2012-13 - wye valley nhs trust · 2013-10-09 · annual report and summary financial statements...

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2012-13Annual Report and Summary Financial Statements

Annual Report and Summary Financial Statements 2012-13

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Welcome......to Wye Valley NHS Trust’s Annual Report and Summary Financial Statements.

Our Annual Report provides a summary of our performance for the year 2012-13 and a look forward to the coming year.

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We strive to ensure that the patients and communities we serve get the best possible care. For us, that means providing the right care, in the right place at the right time. It means providing care with compassion, it means treating all our patients and service users as if they were our friends and family, and it means always trying to improve and deliver care to the highest standards.

Over the past year Wye Valley NHS Trust has continued to improve experiences for patients and service users, as detailed throughout this Annual Report. The benefits and efficiencies of being a single health and social care provider have helped us to do this, as we have sought to reduce costs while improving quality and performance.

Unannounced visits by the Care Quality Commission Inspectors gave us top marks at the County Hospital and Leominster Community Hospital. The quality of the food we provide across all five of our sites was also recognised as part of an NHS assessment.

New facilities and technology have helped us to improve experiences for patients and many more people can now be treated closer to home. The new endoscopy unit at Ross-on-Wye Community Hospital uses the most advanced technology available. This will help with early diagnosis and treatment, as well as reducing waiting times.

Last summer a CT scanner was installed which is already benefiting 11,000 patients a year and the new MRI scanner came into use in the autumn. We are also pleased to announce that the long awaited Radiotherapy Unit is due to welcome its first patients in 2014.

We know that ultimately it is our staff who put the “care” into the health services we provide. We also recognise that our many volunteers make a real difference to our patients’ experience, including the team behind Hereford Hospital Radio which celebrated its 40th anniversary this year.

Chairman and Interim Chief Executive’s foreword

We are operating in tough economic times and we know we face tough challenges ahead. We required further support from the Strategic Health Authority last year and we know this is not sustainable. That’s why we are looking to the future and exploring how we can best deliver the services we provide in a sustainable and financially viable way. (See page 5 on the Wye Valley Futures Project.)

Finally, we welcome colleagues on the newly-formed Herefordshire Clinical Commissioning Group and look forward to working with them to improve and enhance healthcare services.

Mark CurtisChairman

Derek SmithInterim Chief Executive

Wye Valley NHS Trust continues to put people at the heart of healthcare.

Providing a quality of care we would want for ourselves, our families and our friends.

Vision, Mission and Values

VisionWye Valley NHS Trust exists to improve the wellbeing, independence and health of the people it serves in Herefordshire and surrounding areas.

MissionOur mission is to provide a quality of care we would want for ourselves, our families and our friends.

ValuesThe values that guide us can be summarised by the ‘five Ps’: people first, passion for excellence, personal responsibility, pride in our team and promoting thriving communities.


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Ten Strategic ObjectivesThe Trust’s strategy is based upon:

Primary-objectives: • Enjoy a reputation for, and be able to demonstrate, exceptional

quality, safety and customer service • Achieve sufficient financial prosperity to enable services to be

sustained and developed.

Service delivery objectives: • Deliver community focused and integrated health and social care

services • Deliver a clinically sustainable portfolio of secondary care services • Extend our range and, where appropriate, the volume of health and

social care services.

Supporting strategies: • Workforce: Be an excellent employer, enabling us to recruit, develop

and retain the workforce we need

• Technology: Deploy technology to support the quality, efficiency and user friendliness of our services

• Estate: Use our assets efficiently and effectively to provide care in a first-class environment

• Organisation: ‘Fit for purpose’ to fulfil our primary objectives

• Partnership: Work proactively with partners to help us realise our mission.

A major programme which will shape the future provision of health care services, provided by the Trust, is underway.

Wye Valley NHS Trust Futures Project

Wye Valley NHS Trust will seek to review whether it could attain Foundation Trust Status as a stand alone organisation as part of a rigorous review of all options.

The potential options, outlined below, have been developed with Trust stakeholders and partners at a series of events held during February and March, and approved by the Trust Board to be explored and analysed:

• Re-examining whether there could be sufficient change in services delivered and organisational shape to enable the Trust to ensure financial stability and seek a route to Foundation Trust Status

• Wye Valley NHS Trust becoming the partner of a Trust which has already attained Foundation Trust status. This would maintain local accountability

• Wye Valley NHS Trust going into partnership with an independent organisation and run as a local franchise where all staff and assets would remain in the NHS and care would remain free at the point of delivery

• Break up Wye Valley NHS Trust and disperse its services to be run by a range of providers (which could be both public and/or independent sector)

• Include primary care services (such as GPs) in the Trust, creating a one-stop shop for health

• The Trust increasing the number of patients it serves and therefore increasing its income.

This process began with meetings of representatives from key organisations and groups across the county representing those who commission, support and deliver health and social care services in Herefordshire.

These are only options at this stage and once these are developed, a wide programme of engagement will begin, involving patients, staff, members of the public and those involved in the commissioning, delivery and support of health and social care services in Herefordshire.

We will work closely with patients and staff to ensure that whichever way we go forward, it is in the best interests of those using our services.

High quality patient care will always be our priority and this will be the driving force behind any decision that is made.

It has been a long standing government policy for all NHS Trusts to achieve Foundation Trust Status either as a standalone organisation or via a transaction process to a suitable alternative form.

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Neighbourhood TeamsWe have restructured our Neighbourhood Teams into five Neighbourhood Zones and appointed five new Health and Independence Managers to the multidisciplinary teams. Our five Zones are:

• Ross and Golden Valley• Leominster and Kington• Ledbury and Bromyard• City North• City South.

Using technology for mobile workingWe are piloting a range of new technologies such as toughbooks, smartphones and digital pens to help us work better in the community by reducing paperwork and having better access to up-to-date work schedules and information. This pilot will continue through the coming year.

Single Point of Access across HerefordshireOur Single Point of Access service is used by health and social care professionals, including GPs, and by members of the public. It links people to appropriate health, social care and other support services, and makes referrals to our neighbourhood and community teams. In this year alone, more than 1,000 hospital admissions have been avoided as a result of the expertise provided by this service in directing people to appropriate services. The service has developed close links with the local Carers’ Association to improve access to help and support for carers.

Supporting people to live independentlyAll service users are offered a personalised budget to manage their own care package independently, if they wish. There has been an increase in the number of people using a variety of self-directed support options, with a total of 60% of all service users now opting for these packages of care.

Effective service units providing excellent healthcare

Care Closer to HomeProviding local care wherever possible – benefiting patients, service users, their families and carers, and enabling us to make more efficient use of our resources, such as our Single Point of Access service.

1. Care Closer to Home2. Integrated Family Health Services3. Urgent Care4. Elective Care

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Showcasing our skillsOur Learning Disability Specialist Service showcased their innovative therapy programme for learning disability service users at a national conference at St Andrew’s Healthcare, Northampton. A video, developed by two members of the Specialist Learning Disabilities Team, demonstrated their work for learning disability clients attending our Dialectical Behaviour Therapy (psychological therapy) Group, to ensure they were getting maximum benefit from the programme.

Coventry and Warwickshire Partnership NHS Trust are planning to visit the team to share the work being done in Herefordshire.

Focus on Multiple-sclerosis service An Occupational Therapist has been appointed to work alongside the Multiple-sclerosis Clinical Nurse Specialist at Gaol Street Health Centre to help service users maximise their independence and quality of life, focusing on areas such as: fatigue management, vocational rehabilitation, accessing computers/environmental control technology, handwriting and feeding assessments and strategies to support cognitive decline.

Quality accredited servicesUnder a new Department of Health initiative, Any Qualified Provider (AQP), patients can choose from a variety of community services, paid for by the NHS from local AQP service providers, as well as, the local health service.

Wye Valley NHS Trust has qualified as an accredited provider (AQP) for Back and Neck Pain services, Podiatry and Nail surgery – a service delivered by our Care Closer to Home service unit.

Wye Valley NHS Trust is the only accredited provider of Podiatry services in Herefordshire and from January 1 2013 the Trust was one of only a few accredited local providers of Musculoskeletal services for Back and Neck pain.

Improving services for supported adultsWe have implemented a number of improvements for adults who require additional support and who live with carers, including the development of an education and training programme specifically for carers.

A quality assurance survey process is now in place to record our performance and has already shown increased satisfaction: 100 per cent of carers say they have adequate training and development opportunities; 96 per cent of carers say the scheme is always/usually a good scheme to work with.

Integrated Family Health Services

We are committed to delivering right care in the right place, at the right time, every time, and we have developed a number of initiatives.

Specialist breastfeeding supportAdditional advice is now available to new mothers on the maternity ward from community nursery nurses as well as support from midwives. More than 75 per cent receiving this service were still breastfeeding at their six-week check.

We are working towards UNICEF baby-friendly accreditation, which is a way of ensuring that we are providing the best possible support to mothers wishing to breastfeed.

Promoting normal deliveriesA midwife-led clinic enables women to discuss why they had a previous Caesarean section and whether a normal delivery might be an option.

We anticipate that more than 80 per cent of women who would previously have had a second Caesarean section will have a normal delivery.

Maternity triage serviceA dedicated telephone advice service is available for women and their partners if they have any questions or require an assessment at the midwifery triage unit. The new unit:• assesses a woman within 30 minutes of arrival• ensures a medical review is undertaken within the hour• admits the woman to the delivery suite if needed, or discharges

her home with a plan of care if she doesn’t need to be admitted immediately.

