1. ANNUAL PLAN 2009/10
Public Version
Version 27
Date 28 May 2009

2. CONTENTS
Page
1 PAST YEAR PERFORMANCE 3
2 FUTURE BUSINESS PLANS 8
3 RISK ANALYSIS 28
4 DECLARATION AND SELF-CERTIFICATION 33
5 MEMBERSHIP 35
Appendices 40
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3. Past Year
Performance
1 PAST YEAR PERFORMANCE
1.1 Chief Executive’s summary of the year
The past year has seen us build on many of our existing strengths as we prepared
for Foundation Trust status and continued to work towards delivering our key aims.
Throughout 2008/09, the Trust has been firmly committed to ensuring the highest
levels of patient safety and clinical quality. Delivering safe clinical services is the
bedrock of the Trust and the platform from which we are able to pursue the
development of specialist services and research. The organisation reinforced that
the following are the key operational themes underpinning all that we do:
- Clinical quality and safety
- Patient experience
- Productivity and efficiency
Healthcare Acquired Infections are a matter of great importance to staff and patients.
Good practice in relation to infection control procedures is becoming embedded
across the Trust and infection rates have been decreasing year on year. We were
one of a small number of Trusts to achieve our March 09 targets for both Clostridium
Difficile (C Diff) and Methicillin Resistant Staphylococcus Aureus (MRSA). Based on
our track record, we were selected as one of seven Showcase Hospitals across
England to participate in the Healthcare Associated Infections Technology Innovation
programme. The aim is to help further reduce levels of infection through the use of
new products and technologies.
The Trust has been at the forefront of implementing the NHS Institute for Innovation
and Improvement’s Releasing Time to Care Productive Ward programme. The
impact has been significant. We have seen an average increase of 14% in the
amount of time that staff are involved in direct patient care and other improvements
such as reduced food wastage and increased patient satisfaction in relation to pain
management. The NHS Institute is using the Trust as a showcase site and we have
demonstrated our successes to a global audience including delegations from Canada
and New Zealand.
A lot of preparatory work has been undertaken in developing indicators to measure
quality and we have been one of the first wave of hospitals to take part in the NHS
North West’s Advancing Quality initiative. We are now on the threshold of embarking
on our own ground breaking Quality Campaign which aims to bring about sustainable
change at all levels across the organisation.
The New Hospitals Development (NHD) is another key element of our plans to
enhance the quality of the care that we offer. The Trust is in the final year of a six
year (Private Finance Initiative) construction agreement to deliver state of the art
healthcare and research facilities on the Oxford Road site.
The New Hospitals Development is a unique opportunity for the Trust to make a step
change in the quality and effectiveness of patient care delivery for both secondary
services for the local population and specialist services for the population of the
North West.
The appropriately configured new facilities, designed with substantial clinical input,
will help the trust deliver our vision and national standards and targets. Central to the
improvements for patients and to ensuring improved continuity of care is the
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4. Past Year
Performance
amalgamation on one site of specialist children’s services with a range of
redeveloped adult services, maternity and neonatal care.
Strengthened assurance/management arrangements and detailed
operational/commissioning plans for the hospital moves are in place and these plans
have received external stress testing, scrutiny and validation.
We remain on track to open the NHD during Spring/Summer 2009.
A number of services have passed significant milestones during 2008/09 including
undertaking the 1000th cochlear implant and the 4000th renal transplant. In addition
we have seen some ‘firsts’ in pioneering surgery including the first hospital in the UK
to perform a periscope endovascular aneurysm repair and one of only two hospitals
in the region to have taken part in a highly successful pilot study in primary
angioplasty.
A number of our highly specialised services are developed and commissioned on a
national basis through the National Commissioning Group (NCG). In line with our
strategy that prioritises the development of tertiary and specialist services, the
following have recently been designated for NCG commissioning:
- Islet transplantation - from April 2008, the MRI has been one of the six
national implantation centres for islet transplants. This procedure offers an
alternative to insulin therapy for some diabetic patients who are at risk of
hypoglycaemia, a life threatening condition.
- Encapsulating Peritoneal Sclerosis (EPS) - during 2008/09 we were
designated as one of two trusts able to treat EPS, a condition resulting from
prolonged peritoneal dialysis which if left untreated, is fatal.
- Neurofibromatosis (NF1 and NF2) - we are a national and international leader
in clinical care and research into neurofibramatosis, a rare complex genetic
condition. NF1 was designated a NCG commissioned service in 2008/09 and
we are applying for NCG funding for NF2 in 2009/10.
The development of research is one of our priorities. Undertaking research enables
us to contribute to the development of medicine, but also deliver benefits to the
population that we serve and to us as a business enabling us to
- Provide new treatments
- Improve patient outcomes
- Attract and retain the best staff.
These benefits will give us a competitive edge in the market, enabling us to increase
our market share in the areas we plan to develop and enhancing our position as the
leading specialist centre in the North West.
In early 2008 the Trust, in partnership with the University of Manchester, achieved
designation as a Biomedical Research Centre (BRC) and the year has seen ground
breaking research undertaken across a range of specialties including ophthalmology
(blindness in older people), orthopaedic surgery (repairing spinal discs) and
obstetrics (identifying women at high risk of developing complications in pregnancy).
The Trust is a key partner in the Manchester Academic Health Sciences Centre
(MAHSC), one of just five centres approved nationally and the only one outside of the
golden triangle of research hospitals in the South East. MAHSC comprises a range
of organisations including a PCT and specialist mental health and cancer trusts and
covers a diverse population with relatively poor health. We are working closely with
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5. Past Year
Performance
our partners to deliver research, teaching and patient care which are among the best
in the world. The aim is that this will deliver benefit to patients in terms of access to
the latest treatments and newest technologies, leading to improved health locally and
nationally and economic benefits for the region.
We have met some very challenging targets during this year for healthcare
associated infections, cancer waiting time and referral to treatment, however the
A&E target remains a challenge for the Trust and the Manchester Health
economy.
In spring 2008 internal changes were made to the pathways for patients requiring
emergency admission and capacity was increased by opening assessment beds off
site. As a result performance against the 4 hour target improved significantly.
However the Trust, like many other trusts in Greater Manchester, experienced an
exceptional rise in pressure over the winter period and as a result our year end
performance was 97.53% patients treated within four hours.
In response to this growth in demand additional action plans were agreed with key
partners and were progressively put in place. These included increasing resources,
re-opening capacity outside hospital and strengthening processes for discharging
patients. The changes to the internal pathways were also further reinforced. The
impact of these measures is being monitored closely and reported to the Board.
Performance since early March has returned to a consistent level above the 98%
threshold.
Our Council of Governors was elected and appointed in line with our Constitution.
Following a comprehensive induction programme the Governors are beginning to
work together as a council. They have agreed four areas on which they will focus
their work initially; membership; patient experience; public health; and health
promotion and corporate citizenship and are looking forward to developing a
productive working relationship with the Board of Directors.
Our strong commitment to corporate citizenship has seen our involvement with the
City council continue to thrive. As key sponsor of the Manchester Health Academy
developments are progressing well and the Trust is an integral player in The Corridor
Manchester (formerly Oxford Road Corridor Partnership). The Trust’s lead on local
employment initiatives has resulted in significant job placements for local people
throughout the organisation during the past year.
Building on centuries of tradition of excellence in health care in our hospitals, the
move to Foundation Trust status and the imminent completion of the New Hospitals
Development gives us an unprecedented opportunity to change our services to truly
reflect what staff, patients and the public should expect from the NHS in the 21st
Century
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6. Past Year
Performance
1.2 Summary of financial performance
Financial performance for 2008/09 is summarised below in table 1.1
Table 1.1: Summary of Financial Performance in 2008/09
2008/09 plan 2008/09 actual Variance
£'m £'m £'m
Income
Clinical income 502.4 510.5 8.1
Non-clinical income 99.6 101.6 2.0
PFI Specific Income 8.0 8.0 0.0
Total income 610.0 620.1 10.1
Expenses
Pay costs (338.6) (337.6) 1.0
Non-pay costs (195.4) (204.8) (9.4)
PFI Costs (43.8) (44.3) (0.5)
EBITDA 32.2 33.4 1.2
Deprn/Interest/Dividend (26.4) (28.0) (1.6)
Exceptional items
Net surplus 5.8 5.4 (0.4)
Clinical income is ahead of budget by 2% due to over performance across a range of
clinical activity. Non-pay costs are higher than budget due to the additional costs
incurred in delivering the additional activity. Overall actual out-turn was 93% of plan.
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7. Past Year
Performance
1.3 Other major issues
On establishment as a Foundation Trust on 1 January 2009, the Trust implemented
its revised governance arrangements in line with its Constitution.
Board of Directors
The Board of Directors comprises a Chairman, six Non-executive Directors and six
Executive Directors. The following changes took place during 2008/09:
Non-executive directors
Blaize Nkwenti-Azeh term of office expired on 31 July 2008
Sheila Jones and Claire Nangle’s term of office expired on 9 November 2008
Three new non-executive directors appointed on 10 November 2008
- Stephen Mole BSc(Hons) FCMA PGCE
- Brenda Smith FRSA D Litt MBA BSc(Hons) ACA
- Lady Rhona Bradley MA BA(Hons)
Sheila Jones and Clare Nangle were retained as Associate Non-executive Directors
until 31 March 2009.
Council of Governors
The Council of Governors comprises 31 members, 17 public and 6 staff elected
members and 8 representatives of partner organisations. The following changes to
the Council of Governors took place during 2008/09:
Charlie Davies resigned as the Children’s Forum representative on 2 January
2009 and was replaced by Sam King on 10 February 2009
Tom Ladds left the organisation and therefore resigned as a Staff Governor
representing Nursing and Midwifery on 27 March 2009. He has been
replaced through an election process by Mary Metcalf.
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8. Future Business
Plans
2 FUTURE BUSINESS PLANS
2.1 Overall vision
The Trust’s Integrated Business Plan, developed as part of its application to become
a Foundation Trust during 2007/08, set out the vision and strategic aims of the
organisation.
Our vision is:
‘to become the leading integrated health, teaching, research and
innovation campus in the NHS and to position the Trust on an
international basis alongside the major biomedical research centres, as
part of the thriving city region of Manchester – with its strong emphasis on
economic regeneration, science and enterprise.‘
The service related strategic aims below our vision are based on building upon our
already strong position within the health economy and formally establishing the Trust
as being:
• The leading provider of tertiary and specialist services in the North West
• A prestigious internationally renowned centre for research and innovation
• An excellent district general hospital for the residents of central
Manchester
This vision will be underpinned by an operational focus on:
• Clinical quality and safety
• Patient experience
• Productivity and efficiency
and delivered by building on our existing strengths:
- Firstly, our distinctive position as a provider of specialist and tertiary services
to the population of Greater Manchester, the North West and beyond.
- Secondly, the scale and significance of our research ambitions, which set us
apart from other Trusts. Having attained Biomedical Research Centre status
and being a key partner in the newly accredited Academic Health Sciences
Centre is Manchester benefits the Trust both clinically and from a business
perspective. It enables us to differentiate ourselves in service terms, recruit
clinicians of the highest calibre and position ourselves as a leading centre for
research and innovation which will give us a competitive edge within an
increasingly competitive market.
- Thirdly, our New Hospitals Development which is a unique opportunity for the
Trust to make a step change in the quality and effectiveness of patient care
delivery of both secondary services for our local population and specialist
services for the population of the North West.
This vision was developed initially by the Board of Directors. It was subsequently
shared and refined through consultation with the senior clinical and management
teams, the city council, host PCT, the University of Manchester and other key
stakeholders. Finally the Foundation Trust consultation document set out the vision
for the future and staff, patients and members of the public were given the
opportunity to feedback their views.
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9. Future Business
Plans
2.2 Strategic overview
2.2.1 National and local challenges – impact on financial strategy
National
Economic downturn and its impact on public sector funding levels
Following the 2009 budget statement delivered by the Chancellor on April 22nd, we
have reviewed the current and medium-term forecasts for UK government finances
and the probable impacts this can be expected to have upon the Health sector. It is
clear that there will be serious downward pressure on public sector funding levels,
sustained over a prolonged period from 2010 onwards and through into at least the
middle of the next decade. We therefore expect a very challenging period ahead
which will be quite different from the operating environment of the Health sector
through the last two decades.
- We have revised down our income inflation assumptions and revisited our
cost inflation assumptions, ensuring both that we have taken a prudent view
of the impacts on our overall trading gap year-by-year, and that we are being
realistic about an increasing majority of solutions to these annual challenges,
needing to come from productivity gains which release cost savings.
- We have extended the scope and prioritised the implementation of a major
programme of work to increase productivity and efficiency across all aspects
of our work. These will ensure that we continue to deliver high standards of
patient care and good clinical outcomes, as well as further improvements in
positive patient experiences in our front-line service delivery(see section
2.2.3)
Darzi report – High Quality Care for All
The recommendations within Lord Darzi’s report have emphasised the need to
continue to prioritise service quality, good outcomes and positive patient experience.
The emphasis on these themes throughout our plans, has in turn been reflected in
our service and financial plans for 2009/10.
Commissioning landscape
Commissioners are increasingly employing competitive tendering as a means of
procuring services and designating organisations as accredited providers. We
expect to see this approach and other developments in methods of procurement
rolled out over future years, as part of a range of further responses/developments in
the commissioning environment as the squeeze on real-terms growth in purchasing
power takes progressively stronger effect. We are developing working arrangements
with the newly formed procurement department of Manchester PCT. The Trust will
use this as an opportunity to highlight areas which are in line with our strategic aims.
Services that we expect to be tendered in 2009/10 include anti-coagulant service and
designation of accredited providers for Endovascular Repair of Abdominal Aortic
Aneurysm (EVAR).
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10. Future Business
Plans
Introduction of new tariffs through HRG4
The intention of the new tariff was intended to underpin a proper level of recompense
for more specialised services, with better differentiation of case-mix and higher cost
areas of activity. Whilst the new tariffs represent a step towards this objective in
many services, there has been an unintended adverse impact on specialist children’s
services in particular. We have established effective working relationships with DH
on further refinements of the new tariffs to address several of the adverse impacts
identified.
Further developments in national approaches to formulating future ‘Payment by
Results’ tariffs are now being clearly signalled. These will include emerging ‘best
practice’ tariffs. We will ensure that we engage effectively in the programmes of work
which are developing these new tariff approaches and thus that we keep up-to-pace
with assumptions being made about identifying best clinical practice and how this is
connected to the prices which will be paid in future.
The European Working Time Directive (EWTD)
The achievement of compliance with EWTD and the associated requirements of
Modernising Medical Careers, balanced with ongoing service delivery challenges,
remains a continuing priority for the Trust. Further identified areas of medium-term
service delivery and financial risk continue to be progressed, both through resource
bids currently under review by commissioners and North West Strategic Health
Authority (NW SHA) workforce team, and in ongoing re-design projects internally.
Local
Transfer of services into the New Hospitals Development
The financial implications of the transfer of services into the New Hospitals
Development and associated increases in the unitary payment have been
