Annual Report

2011/12

Contents
Section 1 Overview Welcome from the chairman and chief executive About us Our vision, mission and goals Our journey to becoming a Foundation Trust

Section 2 Delivering Quality Community Services Responding to the diverse needs of our communities Delivering clinical excellence Providing excellent personalised patient experience Assuring patient safety Listening to our patients Working in partnership

Section 3 Becoming One Culture, One Organisation Our values Developing our people Staff engagement Staff survey results Inclusion, equality and diversity Sickness absence

Section 4 Being Well Governed Meet the Board Supporting committees Remuneration Report Other statutory information

Section 5 Being Financially Strong Performance Finance including Summary of Accounts Auditors Report

Section 1 Overview
Welcome from the Chairman and Chief Executive
Welcome to our second annual report as an NHS Trust which provides us with the opportunity to share our vision, mission and goals, our achievements over the past financial year and our plans for the future. Central London Community Healthcare NHS Trust (CLCH) is all about people: the patients we support together with their families and carers; the communities they live in and our staff. We are committed to helping everyone we care for remain as healthy as possible, to delivering their care either in or close to their home and to making their healthcare experience the very best we can. We have come a long way in the past few years, thanks to strong support from our patients, staff and stakeholders. CLCH was formed in 2008 from the three community healthcare organisations which were formerly part of the primary care trusts (PCTs) in Hammersmith and Fulham, Kensington and Chelsea, and Westminster. We became an NHS Trust in November 2010 and merged with Barnet Community Services in April 2011. Working as a single provider across four boroughs is enabling us to break new ground in the way community healthcare services are provided. We are working closely with GPs as they take over the reins of commissioning health services and are strengthening our partnerships with hospitals, mental health trusts and local authorities to make a real difference for the communities we all serve. Our ambition now is to become a Foundation Trust. With the freedoms and opportunities that this status will bring, we believe we can improve care and peoples health. 2011/12 was an eventful and exciting year for CLCH as we strengthened our position as a stand-alone community healthcare provider, continued to develop innovative services and delivered a strong performance against financial and non-financial targets. In a rapidly changing commissioning landscape in which GPs are assuming greater responsibility, our commissioners set us very stretching targets to deliver improved quality and value for money. We achieved these and we are pleased to be able to share examples of the progress we have made in this annual report. None of this would be possible without our dedicated workforce. We would like to thank all our staff for their continued dedication, professionalism and creativity. These achievements result from their positive and continuing hard work. Looking forward, we see challenges and opportunities in the year ahead. We must meet an annual savings target of more than five per cent per year for at least the next five years. We are determined to achieve this while continuing to deliver good quality care. We believe that we are well-placed to continue to innovate and work in partnership to support more people to live in better health for longer in their own homes and communities. Pamela Chesters Chairman James A. Reilly Chief Executive

About us
We are the largest, stand-alone, community healthcare organisation in London and we were the first in London to be awarded NHS Trust status. As such, we are at the forefront of changing the way community healthcare services are provided to achieve the best possible results for our patients. We employ around 3,000 staff who provide out-of-hospital, community-based healthcare services for nearly one million people who live and work in the boroughs of Barnet, Hammersmith and Fulham, Kensington and Chelsea, and Westminster. We provide healthcare from more than 160 locally situated sites and in many cases peoples homes in order to make access to our services as easy as possible. We are directly commissioned to provide services by the Inner North West London and North Central London PCT clusters. We also have range of smaller commissioners from other NHS and local authority bodies. In total commissioners invested 190million in our services in 2011/12. Our services Providing effective healthcare is the guiding principle behind everything we do. Our aim is to make sure that the services we offer our patients and their families achieve the best possible outcomes for their health, wellbeing and quality of life. Our services fall into eight main areas: Adult community nursing services including 24 hour district nursing, community matrons and case management. Children and family services including health visiting, school nursing, childrens community nursing teams, speech and language therapy, blood disorders, and childrens occupational therapy. Rehabilitation and therapies including physiotherapy, occupational therapy, podiatry (foot health), speech and language therapy. End of life care for people with complex, substantial, on-going needs caused by disability or chronic illness. Offender health services at HMP Wormwood Scrubs. Continuing care services for older people who can no longer live independently due to a disability or chronic illness, or following hospital treatment. Specialist services including elements of long-term condition management (diabetes, heart failure, lung disease), community dental services, sexual health and contraceptive services. Walk-in and Urgent Care Centres providing care for people with minor illnesses, minor injuries and providing a range of health promotion activities and advice.

There is much more about what we do on our website at www.clch.nhs.uk

Our vision, mission and goals

We want to continue to deliver the very best healthcare and treatment to people in our communities. We recognise how important it is for us to strengthen our partnerships with GPs, hospitals, social care, the voluntary sector and our communities in order to make a real difference to peoples lives. So in 2011 we refreshed our vision and mission into two simple yet powerful statements: Our vision: to lead out-of-hospital community healthcare Our mission: to give children a better start and adults greater independence To support these, we have four strategic goals, which provide us with a clear plan for making improvements over the coming years: Deliver quality community healthcare Be one organisation with one culture Be well governed Be financially strong.

The rest of this annual report sets out the progress we have made against these goals in the past year and what we plan to do in the coming year.

Our journey to becoming an NHS Foundation Trust

We are moving towards becoming an NHS Foundation Trust, which differs from traditional NHS organisations because they have greater autonomy and freedom. While they continue to provide NHS care free of charge to patients, they are able to be more innovative in how they develop their services and in how they respond to the changing needs of their local communities. We believe that as an NHS Foundation Trust we can continue to provide patients with the very best care and treatment, by really focussing on community-based services. Patients and other local people will be part of the organisation, helping us to shape local services. We will also have the additional advantage of having the freedom to invest in state-of-the-art care and treatment for our communities. Over the next year we will be building up our membership, made up of local people, patients and employees. From this we will form our Council of Governors, who will work alongside our Board of Directors to take our organisation forward and achieve our goals. More information about our Foundation Trust journey can be found on our website at www.clch.nhs.uk.

Section 2 Delivering quality community healthcare

Responding to the diverse needs of our local communities
We continue to focus on providing good quality care in innovative ways to support patients and their carers, and improve health and well-being. We are based in four of the most culturally diverse boroughs in the UK. Our boroughs are home to more than 950,000 people from a wide range of different communities from around the world. Approximately a third of our residents are born overseas and there are more than 200 languages spoken. Overall across the four boroughs we serve, health is generally good and life expectancy is above the national average, although this masks significant differences between more affluent and more deprived areas. In some localities, we have levels of deprivation among the highest in the country, alongside neighbourhoods with some of the most expensive housing in the world. This means the health needs vary between boroughs. In the central London areas, we see relatively high levels of substance misuse, mental health issues and suicide. For example, around half of the street homeless people in London live in Westminster - that is 25 per cent of all rough sleepers nationally. Health needs also vary between different ethnic communities. For example, Type 2 diabetes is much more prevalent among people of South Asian, African or African-Caribbean origin. Under the Equality Act 2010 we are required to publish Equality Objectives every four years. We need to ensure that these objectives contribute towards reducing health inequalities experienced by people from diverse backgrounds, and improving access to all our services and the experience of all our patients. Our six Equality Objectives (2012-2016) are to:
Endeavour to ensure that our health services and the information we provide are

accessible to people with disabilities. Ensure that our services are culturally sensitive and responsive to meet the diverse needs of different groups and individuals. Assess the needs and impact on lesbian, gay, and bisexual patients when producing policies and strategies and developing our health services. Respect and be sensitive to our patients religious and spiritual beliefs in delivering healthcare. Be aware of the differing needs of our male and female patients and develop responsive services that meet those needs appropriately. Ensure we promote age equality and that our policies, practices and the attitudes of our staff are not discriminating against patients based upon their age

More information about how we are helping to tackle health inequalities can be found on our website: www.clch.nhs.uk

Case study: Providing Pain Management Services in our Middle Eastern Communities
We have been working with our Middle Eastern communities to make our pain management service more accessible. Our musculoskeletal team analysed the list of patients in its pain management programme and found that patients from Middle Eastern/Arabic backgrounds engaged less well with the programme due in some part to language and literacy difficulties. To address this issue, the team worked with the interpreters and the community and created specific patient information translated into Arabic. It also advocated transcultural competence within our clinical service and decided to run a women-only group because of cultural considerations. The Arabic programme retained the loose outline of the key concepts of the mainstream programme such as understanding pain, setting goals, activity management, role of investigations and medical management, and relaxation techniques. External agencies such as the Muslim Cultural Heritage Centre and CLCHs Health Improvement team were invited to talk during some of the sessions with the aim of improving access to other community services outside the health setting and tackling the common issues around social isolation. Demand for this programme has increased with the group now running approximately every three months with up to eight participants each time, making it our most popular Pain Management programme. One patient commented: This group has changed my life.

