annual report 2004-05 - west london nhs trust · 02 i contents many viewpoints. one vision annual...

Annual Report 2004-05

West London Mental Health NHS Trust

Trust Headquarters

Uxbridge Road

Southall

Middlesex UB1 3EU

Tel: 020 8354 8847 Fax: 020 8354 8848

E mail: [email protected]

Website: www.wlmht.nhs.uk

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02 I Contents

MANY VIEWPOINTS. ONE VISION Annual Report 2004-05

Contents

2 Contents

2 From the chairman – a retrospective

3 From the chief executive – looking ahead

4 Supporting people in hospital and at home

6 Helping children, teenagers and families

7 Better support for older people

8 Putting women first

10 Delivering services in a secure setting

14 Giving, receiving, sharing – PALS, volunteers

and public involvement

18 Developing, supporting and responding

to staff

20 Building for a better future

23 Improvements through research

24 A learning organisation

25 Corporate governance

28 Who we are

29 Finance and accounts

West London Mental Health NHSTrust’s principal aim is:

“By using a process ofcontinuous improvement,to become a leader in thedevelopment and deliveryof high quality mentalhealth services”

From the chairmanAs you will see from this report, 2004/05was a busy year and a particularlychallenging one for West London MentalHealth NHS Trust. It is all the moresatisfying that we managed to achieve twostar status in 2005 whilst introducing newservices, extending and improving existingones and, significantly, balancing the books.All this has been achieved through the hardwork and commitment of many peoplethroughout the Trust.

We’re now seeing the benefit of the mergers of the last few years whichhave consolidated good investment in staff, systems and processes tomake us more consistent and reliable. In the coming year we’ll continueto build on this success and drive up standards.

Many new and exciting developments are nearing completion. Forexample, the Paddock Centre, one of four national pilot sites for treatingpatients with a dangerous and severe personality disorder (DSPD), is dueto open this autumn. This exceptional building integrates safety andtherapy with great design and is a credit to the project team and theclinical staff who developed it.

The Orchard, a new secure facility for female patients at Ealing, has nowreceived outline approval and plans are being developed in consultationwith the local community.

In older people’s services, community mental health teams are beingstrengthened to allow service users to be supported in the communitywhere most prefer to be, rather than in hospital.

A new paediatric liaison service based in Ealing Hospital is working in acompletely new way to help the families of sick children to deal with theeffects of their illness, both psychological and physical.

Behind all these initiatives and the many others being undertaken withinthis Trust are teams of dedicated staff. Our commitment to themcontinues with the roll-out of Agenda for Change, which ensures thecontinuing development of each member of staff, along with ImprovingWorking Lives and Investors in People. In addition, in September thisyear we will hold our first quality awards to recognise the best of thosecontributions. The call for nominations met with a terrific response fromboth staff and patients, giving the judges a hard task in deciding thewinners.

The coming year is likely to be a challenging one, but one in which wewill, nevertheless, continue our planned improvements for patients, theircarers and our staff.

Professor Louis Smidt

Chairman

03 I From the chief executive

From the chief executiveI am delighted to reflect on a very successful 2004/05 for WestLondon Mental Health Trust as represented in this annual report.During 2004/05 we have achieved a great deal, an achievementreflected in the improvement of our star rating from one to twostars.

West London Mental Heath NHS Trust is a complex organisationproviding a whole spectrum of mental health services for patientswith differing levels of need. Our vision is to provide continualservice improvement and to be a leader in the provision of highquality mental health services. We do this by being innovativeand responsive to patient needs, and inclusive of staff, users and

carers in developing and delivering our services. Within the Trust there are many viewpointsbut one vision to develop and improve the service and care we offer to our patients.

Looking forward we want to work with our partners, to develop better:

• Community understanding and acceptance of mental health issues

• Care and maintenance of patients in the community without the need for hospital admission

• Access and choice for patients to appropriate treatments and mental health professionals

• Access to housing, employment, debt counselling, training, voluntary services, supportivefriendships and leisure activities

At the same time, we have to recognise we are working in an environment where finance istight and investment is required in infrastructure and support mechanisms. To achieve thisdemands innovation, change and new ways of working and practice. This often creates fearand uncertainty, and we will work with our partners, community, staff, carers and patients toovercome it. This, I believe, we can do with the dedicated highly skilled and motivatedworkforce we have at West London Mental Health Trust. We operate in a changing NHSenvironment. For example, the current review of primary care trust and strategic healthauthority roles and responsibilities may not substantially affect our structure, but it will alterour relationships. The star ratings too have been replaced by the Healthcare Commission’s newcore standards for health which require us to produce a declaration shared with keystakeholders including oversight and scrutiny committees in each of the boroughs and theTrust’s patient and public involvement (PPI) forum.

The results of our staff survey led us to review our practice in a number of areas where staffsaid they could be better supported, particularly around how we manage and respond toincidents, support our staff and challenge the perpetrator. I want our staff to feel as safe andsupported as they can be, albeit recognising we are often dealing with some of the mostchallenging patients. Despite this, I am constantly reassured by the empathy, professionalismand dedication shown by all our staff to our patients which I see when I and others visit ourservices and sites.

On behalf of the Trust board and our patients, I would like to thank all our staff for thequality of care and service improvements they have given to patients over the last year. We dealwith increasingly difficult challenges year on year, but with support from our dedicatedworkforce I am certain that 2005/06 will be another successful year.

Simon Crawford

Chief executive

04 I Supporting people in hospital and at home


SUPPORTINGPEOPLE IN

HOSPITAL ANDAT HOME

In Ealing, the adult services have been reconfigured to help users become moreinvolved in the wider community and to develop greater independence throughemployment, education and leisure. Head of service Bridget Ledbury explains,“Together with Ealing, Hammersmith and West London College we have set up tasterpackages for training in a variety of practical courses like plumbing, brick-laying, carmaintenance, and hair and beauty. They are being offered to service users, their carersand community workers”.

The college also provides catering, horticulture and other courses on the hospital sitewithin work rehabilitation. Adult literacy will move to two of our community basesfrom September.

“We also funded one service user to learn to play the guitar and now he’s teachingothers!” explains Bridget.

Another Ealing project which won recognition as an example of good practice was‘Letting Through Light’ . Service manager Mark Jenkinson explains, “We wanted tofind out about the views of black and minority ethnic (BME) patients, which have notalways been adequately represented.

“Following a model trialled in Birmingham, and working alongside Ealing socialservices and the Ealing User Involvement Project, we trained a group of black andminority ethnic service users to interview other BME users about what they thoughtof the service we provide. We thought they might talk to another service user in a waythey might not with other pollsters.

“We got a good reception to their report locally and launched it at Ealing Town Hall.The London Development Agency also highlighted it on their website as an exampleof good practice”.

The project led to the funding of a BME user involvement project worker post whichis due to be set up in the coming year.

The activity project employs service users to provide recreational activities to patientson the wards in the Lakeside unit in Hounslow. Evening and weekend activities

Promoting independence

Mark Jenkinson

05 I West London Mental Health NHS Trust

Developing intensive care facilitiesThe development of Hammersmith & Fulham Mental Health Unit’spsychiatric intensive care unit (PICU), led by ward manager HalimaHachimou, has been recognised by the National Institute for MentalHealth in England (NIMHE) as making a contribution to goodpractice and developing national minimum standards for psychiatricintensive care.

Intensive care is available for patients who become disturbed andunwell with severe behavioural difficulties because of their mentalillness, or who become a danger to themselves. It is intended as ashort-term measure, and patients are usually transferred to an openward to continue treatment.

Dr Frank Kelly, clinical director of the Hammersmith & Fulhamacute directorate said, “We set great store by a culture of enquirywhich leads to improved quality. The PICU staff have done afantastic job, despite being a new team, many of whom had noprevious experience of intensive care”.

Helping patients to move onIn Hammersmith and Fulham, a joint initiative between the mentalhealth housing steering group and Supporting People has led to thecreation of a new joint commissioning housing manager post to mapwhere patients are currently living, ranging from hospital through tohigh, medium and low support accommodation. This new post isintended to help patients find suitable accommodation when they areready to leave hospital.

“We found that there were more than 100 patients in the borough inneed of housing who were stuck because they couldn’t find the rightaccommodation. We are workingwith housing and other agenciesto develop a better understandingof the obstacles. Patients who aredelayed can suffer a setback intheir recovery. We will continueto work with Supporting People,a national initiative working withvulnerable people, to find a localsolution so that our patients canmove on when they’re ready”,explains head of service Helen Mangan.

include art and crafts, board games and tabletennis. Workers receive training prior tostarting work, and have monthly supervisionin a group with other workers.They are paid£15 to work a two hour shift once a week.

Alison Hoble, day services coordinator, whostarted the project in 2002 says,“The projecthas been really successful, and is hugelyvalued by both patients and staff. Wecurrently employ 12 workers, most of whomhave been through the unit, found thesessions very important and wanted to putsomething back into the system”.

In Hounslow, electro-convulsive therapy(ECT) and clozapine clinic manager RajBudoo set up a new clozapine clinic forpatients with treatment resistantschizophrenia. “Patients in Ealing, andHammersmith and Fulham already had accessto this service, but in Hounslow we weresome way behind”, says Raj. “Our chiefpharmacist Trudi Hilton recommended thatwe set up a clinic locally, and found fundingfor it. Now we support around 55 patients,which means they can more or less lead abetter quality of life instead of beingcontinually in and out of hospital”.

“The project has beenreally successful, and ishugely valued by bothpatients and staff ”

Alison Hoble

Dr Frank Kelly

Raj Budoo

In Ealing, the introduction of a new choice and booking systemhas markedly increased the uptake of pre-booked appointments.Once a decision has been made to accept a referral, the family iscontacted by phone within 24 hours to agree a convenientappointment date with them.

Alex Tickell, operational manager responsible for introducing thenew system, welcomes the development. “It’s been good to talk topatients and their families. It gives us a chance to explain traveland car parking arrangements, and give them a feel for the place.For those without a phone we write to the parents and invite themto contact us to arrange a convenient appointment time. We’vefound that many do get in touch with us. It has significantlyreduced the numbers who do not come for their appointments,which means that more children are getting the treatment theyneed when they need it”.

Across the Trust our staff work with a wide number of otheragencies and professionals including GPs, teachers, health visitors,school counsellors and youth offending teams. We look afterchildren and teenagers with long standing mental health problemssuch as attention deficit hyperactivity disorder (ADHD),Asperger’s syndrome, psychosis, depression, severe eating disordersand those who self-harm.