incorporated in our financial plans and Long Term Financial Model (LTFM).
- The Trust will incur costs related to maintaining patient activity and waiting
times performance across the overall period of the Hospital moves, together
with double running, staff training, orientation and backfill, and
decommissioning of the hospitals being vacated. These exceptional costs
have been assessed in depth and funding secured to enable them to be
budgeted for in our plans for 2009/10 and 2010/11.
- With the opening of the New Hospitals Development there is a significant step
up in the unitary payment and associated costs.
Reconfiguration of Children’s services across Greater Manchester – Making It Better
The reconfiguration of children’s services across Greater Manchester is now moving
into the full implementation phase.
The financial consequences of all these challenges have been reflected in the
financial plans of the Trust. See section 2.3 below.
The Trust response to these challenges is clearly reflected in the key objectives for
2009/10 which are described in section 2.2.3 Key Actions.
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11. Future Business
Plans
2.2.2 Quality
Overview
The Board of Directors view high quality and value for money as one and the same
thing. Using the most effective treatments, reducing errors and getting things right
first time contribute to the quality of care and to a more efficient and productive
service.
During 2008/09 the Trust has been focussing increasingly on quality as reflected in
our three operational priorities of:
• Clinical quality and safety
• Patient experience
• Productivity and efficiency
The first stage has been to develop indicators that enable us to measure and monitor
quality and to present this information to the Board of Directors.
We have produced a Quality Report for 2008/09 setting out the Trust’s position on
quality, priorities for the future and current performance against relevant indicators
which has been included in our Annual Report.
Going forwards the Chief Nurse/Deputy Chief Executive held a series of discussions,
workshops and events with senior leaders across the organisation, facilitated by the
Executive Director for Improvement from the NHS Institute to agree how we take the
quality agenda on to the next stage.
Through this work our aims and objectives were agreed.
Our overall aim is:
• To provide the best patient experience within the NHS
This is to be underpinned by the following ambitious objectives:
• To be in the top 20% of Trust’s in the National Patient Survey in the next 2
years
• To improve staff satisfaction year on year by 10% on all indicators in the next
2 years
Actions
A two-pronged approach to quality for 2009/10 has been agreed:
1. Improvement programmes - a series of improvement programmes covering
Patient Experience, Patient Safety and Workforce.
The programmes are themed and include a number of work streams that will deliver
continuous improvement as shown in table 2.1:
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12. Future Business
Plans
Table 2.1: Quality Improvement Programmes
Theme 1 Theme 2 Theme 3
Patient Experience Patient Safety Workforce
Pain management Patient Track Leadership
Food Falls prevention & Customer service
reduction
Privacy and dignity Reward and recognition
Advancing Quality
Communication Recruitment & retention
Pressure ulcer prevention
Customer feedback
Reducing hospital acquired
Environment infections
End of life care Reducing high risk
medication errors
Each of these work streams is part of our core business and included in the
corporate work programmes. They will be performance managed through the normal
Trust accountability framework.
2. Quality campaign
It was acknowledged that the work programmes alone will not achieve the change in
culture in the Trust required to deliver the Best Patient Experience in the NHS. In
order to deliver the step change in organisational culture there is to be a Quality
Campaign
The campaign will engage staff, patients and the public in the development of local
initiatives that will improve quality. The aim is to move the locus of ownership for
service quality closer to the patient.
A dedicated team will be formed and resourced to lead the planning, launch and
implementation of the campaign, however as the basis of the campaign is
empowering staff and patients to make changes, their role will be to support and
facilitate.
Divisions will identify quality champions and education and training will be provided
for key individuals to develop improvement capacity and capability within the
divisions
A communication strategy is planned using a variety of media
The Campaign will be regularly reviewed and refreshed to reflect the engagement of
staff and patients which will help set the direction for the team
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13. Future Business
Plans
Indicators
During 2008/09 a programme of work was undertaken to select indicators, set targets
and establish data collection systems for measuring quality. This is an on-going
process with regular review to ensure that the indicators continue to meet the needs
of the Board of Directors. The Trust is currently reviewing the findings of the
Healthcare Commission’s report on Mid Staffordshire NHS Foundation Trust and will
reassess the range of indicators currently used in the light of this.
The indicators are reported within the Intelligent Board report which is produced on a
monthly basis. The report shows current and projected performance and a risk
rating. For any indicators that are rated as red there is an action plan with timescales
and a lead director identified.
Table 2.2 shows the indicators used at the beginning of 2008/09 and the expanded
set of indicators developed during 208/09 that will be used in 09/10. These will be
scored during 09/10 to give a quantitatively description of the quality of care.
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14. Future Business
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Table 2.2: Quality Indicators
Indicator Indicators
used
08/09 09/10
Patient Hospital Standardised Mortality Rate √ √
Safety MRSA √ √
C diff √ √
Falls* √ √
Medication errors* √ √
Clinical Stroke** √
effectiveness – time spent on stroke ward
Surgical non elective admissions** √
– operated on within 24 hours
Primary coronary angioplasty** √
– time to revascularisation
Fracture neck of femur** √
- time to operation
Compliance with pathway √
- Acute myocardial infarction
Compliance with pathway √
- Coronary Artery Bypass Graft
Compliance with pathway √
- Hip and knee replacement
Compliance with pathway √
- Heart failure
Compliance with pathway √
- Community acquired pneumonia
Patient Clean √
experience Clean wards √
Infection control √
Hotel services √
Communication √
Nutrition √
Pain √
Privacy and dignity √
Complaints √ √
– replied within 25 days
* Targets have not yet been set. A programme of work is underway to establish what
the targets should be.
** Data under validation
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15. Future Business
Plans
The Trust also uses a number of externally validated and benchmarked databases as
a guide to outcomes for some services. These include:
- PICAnet (Paediatric Intensive Care Audit) – compares actual with expected
mortality for children admitted to Paediatric ICU.
- ICNARC (Intensive Care National Audit and Resource Network) - benchmarks
patient outcomes based on risk adjustment for severity of illness, not just the
illness itself (developed by the Intensive Care Network for the UK).
- CCAD (Central Cardiac Audit Database) - analyses the outcome for every
patient undergoing cardiac surgery, using a cumulative sum (CUSUM) curve to
reflect expected and actual outcome.
- UKTSA (UK Transplant Support Service Authority) - outcomes (patient death
and graft loss) for renal transplant patients.
In addition to this at divisional level each division has selected its own set of specific
clinical indicators that are used to monitor clinical quality.
We will take on board feedback and learning in drafting future quality reporting
through the annual report.
2.2.3 Key actions to deliver Trust vision
The key actions required to deliver our vision are captured each year in our principal
objectives.
The Trust principal objectives for 2009/10 are set out below.
The first three objectives reflect the three themes that have been identified as being
essential to underpin the achievement of our vision:
• Clinical quality and safety
• Patient experience
• Productivity and efficiency
1. The fusion of patient experience, clinical quality and customer service
into an integrated campaign of improvement, underpinned by
performance metrics.
The Trust aims to provide the best patient experience within the NHS. As set out
under section 2.2.2 Quality, a series of improvement programmes themed around
Patient Experience, Patient Safety and Workforce have been developed. In addition
to this, to deliver the step change in culture necessary to achieve the Best Patient
Experience in the NHS, the Trust is developing a high profile Quality Campaign.
The indicators used to measure quality have been developed alongside and are
integral to our trading gap plans.
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16. Future Business
Plans
2. The commissioning and operational management of the New Hospitals
Development coming on stream during 2009/10.
2009/10 sees the completion of a six year (PFI) construction agreement to deliver
state of the art healthcare and research facilities on the Oxford Road site. This is a
unique opportunity for the Trust to make a step change in the quality and
effectiveness of care for our patients.
The management of the transfer of services and the establishment of the new service
models planned for the future will be a significant element of our work for 2009/10.
The transfer of services is a major undertaking. The service transfers to take place in
2009/10 are:
June 2009 Children’s Hospital – transfer of the two specialist childrens hospitals,
which are currently located off site, into the New Hospitals
Development
July 2009 St Mary’s Hospital – transfer of St Mary’s which is currently on the
hospital campus into the NHD
August 2009 MREH and MRI – transfer of the eye hospital and some acute
services which are all currently on the hospital campus into the NHD
The moves have been risk assessed within and between divisions to ensure the most
appropriate sequencing.
This is the biggest risk facing the Trust in 2009/10 and so arrangements are in place
to provide assurance to the Board of Directors that action has been taken to address
all the risks and to ensure, as far as possible, a smooth transfer of services. These
include:
- Internal peer review of plans within and across divisions.
- Review of risks and mitigating actions through the New Hospitals
Development Implementation group.
- Monitoring of progress through a range of key performance indicators
covering: construction, IT, communications, costs, whole Hospital Policy, HR
and the New Hospital Development Move Plan.
- External peer review of plans and action planning to capture the lessons
learnt
- Liaison with other organisations who have recently undertaken major service
changes eg the airport authorities in relation to terminal 5 at Heathrow and
Manchester Business Continuity Forum on their experience managing
operational disruption to services as a result of utilities and IT failures.
The move will be co-ordinated across the range of emergency services i.e. the Fire
Service, Ambulance Service and Greater Manchester Police. Operational meetings
are taking place with the individual emergency services to agree move protocols and
timescales.
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The corporate management arrangements under the leadership of the Director of
Patient Services/Chief Nurse have been reviewed to ensure they are fit for purpose.
A tiered approach to the overarching arrangements to support the move has been
developed. The tiers reflect the traditional approach adopted by the emergency
services to ensure strategic and operational control over complex situations, i.e.
Gold, Silver and Bronze command.
All divisions have plans in place to ensure business continuity so that they can
deliver the move as well as maintaining safe clinical services. They also have plans
in place to phase activity so that the Trust can continue to meet its targets, despite
the down time associated with the moves.
3. The implementation of service development and trading gap plans for
2009/10 and in advance of 2010/11, together with preparation for the
implementation of future plans.
A framework of productivity programmes for 2009-14 has been developed.
Implementation will start in 2009/10. The key elements of the framework are:
Table 2.3: Framework of Productivity Programmes
Theme Outputs
Strategic portfolio reviews including profit - Strategic decisions on priorities and
and loss position from Service Line on areas for investment/disinvestment
Reporting
Identify and maximise opportunities - Timely final agreements with relevant
around potential service configuration other parties
changes - Clear margins identified and
implemented in future trading gap
plans
Maximise further opportunities for - Update previous plans for
‘economies of scale’ and removing opportunities post-move.
duplication, arising through the New - Clear savings identified and
Hospitals Development implemented in future plans
Strengthen the alignment/ contribution of - Progressive elimination of ongoing
consultant productivity towards overall APS usage
productivity strategies - 10% step up in in-house
capacity/utilisation by March 2010
Clinical productivity programmes (linked - Improvement rate sustained
to above) - Benchmarks achieved
- Margins converted as savings unless
new funded demand growth arises
Implement cost reduction programmes - Clear savings identified and
implemented in future plans,
exceeding ‘October 2008’ plans
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A Clinical Service Portfolio Review is also being undertaken during 2009/10. This is
part of the process of continually evaluating our clinical and business strategies in the
light of the changing environment within which we operate. The purpose of the
review is to:
- update our strategy for the development of individual clinical services, and
- identify areas for investment and disinvestment
- address the worsening economic environment the NHS is going to face over
the coming years.
The review will include analysis of the current position, the market and financial
position using financial and non-financial analysis tools.
The exercise will be undertaken within the clinical divisions led by the Divisional
Director supported by the Divisional team with corporate support if required.
The programme will start in surgery and be rolled out to other clinical divisions in
phases, with a target completion date of June 09 for the pilot and October 09 for the
whole of the Trust.
To support this process, the Trust is in the process of refining its service-line
reporting systems. Service Line reporting is seen as an integral part of this process
and a significant amount of work has been done to refine the allocation of overhead
costs. A project is being undertaken to review pathology to improve the allocation of
these overheads to specialties. A further project is being undertaken, driven by the
move into the New Hospitals Development to review estates and cost of capital
costs. The cost base relating to these costs changes significantly with the move and
the introduction of International Finance Reporting Standards (IFRS), so a recosting
exercise is being undertaken. The new refined information is expected to be available
by September 2009, once the move to the NHD is completed.
Alongside the three key objectives are our other principal objectives necessary to
underpin the achievement of our strategic aims:
4. To continue the implementation of the Research and Innovation Strategy
Through the Biomedical Research Centre (BRC) our researchers and clinicians are
tackling some of the major diseases affecting the local population, focussing on the
five priority areas of:
- Developmental medicine
- Genetics
- Cardiovascular medicine
- Diabetes/endocrinology
- Musculoskeletal medicine.
Funding for the BRC will be used to support the strategic recruitment of new
professorial appointments and fellowships, the development of research facilities and
infrastructure and public engagement and involvement. Research will be
strengthened by the implementation of technology and methodology platforms in
areas such as genomics, proteomics and metabolomics.
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We plan to develop and enhance existing links with specialist BRCs and faculties of
the University of Manchester. We are also increasing our collaborative efforts with
industry by linking with TrusTECH, the National Technology Adoption Centre and
Manchester Integrating Medicine and Innovative Technology.
We are a key partner in the Manchester Academic Health Science Centre (MAHSC).
MAHSC comprises a range of organisations including a PCT and specialist mental
health and cancer trusts and covers a diverse population with relatively poor health.
We are working closely with our partners to deliver research, teaching and patient
care which are among the best in the world. The AHSC award will help us to deliver
the benefits which flow from BRC research activity to patients more quickly and more
effectively.
The Trust is seeking to maximise funding opportunities in order to grow research
income through 2009/10. We will actively bid for National Institute for Health
Research (NIHR) grants for programmes of research in our priority areas.
Key objectives are:
- To implement the recommendations of the External Review of Research in
the Trust during 2009/10, focusing on the areas for investment and
disinvestment
- To prepare, during 2009/10 the resubmission for the Biomedical Research
Centre
- In conjunction with partner organisations develop during 2009/10 the
Manchester Academic Health Sciences Centre
- Successfully appoint up to 12 clinical academic chairs to commence in post
during 2009/10
5. To maintain financial stability
- To achieve and maintain a Monitor Financial Risk Rating of at least “3” overall
for 2009/10
- To achieve a net income and expenditure break-even in 2009/10
- To achieve a closing cash balance of £9 million at March 31st 2010
- To deliver the 2009/10 capital programme within Board approvals
- To achieve the full-year harmonisation savings of £10 million from July 2009
onwards
- To develop financial plans, budget setting and activity for 2010/11 for Board
approval by March 2010
6. To ensure that excellent HR practice underpins the key strategic service
changes
- To implement the workforce strategy for the Children’s move during 2009/10
- To implement the workforce strategy for any agreed harmonisation and
repatriation initiatives during 2009/10
- To achieve 100% compliance with the EWTD for medical staff in 2009/10
19

