annual report 2007-2008 full

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Report and Accounts 2007/08

TransformingSt Georges


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If you would like a translatedcopy of this report or a copyof the full Annual Report and

Accounts 2007/08 please see our

website or contact us:

www.stgeorges.nhs.ukTelephone 020 8725 5151

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St Georges is a unique NHS Trust, treating morethan 500,000 patients every year at three sites insouth west London, while also offering specialised

and expert care for some of the most serious andcomplicated illnesses and injuries.

The Trust has a bright future: this year it launchesits Transforming St Georges programme, whichover the next decade will provide the best possiblecare for all its patients.

St Georges is transforming its services too, with bigimprovements already being delivered at clinics and

wards across the Trust. This year the Trust will launchits campaign to achieve Foundation Trust status.

This will enable the Trust to build on the financialstability that staff at all levels have worked for duringthe last few years, and open up new opportunitiesto build on the excellent care already being deliveredto thousands of patients every year.

01Welcome to St Georges Healthcare NHS Trust

Front cover image: Rehan Rajput,an F1 doctor, started at St Georgesin August after attending KingsCollege, London. He is currentlyon rotation in Cavell Ward,a general surgery ward

01 Welcome

02 Foreword by Trust Chairand Chief Executive

04 Transforming lives

06 Trauma centre

12 Diagnostic expertise

18 Care and rehabilitation

24 On the ward

30 Operating efficiently

36 Leading innovation

42 Board of Directors

44 Financial summary

55 Auditors report

56 St Georges Hospital Charity

Acknowledgementsand contact point


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02Foreword by Trust Chair and Chief Executive

With the help of staff throughout the Trust, David Astley hasdrawn to a close the four-year turnaround of St Georges.The next stage is to begin the Trusts transformation.

David and Trust Chair Naaz Coker explain:

There is a lot for staff at St Georges to beproud of. Over the past year, we have caredfor more patients than ever before, launched

new and innovative services and at the sametime raised the standards of patient careand safety.

We have delivered 5,000 babies, admitted60,000 patients and undertaken 28,000 daycase procedures. Nearly 450,000 patients havebeen seen and treated as outpatients. This istestament to the calibre of staff at St Georges.

Their expertise and the facilities we offer enable

us to care for the most serious of injuries orillnesses and make us the hospital of choicefor our local population.

St Georges has been shadowed by a historicfinancial deficit. Three years ago, the Trustwas spending some 20 million more than

it received. Today, we have eliminated thisunderlying deficit. We still have an historic debtof 33.8 million, but our financial health hasimproved significantly. However we still havetough financial targets to meet year on year,which means increasing productivity as wecontinue to improve the patient and staffexperience, generating financial surpluses sothat we can develop services.

Transforming St Georges is about improvingthe experiences of our patients and caring forour staff. It aims to further develop services byworking efficiently in ways that are sustainable,and delivering ever improving standards of care.


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03

The transformation is already underway.In 2007 St Georges was the first trust in thecapital to provide stroke patients with 24-houraccess to clot-busting drugs, which reduce the

risk of paralysis and disability. Now, throughcollaboration with neighbouring hospitals,we have expanded this service to coverpatients across south west London.

St Georges was one of the few hospitals inthe country to meet the 18 week referral totreatment target early. Patients can now getaccess to diagnostic scans such as x-raysand CT scans as and when then need them,

and where previously our theatres were onlyused for less than 80 per cent of the time,we are now making 85 per cent use of ourtheatres to treat more patients and reducewaiting times.

But we do face challenges. In A&E, staff arecaring for an ever-increasing number of patients on average more than 300 every day.

Many of the patients coming to A&E require

admission into hospital. To manage this we areleading a review of urgent care across southwest London, to ensure staff have the supportthey need and to improve care, from GP referral,to hospital admission, through to discharge.

St Georges is one of the top performingteaching hospitals in the country for infectioncontrol. In our general intensive care unit,for example, where patients are the mostvulnerable to infection, our combination

of stringent standards has seen not a singlecase of MRSA bacteraemia on the unit in

over 15 months (Dec 2006April 2008). Wehave also exceeded our local target to reducecases of Clostridium difficile by 13.7 per centon last year, above our set target of 10 per cent.

Our extensive roster of services makesSt Georges perfectly aligned with theemerging direction of healthcare in London.The Lord Darzi review proposes that hospitalsare assigned different roles, with local hospitalsproviding the bulk of care, and major acutehospitals staffed by specialist surgeonsundertaking all complex surgery. St Georgeshas the ability to provide both and is a clear

contender to become the lead trauma centrefor south west London.