Last year a paediatric liaison service was established in EalingHospital. The team of a consultant psychiatrist, a senior and aliaison nurse and a junior doctor provide care and support forchildren who self-harm, and children suffering long-term physicalillnesses such as diabetes and HIV.

06 I Helping children, teenagers and families


Helping children,teenagers andfamilies

In September 2004, the government launchedthe National Service Framework (NSF) forchildren which sets standards for children’shealth, and for social services and education.At West London Mental Health Trust weprovide community based and out-patientservices for children from 0 – 18 years of ageacross the three London boroughs of Ealing,Hounslow and Hammersmith & Fulham.

Alex Tickell

07 I Better support for older people

BETTER SUPPORTFOR OLDER PEOPLEThe Trust has seen considerable change across westLondon in services for older people. “We havestreamlined many of our services, closing some in-patient facilities to release resources to supportpatients and their carers in the community, wheremany would prefer to be”, explains Lynne Read,head of service for the specialist services for olderpeople directorate.

During the year Chiswick Lodge in Hammersmithwas closed and the community mental health team(CMHT) and day hospital moved to more accessiblefacilities at Stamford Brook. The Nuffield Unit, a 13bed in-patient unit at Chiswick Lodge wasdecommissioned and re-provided in moreappropriate buildings in the private sector.

In June 2006, services based in Stamford Brook willmove to new, purpose-built facilities underconstruction under a private finance initiative (PFI)in Hammersmith.

The 16 bedded Dove ward in the Lakeside unitunderwent a review to establish a better skill mixamong the staff, with improved handoverarrangements which in turn led to better care for the patients.

In Ealing, integrated services are being developedwith other NHS providers and social services, withthe CMHT forming a single access point to ensureconsistency for service users.

“There were a bewildering number of differentprocesses in use among the many partner teams andorganisations which we found confusing, so imaginewhat our service users and their carers thought ofthem! Now we are moving to something which willbe much clearer and easier to steer your waythrough,” says Lynne.

A similar PFI scheme will house CMHT andintegrated day services for the west of Ealing, duefor completion around June 2006. A second PFIbuilding will be completed in the summer of 2007which will house similar services for the east ofEaling.

Derwent ward in the John Conolly wing at Ealingwill be closed in September 2005. Respite willcontinue to be provided but this will be communitybased. Staff are working closely with service users,their carers and the Alzheimer’s Society to make surethat the final outcome is one which is suitable to all.

The Trust is in the final stages of implementing asingle assessment process used by all multi-disciplinary teams and multi-agency staff involved in providing care and support for older people inwest London.

“More children are getting thetreatment they need whenthey need it”

“It’s so specialist it’s opened up a whole new world for us”, explainsSandra Bailey, the team’s service manager. “We already specialise indealing with children who self-harm, but this initiative has seen ussupporting families who are not coping with long-term physicalconditions. Instead of focusing on the physical aspects, we look atthe whole family to see how we can support them emotionally”.

At the Cassel Hospital new patients have welcomed the introductionof a service user handbook written by existing patients. It coversinformation about how the Cassel’s therapeutic community works,what it is like to receive psychotherapy, information about thehospital and its facilities. It will be updated regularly as part of thecontinuing communication between staff and patients.

A bi-monthly family forum was also introduced for parents andcarers of patients in the adolescent and young persons’ service fordiscussion about treatment at the Cassel, to express worries orconcerns, and for feedback.

Sandra Bailey

08 I Putting women first


A six bedded ward for women was opened within the regionalsecure unit at Ealing, where female patients had previously beennursed in ones and twos on the male wards. Debbie Richards,service director for women’s forensic services, says, “This is ahuge improvement for the female patients. Being isolated onwards built by men for men is not a good environment forwomen who have very different needs”. This initiative allows theexisting sixteen bedded women-only ward in the Tony Hilliswing at Ealing to develop its rehabilitation function.

Consultant nurse Anne Aiyegbusi, Debbie Richards and clinicaldirector Dr Susan Iles are bringing staff together across women’sservices to share good practice and deliver care in a way which isappropriate for their patients.

In May 2005 Anne and Debbie ran a conference with delegatesfrom the prison service, forensic mental health and other NHSorganisations from all over the UK as far away as Scotland.“Anne was the clinical brains behind the event, and we used ournetworks as the vehicle to bring people together. It was afabulous day, and we even made a profit which we’re using forstaff training”, says Debbie.

Art, music and occupational therapists demonstrated how slowand careful engagement with even very ill women can reaprewards. In one case, Ann Sloboda, head of arts therapy,explained how she encouraged a patient to communicate usingmusical instruments to express herself. Gradually they began tohave a conversation in music without words. This gave a startingpoint for other care professionals to begin the long journeytowards this patient’s improvement.

Rosie Brown, an arts therapist, used slides to show anotherpatient’s progress from profoundly ill to gradual recovery

Puttingwomen first

A new directorate of women’s secure serviceswas established in November 2004providing high and medium secure, andcommunity forensic services. The newdirectorate focuses on providing women-only care for its 70 patients.

Debbie Richards

09 I Putting women first

through her drawings. Moving from simple and crude images tomore accomplished pieces, Rosie was able to show how herpatient developed the confidence to be able to work with otherhealth professionals and therapists.

Occupational therapist Sarah Devereux described how sheworked over many months with another woman who had barelybeen able to look after her own most basic needs and brought herto the point where she was able to cook a meal for them both.

Two ward-based team leaders from women’s services gaveindividual presentations about the clinical task of providingnursing care. Katie Downes and Sunita Arjune talked about thecomplexity of the nurses’ role. They described how theiradvanced clinical training had strengthened their nursing andleadership roles, enabling a strong underlying culture of reflectionto develop.

The new directorate is actively supporting training with otherdepartments within the Trust. Women’s services has an importantrelationship with the Cassel Hospital in terms of thedevelopment of specialised nursing practice. Team leader SunitaArjune at Broadmoor is the first to have completed jointadvanced nursing training between the Cassel Hospital andSheffield ward at Broadmoor.

In advance of the opening of the Orchard, a new secure unit forfemale patients at Ealing, four team leaders are being appointedwho will also complete specialist training at the Cassel Hospitalin order to strengthen clinical nursing leadership and practicewhen the Orchard opens. Team leader Doreen Whande from theEaling site has been seconded to an acting clinical nurse managerpost at Broadmoor Hospital and it is anticipated that this is oneof the ways that good practice from both sites can be integrated.

Promoting better

physical healthIn Broadmoor, some female patients haveparticular problems with weight gain andeating disorders. The nutrition and specialistdietetic service is applying research to theenvironment where patients eat to help themimprove their health and well-being bymaking meal times more of an event than asimple refuelling stop. “Making more ofmealtimes provides people with a morerelaxing environment, giving the chance forsocial chat as well as allowing food to besavoured, eaten more slowly and feeling fullerfor longer, which in turn reduces intake”,explains Alison Sullivan, head of the Trust’sdietetics service.

The team is also promoting healthy foods. To begin with, they visited the wholesalerswho stock the patients’ shop and selected arange of savoury and sweet foods which offergood nutritional alternatives to the itemspatients might normally choose. Back at theshop they marked those items with green starsto show at a glance the healthier options.

Rosie Brown

“This is a huge improvementfor the female patients”

Helen Webb and Cathy Fowler

10 I Delivering services in a secure setting


In Broadmoor Hospital the Trust has continued todevelop the two men’s directorates to ensure eachcan provide a full range of services. During thelast year, work was undertaken to develop assertiverehabilitation which is aimed at enhancing patientengagement through multi-disciplinary working.This includes teams of nurses, psychologists,psychotherapists, doctors, music, art, drama andspeech and language therapists working togetherto ensure a patient’s needs are fully met. Furtherdevelopment is needed, but it is anticipated thatthis initiative will deliver a more active andintensive approach to treatment. It will also formpart of an agreed care plan with other servicesoutside the hospital to which patients willeventually move.

Delivering services ina secure setting

Developing clinicalpractice

Closer working with the many otherorganisations involved in the care of mentallydisordered offenders is leading to clearerunderstanding of differing roles andimproving the experience of patients. A stakeholder event was held in the autumnto establish closer working betweenBroadmoor Hospital and some of thedifferent providers in medium and low securecare in planning pathways for patients and toensure their discharge and transfer is managedeffectively. Service director Maggie Gairdner,who led the event, was pleased with theresponse, “The work we have been doingensures that everyone knows what to expect

at each step of the way, and that together weplan a patient’s treatment over the course ofmany years. In the end, we want to achievesmooth transfers between the different careproviders with no hiccups or surprises”.

A quarterly meeting with carers has beenestablished at Broadmoor, which is wellattended by relatives of our patients. At eachmeeting doctors and senior managers provideinformation and answer questions raised.Discussions have included improvements tovisiting arrangements and involving carers inthe care planning for their relative.

Working together with partners


To support this assertive rehabilitation initiative and toincrease patient engagement on our higher dependencywards, occupational therapy has been enhanced with theappointment of six new occupational therapists (OT)posts. This ensures there is an OT for every ward and thatthey are all based within every clinical team to engender amore integrated, patient-centred service. The number ofOT assistants has also been increased to support patients’rehabilitation.

One project within the hospital offers a range of vocationalservices to patients who have not accessed them for sixmonths or longer. Patients can also be referred whereappropriate for an assessment of risk, and of managing riskin a work rehabilitation environment. The main emphasisis to develop patients’ skills in a broad range of activities,reducing negative symptoms through engagement,reducing risk through gradual use of tools, and throughthat, enabling access to mainstream vocational services.

Clinical leadership is an important part ofeffective treatment, and the clinical nursemanagers (CNMs) in our high secure services arebeing supported through a leadership programmeintroduced in the autumn. To help them in theirrole of providing clinical supervision andmanaging staff and facilities, the programmeoffers practical human resources and financialadvice, a programme of personal development,and a chance to work in learning sets with otherCNMs to develop and introduce improvements.Feedback from CNMs has so far been extremelypositive.

Team leaders play an important part in ensuringthat the effective supervision is evident at wardlevel. Patrick Sesay, newly appointed during theyear as a team leader, has introduced weekly groupsupervision on his ward to support staff and allowteams to review and reflect on what they do.Because his is a high dependency ward, it can bedifficult to create time for groups of staff to meet,so he has devised a timetable which allows forgroups of staff on the same shift pattern to meetan hour early on one of their late shifts.