20. Future Business
Plans
7. To continue to strengthen the IT and information supporting infrastructure
- To implement a new data warehouse to support the Intelligent Board
reporting in 2009/10
- To continue to develop and implement the next stages of Connecting for
Health during 2009/10 by implementing Lorenzo Release 1 in two pilot areas
during October 2009 and subsequently planning for implementation across
the Trust during 2010/11
8. To implement the marketing strategy
- To implement in 2009/10 the Marketing Strategy developed in 2008 and
approved by the Trust Board, focusing on building strong relationships with
key stakeholders and using the media more effectively
- To implement media training for key individuals in 2009, particularly to
coincide with the opening of the New Hospitals Development
- To implement the publicity campaign and community engagement plan for the
hospital moves from January 2009 through to completion of the moves
- To further develop the new website as a business, marketing and commercial
function in 2009/2010
- To embed branding identities across the organisation in 2009/2010
9. To develop governor and stakeholder engagement
- To grow the public membership to 10,000 members during 2009/10
- To implement the four Governors’ working groups during 2009
- To develop Governor involvement with forward planning and strategy with the
Board of Directors during 2009
- To continue to play a key role during 2009/10 in the development of:-
- The Health Academy
- The Corridor, Manchester
- The Carbon Trust Initiative
- Corporate Citizenship including employment opportunities
The financial consequences and benefits of all these objectives have been reflected
in the financial plans of the Trust. See section 2.3 below.
20