During 2009/10, we aim to become an NHSFoundation Trust and with it gain the autonomyto improve our services in line with the needsof our patients. Our future will also involvecloser working with our neighbours and otherhealthcare providers. Alongside the St GeorgesUniversity of London, we aim to be a leaderin education and research, training the next

generations of healthcare professionals.

It is our responsibility to offer all in ourcommunity equal access to the best standardsof healthcare. This is nothing less than whatour patients and staff deserve.

Naaz Coker David AstleyChair Chief Executive

Working towards Foundation Trust statusSt Georges aims to become a Foundation Trustduring the financial year 2009/10.

The move would provide a greater degree ofautonomy and independence, allowing the Trust tohold onto surpluses generated during each financial

year and invest freely in the services in line with theneeds of people from south west London and beyond.

Patients, staff and members of the public will havea greater say in how the Trust is run, by becomingmembers and governors of the Trust.+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +


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Transforming lives

TRAUMA PATIENT

Jackie AshfordCONDITION

Multiple serious injuries including a torn aorta

STAGES OF PROGRESS

Discover how our careand expertise put Jackie on

the road to recovery, overthese pages:

15 Radiology

21 OccupationalTherapy

27 Ward care

Meet two patients treated at St Georges and find out whatits really like to be a patient at the hospital. In this yearsreport we follow the story of Jackie Ashford, a car crash

trauma patient, and Alfie Pettengell, a paediatric patient.

REPORT

So lucky to be aliveMum of two Jackie Ashford had barely usedthe NHS before being injured in a car crash.

On January 18, 2008, Mrs Ashford, 46,sustained horrific injuries when the car she andher husband Rob were travelling in was involvedin an accident.

She had fractures to her neck and back, asmashed pelvis, damaged ribs and kidneys, deepcuts to her face, and a broken arm. Several cutsavoided major arteries by a fraction of an inch.

She also had a tear in her aorta, the largestartery in the human body, which pumps bloodfrom the heart around the circulatory system.

Paramedics took her to St Peters Hospital inChertsey, her local hospital, where staff at theintensive care unit stabilised her before shewas transferred to St Georges.

Surgeons Prof Matt Thompson, Martin Bircherand Jason Bernard carried out a series ofoperations over two days before she could be

discharged from the General Intensive Care Unitto Holdsworth orthopaedic ward to begin thelong road to recovery.

Mrs Ashford said: Im so lucky to be alive, andgrateful to everybody at St Georges for the workthey put in helping me get back on my feet.They went out of their way to help me, and tokeep my husband and children informed of whatwas being done to me and how I was gettingon when they were worried sick about me.

Its amazing that, a few months after the

accident, Im able to walk with just one crutch.

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PAEDIATRIC PATIENT

Alfie PettengellCONDITION

Serious intestinal condition, immediate surgery required

STAGES OF PROGRESS

See the on-going supporthelping baby Alfie and his

parents resume a normallife, over these pages:

10 PICU

28 Surgeon

33 Dietitian

REPORT

Sarah and Paul Pettengell had no idea how sickAlfie was when they took him to hospital agedtwo weeks.

Sarah said: We thought it was some kind ofinfection. It was awful to see, he was in somuch pain and there was nothing we coulddo about it.

Once he was in the hospital things movedincredibly quickly, he was taken to accident andemergency and then to paediatric intensive care,where they diagnosed what was wrong withhim, then he was sent straight off to theatres.

It was terrifying everything was happeningso fast and wed had no idea it was so serious.You think about paediatric intensive care assomething other kids go to, not your own kid.

Mr Zahid Mukhtar performed surgery to removepart of Alfies intestines, and he was sent backto PICU to recover.

Mr Pettengell said: We felt he was totally safethere, he was being looked after 24 hours a dayevery day, and the staff there dont just care forthe patient, they care for the family too.

People took time out to explain what washappening to us, which was so important.Mr Mukhtar was amazing. Nothing was toomuch, hed spend half an hour with us if heneeded to and he was always calm andprofessional.

Weve been very lucky in that weve been givena room at the Ronald McDonald house near thehospital, which makes a huge differencebecause we dont live in south London.

Everything happened so fast

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Transforming St Georges

Trauma centreSt Georges is already leading the way inproviding trauma services. A review istaking place which could lead to the Trustbecoming one of the capitals three leadtrauma centres


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06/07


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08Accident and Emergency

Consultant Dr Samer Elkohodairstarted working at the depart-

ment in July. He said:I am delighted to be joining

such a successful team and lookforward to contributing tomaintaining and improvingclinical care.

A&E: busier and better than everMore patients are being seen at Accidentand Emergency than ever before, and thedepartment is exceeding its target of 98 per

cent of patients being seen within four hours.

During June, 2008, a record average of306 patients were treated at A&E every day,and more than 98 per cent were seen withinthe Department of Healths four hour target.