“This is new for staff, and although it’s early days,the feedback is that people are doing well on theward”, he says. Patrick has also arranged for staffto have access to one-to-one supervision, “Staffmay have personal issues, as well as issues at work.It’s important that they can discuss these things inconfidence with another professional”, he says.

Supporting staff

“This is new for staff,and although it’s earlydays, the feedback is thatpeople are doing well onthe ward”

Patrick Sesay



Senior occupational therapist Gabrielle Buchanan, supported by senior nurse CharlesFlood, established monthly service user forums at both the Tony Hillis wing and theThree Bridges medium secure unit. “We were setting out to redesign services whichwould involve around 65 patient moves, but didn’t have a forum where we could talkto patients about the plans and listen to their concerns”, explains Charles.

The forums are led by a multi-disciplinary team (MDT) of staff and cover a range ofissues around the ward environment, food, policies and procedures.

“It’s a two-way process”, says Charles, “We bring issues and so do the patients. We’redeveloping an advocacy service at the moment and the patients have been veryinvolved with that. We’re also commissioning our first user survey and they’re telling uswhat questions they want to see included”.

“Over time we are aiming at supporting service users to facilitate meetings and staff areencouraging them to identify the skills required in minute taking and chairingmeetings so that we can arrange training”, adds Gabrielle. “The last 12 months hasbeen incredibly rewarding for me, and feedback from service users has been equallypositive, with people telling us how encouraging it is to be heard and for their viewsand concerns to be taken seriously.

“At the service users’ request, various members of the MDT have made presentationson topics including the new draft mental health act, security and the drug and alcoholsupport service”.

The development of a high dependency unit on Tom Main ward within the ThreeBridges unit has led to a significant improvement among a group of patients with verychallenging behaviour.

“Many of these patients had been with us a considerable amount of time and were notmaking much progress”, explains directorate manager Andy Weir, “Using a therapeuticcommunity framework, staff have dramatically reduced the number of incidents andhave seen patients make great progress, in some cases re-establishing relationships withfamily members which had broken down years ago”.

Andy Acquaye, ward manager on Tom Main, adds, “We have dramatically reduced theamount of anti-psychotic drugs prescribed”.

Relaunched services in Ealing

“Feedback fromservice users hasbeen positive withpeople telling ushow encouraging itis to be heard andfor concerns to betaken seriously”

Gabrielle Buchanan and Charles Flood


Broadmoor Hospital is one of four national pilot sites developing a service for patientswith a dangerous and severe personality disorder (DSPD). The other pilots atRampton Hospital, and at Whitemoor and Frankland prisons are already established.At Broadmoor, the DSPD service opened on an existing ward in 2003 with tenpatients, but from October 2005 the ten patients on this ward will move to a new,purpose-built facility called the Paddock with capacity for 70 patients.

Working with the national Offending BehaviourProgramme Unit, the DSPD staff are developing a modelof care based on cognitive behavioural therapy (CBT)which will be measured against alternative research projectsin the other three units to establish the most effectivetreatment for this extremely challenging group of men, allof whom have offended violently or sexually.

The DSPD service is highly structured and patients have acarefully planned schedule of activities and therapiesthroughout the day. Every evening each patient has adebrief with a member of staff to review the day and planthe next day’s activity.

A multi-disciplinary model of care is embedded into theservice and all staff are based on the ward rather than inprofessional groups. This encourages a more flexibleapproach to treatment in which the person best suited tothe task is the one who undertakes it, rather than arepresentative of a professional group as might previouslyhave been the case.

To help staff cope with their demanding roles, asupervision package has been developed to support themwith monthly hour-long clinical and managerial sessions,and weekly group supervision facilitated by a confidentialstaff support service.

Catherine Farr, a forensic psychologist who carried out anaudit of the supervisory arrangements with team leaderTariro Maburo and clinical nurse manager Jimmy Lucas,commended the supervision process, “It’s very much two-way, with both the supervisor and the supervisee sharinginformation about clinical and management issues. It’s about skills rather thanhierarchy. What we expect is that all staff will take part indelivering therapy, and then we review our practice to see

what skills and experience the individual is acquiring toequip them for their job”.

This practice is reflected in new solutions, such as the postof DSPD therapy assistant which has been developed toprovide staff in the more traditional role of health careassistant with a range of practical skills and academiclearning which is tailored to the needs of the DSPDpatients.

DSPD - finding new solutions

“It’s about skills ratherthan hierarchy”

John Cordwell and Catherine Farr

The Trust runs a patient advice and liaison service (PALS) to provide on the spot helpto service users, their carers, friends and families with the power to negotiate solutionsand speedy resolutions of problems.

Working with Trust staff, PALS acts as a catalyst for change by identifying problemsand gaps in service, finding solutions and feeding them back to be incorporated whereappropriate in new policies and procedures or changes to practice.

Within the west London mental health service, the main issues during the yearconcerned general information about the Trust and recruitment advice. Most enquirieswere received by e mail or telephone, and phone messages can be left and are returnedspeedily if necessary. In addition face-to-face contact can be arranged.

The second largest number of enquiries concerned issues to do with treatment andcare. They included questions about direct care, referrals and appointments.

The service is based at Trust headquarters in Ealing, and it is perhaps unsurprising thatthe majority of the contacts arise from Ealing-based services and patients. There areplans in the coming year to arrange sessions in Hammersmith and Fulham andHounslow, and further to develop the service in the high secure services.

14 I Giving, receiving, sharing – PALS, volunteers and public involvement


Giving, receiving,sharing– PALS,volunteers and publicinvolvement

PALS was contacted by an in-patient who wasconcerned that he was not receiving mail onthe ward that contained benefits from theDepartment of Social Security that he wasentitled to. A meeting was arranged with theward manager, PALS, the service user and hissocial worker. The issue was explored andclarified and the service user was able to checkhis paperwork and confirm that he hadreceived his benefits. The system for recordingservice users’ mail was made morecomprehensive as a result of this query. Theissue was resolved within a day.

RecognisingachievementsThe achievements of service users invocational and educational work, aswell as sports and leisure arerecognised in different ways acrossthe Trust. The work rehabilitationunit at Ealing, for example, holds aday of achievements where certificatesare presented to service user teamworkers. Among a range of activitiesat Broadmoor Hospital, sportingachievements are celebrated at anannual awards event, patients areencouraged to submit work to theannual Koestler awards and theeducation service holds an annualpresentation event.

An in-patient’s relative wasconcerned that her father hadlost some of his propertywhilst in hospital and was notsure what to do about it. Hehad also spent some time inan acute hospital. PALSinvestigated the query andput the relative in touch withthe appropriate lost propertydepartment who were holdingthe lost items.

A relative contacted PALS byemail and asked forinformation and adviceregarding her son’s diagnosis.PALS was able to draw onexpertise within the Trust andadvise the relative on whereshe could go for moreinformation and advice bothlocally and nationally.


Under the direction of Pat McGrath, the volunteer servicescoordinator who took up post in 2003, our first 32 volunteerscompleted their tailor-made induction programme and areworking in their placements. There are two more intakesplanned during the coming year, which will swell the numberfurther.

Our volunteers bring goodwill, energy and insight about thelocal community from which they come. As individuals theyidentified many things which motivated them to join, includingbroadening their outlook, bringing their own experience tosupport others, meeting people and becoming more confident,returning the help they themselves had received, and gainingexperience to work in mental health.

Within our Trust they have contributed support to the team inwork rehabilitation at Ealing, supported activities at ourresource centres, offered continual support for the patientpublic involvement agenda and the diversity office, and plan tosupport day sessions run by occupational therapy. AtBroadmoor, volunteers run the cafeteria in the Julie Ruel centreand, as much valued visitors, play bowls and bingo with thepatients.

Anna was one of the first group of volunteers. She heard abouta new initiative being launched in the Trust and worked withPat helping her as she set up the service, “I worked with Pat inthe office getting the packs of information sorted out andtrying to get departments interested in volunteers.

“Pat sorted a one-day course in Excel for me. I used to be aninvoice typist, now I work in clinical audit doing general officeduties and data entry. I like learning new things. I would like toget a job at some point and this is giving me confidence -learning to make mistakes and see that the world won’t come toan end. Pat’s brilliant, she gives you breathing space andreminds me what I’ve achieved”.

Using that growing confidence, Anna helped to develop anaudit workshop, and is undertaking an Open University degreein health and social care.

VolunteeringThis has been a busy year for the service andwe are gaining recognition as an organisationwhich provides a thoughtful and informedwelcome to volunteering.

Anna



Paulette is a carer, and another from the first intake of volunteers.Her son has been unwell since 1998. “When a member of yourfamily falls ill with a mental illness your life changes radically. Iknew nothing about the illness or the system and didn’t know whereto turn”, she says.

Her son is now receiving treatment from a community mentalhealth resource centre. “I offered to help generate support and stuffenvelopes, but was told I would need to become a volunteer. I wasinducted and from then on it’s been great. The induction puts youin touch with other volunteers and it brings a new circle of friends”,she says.

After her induction she was given a placement at Avenue Housewhere she co-facilitates a carers’ support group. “I was known as acarer, as the mother of a service user, and then as a volunteer, andpeople weren’t sure how to be with me at first but the staff at AvenueHouse have been very supportive – and the carers come!”

“The induction putsyou in touch withother volunteers andit brings a new circleof friends”

Paulette


Patient and publicinvolvementOf course service users, carers and thewider community are involved in all sortsof ways in the business of the Trust, butthere is also a department within the Trustdedicated to making that involvementmeaningful.

“It’s about making service userinvolvement real and not just an add-on”,explains Sue Cumming, head of patientand public involvement (PPI), “Forexample, service users have been involvedin staff interview panels in various waysdown the years, but now we aredeveloping a policy to define how weinvolve them, train them to take part inthe process and pay them for theircontribution”.

The clinical audit team are providingtraining for both staff, service users andcarers in how to carry out audits. “Usersand carers will be a real asset in auditingour services. They know what needslooking at because they have experiencedit, and they know the standards we shouldbe aiming for. Not only that, but they willbe involved in drawing up the actionplans to deliver the solution when thingsdon’t match expectations”, adds Sue.

Sue and her team also liaise with the localindependent patient and publicinvolvement forum (PPIF) whose chair,Andrew Barton, has been invited tobecome a key member of the bi-monthlyTrust user forum where patients raiseissues of concern and receive answers fromthe executive team.