21. Future Business
Plans
2.2.4 Service Development Plans
Clinical Service Developments
Key areas in which growth is expected
The table below shows key areas where volume growth is expected. These can all
be seen to clearly link to our vision and strategic aims. There is specific
commissioner support for all the growth related to specialised services and to
changes following strategic reviews. Growth expected based on historic activity is
the subject of contract negotiations.
Table 2.4: Areas of Expected Growth
Strategic aims Specialty/Service Description
The leading provider Renal dialysis Increase in capacity
of tertiary and Bone Marrow Transplants Increase in activity
specialist services in & Matched Unrelated
the North West Donor transplants
Adult Congenital Heart Development as hub for the
Disease region and spoke for
Manchester
Renal Pancreas Increase in activity
Transplantation
Encapsulated Peritoneal Development as a nationally
Sclerosis Service (EPS) commissioned service
Islet Transplantation Development as a nationally
commissioned service
Renal transplantation Increase in activity
Genetics including Increase in activity and
development of NF1/NF2 development of nationally
commissioned complex
genetics service
Paediatric critical care Increase in capacity
Electrophysiology Increase in activity
Laser eye treatment Increase in activity
Dental implants Increase in activity
Dental sedation Increase in activity for
adolescents
Oral medicine Increase in activity
IVF (NHS) Increase in activity
An excellent district Programmed Investigation Increase in activity
general hospital for Unit
the residents of central Endoscopy Increase in activity
Manchester Obstetrics Expansion in response to
MiB and development of a
MLU
General growth Increase in eg A&E, surgery,
ophthalmology and childrens
outpatient activity
21