Delivering quality services

The following section provides a summary of the work we have done to improve the quality of our services across the areas of clinical outcomes, patient experience and patient safety. For a more detailed overview, our full Quality Account for 2011/12 can be found on our website: www.clch.nhs.uk

Delivering clinical excellence

Our aim is to make sure that the care we provide to our patients and their families achieves the best possible impact on their health, wellbeing and quality of life. Our goal is to deliver clinical excellence along closely integrated pathways. We monitor and measure excellence through: Clinical Outcome Measures measuring a patients progress or improvement in terms of basic clinical goals. Patient Reported Outcome Measures (PROMs) where patients set their own goals for how they would like their treatment to affect their health and quality of life and then work with the clinician to review progress against these goals.

Measuring compliance of our services with best practice guidance, including National Institute of Health and Clinical Excellence (NICE) guidance Clinical audit.

Our Aims for 2011/12: To involve patients more in designing and managing their own care We improved support for patients with long term conditions (specifically respiratory) to manage their own conditions where appropriate and implemented Patient Reported Outcome Measures (PROMs) more broadly across CLCH so that more patients could be involved in joint goal setting and measurement. To improve service models and develop integrated pathways of care We embarked on a transformation project to develop, design and implement 19 high quality clinical care pathways and implemented the national best practice in end of life care. Our aims for 2012/13: Demonstrate service improvements as a result of clinical and patient reported outcomes Implement comprehensive Patient Reported Outcome Measures (PROMs) and outcome measures along all clinically agreed pathways of care.

Case study: Embedding patient reported outcome measurement into standard clinical practice within the heart nursing service
Our heart nursing service sought feedback from some of our patients to see if there was any significant improvement in their quality of life. A questionnaire was offered to 18 clients on two occasions; following their initial assessment and then at a minimum of two months later. There is a reasonable expectation that following a period of support with a clear management plan the patient should in most instances feel physically and emotionally stable enough to cope with the associated long term symptoms of their condition. The results show there is significant improvement in the outcome for most patients. However, in some cases this improvement in their quality of life is not always perceived as evidence of an improvement or positive change. This is often because the patient is either becoming unwell again at the time of the follow-up assessment or the improvement is slower than they had expected. This is where encouraging them to participate in developing a care plan is vital. For example, in one situation a client was able to note the physical improvements in her wellbeing - now being able to go for walks outdoors but she felt emotionally she was still not coping. By showing her the response of her follow-up assessment and comparing the pre/post data she was able to confirm the changes and in fact this spurred her on to adopt a positive outlook on her health.

Providing excellent personalised patient experience

Patient experience refers to the overall experience throughout the course of treatment and not just the results that were achieved at the end. Our goal is to provide an excellent personalised experience to all our patients. Our Aim for 2011/12: To develop a more detailed understanding of patient experience in order to improve quality We refined our patient survey questions and methodology (PREMs) and piloted ways to collect experience data from harder to reach groups including through patient stories and using technology to capture patient feedback. Our Aim for 2012/13: Continue to develop a more detailed understanding of patient experience applied consistently across all services.

Case Study: Patient engagement with young children

A quality module pilot programme enabled a 10-year-old girl to actively engage in her healing process. The young girl described how she felt about her treatment, which involved regular injections both at home and in hospital to treat a tumour behind her eye. She liked the play specialist and community nurse, as they took her mind off the pain of the process. She didnt like it when the nurses left. The CLCH health visiting team reported that the girl had been undergoing treatment for between three and five years. The service worked hard to ensure continuity of staff, and voluntary organisations provided support by arranging outings. The CLCH team advised the effect of the quality module had had a significant impact on delivering care packages, as changes could be made to adjust to familys needs as a result of the feedback received.

Assuring patient safety

Patient safety is our absolute priority at all times. Our goal is to assure safety, protection and regulatory compliance. Our approach is to learn from our experiences and to improve safety for our patients and staff through a systematic process of review and improvement. Our Aims for 2011/12: To improve discharge processes from hospitals into the community

 We successfully piloted placing community liaison nurses in St. Mary's and Chelsea and Westminster hospitals to work in partnership with hospital and social care staff in improving patient discharges into our community nursing services. To strengthen results of clinical and patient reported outcomes We provided central support to ensure that each of our services could carry out the improvement actions that they identified in their area, we improved the quality of clinical audits and we implemented national guidance on safety issues. Our Aims for 2012/13: Reduce the number of preventable pressure ulcers in the community Strengthen clinical record keeping practice to support patient care pathways

Case Study: Community liaison nurses to improve hospital discharges

We placed community liaison nurses in St. Mary's and Chelsea and Westminster hospitals for three months, to work in partnership with hospital and social care staff in improving patient discharges into our community nursing services. Some of the aims of the pilot were to reduce the number of safety incidents related to discharge planning, improve information on community nursing referrals and increase the amount of time community nurses spent with their patients by reducing time spent on poor referrals. We saw some very positive results: A 40% reduction in safety incidents relating to poor discharge at Chelsea and Westminster and 15% at St Marys hospital in the pilot period compared to the same period in the previous year. Around 71 hours of district nursing time was saved as a result of the community liaison nurse informing community nurses that their patients had been admitted to hospital, increasing time with their other patients by 8% compared to the same months in the previous year The majority of the patients were satisfied with their discharge experience whilst the community liaison nurse was involved in their care.

Listening to our patients

We are committed to putting the people who use our services at the heart of everything that we do, which means we begin by listening to and acting upon their views and feedback. Patients bring insights which can help us to improve the quality of our services, so feedback is critical. We have invested in a range of initiatives to help us to understand better the perspectives of people who use our services, such as:

Patient Surveys: we received feedback from just under 12,000 patients completing our patient surveys between September 2011 March 2012. These surveys were made available in paper format, easy-read and in electronic format for services where required. Compliments and Complaints: in 2011, we received 126 formal complaints and 420 compliments from across the organisation, as we resolved 311 issues. Patient stories: over 50 patient stories were captured and analysed over the last year. Mystery Shopping: We are embarking on an exciting partnership project with all Local Involvement Networks (LINks) in the four boroughs that we serve to mystery shop all CLCH reception sites, in person and by telephone, to review the quality of the customer care delivered. Other activities: in addition to this organisation-wide activity, our individual services have delivered a range of other activities to engage with their patients and service users, using different methodologies chosen to make it as easy as possible for people to feedback. These have included focus groups, interviews, online surveys, regular user groups, and creative arts. Working with Local Involvement Networks and other key partners: CLCH facilitates a Quality Stakeholder Reference Group, made up of patients and public, Local Involvement Networks (LINks), members of Overview and Scrutiny Committees (OSCs) and commissioners. The group meets every six weeks to share perspectives and consult on quality related issues across CLCH.

What do we do with peoples feedback? It is essential that we dont just gather peoples feedback, but that we also consider and respond to it, through making service improvements and letting people know you saidwe did. Every service prepared an annual report in 2011/12 which contains specific actions of how they will listen and respond to peoples feedback.

Working in partnership with others

We work in partnership with GPs, acute trusts, mental health trusts, local authority services and the third sector; relationships which we are strengthening for the benefit of our patients. Our goal is to deliver integrated care in line with what our patients, commissioners and the public say they want. Working with GPs, our new commissioners The way health services are planned is changing. GPs, organised as clinical commissioning groups, are taking on the responsibility for managing the majority of the NHS budget and deciding what services need to be provided for their communities. Under these arrangements, GPs will contract organisations like CLCH to provide healthcare for their local population. As an NHS Trust with a clear focus on providing health services within the community, we believe that we are well-placed to adapt to the new commissioning

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climate but this will require us to adapt to the demands of GPs and ensure our services are flexible enough to respond to local needs. Over the last year we have spent time speaking with GPs and practice managers, gaining their feedback to help us understand what they will expect of us in future. The outcomes of this work have prompted us to look at all aspects of our business, with a view to making tangible improvements that will improve on quality, access and value for money. Some of the changes we are making as a result of this include: Setting up service points of access to make it easier for GPs to refer into our services. Creating performance dashboards for our community nursing teams so that GPs can track the quality of the care we deliver, not just the number of visits we make. We are locating community health and social care teams alongside GP practices to ensure everyone works better together. We are creating new health and social care co-ordinators who are working in hospitals to improve the way in which patients are transferred into the community.

Case Study: Integrated Mental Health Service

We are making significant improvements to the way we provide our psychological therapies. We have achieved an average waiting time to first appointment of 15 days. This has been by improving our triaging process, case load management and increasing our clinical capacity. Our service is now part of a new integrated Primary Care Mental Health Service in Kensington and Chelsea. Launched by the West London Clinical Commissioning Group, it is a unique example of commissioning and delivery of primary care mental health support to members of the local community with common mental health problems such as depression and anxiety. The service is being jointly provided by CLCH, Central North West London NHS Foundation Trust, Depression Alliance and The Reader Organisation who are working together to offer a single, integrated, seamless service. The service continues to demonstrate quality with 89% patient reported satisfaction and a 35% recovery rate (quarter 1, 2012/13) and evidence of increased user involvement.

