charity which uses its fundsfrom donations to support innovations

Two major initiatives include:

• £561,000 to develop apharmacogenetics service whichuses the latest research into theuse of genetic markers to tailordrug treatments more accurately toindividual patients. This meansthat the side effects can beminimised and the therapeuticimpact of drugs can be maximised;

• £324,800 to fund a multi-disciplinary project that willdevelop safe and effective carepathways for patients who haveself-harmed across primary andsecondary care.

The Charity also made more than 90smaller grants (each less than£20,000) to support projects whichenhance existing services and thehospital environment. These includedfunding for feasibility studies, artprojects, and faith-led celebrationsand cultural events which benefitpatients, staff and visitors.

The Charity, in collaboration withMedical Physics, also provides fundingfor Trust employees who have ideasfor innovative technological approachesto improving patient outcomesthrough the Guy’s and St Thomas’Innovation Fund for TechnologyTransfer. The programme providesaspiring inventors with the necessarysupport and expertise to develop theirconcept, including help withprotecting intellectual property anddeveloping a prototype, and up to£50,000 in financial support.

We are enormously grateful to theCharity and its supporters for fundingthese initiatives, as well as for theircontinuing support of an exciting visualand performing arts programme, whichprovides therapeutic benefit to patientsand enhances the hospital environmentfor all. For more information, visitwww.gsttcharity.org.uk.

92%of patients rated their care as‘good’ or ‘excellent’ in the CareQuality Commission’s annual survey

15,000queries were answeredby staff in the Knowledgeand Information Centreat St Thomas’

We are committed to wideningaccess to employment opportunitiesfor the local community.

and develop new services, invest inresearch and improve the hospitalenvironment. The Charity also carriesout dedicated fundraising campaignsto support major Trust initiatives.

Guy’s and St Thomas’ NHSFoundation Trust is the mainbeneficiary of the Charity and, overthe year, we received funding for 36service improvement projects valuedat nearly £7 million.


£80,000of Art and Heritage grantswere awarded by Guy’sand St Thomas’ Charity

Areas of best performance

Percentage of staff 87% 78% 81% 80% Improvementreceiving job relevant training, learning or development in the last 12 months

Fairness and effectiveness of 3.64 3.42 3.52 3.42 Improvement incident reporting procedures

Percentage of staff 18% 26% n/a n/a New score in 2009feeling pressure in the last three months to attend work when feeling unwell

Work pressure felt by staff 2.87 3.11 2.96 3.14 Improvement

Staff Survey 2009/2010 2008/2009Trust National Trust National Trust improvement/

Response rate average average deterioration

41% 55% 48% 55% Deterioration

Areas of weakest performance

Percentage of staff reporting 80% 95% 97% 95% Deteriorationerrors, near misses or incidentswitnessed in the last month

Percentage of staff using 58% 70% 55% 71% Improvementflexible working options

Percentage of staff saying 57% 69% 4.66 4.69 Not available – the scoringhand washing materials methodology changedare always available from a scale score in 2008

to a percentage in 2009

Percentage of staff experiencing 10% 7% 10% 7% Unchangeddiscrimination at workin last 12 months

Jack’s MRI AdventureDuring the year, in response to feedback from children and parents, theMRI team at the Evelina Children’s Hospital developed a book and DVDfor children visiting the hospital for a scan, supported by a grant fromGuy’s and St Thomas’ Charity.

Jack’s MRI Adventure is aimed at children between five and 10 yearsold, and there are also photo stories for older children.

Most children find the confined space and noise of thescanner the scariest part of having an MRI, so the newinformation is backed up by preparation sessions with a playspecialist using a play tunnel. This allows children topractice lying still while listening to a CD that helpsfamiliarise them with the different noises they will hear inthe real MRI tunnel.

The success of this initiative is clear from thereduced need for children to have a general anesthetic,and most importantly, because the children are lessanxious and much happier about having a scan.


TeachingThe Trust plays an important role inthe clinical education and training of awide range of health professionals,including doctors, dentists, nurses,allied health professionals and manyother laboratory and technical staffwho are vital to the delivery of firstclass health care.

Education and research are centralto our responsibilities as leadingteaching hospitals and a majoracademic centre, and underpin ourvision for our Academic HealthSciences Centre, King’s Health Partners.

During the year, King’s HealthPartners was awarded £1 million ofgovernment funding to lead a newHealth, Innovation and Education

Our HIEC will focus on four areasinitially: mental health; infectionprevention and control; diabetes; andstroke.

Undergraduate educationMore than 300 consultants andsupporting administrative staffcontinue to make a significantcontribution to the education anddevelopment each year of over 800undergraduate medical students fromour academic partner, King’s CollegeLondon.

The Trust continues to engagenewly appointed consultants in theeducation programme, ensuring theyhave dedicated time for teaching,hosting students and providinglectures in the September introductoryweek and assessing competency inJuly’s final clinical exams. They alsosupport students throughout theacademic year.

We have two unique systems inplace at the Trust to monitorundergraduate teaching. Theundergraduate education committeemeets monthly with representationfrom each of the Trust’s clinicaldirectorates and from King’s CollegeLondon to ensure that the quality ofteaching and the student experience is continuously scrutinised. Inaddition, an undergraduate educationcoordinator sits on a number ofcollege committees, working closelywith staff to facilitate effective two-way communication.

Teaching and research and development5As leading teaching hospitals and a major academic centre, Guy’s andSt Thomas’ is committed to developing first-class healthcareprofessionals and delivering ground-breaking advances in medicaltreatment for the benefit of our patients. We work closely with partnerorganisations and our local community to ensure that education andresearch of exceptional quality adds value to the patient experience.

We have implemented a strategyto attract and retain the bestnursing staff, placing a particularemphasis on recruiting nurses whomay have left the profession.

Cluster (HIEC) for south London,which will improve healthcare deliveryand education. The collaboration,made up of around 30 organisations,is one of the new government fundednetworks that aims to deliver highquality patient care through a bettertrained workforce and the more rapiddissemination of research findings.


We have made improvements tothe support we provide to studentsfollowing feedback from the GeneralMedical Council after a visit in 2008.For example, we now offer an onlinesystem so students can book a rangeof scheduled clinics and get access tomore e-learning opportunities.

Postgraduate educationThe Postgraduate Medical EducationDepartment has enjoyed another busyyear. The online induction programmefor junior doctors, introduced in 2008,was updated to ensure that it remains current and robust, and thedepartment has hosted a number of smaller, specialist inductionsthroughout the year.

The department was alsosuccessful in securing £41,000 offunding from the London Deanery forfaculty development so we cancontinue to run education courses forconsultants free of charge. Theseinclude Teaching for Teachers, ClinicalSupervision and Education Supervisorcourses.

Our annual contract monitoringreport for 2009/10 was submitted inJuly 2009, and resulted in thedepartment being cited as an exampleof best practice by the qualityassurance unit of the London Deanery.

During the year, work began on anew Simulation and InteractiveLearning centre at St Thomas’,following in the footsteps of the multi-disciplinary centre at Guy’s whichopened in May 2008. It will be used totrain staff in real-life scenarios usinglife-sized, high-fidelity mannequins.The mannequins will be programmedto convey typical patient responses,and real clinical incidents will beplayed out and the root causes ofsituations analysed. The environmentwill allow students to practise dealingwith uncertainty, breaking bad news

and end of life decision making in arealistic, but safe environment.

Nursing trainingWe have implemented a strategy toattract and retain the best nursingstaff, placing a particular emphasis onrecruiting nurses who may have leftthe profession and want to return, orwho may be interested in nurseapprenticeship roles.

We have also introduced clinicalassistant practitioners, who aretrained at degree level to performspecific practical tasks under thesupervision of a registered nurse ordoctor. A Band 7 multi-professional

leadership course was also introduced,bringing together leaders from avariety of professions on a singlecourse, which aims to enhanceleadership and team building skills aswell as confidence amongst thisimportant group of front line staff.

Research and developmentOur hospitals have a long tradition of making significant medicalbreakthroughs and developing newtreatments. With our university partner,King’s College London, we are a majorcentre for NHS-funded research.

We are one of only five NationalInstitute for Health Research (NIHR)

Specialist servicesThis year, we became the national centre to treat children with the rareinherited disease Xeroderma Pigmentosum, working closely with thediagnostic laboratory at the University of Sussex, the photobiology unitat Ninewells Hospital in Dundee, and a charitable trust, the XP SupportGroup. Funding was granted by the National Specialised ServicesCommissioning Group – a Department of Health committee whichcommissions these highly specialised services.

The Trust will also receive £1.3 million a year to provide diagnosis,treatment, education and support for people suffering from theneurogenetic disorder neurofibromatosis 1. We are working closelywith Central Manchester University Hospitals NHS Foundation Trust andthe Neurofibromatosis Association to provide the best possible care forpatients and their families.


funded comprehensive BiomedicalResearch funded Centres, and part ofone of the UK’s first Academic HealthSciences Centres, King’s HealthPartners. As such, we are committed todriving forward research andinnovation which will benefit our localpopulation and have a positive impacton healthcare nationally andinternationally.

Our research and developmentportfolio is constantly increasing, withmore than 400 projects involvingpatients and healthy volunteers taking

terms of recruitment in the London(South) Comprehensive Local ResearchNetwork, which we also host.

Studies taking place across theTrust are diverse, ranging fromprojects looking at the causes ofdiseases to the use of robotics inhealthcare, the viability of newtreatments and the analysis of patientsamples to further understand howvarious diseases progress.

Increasing capacity to expand theopportunities for our patients to takepart in research is hugely important.

A scheme introduced in 2008 sawus award 96 consultant staff with oneand a half days of protected time eachweek to carry out research. This hasfostered a new generation ofinvestigative talent and seen thelaunch of many new studies with staffpublishing over 200 articles in peer-reviewed journals.

Biomedical Research CentreDuring 2009, the highly successfultraining schemes run by the NIHRfunded comprehensive BiomedicalResearch Centre continued to flourish,

Teaching and research and development

We are driving forward researchand innovation which will benefitour local population and have apositive impact on healthcarenationally and internationally.

place across the Trust and King’sCollege London this year. We recruitedover 4,000 patients into clinical trialsand other patient-focused studies,making us the most successful Trust in

800undergraduatemedical students traineach year at the Trust


with additional opportunities forconsultants, junior doctors, alliedhealth professionals, nurses andmidwives and PhD students to securefunding for their work.

Five junior consultants wereawarded clinical research consultantposts which are enabling them todedicate half their time to research andestablish independent researchprogrammes. Eight medical and dentalclinical trainees were awarded one yearclinical training fellowships, and sixGuy’s and St Thomas’ nurses,physiotherapists, speech and languagetherapists, dietitians and pharmacistswon research training fellowships.

In June 2009, the centre launchedits Faculty of Translational Medicine,which brings together clinicians,scientists, nurses, midwives, alliedhealth professionals and managers inthe search for new treatments anddiagnostic tests for a wide range ofdiseases and conditions. We aredelighted to be the only centre withfaculty space of this kind as this allowsmembers to interact, collaborate andaccess leading edge technologies andfacilities, as well as advice andconsultancy services. Members of thefaculty and colleagues from ourpartner organisations also cometogether every month for our flagshipBiomedical Forum which allows themto find out about the latest advancesin translational medicine.

A review of the centre’sachievements was carried out inOctober 2009 by an External AdvisoryBoard which concluded it is in astrong position to deliver excellence intranslational research over the nexttwo years. This year the centre movedinto state-of-the-art accommodationon the 16th floor of the Guy’s Towerand this is now home to the researchand development department, theJoint Clinical Trials Office, and the

Involving patientsThe Trust is committed to undertakingresearch which involves our localpopulation. We have worked hard todevelop ways for patients, carers andfamily members, as well as membersof the public and representatives frompatient and charitable organisationsto have their say about the researchtaking place within our hospitals.

We want to demystify the researchprocess for patients and this year wehave developed patient information toexplain the benefits of taking part inmedical research studies and supportstaff in their discussions with patients.We now plan to provide trainingsessions for patients and the publicwho are interested in getting involvedand are running drop-in sessions forstaff in need of advice or support.

£1,200,000is being spent on researching airpollution and vitamin D deficiencyin childhood asthma

4,408patients have been recruitedinto clinical trials and patientstudies at the comprehensiveBiomedical Research Centre

London (South) Comprehensive LocalResearch Network.

The facility is now a one-stop-shopfor all research related matters, co-located with the Guy’s clinicalresearch facility and a new commercialclinical trials unit run by Quintiles, aleading provider of first-in-man trials.

Clinical research facility2009 saw the first full year of operationfor the clinical research facility at StThomas’ and a wide range of studiesinvolving patients and healthyvolunteers regularly take place so thatwe can find more effective ways totackle major health problems such asobesity and heart disease.

Another complementary facility isdue to open in 2010 at Guy’s and willhouse a Good Manufacturing Practicecell therapy unit, enabling researchersto safely control and manage themanufacture and testing of novel celland protein therapies.


Quality report6

The Trust is subject to range ofexternal assessments that monitor ourperformance against national andlocal standards and targets. Wecontinue to attain good outcomes inthese, through the hard work of ourstaff and the robust policies andstructures we have in place.

Guy’s and St Thomas’ is committed to ensuring that our staff are ableto provide the highest quality care to our patients in clean, comfortablesurroundings. This is enshrined in our strategic vision which ensuresthat we provide an outstanding local healthcare system and build onour strength as a provider of specialist services.

Chief Executive’s statementAs leading teaching hospitals, and one of the UK’s first Academic Health SciencesCentres, our commitment is to deliver excellence in everything we do and toensure that first-class patient care lies at the heart of this.

This strong focus on quality reflects the priorities of the NHS as a whole andwe welcome the practical steps to support this agenda. This includes legislationto introduce quality reporting for all NHS Trust’s and the development of thescheme Commissioning for Quality and Innovation, which acts as a positive forceto ensure a strong focus on quality from the ‘ward to the Board’.

The Trust has worked hard over the past year to bring these initiatives, alongwith the requirements of the NHS Constitution, together into a coherent, over-arching strategy which will drive improvements in the quality of clinical care andpatient experience in our hospitals. Actions range from our Trust-wide initiative,Showing we care, to developments in the monitoring of key clinical indicators andimprovements to the hospital environment.

Both the Board of Directors and the Council of Governors take a keen interestin this work. The indicators used for quality reporting are subject to the samecontrols and assurance as all other performance data. We look forward to building on achievements to date and driving this forwardwith ambitious targets for the coming year.

Ron Kerr, Chief Executive

Details of our performance againstthese standards and targets aresummarised in a table on page 43.

During the year, the Trust wasdelighted to achieve the highestpossible rating from the Care QualityCommission (CQC) in its Annual HealthCheck – rated as ‘excellent’ for both the

Reporting back on our performance in 2009/10


that the views of local people are atthe core of what we do.

The Trust’s Governors commentedupon the importance of the QualityAccounts and suggested we indicatecurrent performance in the selectedindicators to demonstrate ourcommitment to improving outpatientexperience, particularly a reduction inwaiting times in clinics. Improvingoutpatient services will be a key focus

of our transformation programmeand we will work with staff, patientsand the wider community to identifyareas for improvement.

The governors also commented onthe importance of continuing toprovide patient education andinformation to empower them to beactive participants in their care. Thisyear, with help from patients, governorsand community representatives, we

Providing safer careThe Trust has a strong patient safety culture and we constantly strive toimprove the quality and safety of the care we provide. Our patientsafety and quality improvement programme concentrates on issuessuch as effective monitoring of patients’ progress, safe use ofantibiotics and a robust infection control policy.

We are committed to improving standards, particularly in elderlycare, and concentrate on patient-centred care as safely and efficientlyas possible.

Together with his team, Associate Medical Director Dr AdrianHopper, below, is leading an innovative quality improvementprogramme to transform the care of elderly patients. He was recentlynamed NHS Quality Champion of the Year in recognition of hisdedication and determination in this field. They have introduced anumber of initiatives to drive up standards of care and patient safety,including setting up weekly multi-disciplinary meetings to conduct real-time audits and ensure timely responses to issues identified;purchasing cupboards to ensure round the clock availability of pressurerelieving mattresses and reducing the incidents of pressure sores andfalls amongst vulnerable patient groups.

quality of services and the quality offinancial management. In addition, wereceived very positive feedbackfollowing our unannounced hygieneinspection in August 2009, and wecontinue to make good progress inreducing rates of hospital acquiredinfections.

The Trust also works closely withlocal healthcare partners andcommissioners to ensure that wecontinue to develop services whichmeet the needs of our local populationthrough the Commissioning for Qualityand Innovation scheme and otherinitiatives.

Last year, we declared fullcompliance with 24 core standards inthe Annual Health Check, and nomatters of concern were raised by ourinternal or external auditors.

We encouraged and receivedfeedback about our submission to theCare Quality Commission from a rangeof local stakeholders including ourLocal Involvement Networks (LINks),Overview and Scrutiny Committees,Lambeth and Southwark Alliance,local Safeguarding Children Boardsand our Council of Governors’ patientexperience working group. Thesegroups have provided valuablefeedback on the Trust’s progressthroughout the year.

The LINks asked for details abouthow we collaborate with King’sCollege Hospital to ensure a joined-upapproach to the provision of localhospital services. Both Trusts have along history of collaboration whichhas developed further in recent years.

The LINks also sought details aboutour plans to redevelop emergencyservices to ensure we are involvingpatients and the public in planningservice changes and developments.

Having introduced a new policy,we have a robust approach to patientand public involvement which ensures


will develop a patient informationstrategy.

We monitor the quality of careclosely at all times, both throughoutcome data and a range of otherqualitative measures including patientfeedback and complaints. Concernsabout elderly care have been raised by anumber of community groups and weare currently working closely togetherto understand and address these issuesto ensure we provide the best possiblecare to all patients.

Our priorities for 2010/11The Trust has identified the followingpriorities for the coming year, within thecontext of the national standards andassessments against which we aremeasured by external organisationssuch as the CQC.

The views of our patients, visitors,staff and governors have been key tothe development of these measures,and in our wider quality strategy, whichencompasses a range of departmentaland Trust-wide initiatives. We have alsoconsulted with LINks and othercommunity groups to ensure that themeasures we choose address the needsof our local communities. Whereappropriate, these measures align withthe CQUIN targets that we have agreedwith our Primary Care Trusts.

Patient safety

Screen adult inpatients for venous-thromboembolism

The Trust is committed to reducing therisk of death from preventable bloodclots through effective assessment ofnewly admitted inpatients. We willcomply with newly introduced NICEguidance to ensure that at least 90 percent of inpatients will receive anassessment.