22. Future Business
Plans
Capabilities and resources required to put strategy into action
The Trust is deliberately building on areas of existing strength. Specialised services
have been prioritised where the Trust is often the designated or accredited service or
where we have the critical mass (expertise/infrastructure) required to deliver the
service.
The identification of services for development follows a market assessment which
has indicated that there is demand or is in response to the commissioning intentions
of commissioners such as the North West Specialised Commissioning Team.
Compliance with PPI cap
The plans include a forecast of private patient income of £2.0m (0.4% of patient
related income). The Private Patient Income (PPI) cap for the Trust, calculated by
reference to the 2002/03 activity levels is set at 1.1% of income (circa £6.5m).
Therefore current levels of income are well below the cap. This provides the Trust
with opportunities for the future.
22

23. Future Business
Plans
2.3 Summary of financial forecasts
2.3.1 How the plan was built
The plan has been developed based on the LTFM produced for the Trust’s
application to become an NHS FT and has been updated to reflect 2008-09 out-turn
position and the latest assessment of the financial out-look for the next 5 years in the
tightening economic climate.
2.3.2 Impact of IFRS
The Trust enters the final stage of the PFI scheme with the New Hospitals
Development handed over for commissioning on 30 April 2009. By 30 September
2009 all services will have moved into the NHD. The capital value of the development
is over £410m. Therefore the move to International Financial Reporting Standards
(IFRS) which has the effect of bringing the New Hospitals Development onto our
balance sheet, has a significant impact on the financial forecasts of the Trust.
2.3.3 Key financial assumptions
The key assumptions relating to activity and capacity that underpin the
financial plans are as follows:
• Underlying growth in elective and new out-patient activity is projected at
prudent, low annual rates following delivery of the 18-week referral-to-
treatment target in 2008 and Commissioners intentions.
• Full account is taken of implementation of the Greater Manchester PCTs’
decisions following the ‘Making it Better’ consultation, in relation to
children’s services where local secondary care provision will transfer to
Salford Royal and North Manchester General Hospitals respectively,
alongside the timing of transferring tertiary and specialist children’s
services into our New Children’s Hospital in 2009.
• Similar account is taken of the commitment, also following ‘Making it
Better’ decisions, for growth in Obstetrics provision to an annual number
of births reaching 6,600 following the move into the new St Mary’s
Hospital in 2009, which achieves the required capacity.
• Based on the demand trends of 2008/09 growth in non-elective medicine
activity has been built into the 2009/10 plans. After this year schemes
being developed by the commissioning PCTs are expected to be fully
operational, so no further growth has been assumed.
• Other than in these three areas, non-elective activity projections are ‘flat-
lined’ at 2008/09 actual levels across all other services, which reflects the
most recent trend experience, in its overall impact.
• Planned step-by-step further expansion of the specialist children’s Critical
Care facilities and in 2013 a major expansion of the adult Critical Care
services, to ensure capacity to deliver more intensive and high
dependency care in support of a continuing growth in the most complex
and intensive aspects of our patient case-mix.
23

24. Future Business
Plans
• Identified pipelines of specific specialist service developments from each
Division are included. Much of the growth is in high cost/low volume
activity areas, such as renal transplant and specialist children’s services.
The impact of these activity assumptions has been tested against existing
bed capacity plans in our New Hospitals Development, and this work confirms
that the Trust can deliver all aspects of these plans from an operational
perspective.
Our projections have also been tested through ongoing substantive
discussions with our two leading commissioners, the North West Specialised
Commissioning Team and Manchester PCT. The forecast impact of the
overall position across government finances, on future allocation of resources
to the health sector, particularly from 2011 onwards, has been taken fully into
account.
The key assumptions in relation to the Income and Expenditure are as
follows:
• Income inflation is as follows:
Table 2.5: Income Inflation Assumptions
Inflation - Base Case 2009/10 2010/11 2011/12 2012/13 2013/14
Tariff inflation 1.7% 0.0% -1.0% -1.0% -1.0%
Non-Tariff inflation 1.7% 0.0% 0.0% 0.0% 0.0%
Non NHS Clinical income inflation 1.7% 2.0% 2.0% 2.0% 2.0%
Education & Training 1.7% 1.0% 0.0% 0.0% 0.0%
Research & Development 0.0% 0.0% 0.0% 0.0% 0.0%
Other income 3.0% 2.0% 2.0% 2.0% 2.0%
• We will continue to strengthen our input and contribution to key
Department of Health Payment by Results (PbR) development work
programmes as national PbR policy and rules continue to evolve each
year. We have also strengthened substantially over the last year, our
arrangements to ensure accurate clinical coding is achieved (and within
tightening contract timescales for completion) appropriate to the full
clinical circumstances of our patient workload in each specialty.
• All further service developments will be assessed and managed within the
ongoing Business Case framework operated within the Trust, based on a
case by case assessment of each scheme.
• Specific service developments have been assessed on a case by case
basis to determine the forecast level of activity, related income and cost.
• We have estimated the financial impact of specific continuing cost
pressures such as Agenda for Change, the European Working Time
Directive, Modernising Medical Careers, Consultant Contract, NICE
drugs. These estimates fall within the framework of an overall assumption
regarding ‘tariff deflation’ on our NHS clinical income streams. For
24

25. Future Business
Plans
2010/11 onwards the assumption we make about the level of nationally-
determined efficiency built into tariffs, has been increased to around 4% in
line with our assessment of annual cost inflation pressures.
• Other inflation rates are:
Table 2.6: Other Inflation Assumptions
Inflation - Base Case 2009/10 2010/11 2011/12 2012/13 2013/14
Pay Costs 2.4% 2.0% 2.0% 2.0% 2.0%
Continuing incremental progression 1.0% 1.0% 1.0% 1.0% 1.0%
Drug Costs 1.7% 1.7% 4.0% 4.0% 4.0%
Clinical Supplies & Services 1.6% 1.8% 4.0% 4.0% 4.0%
Other Costs 3.0% 2.4% 4.0% 4.0% 4.0%
Unitary Charge 0.4% 2.0% 2.3% 2.5% 2.5%
• A full review and re-fresh of the financial dimensions of our PFI New
Hospitals Development has been undertaken. This reflects a
comprehensive updated assessment of the ongoing costs resulting, as
the summer 2009 commissioning of our New Hospitals Development
draws ever nearer. Experience now accumulated over the four years
since Full Business Case sign-off, together with the several significant
commissioning and operational transfer milestones already completed,
has been fully reflected in this update. We are also maintaining our
contacts with other major hospital PFI sites, to ensure our understanding
of future and ongoing risks is informed by experiences elsewhere.
• Contributions towards the overall revenue affordability of our New
Hospitals Development, from the many areas of harmonisation and
consolidation within our clinical and supporting services, are now built into
our operating budgets as we move into the New Hospitals Development in
2009.
• Alongside these projections in relation to our NHS clinical service delivery,
we have updated our detailed forecasts covering research activities in
particular, in light of the withdrawal in 2009 of remaining historic NHS
‘levy’ funding for our Research & Innovation infrastructure. This
infrastructure is now fully recovered through income from our ongoing
research activities. Further development of our strengths in research over
coming years, will continue to build on our designation as a NIHR
Biomedical Research Centre from April 2008, together with the more
recent successful accreditation (by DH) of Manchester as one of five
Academic Health Science Centres in the UK.
• Similarly, specific developments relating to our Teaching and Education
income and activities, are reflected where these indicate any significant
variations in this aspect of our work within the forward planning horizon.
25