Feedback on the new service has been very positive.

Supporting midwives with more training Our new midwifery academy is providing midwives at every level with additional specialist advice, support and continuous training and development from highly trained midwifery experts.

More than 2,000 women in Herefordshire are supported by midwives every year. Our new academy helps us continue to improve maternity services for families across the county.

Health Visiting Academy boosts numbers The Government is committed to increasing the numbers of health visitors nationally by 4,200, and we have responded to this by setting up a new Health Visiting Academy to ensure a high quality training and recruitment programme for health visiting students locally.

19 students have been enrolled in the academy; seven Health Visitors are training to become Community Practice teachers and four to become student mentors. All newly qualified health visitors have secured posts in Herefordshire and Worcestershire.

The academy ensures that students link theory with practice delivered locally in Herefordshire, while learning in a safe and supportive environment. This has been particularly important in relation to the safeguarding of children and vulnerable adults.


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Ranging from hospital-based services such as Gynaecology to community services like Health Visiting.

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New and improved antenatal support Our health visiting and midwifery team has worked closely with Children’s Centres to further improve the support available to families in the community.

Following a successful pilot, three new antenatal group sessions are provided and 62 per cent of parents say their confidence in supporting their baby’s emotional development has increased after attending the classes: • Midwife – focused on labour and birth• Health Visitor – for the journey to parenthood, baby brain

development, and the emotional health and wellbeing of parents and their infant

• Community Nursery Nurse and Family Support Worker – practical care of the newborn baby.

Providing care for children closer to home Our Community Nursing team has trained support workers to care for the increasing numbers of children with complex high dependency care needs in their own homes. This has resulted in some children being discharged from hospital more quickly.

Integrating children’s care A Lead Nurse for Paediatrics has been appointed to integrate acute and community services for children both in and out of hospital to provide a seamless service. Joint posts have been introduced across the Children’s Ward and Community Children’s Nursing teams and best practice is shared and implemented.

Sexual Health services respond to patient needs We have changed the opening hours of our clinics to meet the needs of our patients, which now includes an extended young people’s clinic and a lunchtime express checkout clinic. Gaol Street Health Centre has been refurbished to modernise its facilities for patients, visitors and staff.

In a survey of nearly 400 patients, 89 per cent said they would recommend the service.

Promoting safe clinical practice A new newsletter for staff focuses on promoting safe clinical practice at work as part of our clinical governance strategy to share learning.

Urgent Care

Meeting the challenge We have been doing well despite unrelenting pressures on our services. However, the increase in emergency medical admissions and A&E attendances is having a significant impact at The County Hospital in particular, resulting in under performance in the year in respect of patients waiting longer than four hours to be seen, during the last quarter.

To co-ordinate our response and manage the pressures safely, our incident control team, which has an overview across the entire organisation, was activated to monitor the number and distribution of emergency referrals and discharges. We were supported by the local Clinical Commissioning Board and Herefordshire Council Adult Social Care Commissioners.

Members of staff have responded with exceptional resolve and continue to provide the highest possible standard of care for our patients.

During the winter pressures, we implemented a new clinical A&E IT system, in January, which provides comprehensive real time information on the status of all patients, helping us to deliver more effective care. This has enabled A&E to go paperless.

The system also provides information to the control room and the bed management team.

Patients rate A&E highly Patients have rated the County Hospital’s A&E service highly. Results from a survey of our patients were included in a national report published by the Care Quality Commission. Together with feedback from our patient experience team, the survey is informing on-going work to further improve our services.

Minor Injury Units (MIU) reviewThe decision to reduce our Minor Injury Units opening hours was taken, supported by Herefordshire Primary Care Trust, to protect the clinical safety of patients at MIUs and in community hospitals, and the safety of staff who have to treat patients alone at night.

A review of our MIUs is being undertaken by the Herefordshire Clinical Commissioning Group which is due to be completed in 2013-14.

A rotation of the Emergency Nurse Practitioners at The County Hospital A&E and the MIUs is in place, and an additional emergency night practitioner at Hereford’s A&E helps maintain high quality services.

Helping patients return home soonerThe County Hospital Admissions Ward has been replaced with a new Acute Assessment Unit (AAU) and Short Stay Unit (SSU). This allows senior doctors to review patients more quickly.

This is aimed at enabling patients to go home sooner.

Stroke services in top quartileOur integrated stroke team consistently meets Key Performance Indicators (KPIs) and quality targets (SINAP) for in-patient stroke services, placing us in the top quartile nationally.

In line with the East Midlands Stroke Review Board requirements for 2013-15, we have identified where further improvements can be made and they are already underway in hyperacute services and early facilitated discharge. An additional stroke consultant has been recruited to support the on-going improvements.

We are also working towards providing a seven day Transient Ischemic Attack (mini stroke) service.


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Including our Accident and Emergency (A&E) service, inpatient wards, medical speciality departments and diagnostic departments.

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More local services in Cardiology Many patients who need implantable cardioverter defibrillators and cardiac resynchronisation can now be treated at The County Hospital instead of having to travel elsewhere, thanks to a new service being led by Dr Jim Glancy.

New scanners improve patient services A new £1m digital MRI scanner has been installed at The County Hospital in Hereford.

The scanner, the first digital MRI system available for use, provides better quality images which helps improve diagnosis, a wider tunnel and shorter scanning time to improve the overall patient experience.

A new CT scanner went operational in June 2012, providing patients with access to the latest diagnostic technology, both improving images to aid diagnosis and reducing scan times.

More than 11,000 patients a year in Herefordshire have a CT scan at The County Hospital to diagnose and monitor a variety of health conditions.

Urgent Care activity

Key Target 2010/11 2011/12 2012/13

Total time in A&E: four hours or less 96.0% 95.5% 94.8%

Total time in A&E: two hours or less 56% 59% 55%

Activity 2010/11 2011/12 2012/13Increase/Decrease

12/13 on 11/12

Minor Injury Unit Attendances 7821 7888 5791 -26.6%

A&E Attendances 47495 48387 48118 -0.6%

Emergency Spells 20459 20965 20297 -3.2%

Community Bed days 39932 36543 37149 1.7%

Reduction in emergency spells is largely as a result of changes to the service delivery within maternity. Maternity Services introduced a triage system from August 2012, which resulted in approximately 116 fewer admissions per month (approximately 900 across the rest of the year).

Elective Care

Shorter stays in hospital New techniques are reducing stays in hospital and improving recovery times for:

• hip and knee replacements – the latest techniques mean a much shorter stay in hospital for our patients, just three days, and reduced post-operative pain enabling patients to get back their mobility earlier.

• symptomatic gallstones and with additional bile duct stones – patients can be treated in a single operation, rather than two separate procedures, as day case patients.

• laparoscopic (keyhole) hernia operations – an additional consultant surgeon specialising in minimally invasive surgery has been appointed, which has increased the number of operations we can offer as daycases.

Pre-surgery assessment streamlinedOur new one-stop pre-surgery service means patients have their pre-surgery fitness assessment on the same day as their consultant appointment, when the decision for surgery is made. Alternatively, patients are offered a separate pre-surgery fitness assessment.

As well as assessing patient fitness for anaesthesia, arrangements are made for their admission, discharge and post-operative care at home, promoting patient health and wellbeing with advice on topics such as smoking cessation, reducing alcohol intake, and diet management.

Educational workshops for patients undergoing specific surgeries, such as joint replacements, are now compulsory, preparing them for surgery and enhancing recovery. A new women’s health surgery education workshop has also recently been introduced.

Eye unit expands There are now five ophthalmology consultants in the eye unit thanks to the recruitment of ophthalmologist consultant Mr George Morphis. This means we are able to treat more patients.

Mr Morphis has a special interest in retinal diseases such as age-related macular degeneration (ARMD) and retinal conditions which require surgical intervention, including retinal detachment. At present, patients with retinal detachment have to travel to Birmingham, Cardiff or Bristol for surgery. Mr Morphis will develop a surgical retina service, so that more of these patients can be treated locally.

Top results for cataract surgery Patients having cataract operations have shown improved levels of vision than in comparable national and international studies.

More than 95 per cent reported high levels of satisfaction with the vast majority “very happy” and awarding a score of 5/5.

Immediate breast reconstruction Mr Iqbal Kasana, Consultant Breast Oncoplastic, Reconstructive and General Surgeon has been appointed at The County Hospital following the retirement of Mr Allan Corder. Mr Kasana is able to offer additional surgeries including mastectomies with immediate breast reconstructions where appropriate.

Podiatric Surgery and Belmont Day Surgery UnitThe scope of disciplines using the Podiatric day surgery facility at Belmont in Hereford now includes Orthopaedic work, Plastics and Dermatology, which means we can treat more patients.


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Surgical specialities, Cancer (Oncology & Palliative Care) services, Outpatients services, Audiology, Dental and Pharmacy and Medicines Management.

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Delayed DischargesThe improvement seen from November 2010 into 2011-12 continued into 2012-13 with the average number of delayed discharges per month being 2 compared to 15 during 2010-11.

18 week referral to treatment

Key Target 2010/11 2011/12 2012/13

18 week referral to treatment – Admitted Patients* 99.1% 94.3% 97.8%

18 week referral to treatment – Non Admitted Patients** 99.5% 99.3% 99.8%

*The key target for 18 week referral to treatment admitted is 90% within 18 weeks.