Review unexpected deaths using theGlobal Trigger Tool Assessment

On the rare occasions that a patientdies unexpectedly at the Trust, weconduct a thorough investigation led bya senior doctor and nurse. We aim toimprove on this already rigorous systemof investigation, by using aninternationally validated tool.

We will use the World HealthOrganisation’s Global Trigger ToolAssessment to review at least 75 percent of unexpected deaths.

Reduce rates of MRSA bloodinfections and C.difficile

We understand that many patientsremain concerned about hospitalacquired infections. The Trust has oneof the lowest rates of MRSA andC.difficile infections among hospitals ofour size and complexity, with manyhigh risk patients. We aim to maintainand improve on these very low rates.

In line with year-on-year reductionsin rates of infections, we aim not toexceed nine cases of Trust-attributableMRSA blood infections and no morethan 91 cases of C.difficile infection.

Reduce the number of patientswho come to harm following a fall

The Chief Nurse for England placedreducing harm from falls as one of thetop health priorities for nurses inEngland. In addition, we understandthat the care of older people is ofparticular concern to our local people.

We aim to increase compliance withthe Trust’s falls policy from 85 to 95 percent and reduce the number of fallsthat result in harm by 10 per cent.

Clinical effectiveness

Improve discharge care for olderand vulnerable patientsTo ensure that all older and vulnerablepatients are treated with care, dignityand respect when leaving hospital, theTrust will conduct an independent

review of nursing care for these groupsto identify areas for improvement. Wewill establish an Older Person’sDischarge Group to drive improvementsacross the Trust, and progress will bemonitored through patient feedbackand the Patient Advice and LiaisonService.

Establish a Trust-wide ClinicalOutcomes Group

The Trust was assessed as one of thetop five hospitals for patient safety inEngland (Dr Foster, 2010) and to buildon this achievement, we will establish aClinical Outcomes Group to monitoroutcome data and trends across theTrust to enhance the quality systems wealready have in place.

The group will report to the Trust’sClinical Governance Committee and theBoard via the Patient Quality and SafetyReport and will highlight issues to theMedical Director and Chief Nurse.

Develop ward level quality andsafety information

We aim to engage ward staff at alllevels in delivering quality healthcare toall patients.

We will develop and implement anew toolkit for frontline staff tomonitor and deliver safe, high qualityhealthcare on the ward and inoutpatient departments.

Roll out Releasing time to care

The national Releasing time to careinitiative (sometimes known as Theproductive ward) frees up nurses’ timeto spend on direct patient care. TheTrust has already had considerablesuccess in implementing this initiative ina number of wards across the Trust.

By March 2011, we aim to roll outthe initiative to all eligible wards andestablish a monitoring system to reviewprogress.

Quality report


Implement the agreed year onegoals in the Healthcare for Londondementia care pathway

NHS London recently launched aDementia Services Guide to improvecare for patients suffering withdementia. We will implement the yearone goals which include identifying adedicated consultant lead for eachpatient; implementing training andinduction for staff in high-risk areas;and introducing a new patientassessment tool.

Patient experience

Improve our patient experience infive key areas

During the year, the CQC’s annualinpatient survey showed that 92 percent of our patients rated their care as

‘good’ or ‘excellent’. We aredelighted that overall satisfactionremains high and that many patientsfeel they are treated with dignity andrespect. However, we know there ismore we can do.

We will build on our Showing wecare initiative to further improve theexperience of patients. We arerequired to improve our performanceagainst five key questions in thenational inpatient survey by betweenone and five per cent, dependent oncurrent scores, including:

• Were you as involved as youwanted to be in decisions aboutyour care?

• Did you find someone to talk toabout worries and fears?

• Were you given enough privacywhen discussing your condition ortreatment?

• Were you told about medicationside effects to watch out forwhen you went home?

• Were you told who to contact ifyou were worried about yourcondition after you left hospital?

All of the quality measures identifiedfor delivery in 2010/11 will beregularly monitored by the Board ofDirectors and Council of Governors toensure we achieve these ambitiousimprovements for the benefit ofpatients and the local community.

Summary of Trust’s performance against quality measures 2009/10Measure 2009/10 target Our performance

Patient safety

Observation of Maintain minimum 95% compliance Target achieved – compliance remains greater than 95%.acutely ill patients with Trust observation standards and

medical management of acutely ill patients.

Medicines safety reporting Increase compliance with best practice by Target achieved – reporting of medicines incidents hasensuring effective incident reporting, increased by 20%. The Medicines Safety Forum, chaired byappointing a lead consultant for medicines a consultant is well established and is driving improvementssafety and establishing a medicines safety forum. in a number of areas.

Fluid balance reporting Increase compliance with Trust policy to 95%. Compliance is greater than 90%, although we havefurther work to achieve the target set.

Nasogastric tube Achieve 100% compliance with new Target achieved – compliance is 100% and no NPSAmanagement in adults Trust policy and zero ‘never events’. ‘never events’ were recorded.

Clinical effectiveness

Access to maternity Achieve 80% of mothers assessed Target achieved – 87% of mothers have received aassessment in 13 weeks within 13 weeks. health assessment within 13 weeks.

Reduce overall caesarean rate Reduce total caesarean rate below 27%. We did not achieve this target, in part due to the highproportion of complex cases treated.

Reduce smoking Reduce number of women smoking Target achieved – 4.7% of women smoking at delivery.during pregnancy at delivery below 5%.

Monitor and reduce Identify best practice. Target achieved – all specialties now monitoring unplanned readmissions unplanned readmissions.

Patient experience

Treat patients with Increase percentage of patients who We did not achieve our planned improvement although dignity and respect report staff ‘do not talk in front of them we maintained our 2008/09 performance.

as if they were not there’ to at least 86.5%.

Improve staff attitude Increase percentage of patients who were Target achieved – 69% of patients were ‘very satisfied’and communications ‘very satisfied’ that they were listened to that they were listened to and supported.

and supported to at least 66%.

Involve patients in their care Increase percentage of patients who were Target achieved – 64% of patients were ‘very satisfied’‘very satisfied’ that they were involved that they were involved in their care.in their care to at least 63%.

Same sex accommodation Achieve 98% compliance with latest guidance. Compliance achieved, details available on Trust website.

For a copy of the Trust’s full Quality Accounts, visit www.guysandstthomas.nhs.uk or NHS Choices at www.nhs.uk


Nominations CommitteeThe Nominations Committee makesrecommendations to the Council ofGovernors on the appointment andremuneration of the Chairman andNon-Executive Directors, andconsiders the independent appraisalof the Chairman.

Our organisational structure7

Council of GovernorsThe Council of Governors (ourequivalent of the Board of Governorsdescribed in Foundation Trustlegislation) advises us on how best tomeet the needs of our patients andwider communities.

It has a number of statutoryduties, including appointing theChairman and Non-ExecutiveDirectors, deciding on theirremuneration and ratifying theappointment of the Chief Executive.The Council of Governors also receivesthe Trust’s Annual Report andAccounts, and the Auditor’s Report,and appoints our external auditor.

The patient, public and staffmembers of the Council are electedfrom and by the Foundation Trustmembership to serve for three years.Elections have taken place this year.See opposite for a full list of who’swho.

Constitution During 2009/10, the Council madechanges to our Foundation TrustConstitution, including extending thearea that the membership is drawnfrom to cover the London boroughs ofLewisham, Wandsworth andWestminster, as well as Lambeth andSouthwark. Anyone who has been apatient in the past five years,previously three years, is also noweligible for membership.

The public and patientconstituencies now elect eightgovernors each, and the staffconstituency elects seven. Eightfurther governors are nominated fromour local stakeholders. During2009/10, a Lead Governor was alsoelected by the Council of Governors.

The revised Constitution is on thewebsite of our regulator, Monitor:www.monitor-nhsft.gov.uk.

Working groupsThe Council of Governors’ threeworking groups meet outside theformal meetings of the full Council tofocus on specific issues. They cover:

Service strategy – contributing tothe Trust’s strategy including servicedevelopments. This year the grouptook a particular interest in theHealthcare for London strokeconsultation, out of hospital care andthe development of King’s HealthPartners.

Patient experience – reviewing theresults of the annual postal survey ofinpatients and the quarterly patientexperience telephone surveys. Thegroup was involved in the patientenvironment action team inspectionto help assess and improve thehospital environment and advised oninpatients’ menus.

Membership, development, involve-ment and communications –improving communications andincreasing members’ involvement, aswell as improving recruitment fromunder-represented groups.

Membership and attendance

Name Actual /possible

Pauline Anderson 5 /5

Shamin Khan 1 /1

Madeliene Long 4 /5

David Treacher 4 /4

Jane Wardle 4/5


Patient governors Elected Actual / possiblefrom attendance

Mr Michael Craft July 1 2009 4 / 4

Ms Susan Hardy Feb 1 2008* 4 / 4

Ms Dawn Hill July 1 2009 3 / 3

Mr Brian Lymbery July 1 2009 3 / 3

Mr Jeremy Marsh July 1 2009 3 / 4

Dr John Mathews July 1 2007 4 / 4

Ms Niamh O’Sullivan July 1 2007 4 / 4

Mr John Taylor July 1 2007 4 / 4

Sir Richard Thompson July 1 2007 3 /4

Ms Jane Wardle July 1 2009 4 /4

* Ms Susan Hardy replaced a previous governor mid-term and will therefore serve until July 1 2010.

Staff governors Constituency Elected Actual /possiblefrom attendance

Ms Lesley Blackburn Nursing and 1 Jan 2008 0 / 4midwifery

Ms Liz Dunn Nursing and July 1 2009 3 / 4midwifery

Mrs Margaret Evison Other health July 1 2009 2 / 4professionals

Mr Brian Johnson Other July 1 2009 3 / 4

Mr Shamim Khan Medical and July 1 2009 3 / 4dental practitioners

Ms Jacky Lewis Other July 1 2007 4 / 4

Dr David Treacher Medical and July 1 2009 3 / 3dental practitioners

Stakeholder governors Organisation Actual / possibleattendance

Ms Julia Barfield South Bank Employers Group 1 / 1

Dr Lynn Carlisle King’s College London 1 / 1

Professor Judith Ellis London South Bank University 1 / 1

Ms Caroline Hewitt Lambeth PCT 3 / 4

Professor Denise Lievesley King’s College London 1 / 3

Ms Madeliene Long South London and the Maudsley 3 / 4

Mr Michael Parker King’s College Hospital 1 / 1

Dr Neeraj Patil Lambeth Council 1 / 4

Prof David Sines South Bank University 1 / 1

Cllr Nick Stanton Southwark Council 0 / 4

Mr Stephen Webb NHS London 1 / 4

Ms Susanna White Southwark PCT 3 / 4

Mr Martin Wilkinson Lewisham PCT 2 / 4

Public governors Elected Actual / possiblefrom attendance

Mrs Pauline Anderson July 1 2009 4 /4

Mrs Jean Bates July 1 2009 2/3

Miss Susan Brooks July 1 2007 2 / 4

Mrs Jenny Cobley July 1 2007 4 / 4

Mrs Daphne McKenzie July 1 2007 3 / 4

Mrs Wendy Mathews July 1 2007 4 / 4

Mrs Victoria Silvester July 1 2009 4 / 4

Cllr Peter Truesdale July 1 2007 2 / 4

Mr Philip Turner July 1 2009 2 / 3

Mr Simon Wallace July 1 2009 4 /4

To view the register of interests of our Council of Governors, please contact: Head of Corporate Affairs Gassiot House St Thomas’ HospitalWestminster Bridge RoadLondon SE1 7EH

Tel: 020 7188 0007

Council of Governors


Our organisationalstructure

Our membershipThe Trust membership is an essentialand valuable asset. It helps guide ourwork, decision making and adherenceto NHS values, and holds usaccountable. It also provides one of theways in which the Trust communicateswith patients, the public and staff.There are three membership categories:

Patients – anyone over 18 who hasbeen a patient within the last fiveyears. Carers who are not eligible forother categories are also offeredpatient membership.

Board of Directors Our Board of Directors is made up ofour Chairman, Patricia Moberly, sixNon-Executive Directors and sevenExecutive Board Directors, includingthe Chief Executive. Its role is to:

• set our overall strategic directionwithin the context of NHSpriorities;

• monitor our performance againstobjectives;

• provide effective financialstewardship;

• ensure the Trust provides highquality, effective and patient-focused services;

• ensure high standards ofcorporate governance andpersonal conduct;

• promote effective dialoguebetween the Trust and the localcommunities we serve.

Membership is balanced, complete andappropriate. The Trust is confident allthe Non-Executive Directors areindependent in character, and there areno relationships or circumstances whichare likely to affect, or could appear toaffect, their judgment. We thereforedecided not to appoint a seniorindependent director but appointedRory Maw, Chief Financial Officer ofBridges Community Ventures, as ViceChairman in May 2009.

In September, around 200 peopleattended our Annual Public Meeting,where members, local people, patients,staff and other stakeholders heardabout how we have performed duringthe year and had an opportunity tomeet the Board of Directors and theCouncil of Governors.

There was also a chance to askquestions of the Chief Executive,Chairman and Executive BoardDirectors and to learn more about ourservices.

The Trust membership is an essentialand valuable asset. It helps guideour work, decision making andadherence to NHS values.

Public – residents of Lambeth,Southwark, Lewisham, Wandsworthor Westminster over 18.

Staff – employees whose contractmeans they can work for the Trust forat least a year. Registered volunteersnot eligible for other categories canalso join as staff members.

We have 18,282 members, of whom3,434 are patient members, 4,187 arepublic members and 10,661 are staffmembers. We aim for a membershipthat represents the diverse communitieswe serve, however, analysis of ourmembership shows we still have moreto do in this respect.

Members receive regular mailingsand are invited to events including ourOpen Day, Annual Public Meeting,Council of Governors’ meetings andregular health seminars. The seminarsare extremely popular, and recent topicsinclude skin care and sexual health.

We are keen to hear members’views. Members wishing to get intouch with Governors or Directors,and anyone wanting to know moreabout membership, should contact:

Membership OfficeGround Floor, West WingGuy’s Hospital, Great Maze PondLondon SE1 9RT

Tel: 020 7188 0012Email: [email protected]


Audit Committee The Audit Committee provides theBoard of Directors with an independentreview of financial and corporategovernance and risk management. Itprovides an assurance of independentexternal and internal audit, ensuresstandards are set and monitorscompliance in the non-financial, non-clinical areas of the Trust.

It is authorised by the Board ofDirectors to investigate any activitywithin its terms of reference and toseek any information it requires fromstaff. Last year, the Committeeapproved the internal and externalaudit work plans and received regularreports.

At its meeting in February, theCouncil of Governors accepted theAudit Committee’s recommendationthat Deloitte LLP be appointed as theTrust’s external auditors for 2009/10.The external audit service will be re-tendered after April 2010.

At its meeting in May, theCommittee reviewed the draft annualaccounts and approved theirsubmission to the auditors. During theyear, the Committee also reviewed theTrust’s whistleblowing policy anddisclosure of interests arrangements,and received reports on a number oftopics including data security,consultancy costs and the expenses ofsenior managers and Directors.

Remuneration Committee The Remuneration Committee decidesthe pay and allowances, and otherterms and conditions, of the ExecutiveDirectors.

Working with the Council ofGovernors The Board of Directors interacts withthe Council of Governors to ensure itunderstands their views and those ofour members.

Governors may attend BoardMeetings and they present a formalreport of the activities of the Counciland its working groups, while Boardmembers do the same at Council ofGovernors’ meetings.

Meetings of the Council ofGovernors’ working groups are alsoattended by a Non-Executive andExecutive Director of the Board.

Remuneration Committee attendance

Name Actual / possible

Patricia Moberly (Chair) 2 / 2

David Dean 2 / 2

Mike Franklin 1 / 2

Rory Maw 1 /2

Frank Nestle 1 / 1

Jan Oliver 2 / 2

Diane Summers 1 / 2

Audit Committee attendance


David Dean (Chair) 3 / 3

Rory Maw 3 /3

Diane Summers 3 / 3

Board meeting attendance


Dr Edward Baker 11 / 12

David Dean 11 / 12

Mike Franklin 9 / 12

Ron Kerr 11/ 12

Prof Robert Lechler 0 / 1(to April 2009)

Ann Macintyre 11/ 12

Rory Maw 12 / 12

Steve McGuire 12 / 12

Patricia Moberly 12 / 12

Prof Frank Nestle 7 / 11(from May 2009)

Jan Oliver 12 / 12

Hugh Risebrow 3 /3(from January 2010)

Martin Shaw 12 / 12

Eileen Sills 11 / 12

Diane Summers 12 / 12

Committee Membership

Assurance Mike Franklin (Chair)& Risk Edward Baker

David Dean, Ron KerrSteve McGuire Frank Nestle (from May 09)Jan Oliver, Eileen Sills

Audit David Dean (Chair)Rory Maw Diane Summers

Finance & Rory Maw (Chair) Investment David Dean, Ron Kerr

Robert Lechler (to April 09)Steve McGuire Martin Shaw Diane Summers

Personnel & Jan Oliver (Chair) Workforce Mike Franklin, Ron Kerr

Ann Macintyre Steve McGuire Eileen Sills Diane Summers

Remuneration Patricia Moberly (Chair)All Non-ExecutiveDirectors

£500,000is being spent on a study tofind the next generation ofantibody treatments for skinand other cancers

22Iraqi doctors spent six weeksseeing how medics at theTrust work

600children are taking part inthe world’s largest studyinto peanut allergy at Guy’sand St Thomas’

Eileen Sills CBEChief Nurse and Chief Operating OfficerEileen Sills was appointed

Chief Nurse in 2005, adding the duties ofChief Operating Officer to her role in 2007.

Having qualified as a registered nurse in1983, Eileen has held a number of generalmanagement and senior nursing leadershipposts in London.

She holds two visiting professorships atKing’s College London and London SouthBank Universities. She is a member of theNHS Employers policy board, a trustee ofthe Burdett Trust for Nursing, and recentlyadvised Gordon Brown as a member of hisCommission on the Future of Nursing andMidwifery. She was awarded a CBE in2003 for services to nursing.



Ron Kerr CBEChief ExecutiveRon Kerr took up theposition of Chief Executive

in October 2007. He brings a wealth ofexperience from his extremely successfuland wide-ranging NHS career, includingroles at a local, regional and nationallevel. He was most recently the ChiefExecutive of United Bristol HealthcareNHS Trust.

Previous roles include Director ofOperations for the NHS Executive,Regional Director for North ThamesRegional Office, and Chief Executive ofthe South East London CommissioningAgency. His early career also includedwork at several central London teachinghospitals and, prior to moving to Bristol,he was Chief Executive of the NationalCare Standards Commission. He iscurrently chair of the Association of UKUniversity Hospitals.