“I had received a lot ofsupport and I wanted togive something back”

Different people come to talk to the group, “A clinical psychologistoffered to talk to the group about different aspects of mental illnessevery month and actively encourages discussion. The other carersfind it absolutely brilliant – they say it’s like a therapy session! Hetalks of schizophrenia as an illness you can recover from, andreminds you the sufferer is still there underneath”.

Through volunteering Paulette has been able to access variouscourses, “I’m very grateful to the Trust for providing all this training.I have been on a computer course, learnt about mental illness andhave had training in clinical audit.

“Pat spotted that I was a retired teacher and has encouraged me toattend Trust meetings as a carer. I go to the Ealing partnership boardand the local implementation team (LIT) where my role is to listenand report back to the carers’ group.

“Through the LIT I learned about the reconfiguration of someservices and I invited the Ealing head of service Bridget Ledbury tocome to the carers’ meeting to explain the changes. I’ve learned a lotabout the Trust and about the rights of carers and that helps me tosupport them”.

For Paulette though, like many other volunteers, while she gains ahuge amount from her role as a volunteer her motivation wassimple, “I had received a lot of support and I wanted to givesomething back”.

18 I Developing, supporting and responding to staff


Developing,supporting andresponding to staff“Everything we do, from attracting staff, to training them, makingimprovements in their working lives, breaking down barriers andprejudice and recognising quality has been the focus of detailed workduring the year”, says Kelvin Cheatle, director of human resources (HR).

The work being undertaken towards complying with the Agenda forChange (AfC) programme is on target. By the end of September 2005,nearly all 3,800 staff (excluding doctors and directors) will have had theirjob evaluated, and their individual terms and conditions agreed in orderto transfer over to the new national scheme. “This has been a huge task,carried out in partnership between HR managers and staffrepresentatives, and this achievement is a huge credit to them all”, says Kelvin.

“Partnership working has been clearly demonstrated throughout theAgenda for Change process”, says Giannina Maina, the staff side chairfor the Trust, “It has built on the foundations we had begun and brokendown barriers between staff side and managers. From a staff side point ofview it makes clear who we are, why we’re here and what we do”.

As part of AfC sits a related national project called the Knowledge andSkills Framework (KSF). The KSF builds a competence framework foreach job in the Trust which assesses the individual’s knowledge and skillsand, through annual appraisal, links it to the yearly pay progression.Within West London Mental Health Trust the KSF will be fullyimplemented over the next 12 months.

The Trust is preparing to be assessed later in the year for practice plus -the gold standard - for Improving Working Lives (IWL) which is aprerequisite for any application to become a foundation trust. “IWLassesses an organisation on its HR strategy, diversity, training, healthyworking, staff involvement and communications, but more importantly,it’s about what type of organisation you are and marks you out in therecruitment market place”, says Kelvin.

That market place is very important for an organisation like ours whichrecruited 600 new staff in 2004/2005 and expects to take on a further800 in the coming year. In order to position itself as an employer ofchoice, the Trust worked with a recruitment agency to establish a clearidentity for itself. which has been taken as thetheme of this annual report, sums up the complexity of the Trust, and its focus.

Our annual staff survey gave mixed results. Although strong in manyareas, including access to good quality training, the 42% of staff whoresponded highlighted several aspects of their working life which neededstrengthening. Two away-days were held to feed back the results to allleaders, supervisors and managers across the Trust, and to look at ways tostrengthen the areas highlighted for priority action.

Kelvin Cheatle

Giannina Maina

19 I Developing, supporting and responding to staff

Anne Francois and Ellen Lucien are secretaries based in the Ullswaterunit within the John Conolly wing at Ealing. Both have been activelyinvolved in a local Improving Working Lives (IWL) initiative, “OurIWL group meets every other month to discuss all sorts of issues likediversity, childcare, pensions, caring for older people and flexibleworking”, explains Anne.

“We find when we go back to our colleagues and talk about what we’veheard other people get more interested and it has helped improve two-way communication with our managers”, adds Ellen, “Years ago peopleweren’t that sympathetic towards flexible working for example, butthese days it’s getting better”.

“This is all part of a wider programme which began for us a few yearsago with Investors in People (IiP)”, says Anne. “Our accreditation willbe reviewed to see what improvements there have been as a result ofgetting IiP. For us, we have better feedback from our appraisal andbetter access to training, as well as an area away from the desk for staffto relax. You can see it’s making a difference.”

Much is now being done to address these issues: increased access tochildcare is one strand of many planned to increase work/lifebalance; a bullying and harassment hotline is being set up so thatstaff can access a confidential service to discuss problems, and fromOctober 2005, all managers will be attending a leadershipprogramme to equip them better for their role.

Mandatory diversity training has been rolled out, beginning with theTrust board, and has been very popular. The diversity unit was askedto contribute to the new training for clinical nurse managers. “Theresponse was so positive that we ended up providing it in twosessions, one on diversity in clinical practice and the other ondiversity in employment practice”, says Maggie Fordjuor, who withher colleague Bernie Collins take the diversity leads in the Trust.

The unit also developed the Ealing Breaking Through programme,based on the national model, in collaboration with local partners,Ealing Hospital, Ealing PCT and Ealing Borough Council. Theprogramme provides black and minority ethnic staff with anopportunity to develop management skills.

A positive highlight to the year has been the new quality awardsscheme. “Our predecessor organisations had had schemes, but wewanted a focal point for West London Mental Health Trust torecognise the contribution of our staff”, explains Kelvin. “We had120 nominations for 10 categories, which is a terrific beginning.Some people found it hard to relate to the new Trust, this will createan identity and a sense of value for the organisation”.

Anne Francois and Ellen Lucien

Bernie Collins

20 I Building for a better future


Building for abetter futureThe OrchardIn 2005 the Trust gained approval from the Department of Healthto develop a women-only integrated secure unit at Ealing providing45 enhanced medium secure beds and 15 medium secure beds. Theunit, named the Orchard, is due to open in summer 2007.

“This enhanced secure facility is the first of the kind in the countryand we are working with other NHS bodies, social services, theHome Office, the local community and the voluntary sector todefine exactly what it will provide”, explains Debbie Richards, whois leading the project.

“Our Trust was invited by the North West London Strategic HealthAuthority on behalf of the London-wide NHS to put forward abusiness case for this development. We have brought stakeholderstogether across a massive area representing a population of 21million across London and the south of England, and our plansreflect the needs of that population for specialist services for a smallgroup of women who have traditionally not been well served”.

The local community was initially concerned about the developmentand the team has worked closely with them as it progressed theplans. As a result of those concerns, the building was reduced fromthree stories to two, with the office space being moved to existingbuildings next to the new site.

This developing relationship with the community had unexpectedspin-offs. At Christmas Derek Barnes, chaplain at St Bernard’s,invited a local youth group to put on a pantomime in the chapel,and to attend the Trust’s carol service.

The planning team has actively involved the patients, and theresponse to one patient’s plea “can we be involved in more than justchoosing the wall paper?” was a resounding “yes!” A patientrepresentative visited the mock-up bedroom, and changes were madein response to the comments she brought back from talking to otherpatients. Patients continue to be involved, for example with theemerging visiting policy for the unit.

“The building is being designed to promote a positive, therapeuticand safe environment for the women and to provide them with asense of security and the hope of recovery”, explains Debbie. “Forour staff, it must be a positive, supportive and safe workingenvironment which will enable them to develop good, therapeuticcontact with the patients.”

John Corlett, director of estates and facilities


The Wells UnitCurrently, as a young male up to the age of 18,detained under the Mental Health Act, the onlyforensic NHS beds available to you are inManchester or Newcastle. You might only seeyour family once or twice a year, at a critical timein your development.

All that is changing. Under a new scheme fundedby the National Specialist CommissioningAdvisory Group (NSCAG), the Trust has beeninvited to develop one of the country’s pilot unitsfor an adolescent forensic service.

The new service, called the Wells unit, after theartesian wells beneath the site, will provide ten in-patient beds for boys aged between 13-18. “Thiswill be a very different service”, says Emma Hall,the project manager. “We’re not just designing abuilding, we’re designing a whole new service”.

Dr Kevin Cleary, clinical director, has beenworking on the clinical model and operationalpolicies with senior nurse manager, Gina Hillis.Dr Cleary provides clinical leadership to themental health centre at Feltham Young OffendersInstitute. “Whilst great progress has been madeat Feltham”, he says, “there are limits to what youcan do in a prison setting”.

There will also be links with the Trust’s CasselHospital. “We showed a model to the youngpeople at the Cassel”, said Dr Cleary “and theygave us a young person’s view of what an in-patient unit should have – what’s important andwhat’s not”.

When designing the unit there were otherconsiderations such as the provision of schoolingand space to run about and play sport. Thechoice of location for the new unit was limitedand the best option was identified as an existingward in the Ealing medium secure unit which hasthe advantage of being on the ground floor withaccess to a secure outdoor exercise area.

The move has necessitated refurbishment of otherwards to accommodate the patients who have hadto vacate the space for the Wells unit.

The service, due to open in April 2006, will havea structured timetable with five hours of schoolingeach weekday. “The challenge in treating suchchildren is that for most of them their

“Because thesepatients aremuch younger,you have morechance to makea significantchange to theirwhole life”

development has been disturbedfor a long period of time.They’re likely to have beenexcluded from school andunable to read or write verywell or at all, and they’ll quiteoften have disturbed familyrelationships. Our service isabout getting the child back ontrack, engaging them withschooling and re-establishinghealthy contact with theirfamilies. It is definitely not “a mini-adult’ service”, says Dr Cleary.

“Because these patients aremuch younger, you have morechance to make a significantchange to their whole life. Ifyou can get their problemssorted out when they’re in theirearly teens, there’s no reasonwhy they shouldn’t go on tolead a normal, fulfilling life”.

Building up ourIM&TThe Trust is not only buildingwith bricks and mortar.Development of its informationmanagement and technology(IM&T) capability has been animportant feature of recent years.IM&T is central to the sharing ofrobust, up to date clinicalinformation which supports theTrust in delivering its services andimplementing its strategy.

During the year, IM&T staffimplemented eCPA - the meansby which care programmeapproach information is storedelectronically, and installed astorage area network to give muchhigher resilience for patientadministration activity, e mail and document storage. A Trust-wide informationmanagement and technology(IM&T) call centre offers staffbetter support for IM&T related problems.

Plans are underway to develop aTrust-wide intranet, allowing amuch more robust ability to store,track and search for documentsand, crucially in such ageographically diverseorganisation, a much quicker,more flexible and responsive wayof communicating with staff.