Working with other healthcare providers Our ambition is to move further towards services that work together to deliver care that meets a persons individual needs. That means improving working arrangements between the services we ourselves provide but also ensuring that where a patient needs to access services provided by hospitals, mental health trusts and GPs that the transfer between these different organisations is as seamless as possible. In particular we want to: Support people to manage their long term conditions or complex ongoing health needs.

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Support older people to stay independent in their own homes for longer and avoiding the need for admission into hospital or long term care. Help people to return home more quickly after a stay in hospital. Focus on early support for children and their families.

We have active partnerships with the Royal Free London NHS Foundation Trust, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College Healthcare NHS Trust, Barnet and Chase Farm Hospitals NHS Trust and Central and North West London NHS Foundation Trust.

Case Study: Providing Post Acute Care Enablement (PACE) with the Royal Free London NHS Foundation Trust
Our Intermediate Care Services team in Barnet is running an initiative called Post Acute Care Enablement (PACE). PACE promotes collaborative working between ourselves, the Royal Free and the local council to reduce the number of days patients stay in hospital. It also provides for a safe return home and ensures patients get the medical support and the assessment they need during recovery. The PACE team relocates the latter stages of a patient's acute care from hospital to their home. The remainder of the acute care is provided in the patient's home for up to five days. The community elements of PACE care include nursing, therapy and support, and a patient can expect up to four visits a day. As well as care, the team looks for any signs that the patient may need to be referred elsewhere, and at the end of the period of care, the patient may be referred onto intermediate care services as necessary.

Working with local authorities Two thirds of local authority social care clients have healthcare needs. There are many different kinds of health and social care available from many organisations. But it can be frustrating and confusing dealing with the many different providers of these services. We believe that everyone responsible for a persons care should work closely together as one team to review their needs and provide them with the most appropriate, personalised support. So we are working more closely with local authorities to bring health and social care closer together.

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Case Study: The North West London Integrated Care Pilot

The North West London Integrated Care Pilot (ICP) was recognised for its exceptional work in bringing together the care received by people aged over 75 and those with diabetes at the 30th annual Health Service Journal (HSJ) awards. The CLCH team along with other partners involved picked up the top award in the managing long term conditions category. The project was commended for its innovative approach in ensuring patients get timely, appropriate care that is focused around their long term needs. The pilot is working hard to improve the quality of care delivered to these groups, by joining health and social care workers into local multi-disciplinary teams. These teams are then responsible for ensuring that each patient has a care plan that sets out steps for maximising the standard of the care that they receive. Launched in 2011, the North West London ICP is clinically-led by GPs, hospital doctors and community care professionals. It involves a partnership between local NHS organisations, local authorities and relevant charities. Boundaries are lifted between providers so they can work together as a team allowing patients to receive the right kind of treatment, in the right place at the right time. So far the pilot has a 90% patient satisfaction level and has already developed over 18,000 care plans for patients.

Working with the voluntary sector We have also developed and strengthened our relationships with voluntary sector and education partners over the past year. These relationships are vitally important, as working together allows us to share resources and reach a wider group of people. Over the past year, we took part in a number of joint initiatives including larger programmes and smaller one-off events.

Case Study: Spotlight on HealthInform

HealthInform is a free and confidential health information service provided by CLCH, based at Edgware Community Hospital. The service offers patients and members of the public quality, evidence-based health information about medical conditions, treatment options, and information about support groups and helplines. It also offers training on how to access good quality consumer health information on the internet. From the beginning, patients were involved in the design of the service. When it was first established the views of potential users were sought through close collaboration with voluntary sector organisations and community representatives and this involvement continues to be ongoing.

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Section 3 Becoming one organisation with one culture

We were established as an NHS Trust in 2010, and during the year 2010/11 employed just over 2,400 staff. This increased to 3,000 staff when Barnet joined CLCH in April 2011.

Our values
Our success is down to our people. We can only achieve our vision and mission through the dedication and professionalism of the people who work for us and so in the past year it has been really important for us to refresh our values and to make sure all our staff understand the standards of behaviour expected of them.

Developing our people

We recognise the importance of ensuring that our staff have the right skills to do their jobs well and are equipped for future challenges. A Board Development programme has been underway for more than a year, to ensure we have the necessary leadership and governance in place to lead the organisation to Foundation Trust status. A new management and clinical leadership structure now supports the continued integration of services. At the core of this change is the separation of management and clinical/professional leadership functions and the creation of service manager,

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professional and clinical pathway lead roles. A leadership development and training programme is supporting our management and clinical leaders in these new roles. During the past year, a high proportion of staff received development opportunities in many areas, for example 91% of staff received health and safety training, 85% took part in equality and diversity training and 98.5% completed information governance training. A Learning and Development Strategy was developed over the past year, and was rolled out from May 2011.

Case Study: Work placements and mentoring

The HR team received an award for work-related learning provision from the Royal Borough of Kensington and Chelsea for the work they had carried out to offer unpaid work experience to school leavers and disadvantaged groups. They had made contact with over 400 students annually and between 60 and 70 placements were organised as a result. Seven members of staff currently employed by CLCH have joined the organisation in this way, as has one member of the internal staff bank. Additional staff benefits have included mentoring opportunities for staff at bands two and three who were able to develop their skills through supervision or mentoring students. Going forwards, as funding is no longer available for the scheme, it has been agreed to explore the possibility of funding through charitable funds to ensure this valuable work continues.

Staff engagement
Staff engagement is a key component and enabler of our strategic aim to become a magnet employer by respecting, supporting and developing our staff. We engage with staff through Improving Working Lives meetings, the annual staff survey, the annual development of an Improving Working Lives action plan, an annual all staff away-day and staff awards ceremony. Other engagement activities include a weekly staff newsletter, a monthly senior managers meeting and the monthly team brief. The directors and non-executive directors also regularly visit teams at various sites across CLCH. During March 2012 we embarked on a series of roadshows to engage staff in our refreshed vision, mission and values and to introduce them to the benefits of becoming a Foundation Trust. We enjoy a positive employee relations climate, in large part as a result of close working relationships with trade union colleagues. The chief executive and directors meet with staff representatives on a monthly basis at the Joint Staff Consultative Committee to keep staff side abreast of new developments and to address any concerns. We consulted extensively during 2010/11 on our proposed new clinical operating model and clinical management structures and significant changes to both were made as a result of feedback from staff and staff side. Ninety new workforce

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policies were agreed with staff representatives during 2010/11, including a new Trade Union Recognition and Time off for Trade Union Activities Agreement.

2011 NHS Staff Survey

The results of the 2011 National Staff Survey were published in March 2012 and are based on local surveys undertaken between September and December 2011. This is the largest survey of staff opinion in the UK. The overall national response rate for all trusts was 54%. We achieved a response rate of 62%. The key positives for the Trust were: A high proportion of staff feel that they are satisfied with the level of work and patient care that they are able to deliver (performing well against other community trusts). Over 90% of our staff feel that their role makes a difference to patients. The score showing whether staff would recommend the Trust either as a place to work or to receive treatment is considerably higher than the average position for community and London trusts. The appraisal rates remain in a strong position with circa 90% receiving an appraisal in the last 12 months. 91% of staff have received Health & safety training. 85% of staff have received Equality and Diversity Training. Following analysis of the results, a multidisciplinary working group was formed with staff and trade union representatives from across CLCH to develop an Improving Working Lives action plan which will address some of the concerns that staff raised through the survey. Examples of actions developed under the plan include: Campaigns based on best practice to address violence and abuse of staff including enforcing our zero tolerance message. The continuation of the Empowerment Leadership programme for bands two to seven to encourage and support access to career progression opportunities for under-represented staff groups, including black and ethnic minorities. Improving internal communication and raising senior manager visibility by enacting a formal programme of senior manager visits to different sites. The Improving Working Lives action plan is a key component of our Model Employer Strategy.

Inclusion, Equality and Diversity

We are committed to ensuring diversity and inclusion within our workplace and within the services we provide. As an employer, we aim to improve the working lives of Black and Minority Ethnic (BME) staff by empowering them and ensuring that their rights are respected. After consultation with staff, we merged our three former BME staff networks to create the Diversity and Inspire Network, which now has more than 100 members. To address

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the under-representation of BME staff in management roles, we developed an innovative empowerment programme. In December we also undertook a disability awareness campaign, encouraging staff to disclose their disability status and promoting the support and reasonable adjustments available to staff with disabilities. Over the past year we delivered more than 78 equality and diversity training sessions for 1,600 staff and 24 induction sessions for 466 new starters. CLCH has the following equality and diversity policies in relation to employment of staff: The Equality and Diversity Policy The Disability Policy and Code of Conduct.

Copies of these policies are available by contacting our Head of Equality and Diversity, Lesley Soden, by email: Lesley.Soden@clch.nhs.uk.