Martin Shaw Director of FinanceMartin Shaw joined the NHSin 1981. He joined West

Lambeth Health Authority in 1983, wherehe held a variety of posts and was deputyDirector of Finance there until 1993 whenhe joined Guy’s and St Thomas’ as Businessand Financial Planning Manager, beforebecoming Strategy Director and ProjectsDirector. Since 1998, he has been FinanceDirector of the Trust.

Martin chairs the Healthcare FinancialManagement Association’s FinanceDirectors’ Group and is a member of theFoundation Trust Network’s FinanceDirectors’ Group.

Ann Macintyre Director of WorkforceAnn Macintyre came to theTrust from Barts and The

London NHS Trust, where she wasDirector of Human Resources.

She has over 30 years of NHSexperience working at national, regionaland local level. Ann is the current jointChair of the national JCC (seniors), which isthe negotiating committee for consultantmedical staff in England. She is also amember of the national and regional SocialPartnership Forums working with HealthMinisters and Trade Unions on workforcepolicy implementation.

Hugh Risebrow Commercial DirectorHugh Risebrow joined theTrust in October 2009 from

Interhealth Canada (UK) where he wasChief Executive. He has held leadershippositions with United Health Europe, BUPAand Aid-Call plc. He also spent two yearswith the NHS Modernisation Agency.

Hugh’s early career was in strategicconsultancy with Bain & Co and he holdsan engineering degree from CambridgeUniversity. Until he joined the Trust, hechaired the CBI's health panel and was amember of the CBI's public servicesstrategy board.

Board of Directors

Steve McGuire Director of Capital, Estatesand Facilities Management Steve McGuire joined the

Trust as its first Director of Capital, Estatesand Facilities Management in April 2003from Leeds Teaching Hospitals NHS Trustwhere he was Director of Property andSupport Services.

Steve joined the NHS in 1992 and hasbeen Director of Facilities at both LeedsHealth Authority and St James and SeacroftNHS Teaching Trust. Previously Steveworked for the British Coal Corporationwhere he held a variety of posts. He is aChartered Engineer.

Steve represents the Trust on theSouth Bank Employers Group.

Dr Edward Baker Medical DirectorTed Baker has been MedicalDirector since 2003. He has

been a consultant paediatric cardiologistat the Trust and a senior lecturer at King’sCollege London since 1987. Ted has helda number of Trust positions includingAssistant Medical Director and ClinicalDirector of Children’s Services.

Ted trained in both the UK and theUSA and has pioneered the use ofmagnetic resonance imaging in thetreatment of congenital heart disease.Recently he has led a project for theDepartment of Health reviewing theprovision of specialist children’s servicesnationally.


Non-Executive Directors

130double kidney and pancreastransplants have taken placein the last five years

250tonne crane was used to hoistpre-built surgery units into theEvelina Children’s Hospital

2,990stairs were climbed in the Guy’sTower by HR staff to raisemoney for the Haiti appeal

Rory MawNon-Executive Director and Vice Chairman fromMay 2009

Rory Maw is Chief Financial Officer ofBridges Ventures, a venture capital firmwhich delivers positive social andenvironmental impacts as well as financialreturn for investors.

He read economics at Trinity College,Cambridge before qualifying as a CharteredAccountant and joined Schroders’Investment Banking division in 1989. In2000 he moved to Morgan Stanley,becoming Head of its European ConsumerProducts Group.

Rory joined the Board in March 2005and was reappointed in March 2009. Hewas appointed Vice Chairman in May 2009and also chairs the Finance and InvestmentCommittee.

Jan OliverNon-Executive DirectorJan Oliver has considerableexperience in Equality and

Human Rights. Her previous roles includeDiversity Manager at the BBC and Chair ofthe Black and Asian Forum. She was alsoa Trustee of the Stephen LawrenceCharitable Trust and worked as a coachand mentor at Imperial College London.

Jan now works for Fanon SouthsidePartnership providing recovery focusedservices for people with complex mentalheath needs.

Jan joined the Board in January 2004and was reappointed in 2007. She chairsthe Personnel and Workforce Committee.

Diane Summers Non-Executive Director Diane is a former managingeditor of the Financial Times,

where she worked for 19 years as a writer,editor and executive. Her experiencebefore that spanned the voluntary andprivate sectors and included seniorpositions at the consumers organisationWhich? and the homeless charity Shelter.

Since 2006, Diane has been afreelance writer, editor and consultant.She is a trustee of The GuinnessPartnership, a major social housingprovider, and is an independent adviser tothe BBC Trust.

Diane joined the Board in June 2008.

Professor Frank NestleNon-Executive Directorfrom May 2009

Professor Frank Nestle holds the MaryDunhill Chair of Cutaneous Medicine andImmunotherapy at St John’s Institute ofDermatology, King’s College London. He isDirector of the Clinical Research Facilities,which form part of the National Institutefor Health Research funded comprehensiveBiomedical Research Centre at Guy’s andSt Thomas’ and King’s College London.

His main academic interests focus onimproving understanding of common skindiseases, such as psoriasis and melanoma,and the development of novel therapies.

Frank joined the Board in May 2009.

Mike FranklinNon-Executive Director Mike Franklin is aCommissioner and board

member of the National IndependentPolice Complaints Commission. He waspreviously a member of the TUC racerelations committee and a member of theMetropolitan Police Service IndependentAdvisory Group, set up following theStephen Lawrence Inquiry.

He has extensive legal experience,gained both in the voluntary sector and asa union official. He has a long associationwith Lambeth, playing an active role in raceequality issues and community policing.

Robert LechlerVice Chairman until April 2009Professor Robert Lechler has adistinguished career in academic medicine,including Dean of Guy’s, King’s and StThomas’ School of Medicine.

He stood down from the Trust Boardin April 2009 to focus on thedevelopment of King’s Health PartnersAcademic Health Sciences Centre, ofwhich he is now Executive Director.

Patricia MoberlyChairman Patricia Moberly chairs theBoard of Directors and the

Council of Governors. She has significantexperience of local health services – beforejoining the Trust’s Board in December 1997as a Non-Executive Director, she wasChairman of Lambeth Community HealthCouncil and a member of West LambethCommunity Health Council.

Patricia is a Magistrate and, untilrecently, was a lay member of the GeneralMedical Council.

Patricia was reappointed as Chairmanin June 2002 and again in February 2006.The Council of Governors further extendedher appointment in September 2008, andshe will now serve until October 31 2010.

David Dean Non-Executive Director David Dean enjoyed a longand successful career in

investment banking, working for NomuraInternational in London and Hong Kong,and New Japan Securities Europe, withextensive experience in corporate financeand capital markets. He is a part-timeconcert pianist and Licentiate of the RoyalSchools of Music. He has lived in Dulwichfor 17 years and is a Trustee and organiserof the Dulwich Festival.

David joined the Board in June 2007and chairs the Audit Committee.

Mike joined the Board in November2007 and chairs the Assurance and RiskCommittee.



Trust Management ExecutiveThe membership of the Trust’sManagement Executive bringstogether Executive Board Directors,Trust Directors, Divisional Directors andother senior clinical managers. Its roleis to:

• monitor the management of riskand agree any action plans orresources;

• contribute to the development ofour service strategy;

• review and agree detailedbusiness plans and performancecontracts;

• monitor the delivery of our serviceactivity and financial objectives;

• agree policies and procedures toensure the delivery of externaland internal governance;

• develop and monitor theimplementation of plans toimprove the efficiency,effectiveness and quality of ourservices.

The Management Executive has thefollowing sub-committees:

• Capital Investment;

• Clinical Governance and RiskManagement;

• Clinical Programme Board;

• General Managers Group;

• Medical Workforce;

• Non-clinical Programme Board(formerly Enterprise Executive);

• Research and Development.

Innovative nursing Since May 2009, the Trust has been rolling out the national Releasingtime to care initiative, which will increase the amount of time that staffspend directly with patients, by cutting waste and making processesmore efficient. Simple changes such as a colour coded system in thestore room, or more organised bedside notes are saving valuable timeand allowing our nurses to get back to the bedside.

Queen Ward at Guy’s was one of the first to pilot the scheme andover the last year has increased the amount of time for direct patientcare by 10 per cent. Improved leadership and communication meanthat the ward is now better organised, clean, tidy and stocked with theright equipment, which is in good working order. Patients have a betterexperience whilst in hospital and their safe and timely discharge homeis well planned.

The Trust has also run a pilot initiative on the renal and urologywards where staff carrying out their medication rounds now wear adistinctive red tabard whilst preparing and administering drugs. Thistells colleagues, patients and visitors that they should not be disturbed.The trial was in direct response to feedback which noted thatmedication errors tended to occur when staff were interrupted duringrounds and we are now looking into similar initiatives across the Trust.


Remuneration report8

The remuneration and expenses for the Trust Chairman and Non-ExecutiveDirectors are determined by the Council of Govenors, taking account of theguidance issued by organisations such as the NHS Confederation and the NHSAppointments Commission. Remuneration for the Trust’s most senior managers(Executive Directors who are members of the Board of Directors) is determined bythe Board of Directors’ Remuneration Committee, which consists of the Chairmanand the Non-Executive Directors.

Details of remuneration, including the salaries and pension entitlements of theBoard of Directors, are published on page 68 of the annual accounts.

The only non-cash element of senior managers’ remuneration packages arepension related benefits accrued under the NHS Pensions Scheme. Contributionsare made by both the employer and employee in accordance with the rules of thenational scheme which applies to all NHS staff in the scheme.

Pay levels are informed by executive salary surveys conducted by independentmanagement consultants and by the salary levels in the wider market place.Affordability, determined by corporate performance and individual performance,are also taken into account. Where appropriate, terms and conditions areconsistent with the new NHS pay arrangements such as Agenda for Change.

The Trust’s strategy and business planning process sets key business objectiveswhich in turn inform individual objectives for senior managers. Performance isclosely monitored and discussed through both an annual and ongoing appraisalprocess. All senior managers’ remuneration is subject to performance.

Senior managers are employed on contracts of service and are substantiveemployees of the Trust. Their contracts are open ended employment contractswhich can be terminated by either party with six months notice, or 12 months inthe case of the Chief Executive. The Trust’s normal disciplinary policies apply tosenior managers, including the sanction of instant dismissal for gross misconduct.The Trust’s redundancy policy is consistent with NHS redundancy terms for all staff.

Ron Kerr, Chief Executive, June 4 2010

These accounts, for the year to 31 March 2010, have been prepared by the Guy’s and St Thomas’NHS Foundation Trust in accordance with the NHS Act 2006.

Ron Kerr, Chief Executive and Accounting Officer, June 4 2010

Statement of the Chief Executive’s responsibilities as the accountingofficer of Guy’s and St Thomas’ NHS Foundation Trust.

The NHS Act 2006 states that the Chief Executive is the Accounting Officer of the NHS Foundation Trust.The relevant responsibilities of the Accounting Officer, including their responsibility for the proprietyand regularity of public finances for which they are answerable, and for the keeping of proper accounts,are set out in the accounting officers' Memorandum issued by the Independent Regulator of NHSFoundation Trusts (“Monitor”).

Under the NHS Act 2006, Monitor has directed Guy’s and St Thomas’ NHS Foundation Trust toprepare for each financial year a statement of accounts in the form and on the basis set out in theAccounts Direction. The accounts are prepared on an accruals basis and must give a true and fair viewof the state of affairs of Guy’s and St Thomas’ NHS Foundation Trust and of its income and expenditure,total recognised gains and losses and cash flows for the financial year.

In preparing the accounts, the Accounting Officer is required to comply with the requirements ofthe NHS Foundation Trust Financial Reporting Manual and in particular to:

• observe the Accounts Direction issued by Monitor, including the relevant accounting anddisclosure requirements, and apply suitable accounting policies on a consistent basis;

• make judgements and estimates on a reasonable basis;

• state whether applicable accounting standards as set out in the NHS Foundation Trust FinancialReporting Manual have been followed, and disclose and explain any material departures in thefinancial statements;

• prepare the financial statements on a going concern basis.

The Accounting Officer is responsible for keeping proper accounting records which disclose withreasonable accuracy at any time the financial position of the NHS Foundation Trust and to enable himto ensure that the accounts comply with requirements outlined in the above mentioned Act. TheAccounting Officer is also responsible for safeguarding the assets of the NHS Foundation Trust andhence for taking reasonable steps for the prevention and detection of fraud and other irregularities.

To the best of my knowledge and belief, I have properly discharged the responsibilities set out inMonitor’s NHS Foundation Trust Accounting Officer Memorandum.


Annual accounts9



Statement on internal control 2009/10

1. Scope of responsibilityAs Accounting Officer, I have responsibility for maintaining a sound systemof internal control that supports the achievement of the NHS FoundationTrust’s policies, aims and objectives, whilst safeguarding the public fundsand departmental assets for which I am personally responsible, inaccordance with the responsibilities assigned to me. I am also responsiblefor ensuring that the NHS Foundation Trust is administered prudently andeconomically and that resources are applied efficiently and effectively. I alsoacknowledge my responsibilities as set out in the NHS Foundation TrustAccounting Officer Memorandum.

2. The purpose of the system of internal controlThe system of internal control is designed to manage risk to a reasonable levelrather than to eliminate all risk of failure to achieve policies, aims andobjectives; it can therefore only provide reasonable and not absolute assuranceof effectiveness. The system of internal control is based on an ongoing processdesigned to identify and prioritise the risks to the achievement of the policies,aims and objectives of Guy’s and St Thomas’ NHS Foundation Trust; to evaluatethe likelihood of those risks being realised and the impact should they berealised; and to manage them efficiently, effectively and economically.

The system of internal control has been in place in Guy’s and StThomas’ NHS Foundation Trust for the year ended 31 March 2010 and upto the date of approval of the annual report and accounts.

3. Capacity to handle riskThe Trust has in place a Risk Management Policy which clearly sets out theaccountability and reporting arrangements to the Board for riskmanagement within the Trust. Operational responsibility for theimplementation of risk management has been delegated to Executive andother named directors. Risk Management is a core component of the jobdescriptions of senior managers within the Trust.

A range of risk management training is provided to staff and there arepolicies in place which describe the roles and responsibilities in relation tothe identification, management and control of risk. All relevant risk policiesare available to staff via the Trust intranet.

The Trust learns from good practice though a range of mechanismsincluding clinical supervision, reflective practice, individual and peer reviews,performance management, continuing professional development, clinicalaudit and application of evidence based practice.

4. The risk and control frameworkThe Risk Management Policy and supporting procedures set out the keyresponsibilities for managing risk within the organisation, including ways inwhich the risk is identified, evaluated and controlled.

A risk management matrix is used to ensure a consistent approach istaken to assessing and responding to clinical and non-clinical risks andincidents. This determines the Trust’s appetite for risk with clear processesfor the management and monitoring of proactive risk assessments definedwithin the Risk Management Policy and supporting procedures. All seriousuntoward incidents and serious risks are reported to the Board of Directorsvia the established governance committee structures.

As with all NHS hospital trusts there is a risk that this organisation maynot meet some of its targets or monitoring obligations, in particular some 18week, cancer, maternity or emergency treatment targets. This could be for avariety of external or internal reasons, including capacity, trust and primarycare arrangements, changes to targets or rules or unforeseen issues such asweather, power or mechanical failure. The Trust has robust arrangements inplace to reduce and control the risks, including daily escalation/reviewpolicies, weekly management meetings, speciality reviews to agree prioritiesand clinical practice, monthly monitoring and reporting to the TrustManagement Executive and Board of Directors, clinical escalation processesand arrangements to work with partners in primary care and the South EastLondon Cancer Network to monitor and resolve issues.

All new staff are given information governance training through corporateinduction. They are informed of the law, NHS guidance and the Trust’s policieswith regards to the safe and appropriate processing of data. All existing staff

are provided with bespoke training as and when necessary, and with guidanceby the information governance and risk management teams.

Each Executive Director has nominated a designated person, for everydepartment/specialty who will be responsible for monitoring and managinginformation security risks. In the first quarter of 2010/2011 a baseline auditwill be carried out to assess information security. This information will belogged on a database and any progress made to reduce the risk will berecorded. A quarterly report from each department/specialty will begenerated and will be included in the quarterly information governancereport which is submitted to the Trust Board of Directors.

All data security incidents will be reported via the Trust’s database forreporting incidents – DATIX. The Information Governance Manager and theProgramme Lead for Risk Management will be developing clear guidance forstaff to enable the identification and reporting of data security incidents.Where appropriate these will be recorded on the Trust wide risk register.

Risk management is embedded in the organisation in a variety of ways.All staff are responsible for responding to incidents, hazards, complaintsand near misses in accordance with the appropriate policies. Localmanagement teams, via clinical governance groups, are responsible fordeveloping and maintaining local risk registers and overseeing themanagement of adverse incidents. Management teams are responsible forreviewing risk action plans and ensuring they are implemented throughbusiness planning and other established routes. Risk processes aremonitored and reviewed by the Trust Management Executive, the Assuranceand Risk Committee and the Audit Committee.

Equality Impact Assessments (EIAs) are carried out for existing, new andproposed policies; and for new proposed and changing functions andservices. There is a Trust Board approved EIA toolkit on the Trust intranet forguidance for staff. In 2010-11 the EIA process will be re-launched toinclude human rights issues. Organisational structures to support the EIAprocess include the Trust’s Equality and Human Rights GovernanceCommittee and, through them, the Trust Management Executive and theTrust Board of Directors (with the Executive Director for Workforce andOrganisational Development as the Board lead).

The Trust has a Board Assurance Framework which sets out the principalrisks to delivery of key priorities and overarching Strategic Priorities (corporateobjectives). The Executive Director with delegated responsibility for managingand monitoring each risk is clearly identified. The Board Assurance Frameworkidentifies the assurances available to the Board of Directors in relation to theachievement of the Trust’s key objectives. The principal risks to the delivery ofthese objectives are mapped to key controls. There were limited gaps incontrol in relation to identified risks – these included further development ofprocesses and reporting. The Board Assurance Framework is underpinned bythe robust Standards for Better Health process embedded within the Trust.

Working with our partners we explore potential risks which may impactupon other organisations and public stakeholders.

The process for engaging with our key stakeholders includes exploringrisks that may affect themselves, other organisations and publicstakeholders which include:

• Patients and public

• Local involvement networks (LINks)

• Overview and Scrutiny Committees (OSCs)

• Governors and Foundation Trust members

The process of engagement varies according to the nature of developmentor change. All departments (both clinical and non-clinical) are responsiblefor planning and undertaking patient and public involvement (PPI) initiativesand registering such activities on the corporate PPI Register for which theChief Nurse / Chief Operating Officer is accountable.