26. Future Business
Plans
The resulting I&E position is as follows:
Table 2.7: Forecast I&E Position
2009/10 2010/11 2011/12 2012/13 2013/14
£m £m £m £m £m
Income and Expenditure indicators
Income
NHS Clinical 529.6 548.5 561.4 574.6 586.8
Non-NHS clinical 10.2 10.5 10.6 10.8 11.1
Other income 116.5 102.0 101.0 101.6 103.1
TOTAL INCOME 656.3 661.0 673.0 687.1 700.9
Expenditure
Operational costs (592.3) (594.6) (603.9) (615.4) (625.7)
EBITDA (Earnings before Interest, tax, 64.0 66.4 69.1 71.7 75.2
EBITDA % 9.7% 10.1% 10.3% 10.4% 10.7%
Depreciation and impairments (32.6) (30.5) (31.9) (33.9) (37.6)
Interest payable/receiveable (23.6) (29.3) (30.4) (30.6) (30.2)
PDC dividend (7.3) (6.1) (6.1) (6.2) (6.4)
(63.5) (65.8) (68.4) (70.7) (74.2)
Surplus for the year 0.5 0.6 0.8 1.0 1.0
Surplus % 0.1% 0.1% 0.1% 0.1% 0.1%
2.3.4 Phasing
Income
Activity and the related income have been phased based on the number of days in a
month for non-elective activity and on working days in a month for elective and out-
patient activity.
Income relating to the funding of transitional costs has been phased to match the
trend of the costs (see below)
All other income is phased equally across the year.
Costs
Costs are generally phased equally across the year, however adjustments have been
made to reflect the following issues:
− Clinical supplies are phased in line with the activity and income profile
− Change in cost base when services are repatriated to Salford and North
Manchester following the closure of the Children’s Hospitals in June 2009
− Reduction in costs due to harmonisation of services when all services have
moved onto the one new site.
− One-off costs related to the move into the New Hospitals Development
(transitional costs). As the move takes place between May and August 2009 the
majority of the costs have been phased in this period.
26

27. Future Business
Plans
Working capital
The major items to affect the phasing of working capital and in particular the cash
balance are:
− receipt of Research & Innovation income;
− timing of cash settlements from Primary Care Trusts for contract over-
performance;
− half-yearly payments of PDC Dividend;
− receipt and spending of transitional funding around our hospital moves; and
timing of capital programme
2.3.5 Investment and disposal plans
Capital Investment
The major element of the capital plan for 2009/10 is the equipping of the New
Hospitals Development. This expenditure will have to be incurred by the end of
August and has been phased in the first two quarters of the year. The remainder of
the capital programme is spread across the year.
The major capital scheme for future years is the proposed adult Critical Care
development. An estimated capital scheme of has been included spread across
2010/11 to 2012/13, as a marker at this stage for the indicative level of capital
investment, in line with the outline Business Case currently being drafted. This
investment now appears in the capital plan due to the adoption of IFRS - which
removes the off-balance sheet financing method assumed in previous versions of the
long term financial model.
The Board will be considering this outline Business Case in July 2009.
2.3.6 Loans and working capital
Compliance with the Prudential Borrowing Code
The impact of the above borrowings on the Trust’s Prudential Borrowing Limit (PBL)
has been reviewed. This shows that the Trust’s loans will remain within the upper cap
of potential borrowing, defined in relation to a ‘Tier 2’ borrowing limit within Monitor’s
updated Prudential Borrowing Code (PBC):
Table 2.8: Impact of Borrowing on PBL
PBC Ratios Limits 2009/10 2010/11 2011/12 2012/13 2013/14
Minimum Dividend Cover >1 5.5 6.1 6.3 6.6 7.0
Minimum Interest Cover >2 2.7 2.3 2.3 2.3 2.4
Minimum Debt Service Cover >1.5 2.0 1.8 1.7 1.7 1.8
Maximum Debt Service to Revenue <10% 4.8% 5.7% 6.0% 6.0% 6.0%
However under the new PBC regime the following steps are expected:
− Monitor will provide the Trust with a ‘Tier 2’ limit to accommodate our existing
borrowing commitments, now including the finance lease creditor consistent with
the IFRS ‘on-balance-sheet’ accounting treatment for our New Hospitals
Development.
− The Board of Directors will consider making an application for an additional Tier 2
limit for 2010/11 to allow the adult Critical Care project to be financed. In line with
the Trust’s previous timetable, the Outline Business Case is due to be presented
to the Board of Directors in July 2009.
27

28. Risk Analysis
3 RISK ANALYSIS
3.1 GOVERNANCE RISK
3.1.1 Governance commentary
Legality of constitution
The constitution of the Trust was approved by Monitor at authorisation as a
Foundation Trust on 1st January 2009. Approval for any changes will be sought from
the members at the Annual Members’ meeting in September 2009.
Growing a representative membership
The Trust serves a diverse population and is mindful of ensuring that our
membership is representative of the population. We have actively managed a
number of recruitment initiatives and have specifically targeted under represented
areas. We plan to continue those initiatives that proved successful and introduce
some new ways of recruiting members (as set out in section 5.2). In particular we
plan to focus some of our recruitment on young people and socio economic groups
C2, D and E which are currently under represented across our membership.
Appropriate board roles and structures
The Board of Directors has overall responsibility for the operational and performance
management of the Trust. A good working relationship is being developed between
the Board and the Council of Governors.
As part of our preparation for Foundation Trust status the Trust reviewed the Board
roles and committee structure. A revised committee structure is now embedded
across the organisation. The committees of the Board monitor performance across
finance and activity, patient experience, risk and clinical effectiveness and are now
performing effectively in providing assurance to the Board of Directors.
A register of interests is kept and no director of the Trust has registered a material
conflict of interest.
One of the Non-executive Director’s term of office ends during 2009/10. A
replacement will be appointed in line with our constitution.
Service performance
Achievement of key targets is closely monitored, particularly through the Intelligent
Board report (see section 2.2.2 Quality). We have recently supplemented this
process with the introduction of a Standards Monitoring Framework that covers a
much wider range of standards and targets including for example the period
assessments undertaken for the Annual Health Check, Commissioning for Quality
and Innovation (QUIN), Advancing Quality and on-going national programmes of
clinical standards audit.
28

29. Risk Analysis
The framework ensures that:
- All external assessments over the coming three year period are mapped into
a three year rolling plan
- Early assessments are scheduled in to the plan in a timeframe that allows
results to be reviewed and corrective action taken if necessary
- Supporting data/information flows are set up and responsibility assigned
- Reporting and performance management mechanisms are set up
The framework is overseen by a Clinical Measures Group which is also responsible
for formally reviewing the Trust position against plan.
Using this framework the Trust is able to monitor and manage performance against
all targets, in particular those that are measured periodically or on an ad-hoc basis
through one off assessments, and assure the Board that the Trust is compliant
across the constantly increasing range of indicators.
The main service performance risks for 2009/10 are:
18 weeks
A&E target
Clinical quality
Over the last year the Trust has placed considerable emphasis on the development
of clinical quality measurement and using clinical effectiveness indicators and related
interventions to improve the patient experience. The Board of Directors receive
clinical quality reports as part of the Intelligent Board Framework and are able to drill
down to ascertain any existing risks and mitigation.
Moving into 2009/10 the Trust has signed up to the Patient Safety 1st initiative and
one of our key objectives is to deliver an integrated campaign across the Trust to
improve patient experience, clinical quality and customer service as described in
section 2.2.2.
Effective risk and performance management
The Trust’s Risk Management strategy describes the arrangements in place for the
identification, evaluation, control and reassessment of all types of risk.
The Risk Management Committee is chaired by the Chief Executive and monitors all
clinical and non clinical risk across the organisation. A report of significant risks is
presented at each Audit Committee and at each Board of Directors meeting.
All serious incidents are subject to Root Cause analysis; the outcomes of these
reports inform the risk registers, training needs and action plans.
The Audit Committee receives reports from Internal and External Audit and other
external assessment bodies. The tracking of recommendations is closely monitored.
The Trust achieved Level 2 accreditation Clinical Negligence Scheme for Trusts
(CNST) for General Services in 2008/09 and has Level 3 for Maternity Services.
We assessed ourselves as fully compliant with all the core standards within the
Health Care Commission’s Standards for Better Health.
29