A new Rapid Assessment Unit opened in Julyand is reducing the number of patients sent tothe department unnecessarily, and the MedicalAssessment Unit is taking patients who can be

discharged from A&E but are not ready to goto a regular ward or be discharged home.

A&E consultant Dr Narani Sivayoham said:Everybody at A&E has put in a lot of effortto ensure that where patients need to beadmitted, this is done as quickly and efficientlyas possible, freeing up space for the next patient.

The department is being refurbished, whichwill make a huge difference because it is morethan 20 years old. The refurbishment will makeit easier to keep the department spotlessly

clean.

Many patients with serious trauma andmultiple injuries attend A&E. It is hoped thatSt Georges will become a major trauma centrein the near future, forming a network withsouth west London and Surrey. Then manymore patients will benefit from the high qualitycare we already provide.

Staff in A&E are among a few trained to deal

quickly with septicaemia, a life-threateninginfection which can originate from any partof the body. The departments expertise hashelped countless patients to recover when, ifthey had not been given the right treatmentquickly, they might have deteriorated.

St Georges is leading a review looking at howurgent care is provided across south west London.The review will lead to patients experiencing abetter service, from GP referral to treatment anddischarge.

The Trust is working with Wandsworth and Suttonand Merton Primary Care trusts to manage thedemands placed on staff at A&E.

The A&E Department has four consultants, about

40 junior doctors in general and paediatricemergency medicine, and more than 90 nurses.

Another 200 patients are being seen at the TootingWalk-In Centre, which deals with non-emergency

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09Intensive Care

Bigger unit in the pipeline

The Critical Care (Intensive Care) Group isbusier than ever, and there are plans in placeto update and expand the groups facilitiesand services.

The group is responsible for delivering careto patients who have undergone a very long,or major, surgical procedure, or who haveconditions that are life-threatening, eitherbecause of serious injury or illness, and need

constant, close monitoring.St Georges provides this type of care in threeseparate departments, the general intensivecare unit (GICU), the cardiothoracic intensivecare unit (CTICU) and the neurologicalintensive care unit (NICU). It also has aNeonatal Unit and Paediatric (childrens)Intensive Care Unit.

There are plans to provide an extra 13 beds

at the General Intensive Care Unit, to provideextra capacity if, as expected, St Georgesbecomes one of the capitals regional traumacentres. The unit currently sees around 1,500patients every year.

Once work to expand the ward is complete

there will be 30 beds, up from 17.

Matron Lindsey Izard said: We have a higherturnover of patients than ever before, and weare already seeing more trauma patients.

Becoming a trauma centre would no doubtattract staff to come and work at St Georges,however on GICU we are not experiencingstaffing problems, having a good complementof nursing staff, unlike some other London

teaching hospitals.

The unit, despite treating some of the mostvulnerable patients at the hospital, has nothad a single case of MRSA bacteraemia sinceDecember 2006.

Lindsey said: We have just one or two patientsper nurse, and there are three doctors wardrounds every day.

We take time to speak to the families ofpatients and provide them with up to dateinformation about whats going on and howtheir relatives are doing.

Matron Lindsey Izard, General

Intensive Care Unit:We would expect a more steadyflow of trauma patients not onlyto General ICU but also to ourcardiothoracic and neurologicalintensive care units.


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PAEDIATRIC PATIENT

Alfie PettengellLOCATION

Paediatric Intensive Care Unit, Lanesborough Wing

REPORT

Two week old Alfie Pettengell was transferredfrom his local hospital as an emergency toSt Georges, where specialist neonatal surgeryservices and childrens intensive care supportis available.

His parents Sarah and Paul were told howserious his situation was and how quickly heneeded surgery, and he was taken to theatre,where consultant Mr Zahid Mukhtar operatedto save as much of his intestines as possible.

Mr Mukhtar said: Alfies fighting spirit andhis parents courageous resolve in facing thistraumatic situation has had a great impacton the staff at St Georges.

The team are currently preparing for furthersurgery and remain optimistic that Alfie willeventually recover from this illness and havea good result.

Following several weeks on the PaediatricIntensive Care Unit Alfie was transferred toNicholls Ward, which is set aside for childrenrecovering from surgery.

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The Paediatric Medicine Department providesboth general care for the community andspecialised services not available at all hospitals.

It runs four inpatient wards, including NichollsWard for children who have had surgery, alongwith a purpose-built Paediatric Intensive CareUnit and the Jungle Ward, a day case unit.

Children staying at the hospital can use theplayroom and classroom on Frederick HewittWard, and there is a dedicated childdevelopment area.

Last year the refurbished childrens outpatients

clinics, called The Dragon Centre, opened. Thecentre has a wheelchair-friendly entrance anda new reception and waiting area which isshared by Childrens Outpatients and the ChildDevelopment Centre.