Information management staffhave redesigned the process bywhich Trust information issubmitted to the Department ofHealth. This information is thenused towards the assessment ofour star rating and to providenational statistics on mentalhealth services. Planning has alsobegun for the implementation ofthe NHS care record servicewhich aims to revolutionise thedelivery of patient care throughthe implementation of a singleintegrated electronic health recordfor every person in England.

ThePaddockCentre

I Supporting people in hospital and at home


“The Paddock Centre is totally different from anything elsewe’ve built”, says David Phillips, capital projects manager.David is responsible for the building of this new 70 beddedunit at Broadmoor Hospital opening in the autumn of 2005to provide the service for patients with a dangerous andsevere personality disorder (DSPD).

“We’ve taken the best bits from other buildings on the siteand incorporated them into this development”, he says.“The Victorians knew the therapeutic benefits of givingpatients a view – that’s why they built here at Broadmoor –and that’s what we have done with the Paddock, which hasfabulous views of the Berkshire countryside. “We alsoincorporated other Victorian design features using highceilings, lots of natural light, good ventilation and access tofresh air”.

The staff in the DSPD unit strongly influenced how spacewas used within the centre. For example, in a departurefrom common ward design, the lounge, dining and leisurespace for use during the day is totally open plan, allowingpatients to be clearly visible to staff. The bedrooms strike abalance between strength and aesthetic qualities, and arenaturally ventilated with opening windows.



“It was a tremendous privilege for clinicians to have asay in the design of the building. Instead of outdatedwards, Broadmoor now has an exceptional new facility.The challenge for staff is to develop a moderntreatment regime to match the surroundings, and weare well on the way to doing that”, says Professor TonyMaden, clinical director of the DSPD unit.

Security is integral to this development, and onemember of security staff has been permanently assignedto it throughout the design and build process. Thecentre is designed to be largely self-sufficient and has itsown dedicated sports hall, and small cardio-vascularfitness suite, inner courtyard gardens for access to freshair, and a multi-purpose central forum, where patientscan take breaks, attend presentations and watch films.

“The challenge for staff isto develop a moderntreatment regime to matchthe surroundings”

23 I Improvements through research

Improvements through researchThe Trust’s research and development (R&D) departmentoperates in conjunction with the Central North WestLondon Mental Health Trust (CNWL) as the LondonWest Mental Health R&D Consortium, and is linkedwith the north London hub of the national MentalHealth Research Network. The ultimate aim of all theresearch and development activity carried out is toincrease our understanding of mental health problems and improve the care and services for those people withthese conditions.

The consortium is the lead organisation for six majorresearch programmes: child and adolescent mental health,neurobiology and treatment of psychotic disorder anddementia, personality disorder and risk, primary carehealth and behaviour, substance misuse and comorbidity.There are numerous projects within these researchprogrammes and a significant number of staff throughoutthe organisation and across all professional groups areinvolved in the development and continuation of research.We are constantly looking for additional ways toencourage and foster the research ethos.

The amount of external funding for the registeredconsortium projects in 2004-2005 was approximately thesame as the previous year, and the number of scientificpublications also remained steady. The ways in which ourresearch is impacting directly on patient care can be seenthroughout the Trust and nationally. Examples for 2004-2005 include:

• Development of a physical health checklist, now used widely across the country

• Study of factors that can contribute to risky sexual behaviour influenced training programmes for staff working in genito-urinary services

• Research in the child and adolescent mental health programme has been influencing planning for the provision of psychiatric inpatient beds for adolescents

• Expert advice has been given to the Department of Health in relation to proposed National Institute for Clinical Excellence (NICE) health technology assessment of violence and risk assessment instruments

• Development of a new rating scale for assessing the side effects of antipsychotic medication that has been adopted by other research groups and clinical services nationally

The R&D department plans over the next few years tocontinue to encourage a broad engagement of Trust staffin R&D projects, and maximise the opportunities forpatients to join in research studies. The department willalso continue to ensure that all studies conducted withinthe consortium are of high quality, and comply withrelevant research governance policies and procedures.

Siobhan Burleigh and Shen Khan

24 I A learning organisation


Learning fromcomplaintsPaying attention to things which gowrong is the first step to ensuring we getthem right in the future. Although thenumber of complaints received rose by 49to 282 this year, they are dramaticallyreduced from the 712 recorded in2000/2001.

This may reflect an improvement inresolving problems before they becomeformal complaints, and the introductionof both advocacy provision and thepatient advice and liaison service (PALS).

As with complaints throughout the NHSthe most common complaints relate tospecific care and treatment, and to staffattitude. A number of changes have beenmade which reflect what has been learnedincluding meeting with patients and theircarers to provide information, producinga checklist for patients’ property and wardpolicy on admission, and improvedrecording of incidents and medicationmonitoring.

As a result of complaints received, theTrust is addressing the problem of lengthywaits for patients wanting to access thegender identity service.

In 2004/05 the Trust received 279complaints which it sought to resolve atthe local resolution stage of the NHScomplaints procedure. Of these 223(80%) were responded to within 20working days, compared to 42% ofcomplaints in 2003/04.

Making a differencefor patients“We want clinical governance to have realmeaning, and to make a difference inwhat we do for patients”, says Maria.There are countless examples of this manyof them reported elsewhere in this report,including the development of a serviceuser handbook written by patients andthe establishment of a family forum at theCassel Hospital, a new paediatric liaisonteam based at Ealing Hospital, a newclozapine clinic for patients in Hounslow,the appointment of a user involvementworker in Hammersmith & Fulham, andwork led by the dietitians to improve thephysical health of patients.

A learning organisation

Clinical governance is the way weensure that we are continuouslyimproving the quality of our services,safeguarding high standards of careand creating an environment in whichexcellence in clinical care can flourish.

“It’s about having the right personwith the right skills in the right placeat the right time doing the rightthing”, says Maria Harrington,associate director responsible forclinical governance, “It’s also aboutsharing learning and being innovativeabout how we do things”, she adds.

Key initiatives launched during theyear to create a safer environment forpatients include the introduction ofthe new patient engagement andobservation policy, the suicideprevention strategy, a focus onsafeguarding children and on cardio-pulmonary resuscitation. Extensivetraining programmes have beenimplemented to support nursing andother staff in the introduction of these policies.

The Trust’s leave of absence policy forpatients was reviewed, as was the firepolicy. “We undertook a huge amountof work over the summer detailing fireevacuation arrangements anddeveloping a fire policy”, explains

Helen Mangan, head of service for thenew Hammersmith & Fulham MentalHealth Unit, who led the review forthe Trust. “Staff have been trained inevacuation and as fire marshals, andpatients’ lighters have been confiscatedand replaced with safer, wall-mountedlighters”.

West London was the first mentalhealth trust to be assessed and passedfor Clinical Negligence Scheme forTrusts (CNST) mental health level 1standards, and takes part in the RiskPooling Scheme for Trusts (RPST).

The Trust has an emergency incidentplan in place which is kept underregular review.

The Trust met the standard that nopatient should wait longer than 17weeks after being referred by a GP foran out-patient appointment.

Maria Harrington

“It's aboutsharinglearning andbeinginnovativeabout how wedo things"

25 I Corporate Governanace

For 2004/05 the Trust board comprised:

ChairmanProfessor Louis Smidt

Non executive directorsMs Tesse AkpekiMrs Ann ChapmanMr John CoxProfessor Christopher KennardMr Anthony J PearsonMrs Kamaljit SinghDr Timothy Woolmer

Chief executiveMr Simon Crawford

Executive directorsMrs Barbara Byrne, director of finance & information Mr Kelvin Cheatle, director of human resourcesDr Elizabeth Fellow-Smith, medical directorMr Ian Kent, director of local servicesMr Grant Macdonald, acting director of nursing from 1st June 2004 Mr Robert Nessling, director of nursingMr Sean Payne, director of forensic services

Other Trust directors who attend board meetings are:Professor Thomas Barnes, director of research &developmentMr John Corlett, director of estates & facilitiesMr Alistair McNicol, director of securityMs Jessica Williams, DSPD project director to 28thFebruary 2005 acting programme director, SOC from 1stMarch 2005

The chairman and non executive directors have beenappointed by the Secretary of State for Health, inaccordance with national procedures for appointments tosuch positions, for a term of office that may vary from twoyears to four years and is specified on appointment.Appointments may be terminated by the Secretary of Statefor Health.

The chief executive and other executive directors wereappointed by panels consisting of the chairman, nonexecutive director(s), a representative from the LondonRegional Office and an external assessor. The executivedirectors have permanent contracts with a requirement togive or receive six months notice of termination.

Board meetings The Trust board holds nine business meetings a year, on thelast Tuesday of every month except June, August andDecember. Since July 2004 board meetings have been heldin the board room at Trust headquarters, Southall.Members of the public, patients and staff are welcome toattend these meetings and agendas and papers are available,upon request, from the Trust board secretary. Thechairman invites comment and questions from anyattendees who wish to participate.

In addition, the Trust holds one annual public meeting eachyear, in September, at which it presents its annual reportand accounts. This meeting is also open to the public andquestions and comments invited and encouraged.

Committees To support the work of the Trust board the following sub-committees have been established:

• Governance committeeThe committee is chaired by the Trust chairman, ProfessorLouis Smidt. Three non executive directors, Mr John Cox,Professor Chris Kennard and Mrs Kamaljit Singh arecommittee members; as are executive directors Mr SimonCrawford, Dr Elizabeth Fellow-Smith, Mr Robert Nessling(represented by Mr Grant Macdonald from 1st June 2004),Mr Sean Payne, Mr Ian Kent, Mr John Corlett and MrKelvin Cheatle.

The governance committee was formed in October 2004 tooversee the development, implementation and monitoringof the Trust-wide assurance framework.

This committee identifies the highest principal risks to theTrust delivering its corporate objectives and monitorsprogress against managing these. It reports to the Trustboard biannually on progress in ensuring internal controlsare operating in compliance with controls assurancestandards.

• Audit committeeThe audit committee is chaired by Mr John Cox. MrAnthony Pearson and Dr Timothy Woolmer are the othermembers of this committee.

The audit committee’s function is to consider reports andinformation arising from the activities of the financedepartment, the external and internal auditors and otherservices as applicable. It monitors the financial controls andperformance of the Trust on behalf of the board.

2004/05 Corporate Governance



2004/05 Corporate Governance (continued)

• Clinical & research governance committeeThis committee is chaired by Mrs Kamaljit Singh. MrSimon Crawford, Dr Elizabeth Fellow-Smith, Mr RobertNessling (represented by Mr Grant Macdonald from 1stJune 2004), Professor Thomas Barnes, Dr TimothyWoolmer and Mrs Ann Chapman are members.