The Trust has a policy, ‘Putting Patients First: A Policy for Involvementand Consultation’, which clearly outlines the circumstances and the processby which we might inform, involve and / or consult key stakeholders. Thepolicy aims to ensure compliance with the following legislation:

• Section 242(1b) and 244 of NHS Act 2006 (amended);

• Section 221 – 227 Local Government and Public involvement in HealthAct 2007.


Local Involvement Network (LINks)The above-mentioned policy describes how the Trust engages with LINks. Inmeeting its duties to cooperate with LINks (as described by the LocalGovernment and Public Involvement in Health Act 2007), during 2009/10the Trust has:

• Responded to requests for information from LINks including:

– An enquiry about services for newly hearing impaired and deaf adults;

– Attendance at a special LINks public meeting to present on the topicof ‘Dignity in Care’ (24 March).

• Sought the views and / or invited LINks to:-

– Participate in the development of a Trust policy to support thereimbursement of reasonable expenses for individual service users whoparticipate in specified patient involvement activities;

– Participate in future Standard Audit Toolkit visits to outpatient areas;

– Comment upon the draft Single Equality Scheme.

LINks have powers to make reports and/or recommendations about theprovision of local health and care services and to expect a response from therelevant service provider. We note that LINks have not provided a reportand/or recommendations for the consideration and/or response of the Trustduring 2009/10.

Patient involvementDuring 2009/10, the Trust has involved and actively sought the views ofpatients in a variety of ways, including:

• Quarterly Trust (Ipsos MORI) telephone survey;

• Nationally mandated surveys;

• Comment cards;

• And through other patient involvement activities, including for example:

– The ongoing design of the Chemotherapy Day Unit;

– Informing improvements in cancer services through experience basedco-design;

– The review and improvements to service users’ involvement in patienttransport services;

– Development and work with the End of Life care ModernisationInitiative;

– Patient/public governor involvement in the Patient Environment ActionTeam (PEAT) audit and inspection;

– Patient/public involvement in Standard Audit Toolkit visits.

In 2009/10 the Trust redeveloped its business planning process and set upthe Investment Planning Process. This standardises the approach of alldivisions and departments when looking to request investment to changeservices. At both the initial proposal and the full business case stages, theproposer must show clear evidence of stakeholders who might be affectedand the engagement plans that will be completed to ensure they areconsulted and that their views are addressed before the investment isapproved. Equality Impact Assessment tools are also built into the process.Cases that have been approved and had extensive stakeholder engagementinclude sexual health and paediatric surgery.

During the year the Trust has fully consulted and/or been an activeparticipant in the following:

• PCTs – Health and Well-being committees;

• NHS London’s service reviews (e.g. Stroke and Trauma);

• Local involvement networks (LINks);

• Overview and Scrutiny Committees (OSCs);

• Governors and Foundation Trust members;

• Patients and the public.

The Foundation Trust is fully compliant with the core Standards for BetterHealth.

The Trust has reviewed and continues to monitor the systems in placeto care for people with learning disabilities in light of the followingdocuments and recommendations within them:

• Healthcare for All – an independent inquiry into access to health carefor people with learning disabilities (Department of Health July 2008);

• Valuing people now: a new three-year strategy for people withlearning disabilities (Department of Health, January 2009);

• Valuing people now: the delivery plan (Department of Health, January 2009);

• Six lives: the provision of public services to people with learningdisabilities (Parliamentary and Health Service Ombudsman March 2009).

In line with the recommendations of ‘Six Lives’, the Board of Directors, throughthe Assurance and Risk Committee, received a report within twelve months on:

• the effectiveness of the systems that the Trust currently has in place toenable it to understand and plan to meet the full range of needs ofpeople with learning disabilities; and

• the capacity and capability of the Trust’s services to meet the additionaland often complex needs of people with learning disabilities.

The Trust has developed an action plan to ensure it is compliant with thevarious recommendations, and to further improve the systems in place toeffectively care for people with learning disabilities. The action plan will beupdated and added to as necessary in light of any new requirements.

As an employer with staff entitled to membership of the NHS PensionScheme, control measures are in place to ensure all employer obligationscontained within the Scheme regulations are complied with. This includesensuring that deductions from salary, employer’s contributions andpayments into the Scheme are in accordance with the Scheme rules, andthat member Pension Scheme records are accurately updated in accordancewith the timescales detailed in the Regulations.

Control measures are in place to ensure that all the organisation’sobligations under equality, diversity and human rights legislation arecomplied with. These obligations are set out within the Trust’s Equality andHuman Rights Scheme 2010-2013. The associated action plan is monitoredby the Equality and Human Rights Governance Committee which reportsthrough the Trust Management Executive to the Board of Directors andprovides the Board with an annual report.

The Trust has undertaken risk assessments and Carbon ReductionDelivery Plans are in place in accordance with emergency preparedness andcivil contingency requirements, as based on UKCIP 2009 weather projects,to ensure that this organisation’s obligations under the Climate Change Actand the Adaptation Reporting requirements are complied with.

5. Review of economy, efficiency andeffectiveness of the use of resourcesAs part of their annual audit, our external auditors are required to satisfythemselves that the Trust has made proper arrangements for securingeconomy, efficiency and effectiveness in its use of resources. They do this byexamining documentary evidence and through discussions with seniormanagers. The audit working papers in relation to this work are madeavailable to the Trust and presented to the Audit Committee. These confirmthat they have drawn positive conclusions from their work.

The key processes to ensure that resources are used economically,efficiently and effectively across clinical services include directorate anddivisional performance reviews, the new transformation programme, clinicalworkforce reviews and the regular monitoring of clinical indicators coveringquality and safety.

The emphasis of our internal audit work is on risk management,governance and internal control processes. Individual assignments havealso raised issues relating to economy, efficiency and effectiveness. Wherescope for improvement in terms of value for money was identified during aninternal audit review, appropriate recommendations were made and actionplans were agreed with management for implementation.

The Board of Directors plays a role in procurement as part ofcompliance with the Trust’s policies and procedures to ensure that resourcesare used efficiently and effectively.

6. Annual Quality ReportThe Directors are required under the Health Act 2009 and the NationalHealth Service (Quality Accounts) Regulations 2010 to prepare QualityAccounts for each financial year. Monitor has issued guidance to NHSFoundation Trust boards on the form and content of annual Quality Reports,which incorporate the above legal requirements in the NHS FoundationTrust Annual Reporting Manual.

The Chief Nurse/Chief Operating Officer is the nominated TrustExecutive for the Quality Account. She established two clinical leads, theHead of Performance and Associate Medical Director. An Executive Group


was established and charged with reviewing current quality work streamsand establishing the priorities for our trial Quality Account in 2009/10.

Quality priorities for the coming year were chosen to reflect a numberof internal and external drivers. Internally, the Trust focused heavily onpatient feedback from the Care Quality Commission’s (CQC’s) Nationalpatient survey, choosing priorities that were both local and nationalpriorities, and importantly areas that the organisation needed to improveon. Untoward incidents and complaints established the need to focus onreducing patient harm from medicines. Our staff told us that we needed tobuild on the work around the Acutely Ill Patient Pathway, and focus onimproving our medical records and reducing harm from naso-gastric tubeinsertion.

The internal drivers were cross-referenced against external national drivers– Never Events, National Patient Safety Agency (NPSA) Alerts, The Departmentof Health’s Dignity Campaign, CQC and NHS Litigation Authority accreditation,as well as the new Commissioning for Quality and Innovation (CQUIN) scheme.The report ‘Maternity Matters’ raised some important areas for qualityimprovement at the Trust, and these were also included in the 2009/10accounts.

The Trust is very fortunate to have a dynamic Council of Governors whoactively critique and contribute to our quality agenda. Our local LINks areanother important group for assurance and feedback, and again contributeto the quality agenda.

We appreciate that 2009/10 were Quality Accounts, and we have learntfrom this, improving how we engage with local community groups todirectly contribute to our Quality Account, in particular by involving ourlocal LINks, local residents associations, our Commissioners and Overviewand Scrutiny Committees.

For the annual Quality Report, the Trust employs the same informationassurance processes as used for other aspects of performance. These aim toidentify and correct errors in data recording or data processing; and to givegreater certainty that what is reported is an accurate reflection of what hasactually happened. This provides a truer assessment of performance; allowsbetter decision-making; and aids the understanding of changes in thepattern of service provision.

These processes have applied as key controls in place in the preparationand publication of the Trust's Quality Report. The assurance steps areapplied in four stages: operational data quality, which looks at basicvalidation; reporting assurance, which aims to identify any anomalies;performance analysis, which identifies trends and performance shortfalls;performance review, which addresses divergent performance. Theassessment of quality indicators is integrated into the Trust’s performancemanagement system, and hence they are subject to review by operationaland managerial staff on a monthly basis in a structured framework ofperformance review meetings. In addition, a central data quality team ledby the Director of Health Informatics applies assurance checks on allcentrally-maintained data sources.

7. Review of effectivenessAs Accounting Officer, I have responsibility for reviewing the effectiveness ofthe system of internal control. My review of the effectiveness of the system ofinternal control is informed by the work of the internal auditors and theexecutive managers within the NHS Foundation Trust who have responsibilityfor the development and maintenance of the internal control framework, andcomments made by the external auditors in their management letter and otherreports. I have been advised on the implications of the result of my review ofthe effectiveness of the system of internal control by the Board of Directors andthe Audit Committee, and a plan to address weaknesses and ensurecontinuous improvement of the system is in place.

The Board of Directors and its committees meet regularly and as part oftheir consideration, keep arrangements for internal control under reviewthrough discussion and approval of policies and practice.

The Audit Committee has provided the Board of Directors with anindependent and objective review of financial and corporate governance,and internal financial control within the Trust. The sub-committee hasreceived reports from external and internal audit including reports relatingto the Trust's counter fraud arrangements.

The Trust’s Executive Directors and managers, and the Assurance andRisk Committee, have provided the Board of Directors with reports on riskmanagement, performance management and clinical governance.


Internal audit has reviewed and reported upon control, governance andrisk management processes, based on an audit plan approved by the sub-committee. The work included identifying and evaluating controls andtesting their effectiveness, in accordance with NHS Internal Audit Standards.Where scope for improvement was found, recommendations were madeand appropriate action plans agreed with management.

The indicators used for quality reporting are subject to the samecontrols as for all other performance indicators. A potential weakness incontrol in the operational data quality stage of a non-central system wasidentified. As a result, the Trust has undertaken a risk-based assessment ofinformation flows supporting performance indicators to identify areaswhere additional assurance checks are needed. These apply particularly atthe operational data quality stage and take the form of reviews of writtenpolicies and procedures; and independent checking of sample data.

The Board of Directors reviewed the 2009/2010 Board AssuranceFramework following approval of the Trust Strategic Priorities. The AssuranceFramework was regularly updated throughout the year to reflect the risksassociated with failing to achieve these objectives. In assessing its compliancewith the new Care Quality Commission (CQC) standards for registration inJanuary 2010, the Trust reviewed information from its own existing intelligencesources and the Quality and Risk Profile (QRP) provided by the CQC forpotential issues which may indicate non-compliance with the CQC standards.

The Trust reviewed each ‘concerning item’ within the QRP and its ownexisting intelligence sources. The Trust identified that action had beentaken, or was previously underway to address the issues raised. As a resultof this review, no areas of ongoing concern were identified.

The Trust was also required to demonstrate continued compliance withStandards for Better Health as this forms a large part of the assurancerequired for CQC registration. No significant areas of concerns werehighlighted since October 2009.

In its self-assessment for Standards for Better Health October 2009declaration, the Trust used its proven structured approach which included areview of evidence for each standard and a review by the Board of Directors ofinformation from existing intelligence sources, including the reports of externalagencies, for potential non-compliance issues. This approach builds on theconcept of separating the evidence collation and evidence assurance, allowingthe Board of Directors to have greater confidence in its declaration.

The Trust achieved compliance with the NHS Litigation Authority’s ClinicalNegligence Scheme for Trusts Maternity Risk Management Standards whichoffers considerable assurance of compliance within the areas passed.

8. Significant issuesIn the last quarter of 2009/10 the Trust became aware of potential issueswith its validation processes for the national emergency access target. Areview of the Trust’s processes by internal audit identified a number ofweaknesses in control. The Trust invited the Department of Health IntensiveSupport Team (IST) to work with it to identify actions for improving theemergency pathway, including reviewing validation processes. An actionplan was developed and immediate improvements were made to processeswith other actions incorporated into an ongoing improvement plan. TheBoard is closely monitoring progress against this plan.

ConclusionWith the exception of the internal control issues that I have outlined in thisstatement, my review confirms that Guy’s and St Thomas’ NHS FoundationTrust has a generally sound system of internal controls that supports theachievement of its policies, aims and objectives and that those control issueshave been or are being addressed.


Independent Auditor’s Report to the Board of Governors and Board of Directorsof Guy’s and St Thomas’ NHS Foundation Trust

Basis of audit opinion We conducted our audit in accordance with the Audit Code for NHSFoundation Trusts issued by Monitor, which requires compliance withInternational Standards on Auditing (UK & Ireland) issued by the AuditingPractices Board. An audit includes examination, on a test basis, of evidencerelevant to the amounts and disclosures in the financial statements. It alsoincludes an assessment of the significant estimates and judgements made bythe Directors in the preparation of the financial statements, and of whetherthe accounting policies are appropriate to the Trust’s circumstances,consistently applied and adequately disclosed.

We planned and performed our audit so as to obtain all the informationand explanations which we considered necessary in order to provide us withsufficient evidence to give reasonable assurance that the financial statementsare free from material misstatement, whether caused by fraud or otherirregularity or error. In forming our opinion we also evaluated the overalladequacy of the presentation of information in the financial statements.

OpinionIn our opinion:

• the financial statements give a true and fair view of the state of affairsof Guy’s and St Thomas’ NHS Foundation Trust as at 31 March 2010 and ofits income and expenditure for the year then ended in accordance with theaccounting policies directed by Monitor – Independent Regulator of NHSFoundation Trusts; and

• the information given in the directors’ report is consistent with thefinancial statements.

CertificateWe certify that we have completed the audit of the accounts in accordancewith the requirements of Chapter 5 of Part 2 of the National Health ServiceAct 2006 and the Audit Code for NHS Foundation Trusts.

We have audited the financial statements of Guy’s and St Thomas’ NHSFoundation Trust for the year ended 31 March 2010 under the NationalHealth Service Act 2006 (“the Act”) which comprise the Consolidated Incomeand Expenditure Account, Consolidated Balance Sheet, ConsolidatedStatement of Total Recognised Gains and Losses, Consolidated Cash FlowStatement and the related notes 1 to 34. These financial statements havebeen prepared in accordance with the accounting policies set out therein.

This report is made solely to the Board of Governors and Board ofDirectors (“the Boards”) of Guy’s and St Thomas’ NHS Foundation Trust, as abody, in accordance with paragraph 4 of Schedule 10 of the National HealthService Act 2006. Our audit work has been undertaken so that we mightstate to the Boards those matters we are required to state to them in anauditors’ report and for no other purpose. To the fullest extent permitted bylaw, we do not, in giving our opinion, accept or assume responsibility toanyone other than the Trust and the Boards, as a body, for this report, or forthe opinions we have formed.

Respective responsibilities of the AccountingOfficer and Auditors The Accounting Officer’s responsibilities for preparing the financialstatements in accordance with directions issued by Monitor – IndependentRegulator of NHS Foundation Trusts are set out in the Statement ofAccounting Officer’s Responsibilities.

Our responsibility is to audit the financial statements in accordance withrelevant legal and regulatory requirements (including statute and the AuditCode of NHS Foundation Trusts) and International Standards on Auditing (UKand Ireland).

We report to you our opinion as to whether the financial statementsgive a true and fair view in accordance with the accounting policies directedby Monitor - Independent Regulator of NHS Foundation Trusts. We alsoreport to you whether in our opinion the information given in the directors’report is consistent with the financial statements.

In addition, we report to you if, in our opinion, the financial statementshave not been prepared in accordance with the directions made underparagraph 25 of Schedule 7 of the Act, the financial statements do notcomply with the requirements of all other provisions contained in, or havingeffect under, any enactment applicable to the financial statements, or properpractices have not been observed in the compilation of the financialstatements.

We review whether the statement on internal control reflects compliancewith the requirements of Monitor contained in the NHS Foundation TrustAnnual Reporting Manual. We report if it does not meet the requirementsspecified by Monitor or if the statement is misleading or inconsistent withother information we are aware of from our audit of the financial statements.We are not required to consider, nor have we considered, whether thestatement on internal control covers all risks and controls. We are also notrequired to form an opinion on the effectiveness of the Trust’s corporategovernance procedures or its risk and control procedures.

We read the other information contained in the Annual Report asdescribed in the contents section and consider whether it is consistent withthe audited financial statements. We consider the implications for our reportif we become aware of any apparent misstatements or materialinconsistencies with the financial statements. Our responsibilities do notextend to any further information outside the Annual Report.

Nigel Johnson (Senior Statutory Auditor)For and on behalf of Deloitte LLPChartered AccountantsSt AlbansJune 4 2010


Consolidated statement of comprehensive income for the year ended March 31 2010

March 31 2010 March 31 2009NOTE £000 £000

Operating income 3 683,508 640,426Other operating income 4 246,458 204,063Operating expenses 5 (908,474) (813,699)

OPERATING SURPLUS 21,492 30,790

FINANCE COSTSFinance income 10 782 6,085Finance expenses – unwinding of discount/provision 11 (211) (203)PDC dividends payable (20,215) (17,560)

Net Finance Costs (19,644) (11,678)

Share of operating gain/(loss) in joint ventures 8 – (127)Corporation Tax 12 (1) (4)

SURPLUS FOR THE YEAR 1,847 18,981

Other comprehensive incomeRevaluation gains/(losses) and impairment losses on intangible assets 78 662Revaluation gains/(losses) and impairment losses on property, plant and equipment (17,008) (257)Increase in the donated asset reserve due to receipt of donated assets 4,146 3,182Reduction in the donated asset reserve in respect of depreciation, impairment, (9,304) (43,385) and/or disposal of donated assetsMovement between reserves (292) –Transfers to income in respect of assets disposed of (480) –

TOTAL COMPREHENSIVE INCOME/(EXPENSE) FOR THE YEAR (21,013) (20,817)

The notes on pages 62 to 80 form part of these accounts.