Sickness absence and vacancy

Over the past year we have successfully managed absence levels by introducing a new integrated sickness policy. One of the processes for managing sickness absence set out in that policy is that managers are provided with information on staff reaching sickness absence management trigger levels and the HR team work with managers and staff to identify and take forward action needed to manage and control sickness absence. Practical training sessions for managers on managing long and short term sickness absence are also being run. Having set our own annual target of absent days through sickness of 3.9%, we achieved 3.73%. During the 2011/12 financial year CLCHs staff took a total of 17,543 days (2010/11: 13,156 days) of sickness absence. This is an average of nine days (2010/11: 7) per staff member. These amounts are for the calendar year 2011. Our vacancy rate (14.75%) was also below the London average (15%) but was above the stretch target we set ourselves (11%). This nevertheless represents a considerable achievement, given that we had a vacancy rate in excess of 20% when we were established.

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Section 4 Be Well Governed

Meet our Board
The Board of Directors has overall responsibility for monitoring performance, finance and maximising the efficiency of services provided by CLCH. The Board works collaboratively to gather and meet regularly to discuss issues, challenges and strategic vision, to ensure CLCH maintains its quality services and delivery is on track to meet CLCHs aspiration to become a Foundation Trust. Chairman Our new chairman is Pamela Chesters, who joined CLCH in June 2012 Former chairman Mike ODonovan stepped down at the end of January 2012 Vice Chairman Anne Barnard Anne was our acting chair from February - June 2012. She is also CLCHs audit committee chair. During her acting chair role, non-executive director Tony Brown acted as chair of the audit committee. Non-executive directors Tony Brown Julia Bond Alexa McCulloch Marek Stepniak (stepped down 31 May 2012) David Sines (from June 2012) Chief Executive James A. Reilly Director of Finance Jon Bell Interim Medical Director Dr Piu Ling (from November 2011 June 2012) Dr Chris Farnham (from June 2012) Permanent medical director due to be appointed in September 2012 Director of Nursing, Quality and Assurance Jane Clegg (from April 2012. Formerly Director of Operations) Interim Director of Operations Howard Perry (from March 2012)^ Director of Strategy and Business Development Murray Keith^

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Director of Patient Engagement, Innovation and Technology Professor Keith Stone (formerly Director of Clinical Leadership, Governance, Quality and Information Management and Technology until April 2012. Professor Stone left CLCH in July 2012. Post not replaced) * Director of HR and Organisational Development Mark Hirst* ^ Howard Perry and Murray Keith share a vote at board meetings. *Non-voting directors in attendance at the Board The Board is supported by the following committees: Audit Committee Quality Committee Risk Management Committee Remuneration Committee.

There is a further series of governance groups that support these committees as well as the operational activities of the organisation, and to some extent the strategic elements of the Board.

Remuneration Report
This report is made by the Board on the recommendation of the Remuneration Committee in accordance with Schedule 7a of the Companies Act 1985. The first part of the report provides details of remuneration policy, the second part provides details of the remuneration and pensions of our Senior Managers for the year ended 31 March 2012. The report is in respect of the senior managers of CLCH, who are defined as those persons in senior positions having authority or responsibility for directing or controlling the major activities of the NHS body. This means those who influence the decisions of the entity as a whole rather than the decisions of individual directorates or departments. Remuneration Committee The Remuneration Committee is made up of the Chairman and two Non-Executive Directors of the Trust Board as voting members: the HR Director and Chief Executive are attendees. The Committee meets as necessary to advise the Board on the appropriate remuneration and terms of service for the Chief Executive and Directors. Remuneration Policy The Committees deliberations are carried out within the context of national pay and remuneration guidelines, local comparability and taking account of independent advice regarding pay structures.

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The main components of the Chief Executives, Executives and senior officers remuneration are set out below. Basic Salary CLCHs Chief Executive is seconded from the London Borough of Hammersmith and Fulham and CLCHs Medical Director was seconded from NHS London. As at 31 March 2012 the remuneration of four of the Directors is set by Agenda for Change, the national pay and terms and conditions framework for the NHS. The remuneration of one Director is set by the Very Senior Managers (VSM) Pay Framework and one Director is remunerated via an agency. The Agenda for Change Handbook and the VSM Framework are available to the general public on the Department of Health website. The Director whose remuneration is paid via an agency was appointed after a procurement process that was in line with CLCHs standing financial instructions and orders. The reward package set by the VSM Pay Framework is as follows: 1. Basic pay is a spot rate for the post, determined by the role and an organisation specific weighing factor. This is uplifted annually; 2. Additional payments are made where such payments are appropriate and within the limits described in the Frameworks; and 3. An annual performance bonus scheme, the details of which are set out below. Incentive Arrangements During 2008/09 the DH implemented a performance related pay scheme for VSMs contracts. As part of these pay arrangements those CLCH employees on a VSM contract are eligible to be considered for a performance related bonus scheme. The award payable to individual staff will be determined by the performance category within which they are placed. It is an essential criterion of the performance bonus scheme that CLCH achieves its financial control target and other key national targets as agreed with NHS London. The number of awards in CLCH is decided by the CLCHs Remuneration Committee, but is subject to affordability and also that aggregate bonus payments must not exceed an absolute ceiling of 5% of the pay bill of VSM. Performance bonus payments are not pensionable. VSMs that have been in post for the majority of the reporting period will be eligible for a full year performance bonus. In 2010 NHS London has further determined that awards will only be payable to individual staff who are in the top 25% of performers in London and must be approved by NHS London. Further guidance on the operation of the approval process is awaited.

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Performance bonus awards will be payable once approved by the Remuneration Committee and NHS London. No performance bonuses awards were paid by CLCH during 2010/11 or 2011/12. The overall performance of Non-Executive Directors and the Chief Executive is appraised by the Chair. This appraisal is reviewed by the Directors of NHS London. The performance of Trust Executive Directors is appraised by the Chief Executive and the performance of CLCHs Chair is managed by the Chair of NHS London. NHS Pension Entitlement All staff including senior managers are eligible to join the NHS Pensions Scheme. The Scheme has fixed the employers contribution at 14% (2010/11: 14%) of the individuals salary as per the NHS Pension Agency Regulations. Employee contribution rates for Trust officers and practice staff, and the prior year comparators, are as follows:
Tier 1 2 3 4 Annual Pensionable Pay (full time equivalent) 2011/12 Up to 21,175.99 21,176.00 to 69,931.99 69,932.00 to 110,273.99 110,274.00 plus Contribution Rate 2011/12 5% 6.5% 7.5% 8.5% Contribution Rate 2010/11 5% 6.5% 7.5% 8.5%

Scheme benefits are set by the NHS Pensions Agency and are applicable to all members. Service Contracts Each of the executive Directors and VSMs listed below have or has had substantive or fixed term contracts which can be terminated by either party by giving between 3 to 6 months written notice. CLCH can request that the senior manager either works his or her notice or be paid an amount in lieu of notice. Each executive directors service or fixed term contract became effective on the following dates:
Executive Director Keith Stone Jon Bell Mark Hirst Murray Keith Dr Pui-Ling Li Howard Perry Jane Clegg* Role Director of Patient Engagement, Innovation and Technology Director of Finance Director of Human Resources & Organisational Development Director of Business Strategy & Development Medical Director (from 2 November 2011) Director of Operations (from 1 March 2012) Director of Operations (until 29 February 2012) Director of Nursing, Quality and Assurance (from 1 May 2012) Chief Executive Contract Date 01/09/2008 04/01/2010 01/09/2008 04/01/2010 01/11/2011 01/03/2012 01/09/2008 Leave date

James Reilly

14/02/2011

*From 1 March 2012 Ms Jane Clegg moved from being the CLCHs Director of Operations to take up a role focusing on quality and assurance within the Directorate covering Clinical

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Leadership & Governance, Quality and IMT. She was confirmed as Director of Nursing, Quality and Assurance from 1 April 2012 and remains a member of the Board. This move was proactively designed to strengthen the CLCHs capability to lead quality initiatives and to be well placed in our response to issues arising for the NHS from the Mid Staffordshire Review. Ms Jane Clegg was replaced on an interim basis by Mr Howard Perry and CLCH hopes to appoint substantively to this post in 2012/13. Ms Jane Clegg was a senior manager throughout the period covered by this report. We have therefore disclosed a full twelve months remuneration paid to her during 2011/12 in the table below. None of the service contracts for directors or senior managers make any provision for compensation outside of the national pay and remuneration guidelines or NHS Pension Scheme Regulations.