** The key target for 18 week referral to treatment non-admitted is 95% within 18 weeks.

Community hospitals

Activity 2010/11 2011/12 2012/13

Increase/Decrease 2012/13 on

2011/12

Daycase Spells 1,363 1,420 1,647 16.0%

New Outpatient Attendances 16,795 16,409 14,843 -9.5%

Follow Up Outpatient Attendances 51,176 53,466 52,015 -2.7%

Acute hospital

Activity 2010/11 2011/12 2012/13Increase/Decrease

2012/13-2011/12

Elective Spells 4,081 4,636 4,536 -2.2%

Day Case Spells 13,328 14,395 14,273 -0.8%

New Outpatient Attendances 62,928 64,529 67,441 4.5%

Follow Up Outpatient Attendances 137,372 141,259 149,682 6.0%

Did Not Attends (DNAs)The percentage of Did Not Attends continues to fall from a high of 9.0% in 2009-10 to 5.3% in 2012-13. The Trust continues to improve communication with patients to ensure appointments are appropriately attended and clinic efficiency used to its maximum. Next year we will provide a text service to remind patients of

their appointments.

Going Further on Cancer Waits

The 2012-13 data below is presented in line with the national guidance reporting.

Key Performance Indicators Key target 2012/13 2012/13Cancer Two Week Waits* 93% 95.8%Two Week Waits (Breast Symptomatic)** 93% 90.1%Cancer 31 Days 96% 100%Cancer 31 Days Subsequent Treatments 94 - 98% 99%Cancer 62 Days 85% 87.1%Cancer 62 Days Screening 90% 96.2%Cancer 62 Days Upgrades (no National Target set) (no National Target set) 100%Cancer 62 Days Rare cancers (31 Days) 85% 100%

* Cancer Two Week Waits – GP suspects cancer and patient offered referral within two weeks.

** Two Week Waits (Breast Symptomatic) – GP or other relevant health professional referred patient for breast symptoms but did not suspect cancer. All patient’s referred onto this pathway are given an appointment date within the 14 day threshold. This year, 61 patients out of a total of 614 patients, chose not to accept an appointment within the 2 week target, resulting in the Trust not meeting this national target.

Quality and Safety

When inpatients are discharged from acute hospital or A&E, or within 48 hours of hospital discharge, they will be asked to answer the following question anonymously: “How likely are you to recommend our ward/ A&E to friends and family if they needed similar care or treatment?”

So far, 2,500 patients have participated in our Friends and Family Test pilot and 1800 rated their care as 9 out of 10 or above, with just 187 giving a score of six or below. Patients can also feedback on the care they received and this is shared with the wards to enable improvements to be made.

The FFT aims to provide a simple rating which, when combined with follow-up questions, can be used to drive cultural change and continuous improvements in the quality of the care received by patients at The County Hospital.

Care you can rely on

Inspectors from the Care Quality Commission (CQC) – the national independent regulatory body – made unannounced inspections in November 2012 of The County Hospital and Leominster Community Hospital.

Their report shows that local people can rely on Wye Valley NHS Trust’s staff to provide high quality care. No conditions were raised and the Trust was compliant with all standards reviewed.


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We have piloted The Friends and Family Test (FFT) – a new way of gathering patient feedback and driving improvement – in the Midlands and East Region. This went live on 1 April 2013.

Infection Prevention and Control

Key TargetMaximum permitted

2012-13 Actual 2012-13

MRSA bacteraemia 1 3

Clostridium Difficile (County Hospital)

21 10

Clostridium Difficile (Community Hospitals)

5 6

Prevention of healthcare associated infections in our clinical and non clinical environments continues to be a top priority. Led by our Infection Prevention Team, additional measures have been put in place. Staff receive infection prevention and control training and at year end we achieved 100% attendance at these sessions.

There have been three cases of MRSA bacteraemia in The County Hospital against the target of one. From next year the Government has said hospitals will be penalised for any MRSA bacteraemias considered preventable.

New preventative measures have paid off and, in the fight against Clostridium difficile (C.difficile), we recorded just ten cases against a target of 21, with community hospitals having six cases against the locally set objective of five cases, meaning an overall improvement to last year’s total of 45 cases.

Commissioning for Quality and Innovation (CQUIN)

A proportion of the Trust’s income is linked to the achievement of local quality improvement goals, CQUINs. The Trust had 19 CQUINs for 2012-13 and for the first time achieved 100 per cent.

Looking after patients with long-term conditions

The West Midlands Quality Review Service – an external peer review team – has looked at our services for patients with long-term conditions.

Overall, the review was positive with our excellent leadership and support for staff training highlighted.

Mortality

The Trust’s Summary Hospital-level Mortality Indicator (SHMI) figures – reflecting the ratio of the number of deaths against the expected number – are published monthly, rebased quarterly, but reflect data from nine months previously.

They peaked in August 2011 and have since declined. The most recent figure is 112.

Importantly, the SHMI figure includes deaths which occur outside the hospital but within 30 days of discharge, but does not make any adjustment for deaths occurring in palliative care patients – i.e. our patients who choose to die in hospice or home.

The SHMI figure is further complicated by the fact that we provide hospital, acute and adult social care services – many Trusts solely provide acute hospital services.

It is one of a number of measures, which, combined with other performance data, paints a detailed picture of a hospital’s overall performance and needs to be interpreted in this context.

The Trust Board and senior medical staff review these figures monthly and have spent considerable time understanding what lies behind them.

Every hospital death is reviewed by clinicians and a panel looks at concerns raised. Detailed analysis is made of any ‘outlier’ groupings highlighted by Dr Foster, but none have been highlighted since April 2012.

A number of focused reviews have been undertaken jointly with primary care representatives to ensure that patients receive safe care. The Trust has worked closely with the Dr Foster Unit and has recently invited an external review of the mortality figures to give further assurance.

Customer care

Wye Valley NHS Trust has adopted a policy for the management of complaints, concerns, comments and compliments which has fully embraced the Principles for Remedy which include; getting it right, being customer focused, being open and accountable, acting fairly and proportionately, putting things right, and seeking continuous improvement.

This year we received 286 complaints compared to 230 in 2011/12, an increase on the previous year. In February 2013 there had been a significant increase which is believed to be as a result of the winter pressures experienced across the Trust.

Compliments by far outweigh the number of complaints we receive and we have received in excess of 4000 compliments this year.

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Serious Incidents

Serious Incidents – those which could have or have had a serious impact on a patient, staff, visitor or the Trust’s reputation – increased in the first part of the year.

We had 178 serious incidents during 2012-13 and experienced a spike in June due to an increase in pressures ulcers.

Numbers then plateaued to end the year similar to those reported in the previous financial year.

There is a full implementation plan in place to ensure patients in our care do not acquire a pressure sore. This includes ensuring that all acquired category 3 and 4 pressure ulcers are investigated as part of the Serious Incident Requiring Investigation (SIRI) process.

In addition, we have introduced a mini root cause analysis for investigation of all acquired category 2 pressure ulcers to proactively avoid further deterioration to categories 3 and 4.

We have continued to provide training sessions to all grades of staff across health and social care. This training is aimed at raising awareness in relation to the prevention and management of pressure ulcers, which remains a key focus for 2013-14.

Fewer falls

The number of patient falls reduced from 850 in 2011-12 to 798 during this year, in part due to measures like the introduction of visual aids at patient bedsides, special observation areas for ‘at risk’ patients and additional routine checks. Most patient falls result in negligible or minor harm with only 2 per cent of all falls resulting in moderate (short term) harm.

Developing sites and services

Construction followed the demolition of Dore Ward.

A turf-cutting ceremony was held in March this year to mark the beginning of construction work which had been delayed last year. The Unit is now on course to welcome its first patients in 2014.

It is being built by Gloucestershire Hospitals NHS Foundation Trust which will also staff and manage it.

Endoscopy unit opens

A £380,000 endoscopy unit at Ross Community Hospital is providing some of the most advanced technology available to help with early diagnosis and treatment of patients.

The investment made by NHS Herefordshire and staffed by Wye Valley NHS Trust increases capacity, and reduces waiting times, by enabling more than 1,500 procedures to be performed at Ross Community Hospital. These are in addition to approximately 7,000 endoscopy procedures each year at The County Hospital, to investigate stomach and intestinal, bladder and lung problems.


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Modern facilities for patients and staff

Hereford’s Gaol Street Health Centre has been refurbished to provide up-to-date facilities for patients and staff. The sexual health clinic and dental access centre’s weekend out-of-hours service were temporarily re-located to allow the work to go ahead.

Five star food

It may not be as illustrious as receiving a Michelin star, but all five Wye Valley NHS Trust sites, The County Hospital, Bromyard, Leominster and Ross Community Hospitals and the Hillside Rehabilitation Centre have been awarded top marks for their food as part of an NHS assessment in 2012.

All the sites were also assessed for privacy and dignity, cleanliness, infection control and patient environment – for example bathrooms and patient areas. They all achieved ‘good’ (4) or ‘excellent’ (5).

Fundraising appeal launched

We have launched a joint fundraising appeal ‘Clear About Cancer Herefordshire’ with the medical charity Cobalt. It aims to raise £160,000 to fund digital breast screening equipment at The County Hospital in Hereford so that local women will no longer have to travel to Cheltenham.

A £7.7 million satellite radiotherapy unit is being built by Gloucestershire Hospitals NHS Foundation Trust at The County Hospital, enabling many Herefordshire patients to receive radiotherapy close to home, rather than having to travel to Cheltenham.

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Engagement with partners, public, patients and service users

Patient feedback

This year’s Care Quality Commission Inpatient and Outpatient Survey results continue to show an overall improvement in our services. Feedback from patients is extremely valuable to assist in continuing to improve services.