Statement of financial position as at March 31 2010

GROUP TRUSTMarch 31 2010 March 31 2009 April 1 2008 March 31 2010 March 31 2009 April 1 2008

NOTE £000 £000 £000 £000 £000 £000NON CURRENT ASSETSProperty plant and equipment 14 838,794 819,504 832,292 838,794 819,504 832,292Intangible assets 15 20,000 10,237 223 19,959 10,237 223Trade and other receivables 20.2 2,093 3,835 1,097 3,245 4,946 1,097

TOTAL NON-CURRENT ASSETS 860,887 833,576 833,612 861,998 834,687 833,612

CURRENT ASSETSInventories 19 14,252 7,529 7,905 14,252 7,529 7,905Trade and other receivables 20.1 56,359 58,540 45,968 56,411 58,613 45,968Tax receivable 2,328 2,248 1,901 2,328 2,248 1,901Cash and other equivalents 24 111,911 155,047 146,435 111,825 154,903 146,435

TOTAL CURRENT ASSETS 184,850 223,364 202,209 184,816 223,293 202,209

CURRENT LIABILITIESTrade and other payables 21.1 (88,391) (81,979) (69,091) (88,312) (81,899) (69,091)Tax payable 12/21.2 (11,192) (10,080) (8,866) (11,190) (10,080) (8,866)Other liabilities 21.3 (17,444) (20,347) (16,890) (17,444) (20,347) (16,890)Provisions 22 (2,254) (1,419) (3,328) (2,254) (1,419) (3,328)

TOTAL CURRENT LIABILITIES (119,281) (113,825) (98,175) (119,200) (113,745) (98,175)

NON-CURRENT LIABILITIESTrade and other payables – – (2,124) – – (2,124)Other liabilities 21.3 (6,225) (5,580) – (6,225) (5,579) –Provisions 22.1 (8,955) (8,945) (8,419) (8,955) (8,945) (8,419)

Total non-current liabilities (15,180) (14,525) (10,543) (15,180) (14,524) (10,543)

TOTAL ASSETS EMPLOYED 911,276 928,590 927,103 912,434 929,711 927,103

TAX PAYERS’ EQUITYPublic Dividend Capital 355,766 352,067 329,763 355,766 352,067 329,763Revaluation reserve 220,326 246,527 250,507 220,326 246,527 250,507Donated asset reserve 216,505 218,421 258,661 216,505 218,421 258,661Other reserves 743 743 743 743 743 743Income and expenditure reserve 117,936 110,832 87,429 119,094 111,953 87,429

TOTAL TAXPAYERS’ EQUITY 911,276 928,590 927,103 912,434 929,711 927,103

Ron KerrChief Executive and Accounting Officer, June 4 2010


Statement of changes in Taxpayers’ equity at March 31 2010

GROUP Public Donated Income andDividend Revaluation asset Other expenditureCapital reserve reserve reserve reserve Total£000 £000 £000 £000 £000 £000

Taxpayers’ equity at April 1 2008 329,763 250,507 258,661 743 87,429 927,103

Changes in taxpayers’ equity for 2008/09

Surplus for the year – 405 (40,203) – 18,981 (20,817)Revaluation gains/(losses) and impairment losseson intangible assets – (79) (37) – 116 –Revaluation gains/(losses) and impairment lossesproperty, plant and equipment – (4,306) – – 4,306 –Public Dividend Capital receivable 22,304 – – – – 22,304

Taxpayers’ equity as at March 31 2009 352,067 246,527 218,421 743 110,832 928,590


Surplus for the year – – – – 1,847 1,847Revaluation gains on intangible assets – 78 – – – 78Revaluation (losses) and impairment losses – (18,261) 1,253 – – (17,008)on property, plant and equipmentReduction in the donated asset reserve in respect of – – (9,304) – – (9,304)depreciation, impairment, and/or disposal of donated assetsTransfers to the statement of comprehensive income – (480) – – – (480)in respect of assets disposed ofTransfer of the excess of current cost depreciation over – (3,897) – – 3,897 –historical cost depreciation to income and expenditure reserveReceipt of donated/government granted assets – – 4,146 – – 4,146Public Dividend Capital receivable 3,699 – – – – 3,699Movement between reserves* – (3,641) 1,989 – 1,360 (292)


TRUST Public Donated Income andDividend Revaluation asset Other expenditureCapital reserve reserve reserve reserve Total£000 £000 £000 £000 £000 £000

Taxpayers’ equity at April 1 2008 329,763 250,507 258,661 743 87,429 927,103


Revaluation gains/(losses) and impairment losseson intangible assets – 405 (40,203) – 20,102 (19,696)Transfers to the income and expenditure accountin respect of assets disposed of – (79) (37) – 116 –Transfer of the excess of current cost depreciation overhistorical cost depreciation to income and expenditure reserve – (4,306) – – 4,306 –Public Dividend Capital receivable 22,304 – – – – 22,304



Surplus for the year – – – – 1,884 1,884Revaluation gains on intangible assets – 78 – – – 78Revaluation (losses) and impairment losses – (18,261) 1,253 – – (17,008)on property, plant and equipmentReduction in the donated asset reserve in respect – – (9,304) – – (9,304)of depreciation, impairment, and/or disposal of donated assetsTransfers to the statement of comprehensive income – (480) – – – (480)in respect of assets disposed ofTransfer of the excess of current cost depreciation over – (3,897) – – 3,897 –historical cost depreciation to income and expenditure reserveReceipt of donated/government granted assets – – 4,146 – – 4,146Public Dividend Capital receivable 3,699 – – – – 3,699Movement between reserves* – (3,641) 1,989 – 1,360 (292)


* Movement between reserves has been re-aligned on implementation of the new fixed asset register.


Consolidated cash flow statement for the year ended March 31 2010

NOTE March 31 2010 March 31 2009£000 £000

Cash flows from operating activitiesOperating surplus from continuing operations 21,492 30,790

Non-cash income and expensesDepreciation and amortisation 39,856 35,187Impairments and reversals 5,104 6,655Transfer from donated asset reserve (9,304) (8,185)Transfer from government grants reserve (563) –Decrease/(increase) in trade and other receivables 2,562 (15,608)(Increase)/decrease in inventories (6,723) 376Decrease in other liabilities (2,645) –Increase in trade and other payables 3,837 24,441Increase/(decrease) in provisions 634 (1,612)Tax received 1,112 –Other movements in operating cash flows – (2,173)

NET CASH GENERATED FROM OPERATING ACTIVITIES 55,362 69,871

Cash flows from investing activitiesInterest received 806 6,255Purchase of financial assets (60,000) (120,500)Sale of financial assets 60,000 120,500Proceeds from sale of intangible assets 24 –Purchase of property, plant and equipment (88,127) (77,429)Proceeds from sale of property, plant and equipment – 2,207

Net cash generated from used in investing activities (87,297) (68,967)

Cash flows from financing activitiesPublic Dividend Capital received 3,699 22,304Public Dividend Capital dividend paid (20,445) (17,560)Donated capital receipts 5,545 2,964

NET CASH GENERATED FROM/(USED IN) OPERATING ACTIVITIES (11,201) 7,708

Increase/(decrease) in cash and cash equivalents (43,136) 8,612Cash and cash equivalents at April 1 155,047 146,435

Cash and cash equivalents at March 31 24 111,911 155,047


Notes to the accounts

1 Accounting policies1.1 Basis of preparation of the financialstatementsMonitor has directed that the financial statements of NHS Foundation Trustsshall meet the accounting requirements of the NHS Foundation Trusts'Financial Reporting Manual which shall be agreed with HM Treasury.Consequently, the following financial statements have been prepared inaccordance with the 2009/10 NHS Foundation Trust Financial ReportingManual issued by Monitor. The accounting policies contained in that manualfollow International Financial Reporting Standards (IFRS) and HM Treasury’sFinancial Reporting Manual to the extent that they are meaningful andappropriate to NHS Foundation Trusts. The accounting policies have beenapplied consistently in dealing with items considered material in relation tothe accounts. The financial statements have been prepared under thehistorical cost convention, modified for the revaluation of certain financialassets and liabilities at fair value.

1.2 Basis of consolidationThe group financial statements consolidate the financial statements of theTrust and entities controlled by the Trust (its subsidiaries) and incorporate itsshare of the results of jointly controlled entities (joint ventures) and associatesusing the equity method of accounting. The financial statements of thesubsidiaries are prepared for the same reporting year as the Trust.

Subsidiary entities are those over which the Trust has the power toexercise control or a dominant influence so as to gain economic or otherbenefits. The income, expenses, assets, liabilities, equity and reserves areconsolidated in full into the appropriate financial statement lines.

Where subsidiaries' accounting policies are not aligned with those of theTrust (including where they report under UK GAAP) then amounts areadjusted during consolidation where differences are material.

All intragroup balances and transactions, including unrealised profitsarising from intragroup transactions, have been eliminated in full. Subsidiariesare consolidated from the date on which control is obtained by the Groupand cease to be consolidated from the date on which control is no longerheld by the Group. Where the Group ceases to hold control of a subsidiary,the consolidated financial statements include the results for the part of thereporting year during which the Group held control.

Joint ventures are contracted arrangements whereby two or more partiesundertake an economic activity subject to joint control. Joint ventures arerecognised in the Trust's financial statements using the equity method. Theinvestment is initially recognised at cost. It is increased or decreasedsubsequently to reflect the Trust's share of the entity's profit or loss or othergains or losses (e.g. revaluation gains on the entity's property, plant andequipment) following acquisition. It is also reduced when any distributione.g. share dividends, is received by the Trust from the associate.

In the Group’s financial statements investments in associates and jointventures are initially recognised at cost. Subsequent to acquisition, the carryingvalue of the Group’s investment in associates and joint ventures includes theGroup’s share of post-acquisition reserves, less any impairment in the value ofindividual assets. The statement of comprehensive income reflects the Group’sshare of the results of operations of the associate or joint venture after tax.

A separate income statement for the parent organisation has not beenpresented in accordance with the guidelines in the NHS Foundation TrustFinancial Reporting Manual.

1.3 IncomeIncome in respect of services provided is recognised when, and to the extentthat, performance occurs and is measured at the fair value of theconsideration receivable. The main source of income for the Trust is contractswith commissioners in respect of health care services.

Where income is received for a specific activity which is to be deliveredin the following financial year, that income is deferred.

Income from the sale of non-current assets is recognised only when allmaterial conditions of sale have been met, and is measured as the sums dueunder the sale contract.

1.4 Expenditure on employee benefitsShort-term employee benefits

Salaries, wages and employment-related payments are recognised in the periodin which the service is received from employees. The cost of short-termemployee benefits earned but not taken by employees at the end of the periodis recognised in the financial statements to the extent that employees arepermitted to carry-forward leave into the following period.

Pension costs

NHS Pension SchemePast and present employees are covered by the provisions of the NHS PensionsScheme. Details of the benefits payable under these provisions can be foundon the NHS Pensions website at www.nhsbsa.nhs.uk/pensions.

The scheme is an unfunded, defined benefit scheme that covers NHSemployers, General Practices and other bodies, allowed under the directionof the Secretary of State, in England and Wales. The scheme is not designedto be run in a way that would enable NHS bodies to identify their share of theunderlying scheme assets and liabilities. Therefore, the scheme is accountedfor as if it were a defined contribution scheme: the cost to the NHS Body ofparticipating in the scheme is taken as equal to the contributions payable tothe scheme for the accounting period.

The scheme is subject to a full actuarial valuation every four years (until2004, every five years) and an accounting valuation every year. An outline ofthese follows:

a) Full actuarial (funding) valuation

The purpose of this valuation is to assess the level of liability in respect of thebenefits due under the scheme (taking into account its recent demographicexperience), and to recommend the contribution rates to be paid byemployers and scheme members. The last such valuation, which determinedcurrent contribution rates was undertaken as at March 31 2004 and coveredthe period from 1 April 1999 to that date. The conclusion from the 2004valuation was that the scheme had accumulated a notional deficit of £3.3billion against the notional assets as at 31 March 2004.

In order to defray the costs of benefits, employers pay contributions at14% of pensionable pay and most employees had up to April 2008 paid 6%,with manual staff paying 5%.

Following the full actuarial review by the Government Actuary undertakenas at March 31 2004, and after consideration of changes to the NHS PensionScheme taking effect from April 1 2008, his valuation report recommendedthat employer contributions could continue at the existing rate of 14% ofpensionable pay, from April 1 2008, following the introduction of employeecontributions on a tiered scale from 5% up to 8.5% of their pensionable paydepending on total earnings. On advice from the scheme actuary, schemecontributions may be varied from time to time to reflect changes in thescheme’s liabilities.

b) Accounting valuation

A valuation of the scheme liability is carried out annually by the schemeactuary as at the end of the reporting period by updating the results of thefull actuarial valuation.

The valuation of the scheme liability as at March 31 2010, is based ondetailed membership data as at March 31 2008 (the latest midpoint) updatedto March 31 2010 with summary global member and accounting data.

The latest assessment of the liabilities of the scheme is contained in thescheme actuary report, which forms part of the annual NHS Pension Scheme(England and Wales) Resource Account, published annually. These accountscan be viewed on the NHS Pensions website. Copies can also be obtainedfrom The Stationery Office.

c) Scheme provisions

In 2008-09 the NHS Pension Scheme provided defined benefits, which aresummarised below. This list is an illustrative guide only, and is not intendedto detail all the benefits provided by the Scheme or the specific conditionsthat must be met before these benefits can be obtained:

Annual PensionsThe Scheme is a “final salary” scheme. Annual pensions are normally basedon 1/80th for the 1995 section and of the best of the last three yearspensionable pay for each year of service, and 1/60th for the 2008 section ofreckonable pay per year of membership. Members who are practitioners asdefined by the Scheme Regulations have their annual pensions based upontotal pensionable earnings over the relevant pensionable service.


With effect from April 1 2008 members can choose to give up some oftheir annual pension for an additional tax free lump sum, up to a maximumamount permitted under HMRC rules. This new provision is known as“pension commutation”.

Pensions Indexation

Annual increases are applied to pension payments at rates defined by thePensions (Increase) Act 1971, and are based on changes in retail prices in thetwelve months ending 30 September in the previous calendar year.

Lump Sum Allowance

A lump sum is payable on retirement which is normally three times the annualpension payment.

Ill-Health Retirement

Early payment of a pension, with enhancement in certain circumstances, isavailable to members of the Scheme who are permanently incapable of fulfillingtheir duties or regular employment effectively through illness or infirmity.

Death Benefits

A death gratuity of twice their final year’s pensionable pay for death inservice, and five times their annual pension for death after retirement ispayable.

Additional Voluntary Contributions (AVCs)

Members can purchase additional service in the NHS Scheme and contributeto money purchase AVC’s run by the Scheme’s approved providers or by otherFree Standing Additional Voluntary Contributions (FSAVC) providers.

Transfer between Funds

Scheme members have the option to transfer their pension between the NHSPension Scheme and another scheme when they move into or out of NHSemployment.

Preserved BenefitsWhere a scheme member ceases NHS employment with more than two yearsservice they can preserve their accrued NHS pension for payment when theyreach retirement age.

Compensation for Early RetirementWhere a member of the Scheme is made redundant, they may be entitled toearly receipt of their pension plus enhancement at the employer’s cost.

1.5 LeasesFinance leases

Where substantially all risks and rewards of ownership of a leased asset areborne by the NHS Foundation Trust, the asset is recorded as property, plantand equipment and a corresponding liability is recorded. The value at whichboth are recognised is the lower of the fair value of the asset or the presentvalue of the minimum lease payments, discounted using the interest rateimplicit in the lease. The implicit interest rate is that which produces aconstant periodic rate of interest on the outstanding liability. The asset andliability are recognised at the inception of the lease, and are de-recognisedwhen the liability is discharged, cancelled or expires. The annual rental is splitbetween the repayment of the liability and a finance cost. The annual financecost is calculated by applying the implicit interest rate to the outstandingliability and is charged to the income statement.

Operating leases

Other leases are regarded as operating leases and the rentals are charged tooperating expenses on a straight-line basis over the term of the lease. Benefitsreceived and receivable as an incentive to sign an operating lease are similarlyspread on a straight-line basis over the lease term.

Leases of land and buildings

Where a lease is for land and buildings, the land component is separatedfrom the building component and the classification for each is assessedseparately. Leased land is treated as an operating lease.

1.6 Expenditure on other goods and servicesExpenditure on goods and services is recognised when, and to the extentthat, they have been received, and is measured at the fair value of thosegoods and services. Expenditure is recognised in operating expenses exceptwhere it results in the creation of a non-current asset such as property, plantand equipment. Stock on hand is managed and recognised as inventoryunder current assets.

1.7 Intangible fixed assetsRecognition

Intangible assets are non-monetary assets without physical substance whichare capable of being sold separately from the rest of the Trust’s business orwhich arise from contractual or other legal rights. Intangible assets arecapitalised when: they are capable of being used in a Trust's activities for morethan one year; they can be valued; and they have a cost of at least £5,000.

They are recognised only where it is probable that the future economicbenefits will flow to, or service potential be provided to, the Trust and wherethe cost of the asset can be measured reliably.

Internally generated intangible assetsInternally generated goodwill, brands, mastheads, publishing titles,

customer lists and similar items are not capitalised as intangible assets.Expenditure on research is not capitalised.Expenditure on development is capitalised only where all of the following

can be demonstrated:

• the project is technically feasible to the point of completion and willresult in an intangible asset for sale or use;

• the Trust intends to complete the asset and sell or use it;

• the Trust has the ability to sell or use the asset;

• how the intangible asset will generate probable future economic orservice delivery benefits e.g. the presence of a market for it or its output,or where it is to be used for internal use, the usefulness of the asset;

• adequate financial, technical and other resources are available to theTrust to complete the development and sell or use the asset; and

• the Trust can measure reliably the expenses attributable to the assetduring development.

At the Statement of Financial Position date, no expenditure on developmentis capitalised.

SoftwareSoftware which is integral to the operation of hardware, e.g. an operatingsystem, is capitalised as part of the relevant item of property, plant andequipment. Software which is not integral to the operation of hardware, e.g.application software, is capitalised as an intangible asset.

Measurement

Intangible assets are recognised initially at cost, comprising all directlyattributable costs needed to create, produce and prepare the asset to thepoint that it is capable of operating in the manner intended by management.

Subsequently intangible assets are measured at fair value. Increases inasset values arising from revaluations are recognised in the revaluationreserve, except where, and to the extent that, they reverse an impairmentpreviously recognised in operating expenses, in which case they arerecognised in operating income. Decreases in asset values and impairmentsare charged to the revaluation reserve to the extent that there is an availablebalance for the asset concerned, and thereafter are charged to operatingexpenses. Gains and losses recognised in the revaluation reserve are reportedin the statement of changes in taxpayers’ equity.

Intangible assets held for sale are measured at the lower of their carryingamount or ‘fair value less costs to sell’.

Amortisation

Intangible assets are amortised over their expected useful economic lives ina manner consistent with the consumption of economic or service deliverybenefits. Assets under construction are not amortised until they are completeand available for use in the Trust’s business.

1.8 Property, plant and equipmentRecognition

Property, plant and equipment is capitalised where:

• it is held for use in delivering services or for administrative purposes;

• it is probable that future economic benefits will flow to, or servicepotential be provided to, the Trust;

• it is expected to be used for more than one financial year; and

• the cost of the item can be measured reliably.