30. Risk Analysis
The Finance Scrutiny Committee reviews the adequacy of mitigating actions agreed
to remedy financial variations from plan.
Performance management by the Board is through the dash board approach of the
Intelligent Board report. The three areas of performance management are:-
• Clinical quality and safety
• Patient experience
• Productivity and efficiency.
The report integrates activity, workforce and financial performance and has a subset
of performance indicators for each of the three areas.
Co-operation with NHS Bodies and local authorities
The Executive Directors meet regularly with their counter parts in Manchester PCT
and the Board of Directors has met the Board of the PCT. There is a strong working
relationship with our commissioners and specialist commissioning body.
We have established excellent links with Manchester City Council as part of our
corporate citizenship focus and are working jointly on initiatives such as the Health
Academy, local employment plans and Manchester’s economic development plan.
Our New Hospitals Development and our clinical academic campus are major
contributors to the development of Manchester.
Our research and innovation capacity combined with the Biomedical Research
Centre and the Manchester Academic Health Sciences Centre cements our already
strong relationship with the University of Manchester.
3.1.2 Significant Risks
The significant governance risks are:
Critical care - insufficient critical care capacity for future demand arising from
further concentrations and growth in specialist surgery
New Hospitals Development – scale and complexity of moves gives rise to
clinical and operational risks
A&E target – increases in pressure on the urgent care system compromise
our ability to deliver the 98% target
Surgery – a range of internal constraints and external drivers causing medium
term vulnerability
Laboratory services – technological and policy drivers exist for the
rationalisation of laboratories
18 weeks – remaining risks to achievement of 18 week target, particularly
during the hospital moves period
30

31. Risk Analysis
3.1.3 HCAI targets
The table below sets out the targets and actuals for 2008/09 and the 2009/10 targets
for MRSA and C Difficile.
Table 3.1: Targets for HCAI
Target Q1 Q2 Q3 Q4
MRSA 08/09 target 6 6 6 6
08/09 actual 6 5 3 3
09/10 target 6 4 5 4
C diff 08/09 target 77 75 75 75
08/09 actual 66 58 64 54
09/10 target 60 60 62 84
31

32. Risk Analysis
3.2 Mandatory Services Risk
3.2.1 Significant risks
There are no material risks to the Trust’s ability to comply with its authorisation
relating to the provision of mandatory services
3.3 Financial risk
3.3.1 Commentary on financial risk rating
Based on the financial projections in section 2, the Trust has a financial risk rating of
3, throughout the period.
3.3.2 Significant financial risks
See Future Business Plans
3.4 Risk of any Other Non-Compliance with the Terms of Authorisation
The New Hospitals Development is the biggest risk facing the Trust in 2009/10. The
Board of Directors has been provided with assurances that the risks associated with
the transfer of services have been addressed through peer reviews of plans, external
reviews of plans, reporting of KPIs and learning from organisations who have
recently delivered major service reconfigurations. These are described in more detail
in section 2.2.3
32

33. Declaration and Self-Certification
4 DECLARATION AND SELF-CERTIFICATION
Central Manchester University Hospitals NHS Foundation Trust
Board Statements
2009/10
Clinical quality
The board of directors is required to confirm the following:
the board is satisfied that, to the best of its knowledge and using its own
processes (supported by Care Quality Commission information and including
any further metrics it chooses to adopt), its NHS foundation trust has, and will
keep in place, effective arrangements for the purpose of monitoring and
continually improving the quality of healthcare provided to its patients; and
the board will self certify annually that, to the best of its knowledge and using
its own processes , it is satisfied that plans in place are sufficient to ensure
ongoing compliance with the Care Quality Commission’s registration
requirements
Service performance
The board of directors is required to confirm the following:
the board is satisfied that plans in place are sufficient to ensure ongoing
compliance with all existing targets (after the application of thresholds) and
national core standards and a commitment to comply with all known targets
going forwards;
Risk management
The board of directors is required to confirm the following:
issues and concerns raised by external audit and external assessment groups
(including reports for NHS Litigation Authority assessments) have been
addressed and resolved. Where any issues or concerns are outstanding, the
board is confident that there are appropriate action plans in place to address
the issues in a timely manner;
all recommendations to the board from the audit committee are implemented
in a timely and robust manner and to the satisfaction of the body concerned;
the necessary planning, performance management and risk management
processes are in place to deliver the annual plan;
a Statement of Internal Control (“SIC”) is in place, and the NHS foundation
trust is compliant with the risk management and assurance framework
requirements that support the SIC pursuant to the most up to date guidance
from HM Treasury (see http://www.hm-treasury.gov.uk);
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34. Declaration and Self-Certification
The trust has achieved a minimum of Level 2 performance against the
requirements of their Information Governance Statement of Compliance
(IGSoC) in the Department of Health’s Information Governance Toolkit; and
all key risks to compliance with their Authorisation have been identified and
addressed.
Compliance with the Terms of Authorisation
The board of directors is required to confirm the following:
the board will ensure that the NHS foundation trust remains at all times
compliant with their Authorisation and relevant legislation;
the board has considered all likely future risks to compliance with their
Authorisation, the level of severity and likelihood of a breach occurring and
the plans for mitigation of these risks; and
the board has considered appropriate evidence to review these risks and has
put in place action plans to address them where required to ensure continued
compliance with their Authorisation.
Board roles, structures and capacity
The board of directors is required to confirm the following:
the board maintains its register of interests, and can specifically confirm that
there are no material conflicts of interest in the board;
the board is satisfied that all directors are appropriately qualified to discharge
their functions effectively, including setting strategy, monitoring and managing
performance, and ensuring management capacity and capability;
the selection process and training programmes in place ensure that the non-
executive directors have appropriate experience and skills;
the management team have the capability and experience necessary to
deliver the annual plan; and
the management structure in place is adequate to deliver the annual plan
objectives for the next three years.
Signature……………………………… Signature………………………………
Printed name…………………………. Printed name………………………….
Date………………………………..….. Date……………………………..……..
In capacity as Chief Executive & In capacity as Chairman
Accounting Officer
Signed on behalf of the board of directors, and having regard to the views of the
governors
34

35. Membership
5 MEMBERSHIP
5.1 Membership report
Membership Size and Movements
Public Constituency Last Year Next Year
2008/09 2009/10
At Year Start (April 1) 4,636 8,329
New Members 4,324 2,480
Members Leaving 631 809
At Year End (March 31) 8,329 10,000
Staff Constituency Last Year Next Year
2008/09 2009/10
At Year Start (April 1) 8,965 8,664
New Members 1,147 1,136
Members Leaving 1,448 1,200
At Year End (March 31) 8,664 8,600
Note – Staff opt out of membership. Staff numbers fluctuate during the year.
Service reconfigurations and hospital moves as part of our New Hospital
Development have been taken into account.
5.2 Membership Commentary
Constituencies and changes in membership numbers
The Trust serves its local population for secondary services and provides specialist
services to the residents of Manchester, Greater Manchester and England and
Wales.
There are two membership constituencies, a public constituency and a staff
constituency.
Within the public constituency are 3 areas:-
• Manchester
• Greater Manchester
• Rest of England and Wales.
Within the staff constituency are 4 categories:-
• Medical and Dental
• Nursing and Midwifery
• Non clinical and support
• Other clinical staff.
Staff are members on an ‘opt out’ basis.
35

36. Membership
Elected governors are drawn from each of these constituencies, totalling 23
governors (17 public and 6 staff).
Eight governors are nominated by our partner organisations. Our partner
organisations are:-
• The University of Manchester
• Manchester PCT
• NHS North West Specialist commissioning
• Manchester City Council
• The Youth Forum.
Membership has grown steadily over the past year due to a number of initiatives.
These have included the following:-
• Working with patients and the public through our patient partnership
department to encourage membership
• Production of a newsletter for existing members including a membership
form for family and friends
• Friends and family initiative for staff
• Children’s youth forums, wards and schools visited to encourage
membership
• Lead nurses and ward managers have been fully briefed and supplied
with membership forms to encourage patients to become members when
discharged
• A series of presentations on local radio
• Targeted telephone recruitment
• Distribution of membership forms to:-
- University of Manchester staff – direct mailing to home addresses
- Multi-Faith groups
- Previously discharged patients on a monthly basis
- Retired staff
- Patient groups
- Community groups
- Trust’s charity donors
- Outpatient departments
• Updating our Foundation Trust website and made it an integral part of the
new Trust website.
The recruitment of discharged patients has been particularly successful as has the
targeted recruitment of the Chinese community which had been shown to be
significantly under represented through out regular analysis of our membership.
Our public membership for our first year as a Foundation Trust has exceeded our
target of 8,000 and stands at 8,329.
Plans to develop a representative membership
Our plans for 2009/10 centre on growing the overall membership base and using
specific initiatives to target under-represented groups,
We have developed a Membership working group for our Governors with the first
meeting held in January 2009. A workshop took place in March 2009 with the focus
36