Termination Arrangements Termination arrangements are applied in accordance with statutory regulations as modified by national NHS conditions of service agreements (specified in Whitley Council/Agenda for Change), and the NHS pension scheme. Specific termination arrangements will vary according to age, length of service and salary levels. The Remuneration Committee will agree any severance arrangements. Her Majestys Treasury approval will be sought where appropriate. Salaries direct to limited companies During financial year 2011/12, CLCH has paid no remuneration for VSMs and Directors direct to limited companies wholly or partly owned by the employee. During 2010/11 payments made to Ms Claire Holloway were made to a limited company partly or wholly owned by Ms Claire Holloway. Pay Multiples Reporting bodies are required to disclose the relationship between the remuneration of the highest-paid director in their organisation and the median remuneration of the organisations workforce. The banded remuneration of the highest paid director in CLCH in the financial year 2011/12 was 165,000 to 170,000 (2010/11: 190,000 to 195,000). This was four times (2010/11: five times) the median remuneration of the workforce, which was 39,398 (2010/11: 36,450). The highest paid Director is in both years was the CLCHs Chief Executive. The remuneration of CLCHs Chief Executive has decreased due to the following factors: CLCH had two Chief Executives during 2010/11, and payments made to Ms Claire Holloway (the highest paid Director for that year) related to work performed only in the first ten and a half months of the year before she was succeeded by Mr James Reilly. Payments made to Mr James Reilly in 2011/12 are for a full year; and Ms Claire Holloway was employed via a service company or agency and remuneration disclosed for 2010/11 includes VAT and other administrative expenses that are not disclosed as part of Mr James Reilly gross remuneration for 2011/12.

The median pay of staff employed by CLCH has increased by 2,948, or 8.11% when comparing financial years 2010/11 to 2011/12. This trend has been caused by

22

a number of factors including higher redundancy costs as CLCH implements clinical and non-clinical restructuring, increment pay rises that occur annually when staff gain an extra years NHS service, pay rises for those remunerated below 21,000 per annum (before London weighting) and an increasingly rich skill mix as CLCH leads the development of integrated healthcare pathways and lessens reliance on agency staff. In 2011/12, four (2010/11: 0) employees received remuneration in excess of the highest-paid director. The employees who received remuneration is excess of the highest paid Director during 2011/12 did so due to one off severance payments that reflected the seniority of those staff members and the number of years NHS service. Remuneration paid to employees during 2011/12 ranged between 0 and 5,000 to 290,000 to 295,000 (2010/11: between 0 and 5,000 to 190,000 and 195,000) Total remuneration includes salary, non-consolidated performance-related pay, benefits-in-kind as well as severance payments. It does not include employer pension contributions and the cash equivalent transfer value of pensions. Non-Executive Directors Non-Executive Directors do not have service contracts. They are appointed by the Appointments Commission for a set period, which may be extended. Non-Executive Directors are paid a fee set nationally. Travel and subsistence fees where incurred in respect of official business are payable in accordance with nationally set rates. Non-Executive Directors are also able to reclaim expenses related to all necessary carer expenses incurred as a result of their work. Nonexecutive members do not receive pensionable remuneration and therefore are not eligible to join the NHS Pension Scheme. The Non-Executive appointments became effective on the following dates:
Non Executive Director Mike O'Donovan Tony Brown Marek Stepniak Julia Bond Alexa McCulloch Anne Barnard Role Chair (until 31 January 2012) Non-Executive Director (from 28 April 2011) Non-Executive Director Non-Executive Director Non-Executive Director Non-Executive Director (from 1 February 2012 Acting Chair) Contract Date 19/11/2009 28/04/2011 01/11/2010 17/12/2009 17/12/2009 01/04/2010 Leave date 31/01/12 -* -

* Mr Marek Stepniak resigned and left the Trust board on 31 May 2012.

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Directors and Senior Managers Salaries and allowances Audited

2011/12 Name and Title 2010/11

Salary in Bonus Benefits Other Salary in Bonus Benefits Other (bands payments in Kind Remuneration (bands payments in Kind Remuneration of (bands of (bands (bands of of (bands of (bands (bands of 5000) 5000) of 100) 5000) 5000) 5000) of 100) 5000) 000 0 95-100 000 0

Keith Stone (Director of Patient Engagement, Innovation and Technology) Mark Hirst (Director of Human Resources & Organisational Development) Murray Keith (Director of Business Strategy & Development) Judith Barlow (Director of Services (Hammersmith and Fulham)) Marina Tempia (Director of Services (Westminster)) Jane Clegg (Director of Operations, until 29 February 2012. Director of Nursing, Quality and Assurance from 1 April 2012) Howard Perry (Director of Operations, from 1 March 2012) Dr Pui-Ling Li (Medical Director from 2 November 2011) James Reilly (Chief Executive from 15 February 2011) Jon Bell (Director of Finance and Performance) Claire Holloway (Chief Executive from 1 September 2008 until 14 February 2011)

100-105

100-105

0 95-100

105-110

0 105-110

0 55-60 d)

0 100-105

0 0

0 0

0 55-60 d) 0 95-100

0 0

0 0

0 0

15-20 a)

35-40 e)

165-170 b) 100-105 0

0 25-30 b)

0 0

0 0

0 100-105 0 190-195 a)

0 0

0 0

0 0

a) Remuneration paid to these employees was via a service company or agency and includes VAT. The Trust cannot recover VAT and remuneration disclosed will also that include an element of administration expenses. b) Mr James Reilly was appointed to the post of Chief Executive Officer from 14 February 2011. However, whilst substantially in post, he continues to be paid by his previous employer, the London Borough of Hammersmith and Fulham. He also continues to be a member of the Local Government Pension scheme. The amounts disclosed above is Mr Reillys gross salary but CLCH pays a higher figure to London Borough of Hammersmith and Fulham for Mr Reillys services as CLCH reimburses the Council for their on costs associated with his employment such as London Borough of Hammersmith and Fulhams pension contribution, and also VAT incurred on the transaction. CLCH paid a total of 274,000 for the services of Mr Reilly in

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2011/12. This was his gross salary as disclosed above, 41,000 employers pension contribution, 21,000 employers National Insurance, and 45,000 VAT. c) Professor Keith Stone and Mr Mark Hirst are co-opted Directors of CLCH, participating fully in discussions but without voting rights. Mr Murray Keith and Mr Howard Perry are Directors of CLCH but share one vote at board meetings. d) Ms Marina Tempia and Ms Judith Barlow were Directors of CLCH until it became a legally established Trust on the 1 November 2010. Both continued to be employed by CLCH after this date but are no longer considered VSMs. Remuneration disclosed relates to the 7 months to 30 October 2010. e) Dr Pui-Ling Li was appointed as CLCHs Medical Director from 2 November 2011. Dr Li also holds the post of Deputy Regional Director of Public Health at NHS London. NHS London remains her substantive employer and she divides her time between the two organisations. The amounts disclosed above are not Dr Lis gross salary but includes on costs associated with her employment, such as NHS Londons pension contribution.

Directors and Senior Managers Pension Benefits Audited

Name Real increase in pension at age 60 (bands of 2,500) 000 Real increase in pension lump sum at aged 60 (bands of 2,500) 000 Total accrued pension at age 60 at 31 March 2012 (bands of 5,000) 000 Lump sum at age 60 related to accrued pension at 31 March 2012 (bands of 5,000) 000 105-110 100-105 0 a) 115-120 0 0 Cash Equivalent Transfer Value at 31 March 2012 000 Cash Equivalent Transfer Value at 31 March 2011 000 Real increase in Cash Equivalent Transfer Value 000 Employers contribution to stakeholder pension 00

Keith Stone Mark Hirst Murray Keith Jane Clegg Howard Perry Dr PuiLing Li b) James Reilly g) Jon Bell

0-2.5 0-2.5 0-2.5 0-2.5 0 0

5-7.5 5-7.5 0 a) 5-7.5 0 0

35-40 30-35 0-5 35-40 0 0

602 636 45 724 0 0

481 539 20 618 0 0

106 81 24 86 0 0

0 0 0 0 0 0

0 0-2.5

0 0-2.5

0 10-15

0 40-45

0 214

0 166

0 43

0 0

a) Mr Murray Keith is in the 1998 NHS pension scheme and does not accrue a lump sum on retirement. b) Dr Pui-Ling Li is employed via a secondment from NHS London that remains her substantive employer. Any pension benefits accrued during the year will, if appropriate, be disclosed in NHS Londons publically available Remuneration Report.

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c) Non-Executive members do not receive pensionable remuneration. There are no payments in respect of pensions for Non-Executive members (2010/11: nil). d) There was no Employers contribution to stakeholder pensions in the year (2010/11: nil) as the Trust only pays contributions to the employees NHS defined benefit scheme (where employees are members). e) Cash Equivalent Transfer Values. A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the members accrued benefits and any contingent spouses pension payable from the scheme. A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies. The CETV figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries. f) Real Increase in CETV. This reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period. The NHS Business Services Authority, who manage the NHS pension scheme on behalf of its members, started to use the most recent set of actuarial factors produced by the Government Actuarial Department with effect from 8 December 2011. Therefore the market valuation factors used as at 31 March 2012 are different from those used as at 31 March 2011 and no like for like comparison can be made. g) As disclosed above, Mr Reilly is seconded from the London Borough of Hammersmith and Fulham and remains a member of that Boroughs pension defined benefit pension scheme. As part of reimbursing the Borough for the cost of employing Mr Reilly, the Trust paid the London Borough of Hammersmith and Fulham 41,000 as this was the Boroughs employers pension contribution for Mr Reilly.