Land and Buildings will be valued by an independent registered charteredsurveyor on a yearly basis as required under IAS16 to reflect fair value. For thevaluation as at 1 April 2010 the District Valuation Office was used as theindependent valuer.


ValuationThe valuation has been carried out in accordance with the terms of the RoyalInstitution of Chartered Surveyors’ Valuation Standards, 6th Edition, insofaras these terms are consistent with the requirements of HM Treasury, theNational Health Service and Monitor.

All property, plant and equipment are measured initially at cost,representing the cost directly attributable to acquiring or constructing theasset and bringing it to the location and condition necessary for it to becapable of operating in the manner intended by management. All assets aremeasured subsequently at fair value.

Land and buildings used for the Trust’s services or for administrativepurposes are stated in the statement of financial position at their revaluedamounts, being the fair value at the date of revaluation less any subsequentaccumulated depreciation and impairment losses. Revaluations are performedwith sufficient regularity to ensure that carrying amounts are not materiallydifferent from those that would be determined at the end of the reportingperiod.

Fair values are determined as follows:

• Land and non-specialised buildings - market value for existing use

• Specialised buildings - depreciated replacement cost

Until March 31 2008, the depreciated replacement cost of specialisedbuildings has been estimated for an exact replacement of the asset in itspresent location. HM Treasury has adopted a standard approach todepreciated replacement cost valuations based on modern equivalent assetsand, where it would meet the location requirements of the service beingprovided, an alternative site can be valued. the Trust will value independentlyall land and buildings every year on modern equivalent assets.

Properties in the course of construction for service or administrationpurposes are carried at cost, less any impairment loss. Cost includesprofessional fees but not borrowing costs, which are recognised as expensesimmediately, as allowed by IAS 23 for assets held at fair value. Assets arerevalued and depreciation commences when they are brought into use.

Until March 31 2008, fixtures and equipment were carried atreplacement cost, as assessed by indexation and depreciation of historic cost.From April 1 2009 indexation has ceased. The carrying value of existing assetsat that date will be written off over their remaining useful lives and newfixtures and equipment are carried at depreciated historic cost as this is notconsidered to be materially different from fair value. Equipment with anestimated useful life of over 15 years will be valued using an independentvaluer every 5 years if considered material.

An increase arising on revaluation is taken to the revaluation reserve exceptwhen it reverses an impairment for the same asset previously recognised inexpenditure, in which case it is credited to expenditure to the extent of thedecrease previously charged there. A revaluation decrease is recognised as animpairment charged to the revaluation reserve to the extent that there is abalance on the reserve for the asset and, thereafter, to expenditure. Gains andlosses recognised in the revaluation reserve are reported as othercomprehensive income in the Statement of Comprehensive Income.

Subsequent expenditureWhere subsequent expenditure enhances an asset beyond its originalspecification, the directly attributable cost is capitalised. Where subsequentexpenditure restores the asset to its original specification, the expenditure iscapitalised and any existing carrying value of the item replaced is written-outand charged to operating expenses.

CapitalisationTangible assets are capitalised if they are capable of being used for a periodwhich exceeds one year and they are:

• individually have a cost of at least £5,000; or

• collectively have a cost of at least £5,000 and individually have a cost ofmore than £250,

• where the assets are functionally interdependent, they had broadlysimultaneous purchase dates, are anticipated to have simultaneousdisposal dates and are under single managerial control; or

• form part of the initial equipping and setting-up cost of a new building,ward or unit irrespective of their individual or collective cost.

DepreciationItems of property, plant and equipment are depreciated over their remaininguseful economic lives in a manner consistent with the consumption ofeconomic or service delivery benefits.

The Trust depreciates assets over the following ranges:

• equipment, 3 – 15 years

• buildings, 2 – 67 years

• IT hardware, 3 – 7 years

Freehold land is considered to have an infinite life and is not depreciated.Property, plant and equipment which has been reclassified as ‘held for

sale’ ceases to be depreciated upon the reclassification. Assets in the courseof construction are not depreciated until the asset is brought into use orreverts to the Trust, respectively.

De-recognition

Assets intended for disposal are reclassified as ‘held for sale’ once all of thefollowing criteria are met:

• the asset is available for immediate sale in its present condition subjectonly to terms which are usual and customary for such sales;

• the sale must be highly probable i.e.:

– management are committed to a plan to sell the asset;

– an active programme has begun to find a buyer and complete the sale;

– the asset is being actively marketed at a reasonable price;

– the sale is expected to be completed within 12 months of the date ofclassification as ‘held for sale’, and

– the actions needed to complete the plan indicate it is unlikely that theplan will be dropped or significant changes made to it.

Following reclassification, the assets are measured at the lower of theirexisting carrying amount and their ‘fair value less costs to sell’. Depreciationceases to be charged and the assets are not revalued, except where the ‘fairvalue less costs to sell’ falls below the carrying amount. Assets are de-recognised when all material sale contract conditions have been met.

Property, plant and equipment which is to be scrapped or demolisheddoes not qualify for recognition as ‘Held for Sale’ and instead is retained asan operational asset and the asset’s economic life is adjusted. The asset isde-recognised when scrapping or demolition occurs.

No items were held for sale or de-recognised at statement of financialposition date.

Non-Property assets

We have adopted historical cost as a proxy for fair value for non-volatile,short-life assets. We deem an asset life under 15 years to be short.

We individually review non-property assets with a useful life of over 15years on an annual basis, to ensure that these are being carried at fair value.

Donated fixed assets

Donated fixed assets are capitalised at their current value on receipt and thisvalue is credited to the donated asset reserve. Donated fixed assets are valuedand depreciated as described above for purchased assets. Gains and losses onrevaluations are also taken to the donated asset reserve and, each year, anamount equal to the depreciation charge on the asset is released from thedonated asset reserve to the income and expenditure reserve. Similarly, anyimpairment on donated assets charged to the income and expenditureaccount is matched by a transfer from the donated asset reserve. On sale ofdonated assets, the net book value of the donated asset is transferred fromthe donated asset reserve to the income and expenditure reserve.

1.9 Government grantsGovernment grants are grants from Government bodies other than incomefrom Primary Care Trusts or NHS Trusts for the provision of services. Grantsfrom the Department of Health are accounted for as Government grants, asare grants from the Big Lottery Fund. Funding received as Public DividendCapital is accounted for as NHS capital. Where the Government grant is usedto fund revenue expenditure, it is recorded as revenue income. Where thegrant is used to fund capital expenditure, the grant is held as deferred incomeand released to operating income over the life of the asset on a basisconsistent with the depreciation charge for that asset.

1.10 InventoriesInventories are valued at the lower of cost and net realisable value.

1.11 ProvisionsThe NHS Foundation Trust provides for legal or constructive obligations thatare of uncertain timing or amount at the statement of financial position dateon the basis of the best estimate of the expenditure required to settle theobligation. Where the effect of the time value of money is significant, theestimated risk-adjusted cash flows are discounted using HM Treasury’s


discount rate of 2.2% in real terms.

Clinical negligence costs

The NHS Litigation Authority (NHSLA) operates a risk pooling scheme underwhich the NHS Foundation Trust pays an annual contribution to the NHSLAwhich in return settles all clinical negligence claims. Although the NHSLA isadministratively responsible for all clinical negligence cases, the legal liabilityremains with the NHS Foundation Trust. The total value of clinical negligenceprovisions carried by the NHSLA on behalf of the NHS Foundation Trust isdisclosed in Note 5.1.

Non-clinical risk pooling

The NHS Foundation Trust participates in the Property Expenses Scheme andthe Liabilities to Third Parties Scheme. Both are risk pooling schemes underwhich the Trust pays an annual contribution to the NHS Litigation Authorityand, in return, receives assistance with the costs of claims arising. The annualmembership contributions, and any 'excesses' payable in respect of particularclaims, are charged to operating expenses as and when the liability arises.

Commercial insurance

In addition to the NHSLA Property Expense and Liabilities to Third PartiesSchemes the Trust also holds commercial insurance. The annual premium ischarged to operating expenses.

EU Emissions Trading Scheme

EU Emission Trading Scheme allowances are accounted for as Governmentgrant funded intangible assets if they are not expected to be realised withintwelve months, and otherwise as other current assets. They are valued atopen market value. As the NHS body makes emissions, a provision isrecognised with an offsetting transfer from the Government grant reserve.The provision is settled on surrender of the allowances. The asset, provisionand Government grant reserve are valued at fair value at the end of thereporting period.

1.12 ContingenciesContingent assets (that is, assets arising from past events the existence ofwhich will only be confirmed by one or more future events not wholly withinthe entity’s control) are not recognised as assets, but are disclosed in Note 27where an inflow of economic benefits is probable.

Contingent liabilities are not recognised, but are disclosed in Note 27,unless the probability of a transfer of economic benefits is remote. Contingentliabilities are defined as:

• possible obligations arising from past events the existence of which willbe confirmed only by the occurrence of one or more uncertain futureevents not wholly within the entity’s control; or

• present obligations arising from past events but for which it is notprobable that a transfer of economic benefits will arise or for which theamount of obligation cannot be measured with sufficient reliability.

1.13 Value Added TaxMost of the activities of the NHS Foundation Trust are outside the scope of VATand, in general, output tax does not apply and input tax on purchases is notrecoverable. Irrecoverable VAT is charged to the relevant expenditure categoryor included in the capitalised purchase cost of fixed assets. Where output taxis charged or input tax is recoverable, the amounts are stated net of VAT.

1.14 TaxationCurrent tax assets and liabilities are measured at the amount expected to berecovered from or paid to the taxation authorities, based on tax rates andlaws that are enacted or substantively enacted by the statement of financialposition date.

Deferred taxation is not provided for on the basis that income tax is notsignificant and is immaterial.

1.15 Public Dividend CapitalPublic Dividend Capital (PDC) is a type of public sector equity finance basedon the excess of assets over liabilities at the time of establishment of thepredecessor NHS Trust. HM Treasury has determined that PDC is not afinancial instrument within the meaning of IAS 32.

A charge, reflecting the forecast cost of capital utilised by the NHSFoundation Trust, is paid over as public dividend capital. The charge iscalculated at the real rate set by HM Treasury (currently 3.5%) on the averagerelevant net assets of the NHS Foundation Trust. Relevant net assets arecalculated as the value of all assets less the value of all liabilities, except for

donated assets and cash held within the Government Banking System.Average relevant net assets are calculated as a simple means of opening andclosing relevant net assets.

1.16 Other reservesThe other reserves balance of £743,000 was created by a technicalaccounting adjustment when the original NHS Trust was created in 1993.

1.17 Foreign exchangeThe functional and presentational currencies of the Trust are sterling.

A transaction which is denominated in a foreign currency is translatedinto the functional currency at the spot exchange rate on the date of thetransaction.

Where the Trust has assets or liabilities denominated in a foreign currencyat the statement of financial position date:

• monetary items (other than financial instruments measured at ‘fair valuethrough income and expenditure’) are translated at the spot exchangerate on 31 March;

• non-monetary assets and liabilities measured at historical cost aretranslated using the spot exchange rate at the date of the transaction;and

• non-monetary assets and liabilities measured at fair value are translatedusing the spot exchange rate at the date the fair value was determined.

Exchange gains or losses on monetary items (arising on settlement of thetransaction or on re-translation at the statement of financial position date) arerecognised as income or expenditure in the period in which they arise.

Exchange gains or losses on non-monetary assets and liabilities arerecognised in the same manner as other gains and losses on these items.

1.18 Financial assets and financial liabilitiesRecognition

Financial assets and financial liabilities which arise from contracts for thepurchase or sale of non-financial items (such as goods or services), which areentered into in accordance with the Trust’s normal purchase, sale or usagerequirements, are recognised when, and to the extent which, performanceoccurs i.e. when receipt or delivery of the goods or services is made.

Regular purchases or sales are recognised and de-recognised, asapplicable, using the Trade date.

All other financial assets and financial liabilities are recognised when theTrust becomes a party to the contractual provisions of the instrument.

De-recognition

Financial assets are no longer recognised (de-recognised) when the rights toreceive cash flows from the assets have expired or the Trust has transferredsubstantially all of the risks and rewards of ownership. Financial liabilities arede-recognised when the obligation is discharged, cancelled or expires.

Classification and measurement

Financial assets and financial liabilities at ‘fair value through income andexpenditure’Financial assets and financial liabilities at ‘fair value through income andexpenditure’ are financial assets or financial liabilities held for trading. Afinancial asset or financial liability is classified in this category if acquiredprincipally for the purpose of selling in the short-term. Derivatives are alsocategorised as held for trading unless they are designated as hedges.Loans and receivablesLoans and receivables are non-derivative financial assets with fixed ordeterminable payments which are not quoted in an active market. They areincluded in current assets. The Trust’s loans and receivables comprise: a loanto GSTS Pathology LLP, current investments, cash and cash equivalents, NHSdebtors, accrued income and ‘other debtors’.

Interest on loans and receivables is calculated using the effective interestmethod and credited to the statement of comprehensive income. Available-for-sale financial assetsNon-derivative financial assets classified as available-for-sale are eitherspecifically designated in this category or not classified in any of the othercategories. Available-for-sale financial assets are initially recognised at fairvalue plus direct transaction costs and then remeasured at subsequentreporting dates to fair value, with unrealised gains and losses (except forchanges in exchange rates for monetary items, interest, dividends andimpairment losses, which are recognised in the income statement) recognisedin equity until the financial asset is de-recognised, at which time thecumulative gain or loss previously recognised in equity is taken to the income


statement, in the line that most appropriately reflects the nature of the itemor transaction.

No financial assets were held for sale at statement of financial position date.Financial liabilitiesAll financial liabilities are recognised initially at fair value, net of transactioncosts incurred, and measured subsequently at amortised cost using theeffective interest method. The effective interest rate is the rate that discountsexactly estimated future cash payments through the expected life of thefinancial liability or, when appropriate, a shorter period, to the net carryingamount of the financial liability.

Financial liabilities are included in current liabilities except for amountspayable more than 12 months after the statement of financial position date,which are classified as long-term liabilities.

Interest on financial liabilities carried at amortised cost is calculated usingthe effective interest method and charged to finance costs. Interest onfinancial liabilities taken out to finance property, plant and equipment orintangible assets is not capitalised as part of the cost of those assets.

No financial liabilities were outstanding within the Group at thestatement of financial position date.Determination of fair valueFor financial assets and financial liabilities carried at fair value, the carryingamounts are determined from independent valuations.Impairment of financial assetsAt the statement of financial position date, the Trust assesses whether anyfinancial assets, other than those held at ‘fair value through income andexpenditure’ are impaired. Financial assets are impaired and impairmentlosses are recognised if, and only if, there is objective evidence of impairmentas a result of one or more events which occurred after the initial recognitionof the asset and which have an impact on the estimated future cash flows ofthe asset.

For financial assets carried at amortised cost, the amount of theimpairment loss is measured as the difference between the asset’s carryingamount and the present value of the revised future cash flows discounted atthe asset’s original effective interest rate. The loss is recognised in thestatement of comprehensive income and the carrying amount of the asset isreduced directly.

1.19 Cash and cash equivalentsCash is cash in hand and deposits with any financial institution repayablewithout penalty on notice of not more than 24 hours. Cash equivalents areinvestments that mature in 3 months or less from the date of acquisition andthat are readily convertible to known amounts of cash with insignificant riskof change in value.

In the Statement of Cash Flows, cash and cash equivalents are shown netof bank overdrafts that are repayable on demand and that form an integralpart of the Trust’s cash management.

1.20 Third party assetsAssets belonging to third parties (such as money held on behalf of patients)are not recognised in the accounts since the Trust has no beneficial interestin them. Details of third party assets are given in Note 32 to the accounts.

2 Segmental reportingYear ended Year ended

March 31 2010 March 31 2009£000 £000

INCOMEPatient care income 683,508 640,425Non patient care income 246,458 204,245

Total income 929,966 844,670

EXPENDITUREClinical divisions (621,195) (577,343)Corporate (287,279) (232,248)

Total expenditure (908,474) (809,591)

OFFSETTING ITEMS (19,645) (11,808)

OPERATING SURPLUS 1,847 23,271

Day-to-day financial control is devolved to:

• three clinical divisions accountable to the Board of Directors via the ChiefNurse/Chief Operating Officer

• corporate and other support services accountable to the Board ofDirectors via the other Executive Directors

The chief mechanism for financial management and control is a detailedbudget report and forecast prepared at cost centre level each month. Anaggregated summary budget and forecast report is presented by the Directorof Finance to the Board of Directors at each meeting. This report is madeavailable to the public at the meeting and via the public web sitewww.guysandstthomas.nhs.uk - see the Board of Directors page.

For the purposes of internal financial management, the majority ofcontractual and other income is accounted for centrally; income from activityabove contractual levels is allocated to clinical divisions directly as is incomegenerated locally from non-patient health care activities (e.g. rental income,recharges of staff); all assets and liabilities are accounted for centrally.

On an annual basis the Trust prepares detailed patient level costinginformation analysing income and expenditure to patient/consultant line level.

3 Operating income3.1 Income from activities by source

Year ended Year endedMarch 31 2010 March 31 2009

£000 £000Strategic Health Authorities 3,334 522Primary Care Trusts 656,660 542,234Department of Health* – 77,104NHS other 2,037 2,207Non NHS:

– Private patients 16,985 14,295– Overseas patients (non-reciprocal) 2,147 2,050– NHS injury scheme 1,056 905(was Road Traffic Accident scheme)

– Other 1,289 1,109

683,508 640,426

* Changes to the National Health payment process in 2009 have led toall payments from the Department of Health being channelled throughthe Primary Care Trusts.

3.2 Income from activities by typeYear ended Year ended

March 31 2010 March 31 2009£000 £000

Elective income 148,156 154,777Non-elective income 114,140 116,594Outpatient income 129,819 122,059Other type of activity income 255,917 217,127Accident and Emergency income 16,344 15,574Private patient income 19,132 14,295

683,508 640,426

Included under other type of activity income are critical care, renal dialysis,chargeable drugs and devices, HIV services, radiotherapy, direct accesspathology and other diagnostic services, genetics, PET scans, monetaryadjustments and the NHS injury scheme.

3.3 Private patient incomeYear ended Year ended

March 31 2010 March 31 2009£000 £000

Private patient income 19,132 14,295Total patient related income 683,508 640,426

Proportion as a percentage 2.80% 2.23%

Section 15 of the 2003 Act requires that the proportion of private incometo the total patient related income of NHS Foundation Trusts should notexceed 2.87%, its proportion whilst the body was an NHS Trust in 2002/03.