37. Membership
on reviewing the membership strategy and the communication and engagement plan
with the governors. Our governors will play a pivotal role in identifying initiatives for
raising the profile of the membership, keeping our members informed and updated
about the work of the Trust and agreeing on the future action for membership
recruitment.
Communication with our membership involves a dedicated section of our website and
regular newsletters and our governors receive an e-bulletin from the Chairman each
month.
A week long community event at the Trust in March 2009 enabled Governors to
recruit additional members from the local community and in particular, successfully
engaged with young people from a number of local schools.
We are able to learn from the level of success of recruitment of members through
previous initiatives and rationalise efforts where the return of membership recruitment
was low and build on some of the previous initiatives which were successful.
Contacting our discharged patients with the invitation to become a member has
proved very fruitful and we plan to continue this and expand this in to areas not
previously covered e.g. maternity and young people.
Future actions for 2009/10 include:-
• The publishing of posters for internal locations and external key areas in
the community – supermarkets, dentist/doctor surgeries, libraries for
example
• Further mail shots to recently discharged patients
• Mailing to staff leavers inviting them to become public members
• Continuing work with community groups in order to build a representative
profile of members from the community
• Continuing with our work with patient groups
• Further road shows within the Trust to continue to promote interest and
improve understanding of governance arrangements
• Tele-recruiting to target under represented areas/groups
• Membership news item in Manchester City Council’s newspaper
(circulation 200,000)
• Targeted recruitment of young people at the Universities and Colleges
across Manchester e.g. open days, freshers’ week and websites.
We regularly review the make-up of our membership. Based on a recent analysis we
have found that young people and people from socio economic groups C2, D & E are
under- represented at present. We plan to have a focused campaign on recruiting to
these groups.
Another challenge we face is ensuring member representation from our England and
Wales constituency and we will be working with our governors from this constituency
to address this.
37

38. Membership
Mechanisms by which the Board review membership plans, growth and engagement
during the year
The Board receives regular reports on membership recruitment including initiatives
taking place, analysis of the membership profile and notification of community and
membership events.
The minutes of the Membership working group for Governors are reported to the
Council of Governors and noted by the Board of Directors.
We are planning to incorporate performance against our membership numbers and
profile into the Intelligent Board reports. Through our governors, we are also
planning to involve our directors in further engagement with our members.
Explanation for the membership plan for the future and measures to increase
engagement
We detailed earlier a number of initiatives we have planned for 2009/10. Working
closely with our patient partnership department we plan to actively work with our
patient members during the year to ensure their views are sought. Local events and
meetings with the local community will be targeted to recruit new members.
We aim to ensure that our annual members meeting is well publicised so that
attendance is high and our governors can meet and talk to the members.
Through our Governor Membership working group in addition to monitoring the
membership profile and reviewing the membership strategy, we plan to develop ways
that governors can build a meaningful relationship with members and carry out their
role as the conduit between the membership and the Board of Directors. The working
group reports to the Council of Governors. Our governors’ own networks will be
explored as a means of building our membership base and profile.
Our newsletter ‘Foundation Focus’, which is sent to all members and is on our
website, will be used to promote membership. The newsletter will also enable us to
seek the views of the membership on various topics through questionnaire inserts.
Development of our governors will continue throughout the year with the provision of
dedicated sessions and workshops, a number of which will include our Board of
Directors. These will enhance the performance of our Governors in supporting the
membership through their representation on a number of committees and working
groups of the Council of Governors:-
• Appointments Committee
• Remuneration Committee
• Membership Working Group
• Patient Experience Working Group
• Public Health Working Group
• Corporate Citizenship Working Group
The following appendices are attached:
Appendix A - public membership numbers by area.
Appendix B - membership profile as a percentage of total membership by area
Appendix C- membership profile showing deviation from base population by area
38

39. Membership
Election turnout and trends
The Board of Directors can confirm that the elections for public and staff governors
were held in accordance with the election rules as stated in the constitution approved
by Monitor.
Elections were held during June 2008 to establish a shadow Council of Governors
prior to authorisation on 1st January 2009.
All public governors were elected in the June 2008 elections. All staff governors other
than in the Medical and Dental category were elected in June 2008. No nominations
had been received in time for the Medical and Dental category. A by-election was
held in September 2008 and one governor was elected. One staff governor (nursing
and midwifery) resigned in March 2009. A by-election is planned for April 2009.
The following is a breakdown of the turnout at the elections in June and September
2008. Through the governors we will work to improve the turnout at forthcoming
elections in 2009. The percentage turnout is a good indicator of Member
engagement and ways of promoting the elections will be explored.
Elections: Public & Staff – June and September 2008
Date of Constituencies Number of Number Number of Election
Election Involved Members in of Seats Contestants Turnout
Constituencies Contested
June 2008 Public - 2,695 9 32 30.7%
Manchester
June 2008 Public - 1,738 2 15 39.6%
Greater
Manchester
June 2008 Public - Rest 451 2 4 43.7%
of England
and Wales
The 4 contestants with the next highest number of votes are also elected
June 2008 Staff - Medical 1 0 No election
and Dental held
June 2008 Staff – Nursing 3,679 1 6 15.1%
and Midwifery
June 2008 Staff – Non- 1 1 Uncontested
Clinical and
Support Staff
June 2008 Staff – Other 1,471 1 5 19.6%
Clinical Staff
The 2 contestants with the next highest number of votes are also elected
September Staff – Medical 792 1 5 24.7%
2008 and Dental
39

40. Appendices
40

41. Appendix A – Public Membership Numbers by Area
Rest of
City of National Statistics Greater National Statistics England and National Statistics
Manchester City of Manchester Manchester Greater Manchester Wales Rest of England Totals
Number of
Members 4,766 336,927 2,849 1,790,773 714 42,811,357 8,329
Rest of
City of National Statistics Greater National Statistics England and National Statistics
Gender Manchester City of Manchester Manchester Greater Manchester Wales Rest of England Totals
Female 2,427 172,617 1,436 919,525 339 21,977,559 4,202
Male 2,245 164,315 1,371 871,277 350 20,833,763 3,966
Unknown 94 0 42 0 25 0 161
Rest of
Monitor City of National Statistics Greater National Statistics England and National Statistics
Ethnicities Manchester City of Manchester Manchester Greater Manchester Wales Rest of England Totals
White 3,059 272,769 2,346 1,664,804 586 39,097,497 5,991
Asian 795 30,773 250 89,253 38 1,843,182 1,083
Black 555 15,215 98 10,291 14 958,710 667
Mixed 102 10,870 30 17,336 8 542,603 140
Other 76 7,305 35 9,117 6 369,330 117
Unknown 179 0 90 0 62 0 331
Rest of
City of National Statistics Greater National Statistics England and National Statistics
Age Range Manchester City of Manchester Manchester Greater Manchester Wales Rest of England Totals
0-16 104 31,962 152 174,421 32 3,848,018 288
17-21 131 40,585 86 121,042 43 3,027,359 260
22+ 3,852 264,380 2,344 1,495,310 603 35,935,980 6,799
Unknown 679 0 267 0 36 0 982
Rest of
City of National Statistics Greater National Statistics England and National Statistics
NRS (Age 16+) Manchester City of Manchester Manchester Greater Manchester Wales Rest of England Totals
ABC1 2,885 126,756 1,961 780,231 486 20,092,828 5,332
C2 240 35,690 431 258,585 92 5,855,653 763
D 18 66,574 89 314,825 14 6,595,231 121
E 1,610 65,788 363 269,139 47 6,205,246 2,020
Unclassified 13 0 5 0 75 0 93
41