The committee’s remit is to oversee the implementation ofclinical and research governance issues within the Trust,ensuring the development of systems to support effectiveclinical and research governance, setting the priorities forimproving clinical effectiveness and ensuring appropriateaction is taken where inadequate performance or shortfall inquality is identified.

• Service improvement committeeThis committee is chaired by Mr Simon Crawford. DrElizabeth Fellow-Smith, Mrs Barbara Byrne, Mr RobertNessling (represented by Mr Grant Macdonald from 1stJune 2004), Mr Sean Payne, Mr Ian Kent and Mr KelvinCheatle are members.

This committee is the main forum within the Trustresponsible for the agreement and oversight of Trust-wideservice improvement priorities and the development of theTrust service and performance improvement plan.

• Risk management committeeThe committee is chaired by Mr Simon Crawford. MrRobert Nessling (represented by Mr Grant Macdonald from1st June 2004), Mrs Barbara Byrne, Mr Sean Payne, Mr IanKent, Dr Elizabeth Fellow-Smith, Mr John Corlett and MrAlistair McNicol are members.

The committee is responsible for ensuring that allsignificant risks are reported to the board. It coordinates themanagement of reported clinical and non-clinical risks andsupervises the operation of the risk register and theprocesses that support it.

• Remuneration committeeThe committee is chaired by the Trust chairman, ProfessorLouis Smidt. All the non executive directors are committeemembers.

The remuneration committee determines, on behalf of theTrust, the remuneration and terms of service for the chiefexecutive, the executive directors and other senior managerswho report directly to the chief executive. It overseescontractual arrangements and termination payments for thechief executive and other executive directors and considers

any other remuneration or compensation issue referred to itby the chairman or chief executive.

• Mental Health Act managers’ committeeMr Anthony Pearson chairs the committee. All the nonexecutive directors are committee members. A number oflay Mental Health Act managers also serve as members.

The key role of this committee is to ensure the detention ofunrestricted patients is in compliance with the MentalHealth Act (1983) and its code of practice, whilst the scopeof its interest and concern covers all patient related issues.

• DiversityThe Trust established itself as a leading NHS organisationin this area in 2004/5. The diversity unit has madesignificant progress on a range of work including:

• Implementation of a mandatory diversity training programme that has now reached a large part of the Trust’s workforce and will continue in 2005/6

• Implementation of a new bullying and harassment policy supported by training in this area which will also continue in the year ahead

• Design and implementation of a mentoring scheme for black and minority ethnic (BME) staff in collaboration with Ealing Hospital NHS Trust and Ealing Primary Care Trust

• Development of clinical guidelines to mitigate bullying behaviour by patients

• Continued delivery of a range of bespoke cultural and diversity services for patients including culture-sensitive shop products, multi-denominational spiritual care, multi-cultural events, provision of translation and interpreting services

• A leading role in the Ealing BME staff network providing a celebration of and support for the work and development of BME staff

The Trust continues to promote opportunities for disabledemployees having achieved the two ticks award in 2002. Anemployment scheme for users will be launched shortly andpremises continue to be adapted in line with the provisionsof the Disability Discrimination Act. Staff who experiencedisability problems are afforded opportunities to have theirwork modified or are redeployed where at all possible.


Professor Louis Smidt

Independent consultant Providing some work to NHS clients (currently none within the Ealing Hammersmith & Fulham and Hounslow health communities)

Honorary vice president The Society of Chiropodists & Podiatrists

Ms Tesse Akpeki

Commissioner Equal Opportunities Commission

Mrs Ann Chapman

Council member Council of the Institute of Management Consultancy

Trustee Age Concern, Ealing borough

Independent consultant currently not working to NHS clients

Mr John Cox

Director Campbell-Johnston Associates (Management Recruitment Consultants) Limited

Director North Kensington Opportunity Centre

Part ownership John and Elizabeth Cox, Consultants

Management committee member Octavia Housing & Care Association

Councillor and cabinet member Royal Borough of Kensington & Chelsea for finance & property

Committee member Kensington & Chelsea Tenant Management Organisation

Professor Christopher Kennard

Managing director WCN 2001

Trustee British Brain & Spine Foundation

Trustee Migraine Trust

Trustee Graham Dixon Charitable Trust

Mr Anthony J Pearson

Director Triostar Limited (management consultancy)

Director Pearson Associates (management consultancy)

Director Easy Jam Music Limited

Director Streetlighters Limited (media company)

Member Buckinghamshire Advisory Committee (Lord Chancellor’s Department)

Lay interviewer Independent Tribunal Service

Justice of the Peace Wycombe & Beaconsfield Petty Sessional Division

School Governor Burford School

Dr Timothy Woolmer

Former chief executive The Westminster Pastoral Foundation

Mr Simon Crawford

Governor Royal National Institute of the Blind, New College Worcester resigned December 2004

Mr Ian Kent

Management committee member Crossways Association

Mr Sean Payne

Trustee Harrow Special Needs Consortia

Register of members’ interestsIt is a requirement that the chairman and all board membersshould declare any conflict of interests that arise in the course ofconducting NHS business. On appointment, board membersdeclare any business interests, positions of authority in a charity orvoluntary body in the field of health and social care, or other body

contracting for NHS services. These are formally recorded in theminutes of the board meeting and entered into a register, held bythe secretary to the board and available for the public to view. For 2004/05 the following interests have been registered:

28 I Who we are


The Trust was created in 2001 by the merger ofEaling, Hammersmith & Fulham Mental HealthTrust, and Broadmoor Hospital Authority.Hammersmith & Fulham was itself a recentmerger between West London Healthcare andRiverside.

It was further enlarged by the absorption of theHounslow Mental Health Services following thedissolution of the Hounslow & SpelthorneMental Health and Community Trust in 2002.

In 2003, the remainder of the Hounslow servicesfor adults and older people previously based atAshford Hospital was also absorbed into our trust.

West London Mental Health Trust provides:

• Adult mental health services - a range of community in-patient and specialist therapy for adults aged 16-65 from the Ealing site, Hammersmith & Fulham Mental Health Unit, Lakeside Unit, the West Middlesex University Hospital and a range of community sites

• Specialist mental health in-patient and day services for older people

• Mental health services for children and adolescents

• Specialist treatment for adults, families and adolescents with personality disorder in a therapeutic community at the Cassel Hospital

• Gender identity clinic at the Claybrook Centre in Hammersmith

• High secure services at Broadmoor Hospital in Crowthorne, Berkshire with just under 300 beds, and a new 70 bedded DSPD unit opening in the autumn of 2005

• Medium and local secure services provided from The Three Bridges medium secure unit and the Tony Hillis Wing at Ealing

• Specialist rehabilitation services based at St Bernard’s Horseferry Road court liaison scheme

• Specialist mental health in-reach services to HMP Feltham Young Offenders Institute, including inpatient nursing for the 25 bedded unit and consultant psychiatry support

• A 10 bedded forensic child and adolescent mental health service unit to be opened within the coming year at Ealing for in-patient services to adolescents requiring admission to a secure environment.

Who we are

29 I Finance

The Trust achieved its statutory duty to break even in2004/05. It also met 3 of the 4 administrative duties; therevenue finance limit (EFL), achieved a 3.2% return onnet relevant assets and stayed within the capital resourcelimit. The Trust did not meet the target under the betterpayment practice code; however performance didimprove throughout the year. Details of compliance withthe code are on page 34.

The Trust has achieved a small surplus of £10k in2004/05; this was after repaying the £1.4m deficitincurred in 2003/4. This achievement is a tribute to allthe staff in the Trust, those working directly with patientsand those who provide support services who worked hardto make it happen.

The achievement of break-even was due to a number ofrecurrent and non recurrent measures. There wassignificant service redesign which enabled wards to beclosed and new services developed in line with nationalservice framework (NSF) targets. There was a strongfocus on managing day to day expenditure and gettingbest value for money from the funds invested in theTrust. The use of outlier beds for adult mental healthpatients was virtually eliminated. The development of thestaff bank was a great success with a clear reductionmonth on month in the use of agency nurses comparedto the previous year. The Trust took the opportunity toreview its accounting policies to ensure that all capitalexpenditure was appropriately treated. There were anumber of non recurrent actions that helped theposition. These included a significant rates rebate, somenon recurrent income and a particular effort in the lastquarter to halt any discretionary expenditure.

The Trust income increased from £179m to £198m inyear. This increase part funded the new unit atHammersmith & Fulham, supported somemodernisation across services, met inflation and inaddition the Trust received funding for Agenda forChange pay increases.

The summary financial statements are shown on pages31 to 34. Full details of senior manager’s remunerationare on page 35 and 36, and details of management andadministration costs are on page 34.

The accounts of the Trust have been subjected to externalaudit scrutiny and approval. This has been provided by

KPMG LLP in their role as external auditors to the Trust,appointed by the Audit Commission. The servicesprovided by KPMG LLP in 2004/05 relate purely to thestatutory responsibilities of auditors under the currentAudit Code of Practice and have included review of thefinancial statements and the Trust's arrangements toensure the legality of financial transactions and theproper use of resources. The cost of this work was £289kinclusive of VAT.

Looking forward to 2005/06 the Trust is operating in ahigh risk financial environment. The North WestLondon sector has finished the year with a number ofTrusts and PCTs in financial deficit. This will inevitablyimpact on the Trust as part of the sector recovery. Overallwe have to identify £10m of cost reductions, servicechanges and efficiencies to balance the budget for2005/06.

Our capital expenditure was £32.7m in 2004/2005. TheTrust will receive handover of the new unit for dangerousand severe personality disorder (DSPD) patients atBroadmoor Hospital in September 2005. Overall thisproject will cost £36m. We have progressed the businesscase for the women’s enhanced medium secure facility onthe Ealing site. This project is a Procure 21 project andthe guaranteed maximum price is £30.6m. The tenbedded adolescent forensic unit is expected to becompleted in 2005/06. This has a capital cost of £3m. Inaddition to these projects the Trust continued to invest inbacklog maintenance, health and safety and other minorcapital works.

On a local level the finance, IM&T and procurementdepartments were successful in achieving Investors inPeople (IiP) in 2004/05.