5.2 Audit feesYear ended Year ended

March 31 2010 March 31 2009£000 £000

Audit services for statutory audit 159 146Audit fee for subsidiary companies 9 11Other audit related services 20 5

188 162

5.3 Limitation on auditor’s liabilityThere is no limitation on auditor’s liability for the financial years 2009/10 or2008/09.

5.4 Operating leasesAs Lessee5.4.1 Payments recognised as an expense:


£000 £000

Minimum lease payments under operating 6,674 5,243leases recognised as an expense in the year

6,674 5,243

At the statement of financial position date, the Group had outstandingcommitments for future minimum lease payments under non-cancellableoperating leases which fall due as follows:


£000 £000

Within 1 year 5,221 3,937Between 1 and 5 years inclusive 12,007 7,084After 5 years 12,947 9,571

30,175 20,592

As Lessor5.4.2 Rental revenue: Year ended Year ended

March 31 2010 March 31 2009£000 £000

Other 2,872 377

2,872 377


£000 £000

Within 1 year 2,752 2,263Between 1 and 5 years inclusive 10,655 9,002After 5 years 9,873 9,460

23,280 20,725

From 2009/10 income from overseas visitors not covered by reciprocalagreements is to be reported as private patient income. The comparableproportion to March 2010 of private patient income, excluding income fromoverseas visitors not covered by reciprocal agreements, is £16,985k (2.48%as a proportion of total patient income).

An application has been made to Monitor to update the private patient capto 3.04%, the proportion whilst the body was an NHS Trust in 2002/03calculated on the revised basis.

4 Other operating incomeYear ended Year ended

March 31 2010 March 31 2009£000 £000

Research and development 41,196 24,073Education, training and research 77,659 79,218Charitable and other contributions to expenditure 5,184 4,906Transfers from donated asset reserve 9,304 8,185Non-patient care services to other bodies 2,972 20,822Other income 110,138 65,916Profits on disposal of fixed assets – 943Profits on disposal of tangible fixed assets 5 –

246,458 204,063

Other income includes income from commercial activities, staffaccommodation rentals, clinical excellence awards, catering, foreign currencygains of £1,623k (gains of £3,312k in 2008/09 included other operatingexpenses) and other direct credits.

Revenue is almost totally from supply of services. Revenue from supply ofgoods is immaterial.

5 Operating expenses5.1 Operating expenses comprise:


£000 £000Services from other NHS Trusts 3,013 2,098Services from other NHS bodies 5,435 4,850Services from NHS Foundation Trusts – 1,021Purchase of healthcare from non-NHS bodies 3,367 3,175Executive Directors’ costs 1,390 1,306Non-Executive Directors’ costs 182 183Staff costs 504,055 460,531Drugs 84,343 80,053Supplies and services – clinical 114,193 85,853Supplies and services – general 8,029 7,712Establishment 23,631 13,960Research and Development 35 –Transport 6,460 5,792Premises 45,358 51,172Bad debts 7,666 1,961Depreciation and amortisation 39,856 35,187Impairments of property, plant and equipment 5,104 6,198Audit fees – statutory audit 168 157Other auditor’s remuneration 20 5Clinical negligence 6,311 5,300Other* 49,858 47,185

908,474 813,699

*Other operating expenses includes expenditure on commercial activities, training and legal fees.


5.5 2009/10 Salary and pension entitlements of senior managers

A) RemunerationYear ended Year ended

March 31 2010 March 31 2009Name Title Executive Other Total Total

remuneration remuneration remuneration remuneration£000 £000 £000 £000

Executive DirectorsE. Baker Medical Director 132 85 217 225

R. Kerr Chief Executive 274 – 274 270

A. Macintyre Director of Workforce 155 – 155 60

S. McGuire Director of Capital, Estates and Facilities Management 157 – 157 168

H. Risebrow Commercial Director* 38 33 71 –

M. Shaw Director of Finance 157 – 157 168

E. Sills Chief Nurse/Chief Operating Officer 173 – 173 183

1,086 118 1,204 1,074

Non-Executive DirectorsD. Dean Non-Executive Director and Chairman Audit Committee 20 – 20 19

M. Franklin Non-Executive Director 17 – 17 17

R. Lechler Vice-Chairman (resigned April 2009) – – – 17

F. Nestle Non-Executive Director (appointed May 2009) 16 – 16 –

R. Maw Non-Executive Director 17 – 17 17

P. Moberly Chairman 61 – 61 61

J. Oliver Non-Executive Director 17 – 17 17

D. Summers Non-Executive Director 17 – 17 13

1,251 118 1,369 1,235

* Joined the Trust October 12 2009 and was appointed Executive Director January 1 2010.

B) Pension benefits Total accruedReal increase pension Cash Cash

in pension and related equivalent equivalentand related lump sum transfer transferlump sum at age 60 at value at value atat age 60 March 31 2010 March 31 2010 March 31 2009

Name Title £000 £000 £000 £000

E. Baker* Medical Director – – – –

R. Kerr Chief Executive 129 388 ** 3,062

A. Macintyre Director of Workforce 45 136 856 674

S. McGuire Director of Capital, Estates and Facilities Management 28 83 551 460

H. Risebrow Commercial Director (appointed January 2010) 5 16 95 –

M. Shaw Director of Finance 58 174 1,244 1,126

E. Sills Chief Nurse/Chief Operating Officer 54 162 951 855

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

* The Medical Director is recharged to the Trust from King’s College Medical School.

** The NHS Pensions Agency do not calculate cash equivalent transfer value for individuals over 60.

A cash equivalent transfer value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a memberat a particular point in time. The benefits valued are the member's accrued benefits and any contingent spouse's pension payable fromthe scheme. A CETV is a payment made by a pension scheme, or arrangement to secure pension benefits in another pension scheme,or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pensionfigures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme,not just their service in a senior capacity to which the disclosure applies. The CETV figures include the value of any pension benefitsin another scheme or arrangement which the individual has transferred to the NHS Pension Scheme. They also include any additionalpension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their owncost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries.


6 Employee costs and numbers6.1 Employee costs

Year ended Year endedPermanently March 31 2010 March 31 2009

employed Other Total Total£000 £000 £000 £000

Salaries and wages 394,845 – 394,845 351,959Social security costs 32,260 – 32,260 28,946Employer contributions to NHSPA 43,615 – 43,615 38,688Termination benefits 113 – 113 –Agency and contract staff – 34,388 34,388 38,911Seconded staff 337 – 337 3,390

471,170 34,388 505,558 461,894

6.2 Average number of people employedYear ended Year ended

Permanently March 31 2010 March 31 2009employed Other Total Totalnumber number number number

Medical and dental 1,367 – 1,367 1,248Administrative and estates 2,281 – 2,281 2,060Healthcare assistants and other support staff 774 – 774 737Nursing, midwifery and health visiting staff 3,486 – 3,486 2,833Nursing, midwifery and health visiting learners 429 – 429 517Scientific, therapeutic and technical staff 1,743 – 1,743 1,595Bank and agency staff – 730 730 948

10,080 730 10,810 9,938

6.3 Management costsYear ended Year ended

March 31 2010 March 31 2009£000 £000

Management costs 34,901 29,667Income 929,966 843,546Management costs as a percentage 3.75% 3.52%

Management costs are defined as those on the management cost website at www.dhl.gov.uk/Policy and Guidance/OrganisationPolicy/Finance and Planning/NHSManagement Costs/fs/en

6.4 Retirements due to ill-health

During 2009/10 there were 7 early retirements from the Trust agreed on the grounds of ill-health (9 in the year ended March 312009). The estimated additional pension liabilities of these ill-health retirements is £571k (£619k in 2008/09). These retirementsrepresented 0.67 per 1,000 active scheme members. The cost of these ill-health retirements will be borne by the NHS PensionsAgency.

7 Better Payment Practice Code7.1 Measure of compliance


Number £000 Number £000

Total bills paid in the year 220,410 508,138 204,882 421,409Total bills paid within target 159,638 350,728 157,780 297,013

Percentage of bills paid within target 72% 69% 77% 70%

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

7.2 The Late Payment of Commercial Debts (Interest) Act 1998The Trust did not incur any expenditure relating to the late payment of commercial debts.


8 Share of operating loss in joint venturesYear ended Year ended

March 31 2010 March 31 2009£000 £000

GSTS Pathology LLP – (127)

– (127)

9 Profit /(loss) on disposal of non-current assets

Profit /(loss) on the disposal of non-current assets Year ended Year endedis made up as follows: March 31 2010 March 31 2009

£000 £000

Profit on disposal of intangible assets 5 –(Loss)/profit on disposal of plant and equipment (20) 943

(15) 943

10 Finance incomeYear ended Year ended

March 31 2010 March 31 2009£000 £000

Interest receivable 782 6,085

782 6,085

11 Finance expensesYear ended Year ended

March 31 2010 March 31 2009£000 £000

Unwinding of discounts on provision 211 203

211 203

12 TaxationYear ended Year ended

March 31 2010 March 31 2009£000 £000

UK corporation taxCurrent tax payable on income at 28% 1 4

1 4

Corporation tax is applicable to the profits of GTI Forces Healthcare Ltd and the profits of thejoint ventures. Guidance issued by HMRC states that the earliest date corporation tax will beapplicable to Foundation Trusts is now April 1 2011.

13 Surplus attributable to the TrustThe surplus for the year dealt with in the financial statements of the parent was £1,884k(2008/09 surplus of £20,102k). As permitted by Monitor’s Annual Reporting Manual, noseparate statement of comprehensive income is presented in respect of the parent.


14 Property, plant and equipment14.1 Property, plant and equipment for 2008/2009 comprised of the following elements:

Assets underconstruction

Buildings and FurnitureGroup and Trust excluding payments Plant and Transport Information and

Land dwellings on account machinery equipment technology fittings TotalCost or valuation £000 £000 £000 £000 £000 £000 £000 £000

at April 1 2008 184,500 595,490 6,550 114,297 130 41,688 2,199 944,854Prior period adjustments – – – – – (164) – (164)Additions purchased – 11,465 37,604 12,014 – 9,351 – 70,434Additions donated – 14 – 3,168 – – – 3,182Impairments (17,550) (64,623) – – – – – (82,173)Reclassifications – 6,328 (6,328) – – (20,458) – (20,458)Disposals – – – (2,316) – – – (2,316)

At March 31 2009 166,950 548,674 37,826 127,163 130 30,417 2,199 913,359

Accumulated depreciationat April 1 2008 – 20,186 – 71,769 128 19,035 1,345 112,463Prior period adjustment – – – – – (65) – (65)Provided during the year – 20,332 – 9,039 2 5,719 86 35,178Impairments – (40,518) – – – – – (40,518)Reclassifications – – – – – (11,166) – (11,166)Disposals – – – (2,037) – – – (2,037)

At March 31 2009 – – – 78,771 130 13,523 1,431 93,855

Net book valuePurchased assets 109,250 402,840 5,820 30,838 2 21,968 260 570,978Donated assets 75,250 172,464 730 11,690 – 586 594 261,314

Total at April 1 2008 184,500 575,304 6,550 42,528 2 22,554 854 832,292

Purchased assets 99,200 411,065 37,826 37,583 – 15,906 245 601,825Donated assets 67,750 137,609 – 10,809 – 988 523 217,679

Total at March 31 2009 166,950 548,674 37,826 48,392 – 16,894 768 819,504

14.2 Property, plant and equipment at the statement of financial position date comprise thefollowing elements:

Assets underconstruction

Buildings and FurnitureGroup and Trust excluding payments Plant and Transport Information and

Land dwellings on account machinery equipment technology fittings TotalCost or valuation £000 £000 £000 £000 £000 £000 £000 £000

At April 1 2009 166,950 548,674 37,826 127,163 130 30,417 2,199 913,359Additions purchased – 35,522 25,071 15,682 – 3,631 – 79,906Additions donated – 373 1,864 1,582 – – – 3,819Impairments – (45,165) – – – – – (45,165)Reclassifications – 9,853 (20,014) 2,487 – 3,556 – (4,118)Disposals – – – (793) – – – (793)

At March 31 2010 166,950 549,257 44,747 146,121 130 37,604 2,199 947,008

DepreciationAt April 1 2009 – – – 78,771 130 13,523 1,431 93,855Provided during the year – 23,687 – 7,472 – 6,917 110 38,186Impairments – (23,053) – – – – – (23,053)Disposals – – – (774) – – – (774)

At March 31 2010 – 634 – 85,469 130 20,440 1,541 108,214

Net book valuePurchased assets 99,200 411,065 37,826 37,583 – 15,906 245 601,825Donated assets 67,750 137,609 – 10,809 – 988 523 217,679

Total at April 1 2009 166,950 548,674 37,826 48,392 – 16,984 768 819,504

Purchased assets 99,200 412,110 42,883 51,685 – 16,575 211 622,664Donated assets 67,750 136,513 1,864 8,967 – 589 447 216,130

Total at March 31 2010 166,950 548,623 44,747 60,652 – 17,164 658 838,794


15 Intangible assets15.1 As at March 31 2009

Software Information Assets under Other Totallicences technology construction

Group and Trust £000 £000 £000 £000 £000

Cost April 1 2008 129 – – 1 130Prior period adjustments 164 – – – 164Reclassification – 20,458 – – 20,458Other revaluation – – – 662 662Additions purchased 69 – – – 69

Gross cost at March 31 2009 362 20,458 – 663 21,483

Reclassifications – 11,166 – – 11,166

Amortisation at March 31 2009 – 11,166 – – 11,166

Net book valuePurchased assets April 1 2008 222 – – – 222

Total at April 1 2008 222 – – – 222

Purchased assets at March 31 2009 282 9,213 – – 9,495Donated at March 31 2009 – 79 – 663 742

Total at March 31 2009 282 9,292 – 663 10,237

15.2 As at March 31 2010Software Information Assets under Other Totallicences technology construction

Group and Trust £000 £000 £000 £000 £000

Cost April 1 2009 362 20,458 – 663 21,483Reclassification – 4,118 – – 4,118Other revaluation – – – 78 78Additions purchased 38 4,502 2,188 201 6,929Additions donated – – 327 – 327Disposals – – – (20) (20)

Gross cost at March 31 2010 400 29,078 2,515 922 32,915

Amortisation April 1 2009 80 11,166 – – 11,246Provided during the year 63 1,606 – – 1,669

Amortisation at March 31 2010 143 12,772 – – 12,915

Net book valuePurchased assets April 1 2009 282 9,213 – – 9,495Donated assets April 1 2009 – 79 – 663 742

Total at April 1 2009 282 9,292 – 663 10,237

Purchased assets at March 31 2010 257 16,258 2,188 922 19,625Donated at March 31 2010 – 48 327 – 375

Total at March 31 2010 257 16,306 2,515 922 20,000

A separate schedule for the Trust’s intangible assets has not been produced as the subsidiaries only intangible asset is £41k in respectof assets under construction.

14.3 The net book value of property, plant and equipment at March 31 2010 comprises:Total property

plant andLand Buildings Other assets machinery£000 £000 £000 £000

Protected 166,950 548,623 – 715,573Unprotected – – 123,221 123,221

Net book value 166,950 548,623 123,221 838,794


16 ImpairmentsLand and buildings were valued independently by the District Valuer as at April 1 2010. Both the buildings at Guy’s and St Thomas’ sites havereduced in value due to reduction in the modern equivalent asset valuation basis. The basis of valuation is described in detail in the accountingpolicy under the property, plant and equipment valuation note 1.8.

The valuation on land wasunchanged from the previous valuation as at April 1 2009 while the buildings at these two sites have dropped in valueby £22,112k. £5,104k has been charged against the income and expenditure account and £17,008k netted off against the revaluation reserveaccount.

17 Interest in associates and joint venturesThe NHS Foundation Trust's principal subsidiary undertakings, associates and joint ventures as included in the consolidation at March 31 2010 areset out below. The accounting date of the financial statements for the subsidiaries is March 31 2010 and for the joint ventures December 31 2010.For the joint venture undertakings that have different accounting year end dates, interim accounts to March 31 2010 have been consolidated.

Country of Beneficial Principalincorporation interest activity

Subsidiary undertakings

Guy’s and St Thomas’ Enterprises Ltd. UK 100% Holding companyGTI Forces Healthcare Ltd* UK 100% Healthcare servicesPathology Services Ltd* UK 100% Healthcare services

Joint ventures

GSTS Pathology LLP* UK 50% Healthcare servicesSSAFA GSTT Care LLP* UK 50% Healthcare services

* Not directly owned by NHS Foundation Trust

18 Aggregated amounts relating to joint venturesMarch 31 2010 March 31 2009

£000 £000

Non current assets 4,645 1,081Current assets 9,155 6,516Non current liabilities (2,500) (2,500)Current liabilities (11,636) (4,844)

Group share net assets (liabilities) (336) 253

Revenue 31,955 10,705Expenditure (32,546) (11,562)

Group share net (loss) (591) (857)

As per accounting policy note 1.2 the Group accounts for the joint ventures above on an equity basis. The Group has not recognised its share of lossesexceeding Group interest. The Group share of unrecognised losses is disclosed below.

March 31 2010 March 31 2009£000 £000

Group share of unrecognised losses 1,321 730

19 InventoriesGROUP TRUST

March 31 2010 March 31 2009 April 1 2008 March 31 2010 March 31 2009 April 1 2008£000 £000 £000 £000 £000 £000

Raw materials and consumables 14,252 7,529 7,905 14,252 7,529 7,905

14,252 7,529 7,905 14,252 7,529 7,905


21 Trade and other payables21.1 Current


£000 £000 £000 £000 £000 £000

Receipts in advance 537 956 564 537 955 564NHS payables 14,237 14,687 12,525 14,237 14,686 12,525Trade payables – capital 3,576 1,003 3,636 3,576 1,003 3,636Other trade payables 37,490 17,034 10,112 37,490 17,036 10,112Other payables 2,273 2,116 – 2,273 2,116 –Accruals 30,278 46,183 42,254 30,199 46,103 42,254

88,391 81,979 69,091 88,312 81,899 69,091

NHS payables include £5,891k outstanding pension contributions at March 31 2010 (£5,196k at March 31 2009).

21.2 Current taxes payableGROUP TRUST


Taxes payable 11,912 10,080 8,866 11,190 10,080 8,866

11,912 10,080 8,866 11,190 10,080 8,866

20 Trade and other receivables20.1 Current


£000 £000 £000 £000 £000 £000

NHS receivables 26,354 30,258 23,373 26,354 30,258 23,373Provision for impaired receivables (16,907) (11,703) (10,840) (16,907) (11,703) (10,840)Prepayments 7,071 2,384 – 7,071 2,384 –Accrued income 7,681 8,064 9,517 7,681 8,064 9,517Other receivables 32,160 29,537 23,918 32,212 29,610 23,918

56,359 58,540 45,968 56,411 58,613 45,968

Other receivables include an amount of £2,500k which relates to a loan to the joint venture – GSTS Pathology LLP with a maturity date of January 29 2011 and a variable rate of interest (Libor + 2%), and also includes an amount of £599k which is GSTS Pathology LLP and £180k which isSSAFA GSTT Care LLP sales ledger debts.