We are concentrating on a number of areas including patient nutrition and hydration, reducing waiting times, and providing clear information for patients about their medication.

Volunteers raise £5,000

Volunteers play an important role enhancing the care we provide and enable staff more time to provide direct patient care.

Thanks to their dedication, hard work and ongoing fundraising efforts, £5,000 has been raised this year to enhance patient facilities.

Volunteers also help gather patient feedback and work alongside our Patient Experience Team.

During the year volunteers have been recruited at our community hospitals and Hillside Rehabilitation Centre, in addition to our volunteers at The County Hospital.

Charitable donations

Our Trust is fortunate to receive charitable donations from patients, service users, supportive members of our community and charities, which continue to help enhance our facilities and provide additional equipment.

Charitable donations have assisted the Trust with funding additional monitoring equipment for the special care baby unit and the development of parts of our estate such as the cancer facility, The Macmillan Renton Unit. The use of donations is carefully and sensitively applied by our Charitable Funds Committee.

40 years on the air!

During the first weekend in December 2012, Hospital Radio volunteers celebrated the station’s 40th anniversary with a nonstop 40-hour broadcast.

They were joined by the Trust’s Director of Service Delivery and held an open day to invite everyone to see their studios and meet the volunteers.


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Staff

Staff recognition

A total of 21 Awards have been made this year:

Outstanding Contribution Individual 6 awards

Special Individual 7 awards

Outstanding Contribution team 7 awards

Individual of the year 1 award.

Supporting new talent

We have hosted 154 medical student placements as well as 44 medical work experience placements for 6th formers and mature students who are thinking of applying to medical school – all have been local students and we hope some will return to work here once they have qualified!

Six new consultant appointments have been made this year, mirroring the number who have retired or moved to work in other hospitals.

Community skills and training

An Assistant Practitioner Pilot Programme within the Neighbourhood Teams is training and upskilling staff working in the community to a high level to enhance the quality of the care we provide. The focus continues to be on improving care for people with long-term conditions.

Supporting our support workers

There is added support for our health care support workers thanks to a new programme which gives them simulated practice to gain competence and confidence in the knowledge and skills they need. This programme is expected to support the anticipated future requirements for the development of health care support workers.

Workforce by ethnicity as at 31 March 2013.

Ethnic Group Headcount %

White - British 2,489 89.93

White - Irish 12 0.43

White - Other 64 2.3

Mixed - White & Black Caribbean 2 0.07

Mixed - White & Black African 5 0.18

Mixed - White & Asian 3 0.11

Mixed - Other 2 0.07

Asian or Asian British - Indian 75 2.7

Asian or Asian British - Pakistani 14 0.5

Asian or Asian British - Other 20 0.72

Black British 1 0.04

Black or Black British - Caribbean 6 0.22

Black or Black British - African 15 0.54

Chinese 5 0.18

Other Ethnic Group 18 0.68

Other specified 2 0.07

Not Stated 44 1.58

Total 2,777 100

We aim to be free from discrimination in all our policies, procedures and practices. The Trust’s Equality Delivery Plan and Local Equality Objectives 2012-2015 sets out our commitment to equality.

Within the plan are four main objectives, with clear action frameworks and targets:• better health outcomes for all• improved patient access and experience• fair workforce• ensuring that equality is a key element of leadership within the Trust.

Our staff are our greatest asset and we recognise exemplary achievements through an awards scheme called Going the Extra Mile.

19

We provide equality and diversity training for our staff and an action plan for 2013-14 will ensure that we continue to meet our statutory and best practice commitments.

We work with our staff and partners to ensure we continue to review our practices and processes in relation to equality and diversity.

Monthly forums

A Partnership Forum meets monthly and is very well attended by staff representatives and senior management. The Trust and its recognised trade unions/professional associations share a common objective in ensuring the efficiency and success of the Trust, delivering high quality care, and maintaining effective employment relations.

A Partnership Agreement outlines how partners will work together effectively on the workforce implications of policy and change. It provides a clear framework for consultation and decision making where staff representatives can have a more proactive role in matters of strategic importance that affect the workforce.

The Agreement also recognises: • respective roles and responsibilities • shared values and common purpose• the principle of how joint working will

achieve the vision and objectives of the Trust

• and sets key principles for effective joint working.

Working together transparently, with consultation taking place at the earliest opportunity and information shared, enables the partners to contribute effectively, and in a timely manner, to the process of change.

Consultation and engagement

We take our responsibilities to consult and engage with staff seriously.

A new style Team Brief was introduced in January 2013 with the Interim Chief Executive briefing senior managers. These managers in turn brief their staff who can raise questions and issues through a feedback system.

We also communicate on a weekly basis with staff through our electronic bulletin (Trust Talk), which is created by staff for staff.

We encourage employees to join recognised trade unions and professional associations and participate in their activities.


20

Promoting health and wellbeing

The health and wellbeing of our staff is very important to us. We continue to monitor staff sickness so that staff have the required support and training, including health and wellbeing support, to effectively carry out their work.

We also have a health and wellbeing group that meets monthly, chaired by the Director of Nursing and Transformation.

The Sickness Absence Policy and the Disciplinary Procedure have been revised and agreed by the staff organisations.

Staff sickness

Staff sickness absence as at 31 March 2013.

2011-12 2012-13 % increase

Staff sickness absence 3.97% 4.34% 0.37%

Staff profile

As at 31 March 2013 we employed 2,777 people and had 308 people on secondment to us, as follows.

Our staff profile was:

Staff Group2011-12

Headcount 2012-13

Headcount

Professional Scientific and Technical 128 129

Clinical Services 588 593

Administrative and Clerical 506 504

Allied Health Professionals 226 241

Estates and Ancillary 29 29

Healthcare Scientists 46 46

Medical and Dental 275 285

Nursing and Midwifery Registered 942 933

Students 12 17

Total 2,752 2,777

Adult Social Care (on secondment) 320 308

Grand Total 3,072 3,085

Staff

21

Environmental, social and community

New energy saving projects have already partly offset increased energy prices, although they have generally been fairly small scale.

Our ‘Wye Go Green’ campaign has continued for a second year, which focuses on reducing energy consumption in the Trust, reflected in a 0.5 per cent reduction in electricity consumption. We have completed the national mandatory report on Sustainability, which is available from our Estates and Facilities office.

Ensuring best value

We have followed up on recommendations from advisors and contract management specialists to get the best value from our Private Finance Initiative (PFI) contract which is delivering a number of critical services.

Emergency Planning Response and Recovery (EPRR)

From April 2013, the NHS Commissioning Board will be responsible for ensuring that the EPRR system is fit for purpose and for leading the mobilisation of the NHS in an emergency.

Our Director of Service Delivery acts as our ‘accountable emergency officer’ responsible for making sure we meet newly introduced EPRR core standards. Our Emergency Planning Group draws on personnel from across the Trust and meets regularly.

We continue to look at ways to reduce our carbon footprint.

Being prepared

Every three years we are required to hold a major simulated exercise as part of our emergency planning. This year Exercise ‘Emergo’ was held in July 2012.

Delivered by the Health Protection Agency, the scenario centred on a building collapsing in Hereford with 43 patients either attending or being conveyed to The County Hospital.

The aim was to test the Major Incident Plan, our Lock Down Plan and the capability of Incident Room Staff and the Communication Team.

We were independently assessed in two key areas: overall incident management and management of our emergency department; Intensive Care Unit and elective surgery. We exceeded expectations.

When scenarios become reality

August 2012 saw our Accident Emergency Department respond when workers from a local reclamation yard were exposed to a leaking chemical.

While not a major incident for the hospital, self presenting patients is a scenario for which we have planned and trained. The effective response on the day bears testament to the importance of EPRR.

EPRR also links to the West Mercia Local Resilience Forum which provides practical assistance when required – like the call for 4 x 4 voluntary transport during January’s snow to ferry staff and allow business to continue as usual at the Trust.


22

Governance

There are four statutory Executive appointments which are:• Chief Executive• Finance Director (Director of

Resources)• Medical Director• Director of Nursing (Director of

Nursing & Transformation)

There is also a fifth voting Director, the Director of Service Delivery, but this is not a statutory appointment.

Board member changes

There have been a number of changes this year as we said goodbye to Chief Executive Martin Woodford and to the Director of Business Development Mike Coupe. The Trust would like to thank them for their hard work and commitment over the years.

The Trust welcomed two new Non-Executive Directors; Christina Maclean and Sara Coleman, who were appointed in July 2012.

The Trust also welcomed two new Executive Directors – Derek Smith, Interim Chief Executive, and Ken Hutchinson, Interim Director of Human Resources.

Wye Valley NHS Trust is led by the Board of Directors which comprises eleven directors – the Chairman and five Non-Executive Directors and five Executive Directors who are the Interim Chief Executive, Director of Resources, Medical Director, Director of Nursing & Transformation, Director of Service Delivery.

Four committees

The Trust Board has four committees. These are:• Audit Committee• Remuneration and Terms of Service Committee• Quality Committee• Charitable Funds

The Audit Committee and Remuneration and Terms of Service Committee are statutory committees of the Board.

The Audit Committee, Remuneration and Terms of Service Committee and Quality Committee are all Non-Executive Director Committees with invited attendance of the Chief Executive and other Executive Directors when necessary. All committees are supported by the Company Secretary.

The Charitable Funds Committee supports the Trust Board to discharge its functions as the Corporate Trustee, appointed by the Secretary of State, for the Wye Valley NHS Trust Charitable Funds.