Barbara Byrne Director of finance and information

Finance and information

30 I Finance


INDEPENDENT AUDITORS’ REPORT TO THE DIRECTORS OF WEST LONDON MENTALHEALTH NHS TRUST ON THE SUMMARY FINANCIAL STATEMENTS

We have examined the summary financial statements set out below

This report is made solely to the Board of West London Mental Health NHS Trust in accordance withSection 2 of the Audit Commission Act 1998 and for no other purpose. Our audit work has been undertakenso that we might state to West London Mental Health NHS Trust’s Board those matters we are required tostate to them in an auditor’s report and for no other purpose. To the fullest extent permitted by law, we donot accept or assume responsibility to anyone other than West London Mental Health NHS Trust and theboard of West London Mental Health NHS Trust, as a body, for our audit work, for this report, or for theopinions we have formed.

Respective responsibilities of directors and auditors

The directors are responsible for preparing the Annual Report. Our responsibility is to report to you ouropinion on the consistency of the summary financial statements with the statutory financial statements. Wealso read the other information contained in the Annual Report and consider the implications for our reportif we become aware of any misstatements or material inconsistencies with the summary financial statements.

Basis of opinion

We conducted our work in accordance with Bulletin 1999/6 ‘The auditor’s statement on the summaryfinancial statements’ issued by the Auditing Practices Board for use in the United Kingdom.

Opinion

In our opinion the summary financial statements are consistent with the statutory financial statements of theTrust for the year ended 31 March 2005 on which we have issued an unqualified opinion.

KPMG LLP

London

31 I Finance

INCOME AND EXPENDITURE ACCOUNT FOR THE YEAR ENDED 31 MARCH 2005

31 March 2004

£000 £000

Income from activities 183,072 165,056

Other operating income 15,408 14,061

Operating expenses (189,688) (173,097)

OPERATING SURPLUS (DEFICIT) 8,792 6,020

Cost of fundamental reorganisation/restructuring 0 0

Profit (loss) on disposal of fixed assets 0 0

SURPLUS (DEFICIT) BEFORE INTEREST 8,792 6,020

Interest receivable 284 58

Interest payable (2) 0

Other finance costs - unwinding of discount (103) (155)

Other finance costs - change in discount rate on provisions 0 0

SURPLUS (DEFICIT) FOR THE FINANCIAL YEAR 8,971 6,023

Public Dividend Capital dividends payable (8,961) (7,392)

RETAINED SURPLUS (DEFICIT) FOR THE YEAR 10 (1,369)

All income and expenditure is derived from continuing operations.

Signed on behalf of the Board on 12 July 2005

Mr Simon Crawford Mrs Barbara Byrne

Chief executive Director of finance and information

SUMMARY FINANCIAL STATEMENTS

32 I Finance


BALANCE SHEET AS AT 31 MARCH 2005

31 March 2004

£000 £000

FIXED ASSETS

Intangible assets 0 0

Tangible assets 333,488 266,077

Investments 0 0

333,488 266,077

CURRENT ASSETS

Stocks and work in progress 231 258

Debtors 15,884 9,191

Investments 0 0

Cash at bank and in hand 254 231

16,369 9,680

CREDITORS: Amounts falling due within one year (27,226) (25,304)

NET CURRENT ASSETS (LIABILITIES) (10,857) (15,624)

TOTAL ASSETS LESS CURRENT LIABILITIES 322,631 250,453

CREDITORS: Amounts falling due after more than one year (208) (222)

PROVISIONS FOR LIABILITIES AND CHARGES (5,439) (3,326)

TOTAL ASSETS EMPLOYED 316,984 246,905

FINANCED BY:

TAXPAYERS' EQUITY

Public dividend capital 223,050 199,159

Revaluation reserve 89,479 54,416

Donated asset reserve 1,576 1,517

Government grant reserve 460 460

Other reserves (464) (464)

Income and expenditure reserve 2,883 (8,183)

TOTAL TAXPAYERS EQUITY 316,984 246,905

33 I Finance

CASH FLOW STATEMENT FOR THE YEAR ENDED 31 MARCH 2005

31 March 2004

£000 £000

OPERATING ACTIVITIES

Net cash inflow from operating activities 14,962 10,481

RETURNS ON INVESTMENTS AND SERVICING OF FINANCE:

Interest received 284 158

Interest paid (2) 0

Interest element of finance leases 0 (155)

Net cash inflow from returns on investments

and servicing of finance 282 3

CAPITAL EXPENDITURE

(Payments) to acquire tangible fixed assets (30,151) (17,657)

Receipts from sale of tangible fixed assets 0 275

(Payments) to acquire intangible assets 0 0

Receipts from sale of intangible assets 0 0

(Payments to acquire)/receipts from sale of fixed

asset investments 0 0

Net cash (outflow) from capital expenditure (30,151) (17,382)

DIVIDENDS PAID (8,961) (7,392)

Net cash (outflow) before management of liquid

resources and financing (23,868) (14,290)

MANAGEMENT OF LIQUID RESOURCES

(Purchase) of current asset investments 0 (31,500)

Sale of current asset investments 0 31,500

Net cash inflow from management of liquid resources 0 0

Net cash (outflow) before financing (23,868) (14,290)

FINANCING

Public dividend capital received 26,378 15,520

Public dividend capital repaid (not previously accrued) 0 (512)

Public dividend capital repaid (accrued in prior period) 0 (696)

Loans received 0 0

Loans repaid 0 0

Other capital receipts (2,487) 0

Capital element of finance lease rental payments 0 0

Net cash inflow from financing 23,891 14,312

Increase in cash 23 22

34 I Finance


STATEMENT OF TOTAL RECOGNISED GAINS AND LOSSESFOR THE YEAR ENDED 31 MARCH 2005

31 March 2004

£000 £000

Surplus (deficit) for the financial year before

dividend payments 8,971 6,023

Fixed asset impairment losses (3,858) (2,222)

Unrealised surplus/(deficit) on fixed asset

revaluations/indexation 50,036 20,412

Increases in the donated asset and government grant reserve

due to receipt of donated and government grant financed assets 0 500

Reductions in the donated asset and government grant reserve

due to the depreciation, impairment and disposal of donated and

government grant financed assets 0 0

Additions/(reductions) in "other reserves" 0 0

Total recognised gains and losses for the financial year 55,149 24,713

Prior period adjustment 0 0

Total gains and losses recognised in the financial year 55,149 24,713

MANAGEMENT COSTS

£000 £000

Management costs 12,995 10,914

Income 188,696 172,533

BETTER PAYMENT PRACTICE CODE

The Better Payment Practice Code requires the Trust to aim to pay all valid non-NHS invoices by the due date or within

30 days of receipt of goods or a valid invoice, whichever is later.

Number £000

Total bills paid in the year 40,332 75,667

Total bills paid within target 23,421 48,755

Percentage of bills paid within target 58% 64%

35 I Finance

DIRECTORS' REMUNERATION: SALARY AND PENSIONENTITLEMENTS OF SENIOR MANAGERS

A) Salary 2004-05: 2003-04:

Salary Other Benefits Salary Other Benefits(bands of remuneration (rounded (bands of remuneration (rounded£5000) in kind to £100) £5000) in kind to £100)

(bands of (bands of £5000) £5000)

Name and Title £'000 £'000 £ £'000 £'000 £

Ms Tesse Akpeki 5-10 5-10 Non executive director

Prof Thomas Barnes 200-205 165-170Director of research & development

Mrs Barbara Byrne 85-90 0Director of finance & information c

Mrs Ann Chapman 5-10 0-5Non-executive director a

Mr Kelvin Cheatle 80-85 2100 75-80 2,400Director of human resources

Mr John Corlett 80-85 75-80Director of estates & facilities

Mr John Cox 5-10 5-10Non-executive director

Mr Simon Crawford 125-130 4300 100-105 3,800 Chief executive b

Dr Elizabeth Fellow-Smith 215-220 115-120Medical director

Mrs Dawn Hines 0 20-25Acting director of finance c

Dr Julie Hollyman 0 90-95 Chief executive d

Prof Christopher Kennard 5-10 5-10Non-executive director

Mr Ian Kent 90-95 85-90Director of local services

Mr Alistair McNicol 60-65 60-65 Director of security

Mr Grant Macdonald 60-65 0 Acting director of nursing e

Mr Robert Nessling 80-85 80-85Director of nursing f

Mr Sean Payne 90-95 90-95Director of forensic services

Mr Anthony Pearson 5-10 5-10Non-executive director

Mr M Seale 0 0-5Non-executive director g

Mrs Kamaljit Singh 5-10 5-10Non-executive director

Prof Louis Smidt 20-25 20-25 Chairman

Ms Jessica Williams 70-75 55-60Project director-DSPD

Dr Timothy Woolmer 5-10 5-10Non-executive director h

36 I Finance


DIRECTORS' REMUNERATION: SALARY AND PENSIONENTITLEMENTS OF SENIOR MANAGERS

B) Pension Benefits

Real Total Cash Cash Realincrease accrued Equivalent Equivalent increasein pension pension Transfer Transfer in Cashand related and related Value Value Equivalentlump sum lump sum at 31 at 31 Transfer at age 60 at age 60 March March(bands of (bands of 2005 2004£2500) £5000)

Name and Title £000 £000 £000 £000 £000

Prof Thomas Barnes 12.5-15 230-235 742 646 19Director of research & development

Mrs Barbara Byrne 25-27.5 80-85 334 218 109Director of finance & information c

Mr Kelvin Cheatle 2.5-5 20-25 84 66 17Director of human resources

Mr John Corlett 5-7.5 110-115 509 459 37Director of estates & facilities

Mr Simon Crawford 25-27.5 120-125 371 281 82Chief executive b

Dr Elizabeth Fellow-Smith 60-62.5 175-180 623 384 228Medical director

Mr Ian Kent 5-7.5 75-80 235 209 20Director of local services

Mr Alistair McNicol 2.5-3 30-35 127 108 16Director of security

Mr Grant Macdonald 7.5-10 25-30 70 46 29Acting director of nursing e

Mr Robert Nessling 5-7.5 165-170 704 664 21Director of nursing

Mr Sean Payne 0-2.5 155-160 602 569 17Director of forensic services

Ms Jessica Williams 10-12.5 40-45 106 73 31Project director-DSPD

Notes:

a. Mrs A Chapman was appointed as Non-executive Director on 1 December 2003.

b. Mr S Crawford was Deputy Chief Executive/ Director of Finance and Information until 31 December 2003, when he was appointed Chief Executive ofthe Trust.

c. Mrs D Hines was Acting Director of Finance from 1 January 2004 to 31 March 2004, when Mrs Barbara Byrne was appointed as Director of Finance andInformation.

d. Dr J Hollyman resigned from the Board on 31 December 2003.

e. Mr G. Macdonald was appointed as Acting Director of Nursing on 1 June 2004

f. Mr R. Nessling retired from the Board on 31 May 2005.

g. Mr M. Seale resigned from the Board on 31 October 2003.

h. Dr T Woolmer was appointed as Non-executive Director on 1 May 2003.