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Reporting of other compensation schemes - exit packages

Exit package cost band (including any special payment element) Less than 10,000 10,001 25,000 25,001 50,000 50,001 100,000 100,001 150,000 150,001 200,000 >200,000 Total Number of compulsory redundancies, Number 0 0 0 0 0 0 0 0 Cost of compulsory redundancies, 000 0 0 0 0 0 0 0 0 Number of other departures agreed, Number 1 4 11 7 4 2 1 30 Cost of other departures agreed, 000 Total number of exit packages by cost band, Number 5 68 386 501 495 358 207 2,020 1 4 11 7 4 2 1 30 0 Total cost of exit packages by cost band, 000 5 68 386 501 495 358 207 2,020 0

Total number of special payments (and total cost of special payment element)

Sustainability
A significant amount of guidance has been issued by the Government and the NHS stating their expectations of Trusts and Foundation Trusts in relation to sustainability and CLCH intends to improve and embed sustainability throughout all its service areas. We recognise and acknowledge our duty to be a good corporate citizen by ensuring our services are developed and delivered in a sustainable way by considering economic, social and environmental factors in our decision making. So our policy is to: Encourage our staff to travel in a way that reduces the impact on the environment and society. Encourage our suppliers and contractors to adopt principles of sustainable development and develop a sustainable supplier programme through a consideration of the life cycle of the products we purchase. Reduce the consumption of natural resources and products across all are services including those used in the management and maintenance of our facilities. Adopt the Improving working lives standard to help benefit the mental and physical health of employees and ensure a work - life balance. Develop a systematic approach to managing sustainability in the Trust and integrating it throughout the business. Set targets for improvement and to monitor and report performance against these targets. Include sustainability performance on the appraisal and rewards of senior staff. Consider sustainable development in strategic decisions. Appraise how we may best contribute to the communities we operate in.

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CLCH is committed to developing sustainable practices in the organisation so that consideration of sustainability becomes part of everyday decision making and day to day operations.

Emergency preparedness
CLCH has a Major Incident Plan which complies with the requirements of the NHS Emergency Planning Guidance 2005 and all associated guidance. We have business continuity arrangements in place and these were tested during 2011/ 2012 with local and national events impacting on the delivery of CLCH services. These events included the planning and response to student protests, wide spread civil unrest and the coordinated day of industrial action. In 2012 /2013 CLCHs Resilience Team will be focussing on ensuring our plans are sufficiently flexible to respond to planned disruption and the uncertainties associated with the London Olympic and Paralympic Games 2012. In addition to this CLCH will be considering the implications of emerging planning guidance resulting from the reforms of the NHS nationally.

Principles for Remedy

CLCH has incorporated the Principles of Remedy published by the Parliamentary and Health Service Ombudsman into our complaints handling procedure.

Serious Incidents involving data loss or confidentiality breaches

All NHS Trusts are required to provide information about Serious Incidents involving data loss or confidentiality breaches in the following format, which is specified by the Department of Health. We reported two Serious Incidents involving data loss or confidentiality to NHS London during the year 2011/12. One of these was classed as severity rating 2 and the other was severity rating 3. Both our Board and NHS London have been notified of full details of these incidents through the required reporting processes. We also notified the Information Commissioners Office of the incident rated at level 3, and provide more details below.
Summary of other personal data related incidents in 2011/12 Category I II III IV V Nature of Incident Loss of adequately protected electronic equipment, devices or paper documents from secured NHS premises Loss of inadequately protected electronic equipment, devices or paper documents from outside secured NHS premises Insecure disposal of inadequately protected electronic equipment, devices or paper documents Unauthorised disclosure Other Total 0 1 0 0 0

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Summary of Serious Untoward Incidents involving personal data as reported to the Information Commissioners Office in 2011/12 Notification steps Date of Incident Nature of Incident Nature of data involved Number of people potentially affected 59 Contacted by post June 2011 Unauthorised fax Inpatient details, including; disclosure Name Date of Birth Hospital Number Date of admission Diagnosis Careplan summary Advance decision status Further action on CLCH will continue to monitor and assess its information risks in order to identify and address information risk any weaknesses and ensure continuous improvement of its systems. Planned steps for the coming year include the deployment of encrypted email to reduce reliance on faxing to transfer clinical information.

Research and development

We have an active programme of service evaluation, review, audit and research. A full breakdown of projects can be found in our Quality Account 2011/12. We aim to be recognised as a centre of expertise in developing innovative programmes of care, and believe that excellent research and development must underpin this ambition. Our research, therefore, reflects best practice approaches where these exist, and focuses on testing new ways of working which will enhance patient outcomes and experiences of healthcare. Over the past year, we have been working to develop an organisational culture that encourages innovation, reflective practice and evaluation as core activities in which all clinicians should participate. We are supporting this through a research and development programme, based on collaboration with experienced research partners in the academic and commercial world. We have important existing relationships with: the National Institute for Health Research / Collaborations for Leadership in Applied Health Research and Care (NIHR / CLAHRC); West London Primary Care Consortium for Research and Innovation (WELREN) and Health Innovation and Education Cluster (HIEC). We are also looking to work with other academic institutions to support research activities, offer expert advice and encourage research and development across CLCH for the benefit of patients.

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Section 5 Be Financially Strong

Performance
We owe it to our patients to ensure we manage our organisation as effectively and efficiently as possible. This means our focus on performance must be relentless. Key performance indicators We publish key performance indicators (KPIs), which measure how well we are doing. To make sure they drive our work, CLCH-wide KPIs are reviewed by the Board of Directors using a traffic light (red, amber, green) system which helps to quickly identify any areas for improvement. A programme of work is underway to design and implement a new CLCH-wide performance framework, including a review of all KPIs and associated structures. The new performance framework is aligned to our strategic goals, and designed to support the CLCHs vision. The following table provides a view of our non-financial performance for 2011/2012, and shows the main dashboard categories measured. Each of the six categories includes a number of individual KPIs which we measure against well-defined targets. For the complete performance management dashboards see our Board section of our website www.clch.nhs.uk Balanced scorecard Workforce National targets Productivity Process Outcomes Data completeness and quality 2010/2011 2011/12

Workforce KPIs include indicators such as measuring against targets set for sickness absence, staff job satisfaction and improving work-related learning. Our overall performance for 2011/2012 remained amber, in part because of issues relating to the integration of Barnet Community Services. National target KPIs include indicators such as measuring waiting times, one of the areas identified by patients as being important to them. We met all of our targets in this category during 2011/2012. Productivity KPIs include measuring the actual amount of time district nurses and health visitors spend face-to-face with their patients and how much this costs per contact. We maintained a green rating in this category, improved our face-to-face time and reduced our costs per contact. Process KPIs measure how well the system is working and how reliably the processes of care are being performed and include indicators such as complaints

30

handling. We moved from amber to green during 2011/2012 as a result of improving our District Nurse response times, dealing with Serious Incidents in a timelier manner, and reducing the number of appointments where patients did not attend. Outcomes KPIs measure the end results against six indicators including checking how well community matrons perform in managing the needs of people living with long-term conditions and whether care for palliative care patients (people nearing the end of their lives) meets best practice guidelines. Although both years show a red rating, we met all of our targets in this category with the exception of HPV immunisation rates. We did, however, improve our HPV immunisation rates by over 14% between the two years. Finally, data completeness and quality targets ensure that data entered into our clinical information systems meets national requirements for data completeness, accuracy and quality. We met all of our targets in this category during 2011/2012. Commissioning for Quality and Innovation (CQUIN) Another way we ensure that performance management is targeted at those areas which matter most is through the CQUIN payment framework. We agree key service priorities with commissioners based on local health needs, and a proportion of our funding is tied to achieving targets in these areas. We achieved all of our targets for Inner North West London, and 75% of our targets for North Central London. In doing so we secured incentive payments of nearly 2.2m. Below we summarise our CQUIN targets for 2012/2013: Inner North West London: 1. Improve the collection of data in relation to pressure ulcers, falls and urinary tract infections. 2. Improve outcomes for patients with pressure ulcers and reduce the number of patients on the District Nursing caseload who experience a fall. 3. Develop secure electronic clinical communications to GPs. 4. Capture patient stories. 5. Improve health outcomes for vulnerable patients. 6. Enable the child health promotion programme 7. Comply with the Inner North West London Dressing Formulary. North Central London: 1. Improve the collection of data in relation to pressure ulcers, falls and urinary tract infections. 2. Improve outcomes for patients with pressure ulcers. 3. Reduce the number of patients on the District Nursing caseload who experience a fall. 4. Capture patient stories. 5. Develop secure electronic clinical communications to GPs. 6. Increase the number of patients entering the smoking cessation programmes.