20.2 Non currentGROUP TRUST


NHS receivables 563 539 506 563 539 506Other receivables with related parties – 2,500 – 1,152 3,611 –Other receivables 1,530 796 591 1,530 796 591

2,093 3,835 1097 3,245 4,946 1097

20.3 Ageing of trade and other receivablesGROUP TRUST


Not past due date 54,013 52,947 33,103 54,065 53,020 33,103Up to three months 831 4,048 5,457 831 4,048 5,457In three to six months 2,216 1,668 1,218 2,216 1,668 1,218Over six months 1,392 3,712 7,287 2,544 4,823 7,287

58,452 62,375 47,065 59,656 63,559 47,065


22 Provisions for liabilities and charges22.1 Overall provisionsGroup and Trust Current Non Current Total Provisions

March 31 March 31 April 1 March 31 March 31 April 1 March 31 March 31 April 12010 2009 2008 2010 2009 2008 2010 2009 2008£000 £000 £000 £000 £000 £000 £000 £000 £000

Pensions relating to former staff 784 757 751 7,729 7,736 7,913 8,513 8,493 8,664Legal claims 777 398 706 – – – 777 398 706Other 693 264 1,871 1,226 1,209 506 1,919 1,473 2,377

2,254 1,419 3,328 8,955 8,945 8,419 11,209 10,364 11,747

22.2 Changes in provisionsPensions

relating to Legalformer staff claims Other Total

£000 £000 £000 £000

As at April 1 2009 8,493 398 1,473 10,364Arising during the year 643 642 453 1,738Utilised during the year (809) (2) (32) (843)Reversed unused – (261) – (261)Unwinding of discount 187 – 24 211

As at March 31 2010 8,514 777 1,918 11,209

Expected timing of cashflows:

22.3 Timing of provisionsPensions

relating to Legalformer staff claims Other Total

£000 £000 £000 £000

Within one year 785 777 692 2,254Between one and five years 2,969 – 119 3,088After five years 4,760 – 1,107 5,867

8,514 777 1,918 11,209

The provision relating to pensions to former staff consists of provisions for pre 1995 early retirements and has been calculated using information provided by theNHS Pensions Agency. £68,920k is included in the provision of the NHS Litigation Authority under legal claims at March 31 2010 in respect of clinical negligenceliabilities of the Foundation Trust. (£62,315k at March 31 2009). Other Provisions consists of provisions for EU Emissions and injury benefits.

The timing of the provisions cash flow represents our best estimate of future liabilities based on available input from NHS professionals in the respective areas.

21.3 Other liabilitiesGROUP TRUST

March 31 2010 March 31 2009 April 1 2008 March 31 2010 March 31 2009 April 1 2008Current £000 £000 £000 £000 £000 £000

Deferred income 17,079 19,913 16,890 17,079 19,913 16,890Deferred Government grant 365 434 – 365 434 –

17,444 20,347 16,890 17,444 20,347 16,890

Non-current

Deferred income 4,635 4,402 – 4,635 4,401 –Deferred Government grant 1,590 1,178 _ 1,590 1,178 –

6,225 5,580 – 6,225 5,579 –


25 Capital commitmentsCommitments under capital expenditure contracts at the balance sheet date were £6,529k (£4,467k at March 31 2009) for the Group and the Trust.

26 After the balance sheet dateThere are no items arising that require disclosure following the financial reporting year end.

27 ContingenciesMarch 31 2010 March 31 2009

£000 £000

Contingent liability for other claims against the Group and the Trust 68 230

68 230

All contingent liabilities recorded are in respect of Public and Employee liability cases as advised by the NHS Litigation Authority. This represents ourbest estimate of future liabilities based on available input from NHS professionals in the respective areas.

23 Prudential borrowing limitMarch 31 2010 March 31 2009 April 1 2008

£000 £000 £000

Long term borrowing limit set by Monitor 182,700 175,600 160,600Working capital facility agreed by Monitor 30,000 30,000 30,000

212,700 205,600 190,600

24 Analysis in changes of net cashAt April 1 2008 Cash changes At April 1 2009 Cash changes At March 31

GROUP in year in year 2010£000 £000 £000 £000 £000

Cash at bank and in hand – 142,349 (2,440) 139,909 (28,546) 111,363Office of the Paymaster General (OPG)Cash at bank and in hand – 4,086 11,052 15,138 (14,590) 548commercial bank accounts

146,435 8,612 155,047 (43,136) 111,911

TRUST

Cash at bank and in hand – 142,349 (2,440) 139,909 (28,546) 111,363Office of the Paymaster General (OPG)Cash at bank and in hand – commercial bank accounts 4,086 10,908 14,994 (14,532) 462

146,435 8,468 154,903 (43,078) 111,825


28 Public Dividend Capital dividendThe Trust is required to demonstrate that the PDC dividend paid is in line withthe actual rate of 3.5% of average relevant net assets. The dividend payableto March 2010 period of account was £20,215k and, based on the averagerelevant net assets of £577,694k, the Trust’s performance on an annualisedbasis was 3.5% (3.2% to March 2009).

29 Financial performance targetsThe following information relates to the Prudential Borrowing Limit (PBL) withwhich Guy’s and St Thomas’ NHS Foundation Trust is required to comply.

A) The Foundation Trust had no long-term borrowing at March 31 2010.

B) The Dividend Cover ratio is 3.039 compared to a minimum cover requiredof 1 (4.459 in the year ended March 31 2009, restated to include interestreceived).

30 Related party transactionsGuy’s and St Thomas’ NHS Foundation Trust is a body corporate establishedby order of the Secretary of State for Health.

The Trust has taken advantage of the exemption provided by IAS 24‘Related Party Disclosures’, where the parent’s own financial statements arepresented together with the consolidated financial statements and anytransactions or balances between group entities have been eliminated onconsolidation. The debtors trading balances with the Group’s associate andjoint ventures are presented in note 20. There are no outstanding creditorsbalances with the Group’s associate and joint ventures as at March 31 2010.

The Board members of SSAFA GSTT Care LLP include the followingdirectors from the Trust: Mr Ron Kerr as Non-Executive Director andChairman, Mr Martin Shaw as Non-Executive Director, Dr Robert O’Leary asDeputy Managing Director, Mr Alistair Scarborough as Commercial Directorand Mr Michael Powell as Director of Secondary Health Care.

The Board members of GSTS Pathology LLP include the followingdirectors from the Trust: Mr Ron Kerr, Mr Martin Shaw, Dr Robert O’Leary andDr Jonathan Edgeworth.

The Department of Health is regarded as a related party. During the yearGuy’s and St Thomas’ NHS Foundation Trust has had a significant number of

material transactions with entities for which the department is regarded asthe parent. The main local commissioners are Lambeth PCT, Southwark PCTand Lewisham PCT from whom the Trust received £255,373k at March 312010 for health care contracts (£205,536k at March 31 2009). Additionallythe Trust has transacted with a large number of other PCTs and NHS Trustsincluding Croydon PCT, West Kent PCT, Bromley PCT, Greenwich PCT andBexley PCT, as well as the NHS Litigation Authority and NHS Logistics.

The debtors balance for NHS bodies as at March 31 2010 stood at£26,917k (£30,797k at March 31 2009).

In addition, the Trust has had a number of material transactions withother Government departments and other central and local Governmentbodies. £37,514k at March 31 2010 (£36,059k at March 2009) has beenreceived from the Ministry of Defence for health services supplied. There werealso many transactions with King’s College London totalling £8,442k atMarch 31 2010 (£10,460k at March 31 2009).

The Trust has also received revenue and capital payments from a numberof charitable funds, principally Guy’s and St Thomas’ Charity to the amountof £11,662k at March 31 2010 (£10,952k at March 31 2009). The balancefor Guy’s and St Thomas’ Charity debtors was £1,632k for March 31 2010(£2,988k at March 31 2009) and for creditors £280k for March 31 2010(£788k for March 31 2009). Guy’s and St Thomas’ Charity is regarded as arelated party.

The Trust works closely with its partners in the King’s Health Partnership:King’s College London, King’s College Hospital NHS Foundation Trust andSouth London and Maudsley NHS Foundation Trust.

Ron Kerr, Chief Executive and Eileen Walsh, Director of Assurance rentaccommodation from the Trust at a commercial rate.

Rory Maw (Non-Executive Director) is a trustee of Guy’s and St Thomas’Charity.

Tony West (Chief Pharmacist) is chair of an Advisory Board forGlaxoSmithKline.

The Council of Governors includes representatives from organisationsthat work closely with the Trust including Lambeth Council, SouthwarkCouncil, Lambeth PCT, Southwark PCT, Lewisham PCT, London South BankUniversity, South Bank Employers Group, NHS London, King’s College Londonand South London and Maudsley NHS Foundation Trust.

Aside from these transactions none of the other Board members, themembers of the Council of Governors, members of the key management staffor parties related to them have undertaken any material transactions withGuy’s and St Thomas’ NHS Foundation Trust.

31 Financial assets and liabilities31.1 Financial assetsFloating rate GROUP TRUST

March 31 2010 March 31 2009 March 31 2010 March 31 2009£000 £000 £000 £000

Denominated in £ Sterling 161,540 206,188 160,328 207,227 In other currencies, restated in £ Sterling 1,523 11,098 1,523 11,098

Gross financial assets at March 31 2010

163,063 217,286 161,851 218,325

31.2 Analysis of financial liabilitiesFloating rate GROUP TRUST


Denominated in £ Sterling 99,063 91,117 98,985 91,308

Gross financial liabilities at March 31 2010

99,063 91,117 98,985 91,308


31.3a Financial assets by categoryLoans and

GROUP Total receivables£000 £000

At March 31 2010Assets as per balance sheetNHS Debtors 26,917 26,917Accrued income 7,681 7,681Other debtors 33,690 33,690Provision for doubtful debts (16,907) (16,907)Cash at bank and in hand 111,912 111,912

At March 31 2010 163,293 163,293

At March 31 2009 NHS Debtors 30,797 30,797Accrued income 8,064 8,064Other debtors 35,081 35,081Provision for doubtful debts (11,703) (11,703)Cash at bank and in hand 155,047 155,047

Total at March 31 2009 217,286 217,286

Loans andTRUST Total receivables

£000 £000 At March 31 2010Assets as per balance sheetNHS Debtors 26,917 26,917Accrued income 7,681 7,681Other debtors 32,336 32,336Provision for doubtful debts (16,907) (16,907)Cash at bank and in hand 111,825 111,825

At March 31 2010 161,852 161,852

At March 31 2009NHS Debtors 30,797 30,797Accrued income 8,064 8,064Other debtors 36,275 36,275Provision for doubtful debts (11,703) (11,703)Cash at bank and in hand 154,892 154,892

Total at March 31 2009 218,325 218,325

31.3b Financial liabilities by categoryOther financial liabilities GROUP TRUST

£000 £000

At March 31 2010NHS creditors 14,237 14,237Other creditors 43,339 43,339Accruals 30,278 30,200Provisions under contract 11,209 11,209

At March 31 2010 99,063 98,985

At March 31 2009NHS creditors 14,687 14,686Other creditors 20,153 20,155Accruals 46,183 46,103Provisions under contract 10,094 10,094

Total at March 31 2009 91,117 91,038

31.4 Fair values of financial assets at March 31 2010GROUP TRUST

Book value Fair value Book value Fair value£000 £000 £000 £000

Debtors over one year – 2,093 2,093 3,245 3,245Agreements with commissioners to cover creditors and provisions

Other 111,911 111,911 111,825 111,825

114,004 114,004 115,070 115,070

As allowed by IFRS 7, short term trade debtors and creditors measured at amortised cost may be excluded from the above disclosure astheir book values reasonably approximate their fair values.

31.5 Maturity of financial liabilitiesGROUP TRUST


Less than one year (99,063) (91,117) (98,985) (91,308)

(99,063) (91,117) (98,985) (91,308)


31.6 Financial assets interest riskGROUP Non- Weighted

Floating Fixed interest averageCurrency Total rate rate bearing interest

£000 £000 £000 £000 rate % At March 31 2010Sterling 110,957 110,058 569 330 0.2Other 1,502 – – 1,502 0.0

Gross financial assets 112,459 110,058 569 1,832

At March 31 2009Sterling 144,563 143,931 607 25 0.3Other 11,098 11,072 – 26 0.6

Gross financial assets 155,661 155,003 607 51

TRUST Non- WeightedFloating Fixed interest average

Currency Total rate rate bearing interest£000 £000 £000 £000 rate %

At March 31 2010Sterling 110,870 110,058 569 243 0.2Other 1,502 – – 1,502 0.0

Gross financial assets 112,372 110,058 569 1,745

At March 31 2009Sterling 143,524 142,892 607 25 0.3Other 11,098 11,072 – 26 0.6

Gross financial assets 154,622 153,964 607 51

31.7 Financial risk managementFinancial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the period in creating or changing the risksa body faces in undertaking its activities. Because of the continuing service provider relationship that the NHS Trust has with Primary Care Trusts andthe way those Primary Care Trusts are financed, the NHS Trust is not exposed to the degree of financial risk faced by business entities. Also financialinstruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which the financial reportingstandards mainly apply. The NHS Trust has limited powers to borrow or invest surplus funds and financial assets and liabilities are generated by day-to-day operational activities rather than being held to change the risks facing the NHS Trust in undertaking its activities.The Trust’s treasury management operations are carried out by the finance department, within parameters defined formally within the Trust’s standingfinancial instructions and policies agreed by the Board of Directors. Trust treasury activity is subject to review by the Trust’s internal auditors.

Currency riskThe Trust is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK and sterling based. The Trusthas an operation overseas with British Forces in Germany, but has low exposure to currency rate fluctuations.

Interest rate riskThe Trust borrows from Government for capital expenditure, subject to affordability as confirmed by the Strategic Health Authority. The borrowings arefor 1 – 25 years, in line with the life of the associated assets, and interest is charged at the National Loans Fund rate, fixed for the life of the loan. TheTrust therefore has low exposure to interest rate fluctuations.

Credit riskBecause the majority of the Trust’s income comes from contracts with other public sector bodies, the Trust has low exposure to credit risk. The maximumexposures as at March 31 2010 are in receivables from customers, as disclosed in the Trade and other receivables note.

Liquidity riskThe Trust’s operating costs are incurred under contracts with Primary Care Trusts, which are financed from resources voted annually by Parliament. The Trustfunds its capital expenditure from funds obtained within its prudential borrowing limit. The Trust is not, therefore, exposed to significant liquidity risks.


32 Third party assetsThe Trust held £20,694 cash at bank and in hand at March 31 2010 (£11,413 at March 31 2009) which relates to monies held by the Trust on behalfof patients. This has been excluded from cash at bank and in hand figure reported in the accounts.

33 Losses and special paymentsThere were 1,905 cases of losses and special payments totalling £2,112k (£1,323k at March 31 2009) approved during the year to March 31 2010.This includes cash payments during the year. These are not calculated on an accruals basis.

34 Translation to IFRSAs required under IFRS1, detailed below is a reconciliation of reported equity under previous GAAP to equity under IFRS at the date of transition,together with the effect on the 2008/09 surplus.

Income and Donated Publicexpenditure Revaluation asset dividend Other

Group reserve reserve reserve capital reserve£000 £000 £000 £000 £000

Taxpayers’ equity at March 31 2009 under UK GAAP 119,214 221,683 244,111 352,067 743

Adjustments for IFRS changes:Leases (236) – – – –Holiday cost accrual (2,679) – – – –Impairment on modern equivalent valuation (6,198) – – – –Other investments in joint ventures 731 – – – –

Adjustment for:Revaluation/impairment recognised on transition – 24,844 (25,690) – –

Taxpayers’ equity at April 1 2009 under IFRS 110,832 246,527 218,421 352,067 743

£000

Surplus for 2008/09 under UK GAAP 25,453

Adjustments for:Leases (156) Employee benefits - holiday creditors (849) Impairment on modern equivalent valuation (6,198) Other investments 731

Surplus for 2008/09 under IFRS 18,981

Income and Donated Publicexpenditure Revaluation asset dividend Other

Trust reserve reserve reserve capital reserve£000 £000 £000 £000 £000

Taxpayers’ equity at March 31 2009 under UK GAAP 119,214 221,683 244,111 352,067 743

Adjustments for IFRS changes:Leases (236) – – – –Holiday cost accrual (2,679) – – – –Impairment on modern equivalent valuation (6,198) – – – –

Adjustment for:Revaluation/impairment recognised on transition – 24,844 (25,690) – –

Taxpayers’ equity at April 1 2009 under IFRS 110,101 246,527 218,421 352,067 743

£000

Surplus for 2008/09 under UK GAAP 25,453

Adjustments for:Leases (156) Employee benefits – holiday creditors (849) Impairment on modern equivalent valuation (6,198)

Surplus for 2008/09 under IFRS 18,250

Chief ExecutiveIf you have a comment for the Chief Executive, contact:Ron Kerr, Chief ExecutiveTel: 020 7188 0001Email: [email protected]

Patient Advice and Liaison Service (PALS)If you require information, support or advice about our services, contact:PALSTel: 020 7188 8801 (St Thomas’)or 020 7188 8803 (Guy’s)Email: [email protected]

MembershipIf you are interested in becoming a member of our NHS Foundation Trust, contact:Tel: 020 7188 0012 Email: [email protected]

Recruitment If you are interested in applying for a job at Guy’s and St Thomas’, contact:The Recruitment CentreTel: 020 7188 0044http://jobs.gstt.nhs.uk

Further informationIf you have a media enquiry or require further information, contact:Anita Knowles, Director of CommunicationsTel: 020 7188 5577Email: [email protected]

Contact information


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duced

by A

ndrew

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ciates 020 8995 8787 www.aya-creative.co

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uy’s an

d St Th

omas’ N

HS Fo

undatio

n Tru

st / June 2010

Guy’s and St Thomas’ NHS Foundation TrustGuy’s Hospital Great Maze Pond London SE1 9RTSt Thomas’ Hospital Westminster Bridge Road London SE1 7EHTel: 020 7188 7188

www.guysandstthomas.nhs.uk

ANNUAL REPORT AND ACCOUNTS 2009|10 · Annual Report and Accounts 2009/2010 3 As well as being one...

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Transcript of ANNUAL REPORT AND ACCOUNTS 2009|10 · Annual Report and Accounts 2009/2010 3 As well as being one...