Members of the Board and committees

The Board is comprised of the following Directors:

Mark Curtis Chairman of the Trust Board

Derek Smith Interim Chief Executive

Michelle Clarke Director of Nursing & Transformation

Sara Coleman Non-Executive Director

Ken Hutchinson Interim Director of Human Resources

Christina Maclean Non Executive Director

Frank Myers MBE Non-Executive Director & Chairman of Quality Committee and Charitable Funds Committee.

Howard Oddy Director of Resources

Simone Pennie Non-Executive Director & Chairman of Audit Committee

Tim Tomlinson Director of Service Delivery

Mark Waller Non-Executive Director, Deputy Chairman of the Trust Board & Chairman of Remuneration and Terms of Service Committee

Peter Wilson Medical Director

23

Attendance at the Board of Directors 1 April 2012 – 31 March 2013

Name Position AttendanceMark Curtis Chairman of the Board 92%

Derek Smith (appointed Sept 12) Interim Chief Executive 71%

Martin Woodford (retired Sept 12) Chief Executive 0%

Michelle Clarke Director of Nursing & Transformation 92%

Sara Coleman (appointed July 12) Non-Executive Director 100%

Christina Maclean (appointed July 12) Non-Executive Director 87%

Frank Myers MBE Non-Executive Director 92%

Howard Oddy Director of Resources 100%

Simone Pennie Non-Executive Director 83%

Tim Tomlinson Director of Service Delivery 83%

Mark Waller Non-Executive Director 92%

Peter Wilson Medical Director 83%

Jonathan Wren Acting Director of Finance (April - Sept 2012) 100%

In attendance

Name Position AttendanceAnn Donkin (non voting) (retired May 2012) Interim Director of Performance 100%

Ken Hutchinson (non voting) (appointed Nov 2012) Interim Director of Human Resources 80%

Sara Keetley (non voting) Advisor for Adult Social Care 83%

Nicola Licence (non voting) Company Secretary 100%


24

The Audit Committee

This is a Non-Executive Committee of the Trust Board of Directors. It met on six occasions during the year. The Chairman of the Trust Board is not a member of the Audit Committee, however, he is invited to attend as required by the Chair of Audit Committee. Other Executives who attend the Audit Committee include the Chief Executive, Director of Resources and the committee is supported by the Company Secretary. The Trust’s internal and external auditors are also invited to attend Audit Committee meetings.

Attendance at Audit Committee Meetings 1 April 2012 – 31 March 2013

Name Position AttendanceSimone Pennie Committee Chair 100%

Sara Coleman Non-Executive Director 100%

Christina Maclean Non-Executive Director` 100%

Frank Myers MBE Non-Executive Director 83%

Mark Waller Non-Executive Director 67%

Declarations of Interest 1 April 2012 – 31 March 2013

Board Member Position InterestM Curtis Chairman Partner, The Design IV Partnership

Patron, Herefordshire Muheza Link SocietyD Smith (appointed Sept 12) Interim Chief Executive Associate of Durrow Ltd

M Woodford (retired Sept 12) Chief Executive None

M Clarke Director of Nursing & Transformation None

S Coleman (appointed July 12) Non Executive Director CEO Hope Support Services Charity Director of Colemans Software ltd

N Licence Company Secretary None

C Maclean (appointed July 12) Non Executive Director Ownership of PR consultancy 8AZ Communications Business Development, Fundraiser and Consultant to Rural Media Company, Consultant Solicitor, Commercial Consultant Allpay

F Myers MBE Non Executive Director MERU, position of authorityMyers Road Safety Ltd (Owner and Managing Director)MCP Systems Consultants Ltd (Joint Owner and Director)Queen Elizabeth’s Foundation for Disabled People (Director, Trustee and Pension Fund Trustee)

H Oddy Director of Resources Non Executive Director Hoople Limited

S Pennie Non Executive Director Non Executive Director, Hoople Limited

T Tomlinson Director of Service Delivery None

M Waller Non Executive Director Chairman, Hereford MIND

P Wilson Medical Director None

K Hutchinson (appointed Nov 12) Interim HR Director Non Executive Director, Association of Respiratory Technology & Physiology

25

Remuneration and Terms of Service Committee

The policy of the Remuneration and Terms of Service Committee has continued to be guided by five principles:

1. Reward will attract and retain high quality people2. There must be a clear link between performance and reward3. The rationale for setting salary / performance pay levels must be

clear to all4. Competitive levels of remuneration will be determined by reference

to similar posts within comparable NHS Trusts5. Rewards will reflect the market but not drive it.

These principles have been adhered to, together with consideration of the size and responsibility of the role, in the recruitment plans to appoint substantively to the post of Chief Executive, Chief Operating Officer and Director of Human Resources. Executive Directors receive a fixed base salary and may occasionally participate in a performance-related bonus plan. However, in view of the financial challenges being faced by the Trust, Executive Directors did not participate in such a plan this year or last year.

Benefits in the table include pension provision. Directors are not paid a car allowance, nor are they provided with a Trust funded vehicle and they do not receive any private healthcare provision.

Contracts of Directors include a six month notice period; senior managers have a three months notice period.

During the year the Trust engaged third parties for the services of Interim Chief Executive and an Interim Director of Human Resources. The contracts commenced on 12 September 2012 and 19 November 2012 respectively. The contract for the Interim Chief Executive was for six months and was extended until 31 March 2013. The contract for the Interim Director of Human Resources was for six months and had seven weeks left, after the end of the financial year, until termination on 17 May 2013. The notice period for the contracts of the Interim Chief Executive is three months or automatically on the termination date. The notice period for the Interim Director of Human Resources is four weeks or automatically on the termination date. There is no

provision for early termination and there are no other liabilities in the event of early termination.

Assessing performance

Executive Directors all have objectives set for the financial year by the Chief Executive with the Chief Executive’s objectives being set by the Chairman in conjunction with the Remuneration and Terms of Service Committee. A review of performance of achievement of objectives is undertaken mid way through the year and at the end of the year.

Remuneration of Chairman and Non-Executive Directors

The Secretary of State for Health sets and reviews the level of remuneration payable to the Chairman and Non Executive Directors (excluding NHS Foundation Trusts who set their own rates). In 2012-13 there was no increase to the remuneration of these roles. The rates were £6,096 for Non Executive Directors and £18,437 for the Chairman of the Trust. The Chairman and the Non-Executive Directors do not receive a pension provision.

Mark Waller

Chairman Remuneration and Terms of Service Committee


26

Pension Benefits 2012-13

Name

Real increase in pension at

age 60 (bands of £2,500)

Real increase in pension

lump sum at aged 60 (bands

of £2,500)

Total accrued pension at age 60 at 31 March

2013 (bands of £5,000)

Lump sum at age 60 related to accrued pension

at 31 March 2013 (bands of £5,000)

Cash Equivalent

Transfer Value at 31 March

2013

Cash Equivalent

Transfer Value at 31 March

2012

Real increase in Cash

Equivalent Transfer Value

Employer’s contribution

to stakeholder

pension£000 £000 £000 £000 £000 £000 £000 £00

P Wilson -0 - 2.5 -2.5 - 5.0 50 - 55 155 - 160 1048 985 12 –

H Oddy -0 - 2.5 -0 - 2.5 35 - 40 115 - 120 695 653 8 –

M Clarke 2.5 - 5.0 12.5 - 15.0 25 - 30 80 - 85 434 332 85 –

Salaries and Allowances 2012-13 2011-12

Name and title

Salary (bands of

£5,000)£000

Other Remuneration

(bands of £5,000)

£000

Bonus Payments

(bands of £5,000)

£000

Benefits in kind

(Rounded to the nearest £00)

£00

Salary (bands of

£5,000)£000

Other Remuneration

(bands of £5,000)

£000

Bonus Payments

(bands of £5,000)

£000

Benefits in kind

(Rounded to the nearest £00)

£00

M Woodford Chief Executive

Voluntary early retirement Sept 12

100 - 105 140 - 145

D Smith Interim Chief Executive

Appointed 13 Sept 12

120 - 125

A Budd Medical Director

Left 8 Jan 12 95 - 100

Jonathan Wren (Acting Director of Resources)

from April to Sept 2012 45 - 50

K Hutchinson Interim Director of Human Resources

Appointed Nov 2012 75 - 80

H Oddy (Acting CEO)Director of Resources

1 April to 30 Sept 12

130 - 135 100 - 105

T Tomlinson Director of Service Delivery

100 - 105 100 - 105

Michelle Clarke Director of Nursing & Transformation

90 - 95 55 - 60 (part year)

Peter Wilson Medical Director

135 - 140 35 - 40* 30 - 35 (part year)

5 - 10*

ChairmanM Curtis 15 - 20 15 - 20

Other Non Executive DirectorsS Pennie 5 - 10 5 - 10

F Myers MBE 5 - 10 0 - 5 (part year)

M Waller 5 - 10 0 - 5 (part year)

C E Maclean appointed July 12 0 - 5

S Coleman appointed July 12 0 - 5

* This relates to payments under the national clinical excellence reward scheme.

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 organisation’s workforce. The banded remuneration of the highest paid director in Wye Valley NHS Trust in the financial year 2012-13 was £172,700 (2011-12 £142,500 (This was a different Director). This was 7.6 times (2011-12 6.3) the median remuneration of the workforce, which was £22,676 (2011-12 £22,676). Total remuneration includes salary, non-consolidated performance-related pay, as well as severance payments. It does not include employer pension contributions and a cash equivalent transfer value of pensions. In 2012-13, 6 (2011-12, 17 employees) employees received remuneration in excess of the highest paid Director. Remuneration ranged from £172,700 to £203,900 (2011-12 £145,000 to 198,000).