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Finance
This year we are presenting our financial performance in two different parts. Within this report, we provide a brief overview of our financial performance, which looks at our end of year financial position, and our summary of accounts. These parts may not contain sufficient information for a full understanding of the entitys financial position and performance. For a full overview of our financial review and accounts and the second part of our reporting of financial performance please go to our website www.clch.nhs.uk. Financial overview Our Earnings before Interest Tax Depreciation and Amortisation (EBITDA) for the year ending 31 March 2012 were 4,629k, which equates to a 2.4% gross margin (2010/11: 2,183k, 1.4% gross margin). Our gross margin has risen due to both improved operational efficiency and the impact of depreciation and amortisation as we own property plant and equipment for the first time: depreciation and amortisation is a non-cash cost which does not count towards expenditure used to calculate EBITDA. We have capital and reserves totalling 8,435k at 31 March 2012 (2010/11: 2,196k). Our capital and reserves have increased by 6,239k during the year. The increase has been caused by a net profit of 3,835k and the inheriting of accumulated reserves from Barnet Community Services (BCS) with a value of 2,404k. Further details on why we inherited these reserves from BCS are included below. We delivered a full year surplus of 3,835k (2010/11: 2,196k), 1,058k more than set out in our annual plan for the year. This record surplus was made against a trend of higher permanent pay costs caused by annual incremental increases and non-pay cost inflation and is a testament to the commitment shown by the CLCHs staff to making every penny spent count whilst delivering the best possible care. We will continue to monitor all known cost pressures, notably around bank and agency costs, and further efforts will be made during 2012/13 to reduce bank and agency spend by increasing the number of staff we permanently employ. BCS joined CLCH on 1 April 2011. After this point CLCH became one organisation providing community healthcare services in the four boroughs of Barnet, Hammersmith and Fulham, Kensington and Chelsea and Westminster. CLCH inherited 2,404k of plant and equipment from the previous provider of community services in Barnet, NHS Barnet. We did not pay NHS Barnet cash for these assets but due to the application of merger accounting as amended for use in the NHS include these assets on our statement of financial position (our balance sheet) as if we always owned them. We therefore increased our opening 1 April 2011 property, plant and equipment by 2,404k and also our capital and reserves by the same value. CLCH also inherited payables and receivables that were outstanding at 31 March 2011 with a net value of nil. An immaterial amount of these payables and receivables remains outstanding at 31 March 2012. BCS has increased the income and expenditures of CLCH by 39,492k when comparing financial years 2010/11 and 2011/12. 32,206k of the increased spend relates to pay costs.

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Our annual accounts

The Chief Executive is our designated Accounting Officer with the duty to prepare the accounts in accordance with the National Health Service Act 2006. The Secretary of State, with the approval of the Treasury, directs that these accounts give a true and fair view of the state of affairs of the trust and of the income and expenditure, recognised gains and losses and cash flows for the year. In preparing those accounts, directors are required to: apply on a consistent basis accounting policies laid down by the Secretary of State with the approval of the Treasury; make judgements and estimates which are reasonable and prudent; and state whether applicable accounting standards have been followed, subject to any material departures disclosed and explained in the accounts.

The directors are responsible for keeping proper accounting records which disclose with reasonable accuracy at any time the financial position of CLCH and to enable them to ensure that the accounts comply with requirements outlined in the above mentioned direction of the Secretary of State. They are also responsible for safeguarding the assets of CLCH and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities. The directors confirm to the best of their knowledge and belief they have complied with the above requirements in preparing the accounts. James A. Reilly Chief Executive Jon Bell Director of Finance

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Income Our recorded income for the year to 31 March 2012 was 190,946k (2010/11: 155,379) which came from the following sources:

Source of Trust Income, '000

200,000 180,000 160,000 140,000 120,000 100,000 80,000 60,000 40,000 20,000 0 2010/11 2011/12 Other sources Department of Health Local Authorities Foundation Trusts Primary Care Trusts NHS Trusts Strategic Health Authorities

We have no income due from private patients. Expenditure Our total expenditure for the year to 31 March 2012 was 187,195k (2010/11: 153,196k) and was spent in the following areas:

Source of Trust Expenditure, '000

Employee Benefits (excluding board members)

200,000 180,000 160,000 140,000 120,000 100,000 80,000 60,000 40,000 20,000 0 2010/11 2011/12

Premises Supplies and Services - Clinical Establishment Supplies and Services - General Consultancy Services Services from Foundation Trusts Purchase of Healthcare from Non-NHS Bodies Services from Other NHS Trusts Education and Training Trust Officer Board members Depreciation Transport Other Services from PCTs

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STATEMENT OF COMPREHENSIVE INCOME FOR THE YEAR ENDED 31 MARCH 2012

2011/12 000 Revenue Revenue from patient care activities Other operating revenue Employee benefits Other operating expenses Operating surplus/(deficit) Finance costs: Investment revenue Finance costs Surplus/(deficit) for the financial year and total comprehensive income 188,402 2,544 (138,664) (48,531) 3,751 92 (8) 3,835 2010/11 000 153,774 1,605 (106,249) (46,947) 2,183 13 0 2,196

All income and expenditure is derived from continuing operations. There is no difference between the retained surplus noted above and the reported NHS financial performance position.

STATEMENT OF FINANCIAL POSITION AS AT 31 MARCH 2012

31 March 2012 000 Non-current assets: Property, plant, and equipment Intangible assets Total non-current assets Current assets: Trade and other receivables Cash and cash equivalent Total current assets Total assets Current liabilities: Trade and other payables Provisions Total current liabilities Net current assets Total assets less current liabilities Non-current liabilities: Provisions Total non-current liabilities Total assets employed: Financed by: Taxpayers equity Retained Surplus Revaluation Reserve Total taxpayers equity 3,510 400 3,910 8,949 15,266 24,215 28,125 1 April 2011 As amended* 000 2,097 307 2,404 16,075 7,026 23,101 25,505 31 March 2011 000 0 0 0 13,219 7,023 20,242 20,242

(16,647) (3,060) (19,707) 4,508 8,418

(18,300) (2,513) (20,813) 2,288 4,692

(15,552) (2,494) (18,046) 2,196 2,196

(276) (276) 8,142

(385) (385) 4,307

0 0 2,196

8,142 0 8,142

4,167 140 4,307

2,196 0 2,196

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STATEMENT OF CHANGES IN TAXPAYERS EQUITY FOR THE YEAR ENDED 31 MARCH 2012

Retained Surplus 000 0

Balance as at 31 March 2010 Total comprehensive income for the year: Retained surplus/(deficit) for the year Balance as at 31 March 2011 Adjustments for Transforming Community Services transactions* Balance as at 1 April 2011 as amended Total comprehensive income for the year: Retained surplus/(deficit) for the year Movements between reserves Balance at 31 March 2012

Revaluation Reserve 000 0

Total Reserves 000 0

2,196 2,196 1,971

0 0 140

2,196 2,196 2,111

4,167

140

4,307

3,835 140 8,142

0 (140) 0

3,835 0 8,142

Retained Surplus reflects the accumulated surpluses of CLCH since its inception plus those inherited from Barnet Community Services. The Trust inherited a 140,000 revaluation reserve from BCS relating to its plant and equipment used in the provision of community services in the borough of Barnet. In line with the NHS Manual of Accounts under which these financial statements have been prepared this reserve has now been be transferred to the Trusts retained surplus. The Trust has no Public Sector Dividend (PSD) payable for the year.

STATEMENT OF CASH FLOWS FOR THE YEAR ENDED 31 MARCH 2012

2011/12 000 Cash flows from operating activities Operating surplus/(deficit) Depreciation and Amortisation Impairments and Reversals (Increase)/decrease in trade and other receivables Increase/(decrease) in trade and other payables Provisions Utilised Increase/(Decrease) in Provisions Net cash inflow/(outflow) from operating activities Cash flows from investing activities Interest received (Payments) for Property, Plant and Equipment (Payments) for Intangible Assets Net cash inflow/(outflow) from investing activities Net cash inflow/(outflow) before financing Net cash inflow/(outflow) from financing Net increase / (decrease) in cash and cash equivalents Period opening cash and cash equivalents Adjustments for Transforming Community Services transactions* Balance as at 1 April 2011 as amended* Period closing cash and cash equivalent 000 3,751 878 26 4,270 681 (1,580) 2,119 10,145

2010/11 000 000 2,183 0 0 (8,632) 10,907 0 2,494 6,952

92 (1,761) (236) (1,905) 8,240 0 8,240 7,023 3 7,026 15,266 13 6,965 0 6,965 58 0 58 7,023

13 0 0

*These financial statements have been prepared using merger accounting as amended for use by the NHS Manual of Accounts. In accordance with the Manual of Accounts we have not adjusted the prior year comparators for the addition to the Trust of services provided by BCS from 1 April 2011 but have instead amended our opening balance sheet for balances held by Barnet Community Services at 31 March 2011.