The Trust considers that there is no sound basis for distinguishing between duties as a director and other duties and that it would therefore not bemeaningful to attempt to split directors' remuneration in this way.

As Non-Executive members do not receive pensionable remuneration, there will be no entries in respect of pensions for Non-Executive members. A CashEquivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point intime. The benefits valued are the member's accrued benefits and any contingent spouse's pension payable from the scheme. A CETV is a payment madeby a pension scheme, or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme andchooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as aconsequence of their total membership of the pension scheme, not just their service in a senior capacity to which the disclosure applies. The CETVfigures, and from 2004-05 the other pension details, include the value of any pension benefits in another scheme or arrangement which the individualhas transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasingadditional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Instituteand Faculty of Actuaries.

Real Increase in CETV - This reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due toinflation, contributions paid by the employee (including the value of any benefits transferred from another pension scheme or arrangement) and usescommon market valuation factors for the start and end of the period.

37 I Finance

STATEMENT OF DIRECTORS' RESPONSIBILITIES INRESPECT OF INTERNAL CONTROL

1. Scope of responsibilityThe board is accountable for internal control. Asaccountable officer, and chief executive of this board,I have responsibility for maintaining a sound systemof internal control that supports the achievement ofthe organisation's policies, aims and objectives. I alsohave responsibility for safeguarding the public fundsand the organisation's assets for which I ampersonally responsible as set out in the accountableofficer memorandum.

I am accountable to the chairman of West LondonMental Health Trust, with whom I agree myobjectives annually. The chairman reviews progresswith the objectives in year and performance at theend of the year.

I am also accountable to the SHA for theperformance of the Trust, and the directors and Imeet with them for formal performance reviewsthree times per year. There are separate performancereviews with the SHA for the services provided bythe high secure hospital, Broadmoor and for all in-patient services with the Mental Health ActCommissioners. I work in partnership with PCTsand local authorities, through local partnershipboards, to deliver objectives that cut acrossorganisational boundaries.

2. The purpose of the system of internal controlThe system of internal control is designed to managerisk to a reasonable level rather than to eliminate allrisk of failure to achieve policies, aims andobjectives; it can therefore only provide reasonableand not absolute assurance of effectiveness. Thesystem of internal control is based on an ongoingprocess designed to:

• identify and prioritise the risks to the achievement of the organisation's policies, aims and objectives

• evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically

The system of internal control has been in place inWest London Mental Health Trust for the yearended 31 March 2005 and up to the date ofapproval of the annual report and accounts.

3. Capacity to handle riskLeadership of the risk management process

The responsibility of the Trust chief executive The chief executive has overall responsibility forhaving effective risk management processes in place.The chief executive chairs the Trust riskmanagement committee.

The director of estates & facilities is the designateddirector with overall responsibility for non-clinicalrisk management and organisational controls. Thedirector of nursing has responsibility for clinical riskmanagement/patient safety. The medical directorhas overall responsibility for clinical governanceincluding an overview of clinical risk.

Operational directors are responsible for ensuringrisk is assessed and managed within their area ofresponsibility. The board is aware of the risks in theorganisation through the population of the riskregister and is responsible for ensuring action plansare in place to manage those risks. Risks aremanaged in different ways including risk transferand developing systems to mitigate risks. Risks thatcannot be managed within the directorates areescalated to the corporate risk register. There will besome residual risk that cannot reasonably beeliminated that the board will choose to acceptwhere this is necessary to deliver its objectives.

4. Education & trainingInductionA comprehensive Trust induction programme is inplace and includes risk management, themanagement of violence and aggression and healthand safety. All new Trust employees attend theinduction course before starting work in the Trust.The Trust has a programme of mandatory fire andhealth and safety refresher training for all staff. Allstaff who have patient contact receive a mandatoryupdate in the management of violence andaggression.

Risk management trainingThe Trust has instituted risk management seminars atall venues throughout the Trust to support staff inunderstanding and applying the risk managementstrategy. The Trust in 2004/05 has increased thenumber of trained risk assessors so there are now 85trained risk assessors whose role is to supportmanagers and staff across the Trust in identifying andassessing risk within their area. Each directorate andservice has a number of staff who have attended theformal three day training programme. This training isupdated by attending quarterly workshops.

38 I Finance


STATEMENT OF DIRECTORS' RESPONSIBILITIES INRESPECT OF INTERNAL CONTROL (continued)

5. The risk and control frameworkThe overarching mechanism for managing risk andgaining assurance is the assurance framework. Theassurance framework identifies risks to the principalstrategic objectives of the Trust, the controls in placeto manage those risks, any gaps in controls and thesource of assurance. The assurance framework was inplace at the start of the year and has been reviewed,revised and developed in year by the executivedirectors. The assurance framework was reviewed bythe governance committee, the audit committee andthe board itself at an away day and at its publicmeeting. An action plan has been developed toeliminate any gaps in control and progress on thisplan is reviewed at the quarterly performancemanagement meetings of the Trust.

WLMHT has a number of departments andprocesses that contribute to the systematicidentification and management of risk:

• Health & safety

• Clinical risk management (CNST)

• Risk management & insurance (RPST)

• Complaints

• Incident reporting

• Security

• Serious & critical incident investigations & reporting

• Maintaining the risk register

• Reports to the National Patient Safety Agency

Health & safety - a proactive approach is adoptedthrough an ongoing risk assessment programme,identifying deficits in compliance with legislation,policies and procedures. A formal system is in placeto ensure that risk assessments have been carried outand the results recorded and acted upon.

Clinical risk management - In the last year theTrust has been successful in achieving level one ofthe CNST Mental Health & Learning DisabilityClinical Risk Management Standards. In accordancewith NHSLA and CNST requirements, the Trustwill need to be re-assessed against the level onestandards no later than February 2007. The Trust isable to request a visit earlier.

Non-clinical risk management & insurance -TheTrust is a member of the Risk Pooling Scheme forTrusts (RPST), administered by the NHS LitigationAuthority. This is an NHS self insurance scheme forproperty and third party liabilities. In the last yearthe Trust has been successful in achieving level onecompliance with risk management standards.

Complaints - the Trust's complaints policy thatreflects the NHS Complaints Procedure 1996 isunder review to incorporate the NHS ComplaintsRegulations 2004. The system of managingcomplaints is regularly reviewed by a complaintsanalysis group chaired by a non-executive director, toensure that guidelines are being met and to ensurethat improvements in care as a result of complaintsare evident.

Accident / incident reporting - the Trust hasadopted a computerised accident / incidentreporting system throughout the organisation forreporting all incidents, including "near misses". Thissupports a systematic approach to the monitoring ofuntoward or serious incidents. A summary report ispresented to the risk committee to ensure that issuesidentified in one service can be shared more widelyacross the Trust.

Serious & critical incident investigations &reporting - Serious untoward incidents are definedin the Trust's serious untoward incident policy. Allsuch incidents are reported within the policy processand time-scales. The overriding purpose of theserious and critical incident procedures is not toapportion blame, but to analyse the circumstances inwhich the incident occurred, and refine the systemof care to prevent recurrence.

The risk management strategy defines the lines ofaccountability and the responsibilities of all staff,including accountability arrangements with keystakeholders. It sets out the committee structure inplace to support risk management and ensure thatthe board has information on the principal risks tothe Trust and how it is mitigating and managingthose risks.

The Trust reports all appropriate incidents to therelevant external agencies; these include the NationalPatient Safety Agency, the Counter Fraud andSecurity Management Service and the Health andSafety Executive.

39 I Finance

STATEMENT OF DIRECTORS' RESPONSIBILITIES INRESPECT OF INTERNAL CONTROL (continued)

6. Review of effectivenessAs accountable officer, I have responsibility forreviewing the effectiveness of the system of internalcontrol. My review is informed in a number of ways.The head of internal audit provides me with anopinion on the overall arrangements for gainingassurance through the assurance framework and onthe controls reviewed as part of the internal auditwork.

Opinion on the assurance frameworkThe internal audit review of the organisation'soverall arrangements for gaining assurance hasconcluded that:

An assurance framework has been established whichis designed and operating to meet the requirementsof the 2004/05 SIC and provide reasonableassurance that there is an effective system of internalcontrol to manage the principal risks identified bythe organisation.

Executive managers within the organisation whohave responsibility for the development andmaintenance of the system of internal controlprovide me with assurance.

The assurance framework itself provides me withevidence that effectiveness of controls that managerisks to the organisation achieving its principalobjectives have been reviewed.

My review is also informed by the work of theclinical audit programme in the Trust and theexternal audit interim review of the organisation.

I have been advised on the implications of the resultof my review of the effectiveness of the system ofinternal control by the following committees withinthe Trust:

Governance Audit Risk Management

Risk management is embedded in the activity of theTrust through the business planning process. TheTrust’s corporate objectives are agreed by the boardand a risk assessment carried out on theirachievement, using the standard risk evaluation tool.These risks are entered on to the risk register. Therisk register is reviewed by the risk managementcommittee, along with the action plans in place tocounter these risks. The risk managementcommittee reports to the board.

Through the use of a robust risk evaluation tool therange of risks from strategic risks to health and safetyrisks can be assessed in relation to each other. Thereare 85 qualified risk assessors evenly spreadthroughout the clinical and non-clinical directoratesto ensure that consistency in the use of the tool ismaintained.

The Trust continued to review and strengthen itsassurance framework and supporting committeestructure in 2004/05.

The board will continue to review progress as part ofeliminating weakness and ensuring that a process ofcontinuous improvement is in place in the Trust in2005/06 through the following key action plans:

• Action plan to support the board draft statement in October, led by the director of nursing

• The CHI action plan agreed as a result of the CHI assessment, led by the medical director

• Performance improvement plans agreed with the SHA, once Healthcare Commission ratings are published, led by the director of strategy, performance and corporate development

• Internal and external audit recommendations constitute a continuous, ongoing review process

• The development of a new three year business plan in the Autumn of 2005, led by the director of strategy, performance and corporate development

• The development of improved financial risk management with improved financial reporting to the board, led by the director of finance and information.

Signed on behalf of the board on 12 July 2005

Chief executive

Simon Crawford

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