27

FinanceOur financial position

As in the previous financial year, the last twelve months has seen Wye Valley NHS Trust face significant financial challenges.

The planned outturn position was a £200k surplus; thus allowing the Trust to meet its statutory five year breakeven duty. Delivery of this was, however, dependent upon internally generated savings of £5.5m and external financial support of £9.5m.

Given the above position, the Trust is pleased to report the delivery of a £294k surplus in 2012-13 on a turnover of £175,798k (0.2%).

As indicated above, the reported position includes financial support of £9.5m, which was made available to the Trust following agreements reached within the local health economy. This follows similar support of £6m received in the previous financial year. The Trust has been working, and continues to work, with the Clinical Commissioning Group and National Commissioning Board Area Team to determine how the Trust’s activities can be provided without the need for ongoing non recurrent support. It is clear that this will lead to a change in how the services are currently provided.

One of the most significant cost pressures faced by the Trust was the need to provide the capacity to treat increasing activity. The Trust thus provided additional beds at its community hospital sites. At various times throughout the year, particularly over the winter period, additional capacity has been provided at Bromyard, Leominster and Ross Hospitals that saw the Trust incur large additional unplanned costs.

In addition to the cost pressures relating to opening additional beds, the Trust had to mitigate against additional costs such as: medical staffing (i.e. by filling vacancies with locum or agency staff), and the increased use of medical supplies and drugs (in line with rises in activity).

As contained within the initial plan, the Trust planned to deliver savings of £5.5m in order to achieve its year end financial targets. This saving had been delivered in full by 31 March 2013, albeit through a number of schemes, some of which were non-recurrent (£2.9m) and some of which were different from the original plan, over a range of cost categories.

The Trust achieved its External Financing Limit (EFL) and delivered its capital programme within the preset Capital Resource Limit (CRL) during 2012-13.

Staff 100.4

Supplies/Services 28.1

Adult Social Care 9.1

PFI 10.2

Premises 4.5

Depreciation 3.3

Services from PCT’s 0.9

Insurance 2.9

Establishment 2.1

Other 8.9

Fig 1. the composition of total expenditure.

2012-13 Annual Expenditure (£m)


28

Capital expenditure

Capital funding is generated by six main mechanisms:• Depreciation on existing assets• Revenue surplus• Borrowing• Donation• Movements in working capital• Sale of existing assets

In 2012-13, the Trust’s access to capital funding was extremely limited and just £1.3million was invested in capital purchases. The main areas of such investment are outlined in the following table:

2012/13 Capital Expenditure

£000

Medical Equipment 356

IT development/replacement 169

Construction schemes 777

1,302

Focus on cash flow

The most significant components of the Trust’s cashflow are:• Receipts for healthcare contracts (both at base levels and for any

under/over performance)• Payments to staff (which account for 58.9 per cent of the Trust’s

operating costs)• Quarterly in-advance payments to the Trust’s Private Finance Initiative

(PFI) partners.

During 2012-13, the Trust did not experience any major cashflow difficulties and therefore, no payments to suppliers were delayed for this reason. Furthermore, the Trust reduced the level of outstanding debt, owed to it over the course of the year.

Better Payment Practice Code

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

During 2012-13, for non-NHS bodies, we paid 87.95 per cent (by value) and 76.50 per cent (by volume) in line with the target. This represented an increase in both the value and volume compared with the previous year’s performance of 83 per cent and 63 per cent respectively.

2012-13 Commissioner Income (£m)

Fig 2. a breakdown of activity based income.

Herefordshire 113.5

Powys 12.6

Shropshire 3.2

Worcestershire 1.7

Monmouthshire 1.3

Specialist Commissioning 2.3

Other Income from Activities 4.5

29

Pension liabilities

Within the Annual Accounts ongoing employer pension contribution costs are included within employee costs (see note 10 of the full accounts for more detail).

During 2012-13, as an employer, the Trust made contributions of £9.3m to the scheme (£9.1m in 2011-12).

Past and present employees are covered by the provisions of the NHS Pensions Scheme. Details of the benefits payable under these provisions can be found on the NHS Pensions website atwww.nhsba.nhs.uk/pensions

Off payroll engagements

There were three new off payroll engagements between 31 August 2012 and 31 March 2013, Interim Chief Executive Officer, Interim Director of Human Resources, and Project Management Office Manager. Of these three engagements all had clauses within their contracts giving the Trust the right to request assurance in relation to include tax and national insurance obligations. Assurance has been received and accepted in relation to these contracts for service.

Looking ahead

Having required external financial support in the previous two years, the Trust will require at least £9.7m of external support in 2013-14. This will be in addition to the delivery of an £8.8m cost improvement programme.

It is as a result of this reliance on external support that it has become clear the Trust is unable to be financially viable in its current form and will not be able to achieve Foundation Trust status. As a result of this, the Trust is considering alternative organisational models and service charges to help secure a financially sustainable future.

Full set of Annual Accounts and Governance Statement

The following summary financial statements are a summary of the information contained in the full set of annual accounts for Wye Valley NHS Trust for 2012-13. Please note that the summary financial statements may not contain sufficient information to provide a full understanding of the Trust’s financial position and performance

throughout the year. A complete set of full annual accounts and governance statement for 2012-13 is available upon request and is free of charge by contacting:

Howard OddyDirector of ResourcesWye Valley NHS TrustCounty HospitalUnion WalkHereford HR1 2ER.

Alternatively, please telephone (01432) 364 134, email [email protected] or visit www.wyevalley.nhs.uk

External Auditor

Our External Auditor is:

Grant PattersonSenior Statutory AuditorGrant Thornton UK LLPColmore Plaza20 Colmore CircusBirmingham B4 6AT.

The cost of Audit Services (statutory audit and services carried out in relation to the statutory audit) included – within the 2012-13 Annual Accounts is £109K.

The Trust has also employed a separate Grant Thornton team in relation to non-audit services.


30

Statement Of Comprehensive Income for the year ended 31 March 2013

2012/13£000

2011/12£000

Employee benefits (100,429) (98,991)

Other costs (70,061) (64,047)

Revenue from patient care activities 140,151 139,873

Other Operating revenue 35,647 32,025

Operating surplus (deficit) 5,308 8,860

Finance costs:

Investment revenue 27 22

Other gains and (losses) 0 0

Finance costs (4,995) (5,182)

Surplus/(deficit) for the financial year 340 3,700

Public dividend capital dividends payable 0 0

Retained surplus/(deficit) for the year 340 3,700

Other comprehensive income

Impairments and reversals (14) (16)

Net gain/(loss) on revaluation of property, plant & equipment 372 810

Net gain/(loss) on revaluation of intangibles 0 0

Net gain/(loss) on revaluation of financial assets 0 0

Movements in Other Reserves eg. Non NHS Pensions Scheme 0 0

Net gain/(loss) on available for sale financial assets 0 0

Net Gain / (loss) on Assets Held for Sale 0 0

Net actuarial gain/(loss) on pension schemes 0 0

Reclassification adjustment on disposal of available for sale financial assets 0 0

Total comprehensive income for the year * 698 4,494

* This sums the rows above and the surplus/(deficit) for the year before adjustments for PDC dividend and absorption accounting

Financial Performance for the year

Retained surplus/(deficit) for the year 340 3,700

IFRIC 12 adjustment 0 (1,750)

Impairments (115) (1,631)

Adjustments iro donated asset/gov't grant reserve elimination 69 (248)

Adjusted NHS financial performance position 294 71

A Trust’s reported NHS financial performance is derived from its retained surplus/(deficit), but adjusted for the following:

IFRIC 12 adjustmentDue to the introduction of International Financial Reporting Standards (IFRS) accounting in 2009/10 and the associated revenue cost of bringing PFI assets onto the balance sheet, an NHS Trust’s financial performance measurement needs to be aligned with the guidance issued by HM Treasury measuring Departmental expenditure. Therefore, the incremental revenue expenditure resulting from the application of IFRS to PFI, which has no cash impact and is not chargeable for overall budgeting purposes, should be reported as technical. Any additional cost is not considered part of the organisation’s operating position. Subsequently, in January 2013, the DH introduced new guidance on this adjustment which stated that, where IFRIC 12 costs were lower than those under UK GAAP (as is the case with Wye Valley NHS Trust), the shortfall will not be an additional charge included within reported financial performance.

Impairments to Fixed AssetsAn impairment charge or reversal of any previous impairment made is not considered part of the organisation’s operating position.

Elimination of Donated Asset reserveUnder national guidance implemented in 2011/12, the Trust’s donation reserve (which, at all times, equalled the net book value of donated assets) was eliminated from the Statement of Financial Position. The revenue impact of this accounting change has been eliminated from the Trust’s operating position.