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Better Payment Practice Code

Number Non-NHS Payables Invoices Paid in the Year Invoices Paid Within Target - 000 Invoices Paid Within Target - % NHS Payables Invoices Paid in the Year Invoices Paid Within Target - 000 Invoices Paid Within Target - % 38,852 34,806 89.6 2011/12 000 62,448 58,580 93.8 Number 40,940 35,462 86.6 2010/11 000 78,902 74,606 94.6

1,825 1,538 84.3

29,030 27,270 93.9

2,128 1,858 87.3

25,794 24,361 94.4

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

External Financing Limit

2011/12 000 540 (8,240) 0 0 (8,240) 8,780 2010/11 000 -

External Financing Limit Cash Flow Financing Finance Leases Taken Out in the Year Other Capital Receipts External Financing Requirement Under/(Over) Spend against EFL

As CLCH was a statutory entity newly formed during 2010/11 it was not set an External Financing Limit (EFL) for the year and so no performance against an EFL was presented. CLCH was set a target equivalent to an EFL which meant that it had to meet a target of holding cash balances of 7,000k at the balance sheet date.

Breakeven performance
Turnover, 000 Retained surplus/(deficit) for the year, 000 Break-even in-year position, 000 Break-even cumulative position, 000 Break-even in-year position as a percentage of turnover Break-even cumulative position as a percentage of turnover 2011/12 190,946 3,835 3,835 6,031 2.0% 3.2% 2010/11 155,379 2,196 2,196 2,196 1.4% 1.4%

Capital Resource Limit

Gross capital expenditure Less: book value of assets disposed of Less: capital grants Less: donations towards the acquisition of non-current assets Charge against the capital resource limit Capital resource limit (Over)/underspend against the capital resource limit 2011/12 000 (2,410) 26 0 0 (2,384) 3,425 1,041 2010/11 000 0 0 0 0 0 0 0

Related Party Transactions

During the financial period there have been no transactions between CLCH board members or their families and key members of staff, and CLCH. CLCH is not the corporate trustee for Charitable Funds and has no control or influence through shared management, Directors, or Trustees over the Charitable Funds held by its legacy PCTs, Kensington & Chelsea PCT, Hammersmith & Fulham PCT, and Westminster PCT. The Department of Health is regarded as a related party. During the year CLCH had a number of material transactions with entities controlled by the Department, and other entities for which the Department is regarded as the parent. These transactions are as follows:

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Payable as at 31/3/2012 000 0 5,993

Receivable as at 31/3/2012 000 0 6,392

Department of Health Other NHS bodies*

Income in the 12 months to 31/3/2012 000 0 182,333

Expenditure in the 12 months to 31/3/2012 000 81 26,161

*Material related party transactions with NHS bodies are listed below: Payable as at 31/3/2012 000 830 1,417 1,391 101 0 647 129 0 15 112 189 0 0 50 93 4,974 Receivable as at 31/3/2012 000 574 557 831 359 214 474 0 37 1,353 272 0 206 111 15 30 5,033 Income in the 12 months to 31/3/2012 000 49,032 40,740 40,065 36,680 2,378 1,625 1,488 1,376 1,353 1,347 926 659 626 460 205 178,960 Expenditure in the 12 months to 31/3/2012 000 4,169 6,477 5,088 2,171 0 1,937 15 0 0 1,383 123 0 0 692 3,083 25,138

Westminster PCT Barnet PCT Kensington and Chelsea PCT Hammersmith and Fulham PCT Brent Teaching PCT Imperial College Healthcare NHS Trust London Strategic Health Authority Hertfordshire PCT Royal Free Hampstead NHS Trust Barnet and Chase Farm Hospitals NHS Trust Enfield PCT Harrow PCT Haringey Teaching PCT Chelsea and Westminster Hospital NHS Foundation Trust Central and North West London MH NHS Foundation Trust

Other financial statements

Cost improvement programme We are committed to a challenging efficiency programme that will ensure our financial good health. 11,381k of recurrent efficiencies were delivered in 2011/12 (7,988k 2010/11k). CLCH had initially planned to deliver recurrent efficiencies of 10,452k during 2011/12. We exceeded our plan by 929k due to the commitment shown by all our staff in identifying and then delivering long term and sustainable improvements in how we provide our services. It is anticipated that a further 10,731k of recurrent savings will be delivered over the next financial year as we continue make CLCH as efficient as possible. This programme is essential to deliver services within the financial revenues agreed with commissioners and it will also enable us to deliver a modest surplus that will be reinvested in developments in line with our service strategy. This will support us to succeed in a more competitive market environment as a provider of choice. It will also create a financial contingency against the risks which we face. The programme is broken down into initiatives that will increase income with minimal increase in cost; and those that reduce costs with minimal reduction in income; most notably in service redesign, procurement, and workforce modernisation. This programme does not involve a reduction in the safety or quality of services provided. Financing and investment During 2011/12 we made significant investments in our information technology infrastructure. This investment is a core part of how we will achieve our cost improvement programme over the coming years. It will demonstrably improve our labour productivity and free both clinical time and financial resources to focus on

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improving patient care. Our 2011/12 investment program totalled 2,409k. The most significant investments were: 538k: integrating CLCHs existing Wide Area Networks (WAN) into one shared platform to enable seamless communication between all CLCH sites and between CLCH and our core partners; 1,075k: mobile computing as we invest in ensuring that all our staff can access and process clinical information whilst on the move; 176k: investment in our EDMS (Electronic Document Management System) with an objective to improve the way we store and track electronic documents, freeing clinical staff to focus on the experience of the patient; and 193k: development of a Single Patient View for our medical records, so patient information such as prescriptions, doctor and exam notes are accessible on one template, saving clinical and administrative time searching for documents across a number of data sources. We also invested 119k to replacing aged decontamination and diagnostic equipment used by the Day Surgery Unit in Edgware Community Hospital and 54k on a modern fluoroscope (a portable imaging unit, similar to an x-ray machine, which can be used to take radiographic images of the skeleton) for use by our podiatric surgeons. We have identified a number of areas where future investment will help us achieve our objectives and meet the aspirations of all of our stakeholders. These areas include continuing to roll out EDMS and mobile computing to all our sites and staff and improvements to RiO, the Trust's electronic patient records system. We also expect to inherit a number of buildings - within which we provide services - from our legacy PCTs during 2012/13. CLCH will seek to improve and modernise these assets and leverage them to ensure that we provide our services in the most efficient and effective manner and in the locations required by our service users. Political and charitable donations We have not made any political or charitable donations this year. Public sector payment policy We have signed up to the Prompt Payments code. In accordance with the Better Payment Practice code, we seek to pay all trade creditors within 30 days. During the year, we have paid 89.6 (2010/11: 86.6) percent of non NHS invoice by number and 93.8(2010/11: 94.6) percent by value within the 30 day limit. We have paid 84.5 (2010/11 87.3) percent of NHS invoice by number and 93.9 (2010/11: 94.4) percent of invoices by value within the 30 day limit. Disclosure of information to Auditors As far as each of the directors is aware, there is no relevant audit information that the auditors are unaware of. Each director has taken all the steps they ought to have taken to make themselves aware of any relevant audit information and to establish that the auditors are aware of such information.

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Auditors Report
Our appointed external auditors for this financial year were the Audit Commission. The auditors carry out the statutory audit of our annual accounts. The cost of this audit service in 2011/12 was 110k (2010/11: 80k). The Audit Commission did not perform any work for us other that the statutory audit. For the financial year 2012/13 the Audit Commission will be replaced as our statutory auditors by KPMG LLP. INDEPENDENT AUDITORS REPORT TO THE DIRECTORS OF CENTRAL LONDON COMMUNITY HEALTHCARE NHS TRUST I have examined the summary financial statement for the year ended 31 March 2012 which comprises the section of the Annual Report titled Our annual accounts. This report is made solely to the Board of Directors of Central London Community Healthcare NHS Trust in accordance with Part II of the Audit Commission Act 1998 and for no other purpose, as set out in paragraph 45 of the Statement of Responsibilities of Auditors and Audited Bodies published by the Audit Commission in March 2010. Respective responsibilities of directors and auditor The directors are responsible for preparing the Annual Report. My responsibility is to report to you my opinion on the consistency of the summary financial statement within the Annual Report with the statutory financial statements. I also read the other information contained in the Annual Report and consider the implications for my report if I become aware of any misstatements or material inconsistencies with the summary financial statement. I conducted my work in accordance with Bulletin 2008/03 The auditor's statement on the summary financial statement in the United Kingdom issued by the Auditing Practices Board. My report on the statutory financial statements describes the basis of my opinion on those financial statements. Opinion In my opinion the summary financial statement is consistent with the statutory financial statements of the Central London Community Healthcare NHS Trust for the year ended 31 March 2012. Jon Hayes Engagement Lead Audit Practice Audit Commission 1st Floor Millbank London SW1P 4HQ 8 June 2012

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