The Trust made an overpayment of PDC dividend in 2012/13 and the amount due to the Trust is disclosed below:

PDC dividend: balance receivable/(payable) at 31 March 2013 62

PDC dividend: balance receivable/(payable) at 1 April 2012 0

31

Statement Of Financial Position as at 31 March 2013

31 March 2013£000

31 March 2012£000

Non-current assets

Property, plant and equipment 67,814 69,208

Intangible assets 126 261

Other financial assets 0 0

Trade and other receivables 116 116

Total non-current assets 68,056 69,585

Current assets

Inventories 2,212 2,180

Trade and other receivables 6,641 11,763

Other financial assets 0 0

Other current assets 0 0

Cash and cash equivalents 9,428 2,449

18,281 16,392

Non-current assets held for sale 0 0

Total current assets 18,281 16,392

Total assets 86,337 85,977

Current liabilities

Trade and other payables (16,274) (14,254)

Other liabilities 0 0

Provisions (445) (260)

Borrowings (2,256) (2,609)

Capital loan from Department (470) (470)

Net current assets/(liabilities) (19,445) (17,593)

Non current assets plus/less net current asset/liabilities 66,892 68,384

Non-current liabilities

Provisions (755) (567)

Borrowings (57,782) (59,690)

Other liabilities 0 0

Capital loan from Department (2,935) (3,405)

Total assets employed 5,420 4,722

Financed by taxpayers' equity:

Public dividend capital 17,724 17,724

Retained earnings (24,596) (25,105)

Revaluation reserve 12,292 12,103

Other reserves 0 0

Total taxpayers' equity 5,420 4,722

The financial statements on pages 1 to 49 of the full Accounts were approved by the Board on 30 May 2013 and signed on its behalf by:

Signed: …………………………………………… Date: 3 June 2013 Derek Smith (Interim Chief Executive)


32

Statement of Changes in Taxpayers’ Equity For the year ended 31 March 2013

Public Dividend

capital£000s

Retained earnings

£000

Revaluation reserve

£000

Other reserves

£000

Total reserves

£000

Balance at 1 April 2012 17,724 (25,105) 12,103 0 4,722

Changes in taxpayers’ equity for 2012-13 0

Retained surplus/(deficit) for the year 340 340

Net gain/(loss) on revaluation of property, plant, equipment

372 372

Net gain/(loss) on revaluation of intangible assets 0 0


Net gain/(loss) on revaluation of assets held for sale 0 0


Movements in other reserves 0 0

Transfers between reserves 169 (169) 0 0

Release of reserves to Statement of Comprehensive Income

0 0

Reclassification Adjustments 0

Transfers to/(from) Other Bodies within the Resource Account Boundary

0 0 0 0 0

Transfers between Revaluation Reserve & Retained Earnings in respect of assets transferred under absorption

0 0 0

On Disposal of Available for Sale financial Assets 0 0

Reserves eliminated on dissolution 0 0 0 0 0

Originating capital for Trust established in year 0 0

New PDC Received 0 0

PDC Repaid In Year 0 0

PDC Written Off 0 0

Transferred to NHS Foundation Trust 0 0 0 0 0

Other Movements in PDC In Year 0 0

Net Actuarial Gain/(Loss) on Pension 0 0 0

Net recognised revenue/(expense) for the year 0 509 189 0 698

Balance at 31 March 2013 17,724 (24,596) 12,292 0 5,420

33

Continued

Public Dividend

capital£000s

Retained earnings

£000

Revaluation reserve

£000

Other reserves

£000

Total reserves

£000

Balance at 1 April 2011 17,724 (28,955) 11,459 0 228

Changes in taxpayers’ equity for the year ended 31 March 2012

0

Retained surplus/(deficit) for the year 3,700 3,700

Net gain/(loss) on revaluation of property, plant, equipment

810 810

Net gain/(loss) on revaluation of intangible assets 0 0


Net gain/(loss) on revaluation of assets held for sale 0 0


Movements in other reserves 0 0

Transfers between reserves 150 (150) 0 0

Release of reserves to Statement of Comprehensive Income

0 0

Reclassification Adjustments 0

Transfers to/(from) Other Bodies within the Resource Account Boundary

0 0 0 0 0

On Disposal of Available for Sale financial Assets 0 0

Reserves eliminated on dissolution 0 0 0 0 0

Originating capital for Trust established in year 0 0

New PDC Received 0 0

PDC Repaid In Year 0 0

PDC Written Off 0 0

Transferred to NHS Foundation Trust 0 0 0 0 0

Other Movements in PDC In Year 0 0

Net Actuarial Gain/(Loss) on Pension 0 0 0

Net recognised revenue/(expense) for the year 0 3,850 644 0 4,494

Balance at 31 March 2012 17,724 (25,105) 12,103 0 4,722


34

Statement of cash flows for the year ended 31 march 2013

2012/13 £000

2011/12 £000

Cash Flows from Operating Activities

Operating Surplus/Deficit 5,308 8,860Depreciation and Amortisation 3,304 3,292Impairments and Reversals (115) (1,631)Other Gains/(Losses) on foreign exchange 0 0Donated Assets received credited to revenue but non-cash 0 (394)Government Granted Assets received credited to revenue but non-cash 0 0Interest Paid (4,994) (5,168)Dividend paid (62) 0Release of PFI/deferred credit 0 0(Increase)/Decrease in Inventories (32) 15(Increase)/Decrease in Trade and Other Receivables 5,108 (4,770)(Increase)/Decrease in Other Current Assets 0 0Increase/(Decrease) in Trade and Other Payables 2,618 3,163(Increase)/Decrease in Other Current Liabilities 0 0Provisions Utilised (180) (65)Increase/(Decrease) in Provisions 509 119Net Cash Inflow/(Outflow) from Operating Activities 11,464 3,421

Cash Flows from Investing ActivitiesInterest Received 26 21(Payments) for Property, Plant and Equipment (1,388) (2,900)(Payments) for Intangible Assets 0 0(Payments) for Investments with DH 0 0(Payments) for Other Financial Assets 0 0(Payments) for Financial Assets (LIFT) 0 0Proceeds of disposal of assets held for sale (PPE) 0 0Proceeds of disposal of assets held for sale (Intangible) 0 0Proceeds from Disposal of Investment with DH 0 0Proceeds from Disposal of Other Financial Assets 0 0Proceeds from the disposal of Financial Assets (LIFT) 0 0Loans Made in Respect of LIFT 0 0Loans Repaid in Respect of LIFT 0 0Rental Revenue 0 0Net Cash Inflow/(Outflow) from Investing Activities (1,362) (2,879)

NET CASH INFLOW/(OUTFLOW) BEFORE FINANCING 10,102 542

CASH FLOWS FROM FINANCING ACTIVITIESPublic Dividend Capital Received 0 0Public Dividend Capital Repaid 0 0Loans received from DH – New Capital Investment Loans 0 0Loans received from DH – New Working Capital Loans 0 0Other Loans Received 0 0Loans repaid to DH – Capital Investment Loans Repayment of Principal (470) (470)Loans repaid to DH – Working Capital Loans Repayment of Principal 0 0Other Loans Repaid (140) (94)Cash transferred to NHS Foundation Trusts 0 0Capital Element of Payments in Respect of Finance Leases and On-SoFP PFI and LIFT (2,513) (2,828)Capital grants and other capital receipts 0 1,619Net Cash Inflow/(Outflow) from Financing Activities (3,123) (1,773)

NET INCREASE/(DECREASE) IN CASH AND CASH EQUIVALENTS 6,979 (1,231)

Cash and Cash Equivalents (and Bank Overdraft) at Beginning of the Period 2,449 3,680Effect of Exchange Rate Changes in the Balance of Cash Held in Foreign Currencies 0 0Cash and Cash Equivalents (and Bank Overdraft) at year end 9,428 2,449

35

Income from Activities

2012/13 £000

2011/12 £000

Strategic health authorities 0 0

NHS trusts 0 0

Primary care trusts – tariff 69,097 71,664

Primary care trusts – non-tariff 52,560 50,118

Primary care trusts – market forces factor 1,694 1,765

Foundation trusts 0 0

Local authorities 0 0

Department of Health 0 0

NHS other 1,393 1,285

Non-NHS:

Private patients 161 280

Overseas patients (non-reciprocal) 0 9

Injury costs recovery 392 434

Other 14,854 14,318

Total revenue from patient care activities 140,151 139,873

Injury cost recovery income is subject to a provision for impairment of receivables of 12.6% (2011/12 10.5%) to reflect expected rates of recovery. Non-NHS Other includes £14,630k (£14,107k in 2011/12) from Welsh Health bodies.

Other Operating Income

2012/13 £000

2011/12 £000

Recoveries in respect of employee benefits 0 0

Patient transport services 0 0

Education, training and research 4,246 3,970

Charitable and other contributions to expenditure 0 0

Receipt of donations for capital acquisitions 73 394

Receipt of Government grants for capital acquisitions 0 0

Non-patient care services to other bodies 0 122

Income generation 165 155

Rental revenue from finance leases 0 0

Rental revenue from operating leases 0 0

Other revenue 31,163 27,384

Total other operating income 35,647 32,025

Other income includes cross charges and drug recharges to NHS Herefordshire (2,241k; 2011/12 £2,421k), Gloucestershire Hospitals NHS Foundation Trust for chemotherapy treatment (£3,218k; 2011/12 £2,985k), Powys LHB for clinics using the Trust’s clinical staff (£597k; 2011/12 £585k), non-recurrent funding received (£9,500k; 2011/12 £6,000k), Section 75 income (£10,803k; 2011/12 £9,848k), support for redundancy payments from NHS Herefordshire (£0k; 2011/12 £500k), contribution to winter pressures (£220k; 2011/12 £0k),part funding of the WVT “Futures” project (£200k; 2011/12 £0k), funding of social worker recharges (£500k; 2011/12 £0k) and other recharges (£2,120k; 2011/12 £2,609k).


36

Operating Expenses

2012/13£000

2011/12£000

Operating expenses (excluding employee benefits)

Services from other NHS trusts 0 0

Services from PCTs 934 2,589

Services from other NHS bodies 0 0

Services from foundation trusts 62 0

Purchase of healthcare from non NHS bodies 916 1,005

Trust chair and non executive directors 49 48

Supplies and services – clinical 25,081 24,311

Supplies and services – general 3,024 2,352

Consultancy services 1,428 817

Establishment 2,062 1,835

Transport 273 315

Premises 4,538 4,742

Impairments and Reversals of Receivables (48) 382

Inventories write down 0 58

Depreciation 3,161 3,139

Amortisation 143 153

Impairments and reversals of property, plant and equipment (115) (1,631)

Impairments and reversals of intangible assets 0 0

Impairments and reversals of financial assets 0 0

Impairments and reversals of non current assets held for sale 0 0

Impairments and reversals of investment properties 0 0

Audit fees 109 186

Other auditor's remuneration 19 0

Clinical negligence 2,840 2,509

Research and development (excluding staff costs) 12 0

Education and Training 284 335

PFI costs 10,234 8,643

Ambulance and other patient travel 957 902

Insurance 79 72

External lab tests 328 217

NHSPA injury benefits 0 26

Adult Social Care 9,102 9,296

Back Office Services 2,303 952

Change in Discount rate 40 0

Other 2,246 794

70,061 64,047

Employee benefits

Employee benefits excluding Board members 99,421 98,017

Board members 1,008 974

Total employee benefits 100,429 98,991

Total operating expenses 170,490 163,038

37

2012-13 Performance against Better Payment Practice Code (BPPC)

Number £000

Total Non-NHS trade invoices paid in the year 43,604 70,596

Total Non-NHS trade invoices paid within target 33,357 62,090

Percentage of Non-NHS trade invoices paid within target 76% 88%

Total NHS trade invoices paid in the year 1,281 14,025

Total NHS trade invoices paid within target 907 10,827

Percentage of NHS trade invoices paid within target 71% 77%

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 goods or a valid invoice, whichever is later. The Trust is a signatory to the Government’s Prompt Payment Code.

INDEPENDENT AUDITOR’S REPORT TO THE DIRECTORS OF WYE VALLEY NHS TRUST

We have examined the summary financial statement for the year ended 31 March 2013 which comprises Statement of Comprehensive Income, Statement of Financial Position; Statement of Changes in Taxpayers’ Equity, Income from Activities, Other Operating income, Operating Expenses and Performance against Better Payment Practice Code set out pages 30 to 37.

This report is made solely to the Board of Directors of Wye Valley 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. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Trust’s directors and the Trust as a body, for our audit work, for this report, or for opinions we have formed.

Respective responsibilities of directors and auditor

The directors are responsible for preparing the Annual Report.

Our responsibility is to report to you our opinion on the consistency of the summary financial statement within the Annual Report with the statutory financial statements.

We also read the other information contained in the Annual Report and consider the implications for our report if we become aware of any misstatements or material inconsistencies with the summary financial statement.

We conducted our 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. Our report on the statutory financial statements describes the basis of our opinion on those financial statements.

Opinion

In our opinion the summary financial statement is consistent with the statutory financial statements of the Wye Valley NHS Trust for the year ended 31 March 2013. We have not considered the effects of any events between the date on which we signed our report on the statutory financial statements 7 June 2013 and the date of this statement.

Grant Thornton UK LLP

Colmore Plaza20 Colmore CircusBirmingham B4 6AT

28 June 2013


38

Term Description

Accounting policies Guidelines adopted by an organisation that govern the treatment of the financial transactions within that body.

Annual accounts The annual accounts, of an NHS body provide the financial position for a financial year i.e. 1 April to 31 March. The format of the annual accounts is set out in NHS accounts, manuals and includes financial statements and notes to the accounts.

Audit report A final report by an NHS body’s auditor on the findings from the audit process.

Average net relevant assets Relevant net assets are calculated as the total capital and reserves of the NHS trust less the donated asset reserve and cash balances. The average is the average of the opening and closing figures.

Better Payments Practice Code

The target of the Better Payments Practice Code is to pay all NHS and non-NHS trade creditors within 30 calendar days of receipt of goods or a valid invoice (whichever is later) unless other payment terms have been agreed.

Break even Where income equals expenditure.

Capital Within the NHS, capital expenditure is primarily defined as outgoings on equipment or property over £5,000 which has an estimated life in excess of one year.

Capital charges The revenue costs associated with fixed assets. This includes elements of depreciation and interest.

Capital receipts Funding received from the sale of capital items (items with a value greater than £5,000) including land, buildings and equipment.

Capital cost absorption rate The financial regime of NHS trusts recognises that there is a cost associated with the maintenance of the capital value of the organisation. NHS trusts are required to absorb the cost of capital (effectively the dividend paid on PDC) at a rate of 3.5 per cent of average net relevant assets. If the calculation of PDC dividends over relevant net assets is not within the 3-4 per cent range then the Trust is deemed to have failed this duty.

Capital resource limit (CRL) The amount of money an NHS body is allocated to spend on capital schemes in a given financial year.

Cash releasing savings Where a saving is realised because the organisation or function delivers the same service with fewer outgoings.

Cash requirement This is the amount of cash an NHS body needs to provide to support its operational activities during the year.

Cost pressure Increased outgoings arising from an unplanned or unforeseen event(s).

Cost savings/improvement programme

A collection of projects designed to reduce overall costs and improve the efficiency of the organisation.

CQUIN The Commissioning for Quality and Innovation (CQUIN) payment framework enables commissioners to reward excellence by linking a proportion of providers’ income to the achievement of local quality improvement goals.

Cumulative deficit The excess of expenditure over income built up over more than one year.

Cumulative surplus The excess of income over expenditure built up over more than one year.

Donated asset reserve Represents the carrying value of all those assets within the organisation that have been purchased through charitable funds or external fundraising activities.

External Financing Limit (EFL)

A cash limit on net external financing. The purpose of the EFL is to assist with the control of cash expenditure by NHS trusts. The EFL for each trust is set by the Department of Health and determines how much more (or less) cash than is generated from its operations the trust can spend in a year and is closely linked to the cash required to fund capital schemes.

Financial statements The main statements in annual accounts of an NHS body. These include: an income and expenditure account, statement of recognised gains and losses, balance sheet and cash flow statement. The format of these statements is specified in NHS accounts’ manuals.

Glossary of financial terms

39

Term Description

Financial stewardship Financial stewardship ensures that expenditure is properly incurred and authorised. Proper accounting records are maintained and financial statements are prepared in line with standard accounting practice and relevant guidance.

Growth Year on year general funding increases to NHS bodies allocated by the Department of Health.

IFRS International Financial Reporting Standards. This accounting guidance replaced UK Generally Accepted Accounting Practice (UK GAAP) in 2009/10.

In-year financial performance

Result of income compared with expenditure, ignoring any impact of the previous years’ financial results.

Management costs Are defined as those on the management costs website at www.dh.gov.uk/PolicyAndGuidance/OrganisationPolicy/FinanceAndPlanning/NHSManagementCosts/fs/en.

Non-recurring funds An allocation of funding for projects with a specific life span, or one-off receipts. This includes ring-fenced funding and capital receipts.

One-off funding Funding which is provided for one year only.

Operational cost base The cost of providing day-to-day healthcare services in an NHS body.

Outturn The final financial position, which could be the actual or forecast position.

Private Finance Initiative (PFI) The UK Government’s initiative to encourage the development of private finance in the public sector. A generic term for projects involving both the public and private sectors. The involvement can be to varying degrees and the partnership can take different forms.

Public dividend capital (PDC) PDC is a form of long-term government finance which was initially provided to NHS trusts when they were first formed to enable them to purchase the trust’s assets from the Secretary of State. Additional capital expenditure can be funded as PDC. A dividend is payable by trusts to the Exchequer to cover the expected return on the Secretary of State’s investment.

Qualified audit opinion When an auditor is of the opinion that there is a problem with the annual accounts of an NHS body, they can issue a qualified report on the accounts. The qualification may be on the truth and fairness of the accounts, the regularity of transactions or both.

Regularity opinion Auditors provide an opinion as to whether an NHS body’s transactions throughout the year are regular i.e. they are in accordance with relevant legislation.

Resource accounting and budgeting

Accruals accounting for government, which plans, controls and analyses expenditure by departmental objectives.

Tariff A national price list for hospital procedures carried out on behalf of patients. The national tariff is intended to simplify the process for service level agreements between NHS organisations.

Time-releasing savings Efficiencies which do not release cash but allow frontline services to deliver more or better services with fewer outgoings. An example may be through the reduction sickness absence across the organisation.

True and fair opinion Auditors provide an opinion as to whether an NHS body’s accounts have been prepared in accordance with all relevant accounting standards, legislation and guidance.

Unfunded defined benefit scheme

Refers to a type of pension scheme in which no reserves are accumulated and benefits are paid by the employer as and when they are paid to the scheme’s members.

Unqualified audit opinion When auditors of NHS bodies are satisfied with the annual accounts they will issue an unqualified audit opinion.

This document is available in large print, braille or a language of your choice. Please contact Fiona Gurney, Communications Assistant, 01432 364000 or email [email protected]

Wye Valley NHS TrustTrust Headquarters The County HospitalUnion WalkHerefordHR1 2ER

01432 364000www.wyevalley.nhs.uk

2012-13 - wye valley nhs trust · 2013-10-09 · annual report and summary financial statements...

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