The number of clinic rooms has risen fromseven to 10, potentially increasing the numberof patients who can be seen.

The interior has new flooring, lighting, paint

and soft furnishings. The six-month project tomodernise and re-design the space was fundedby a grant from the hospitals Charity.

Paediatric care 11

St Georges one of the top five hospitalsHealthcare information company CHKS namedSt Georges as one of the top five hospitals in thecountry for providing the right level of care accordingto patients diagnosis in April 2008.

St Georges was highly commended for being short-listed for the CHKS Quality of Care award, a newaward for 2008 which is based on assessment of allUK hospitals using criteria including length of stay,rate of readmission and whether the care pathway

proceeded as originally intended.This was the second time St Georges had beenhonoured at the CHKS awards. In 2005, the Trustwas named top performing hospital and mostimproved hospital for clinical care.+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +


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DiagnosticexpertiseDiagnostic services such as radiology havebeen working to reduce waiting timeswhile seeing more patients than everbefore, using new technology to offerfaster, more accurate diagnoses


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14Radiology

Radiologist Dr Mark Bratby

More scans in less timeThe Radiology Department carried out nearly250,000 patient examinations during the lastyear while driving down waiting times.

The service is improving the efficiency of thehospital by mapping patient pathways andanalysing how much demand there is onservices.

Instead of the department opening from9am to 5pm, Mondays to Fridays, areas of thedepartment such as CT and particularly MRIare now open during some evenings andweekends.

As patients now have quicker access toCT scans this allows a speedy diagnosis andreduces the length of stay for inpatients,releasing beds for other patients.

The department also now has direct accessfor specific MRI examinations to GPs inWandsworth. This means that their patientscan have certain MRI scans without beingreferred to a hospital consultant first.

If a referral is subsequently required thesepatients will already have had their MRI. Thisremoves a step in the patient pathway in the18 week referral to treatment target.

Building on the modernisation agendaprogressing from the introduction of thePatient Archiving and Communications System(PACS) which enables Trust wide electronic

access to x-ray images, radiology has nowintroduced a voice recognition reportingsystem which means x-ray results are nowissued faster.

Lead Superintendent Radiographer DorothyWhite said: The improvement in the qualityof the service is due to the commitment andincredible hard work of all of the radiologystaff as well as their willingness to embrace

change.They have been instrumental in driving downwaiting times whilst maintaining a consistentlyefficient and effective service.

There is still more work to be done followingfeedback from patients, front line cliniciansand our GP colleagues. The department is nowin what is really a challenging period with astaff consultation to transform the service to

provide a better work life balance for theradiographic staff and further improve patientaccess.

New technology for quicker scansIn September 2007 the Radiologydepartment took delivery of a16 slice CT scanner. The machinetakes 16 images at a time, meaning

patients spend less time beingscanned than they would with aone slice or eight slice scanner.+ + + + + + + + + + + + + + + + + + + + + + + +


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15

TRAUMA PATIENT

Jackie AshfordLOCATION

X-ray department, St James Wing

REPORT

Dr Julian Taylor, (above) with Jackie, said:Radiology was involved every step of the wayin providing Jackies care. Radiologists workedto diagnose the degree of her injuries, and also

carried out interventional radiology, scanningthe patient during their operation.

Consultant Martin Bircher was a memberof the team responsible for planning JackieAshfords care when she was transferred toSt Georges.

He said: Jackie had a torn aorta, the mainvessel leading to the heart, and that was thebiggest and most urgent problem. She also hada complex pelvic fracture, a neck fracture anda broken back.

St Georges is a referral centre for complexpelvic fractures, and Prof Matt Thompson isone of the capitals leading vascular surgeons,specialising in aortic repair.

Mr Bircher said that before Mrs Ashford wastransferred to St Georges, the cardiovascularteam worked out which procedures shouldtake place first and what specialties should be

involved.

Some of the elective operations planned forthe day were postponed to make way forMrs Ashfords emergency procedures. X-rays,CT scans and other diagnostic tests were carriedout to determine the exact nature of her injuries.

Mr Bircher said: She had the vascular workcarried out as soon as she was transferred. Thatwas the most pressing issue because a torn aortaleads to death in a high proportion of cases.The following day we fixed her pelvis and neck.

Because St Georges is a regional centre ofexcellence for pelvis fractures and torn aortas itmade sense for Mrs Ashford to be transferredhere.


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16Pathology

Improvements to Pathology servicesHospital laboratories are being refurbishedand modernised to enable the Pathology CareGroup to provide faster and more accurate

diagnoses.

The group is made up of five specialtiesthat examine blood, cell and tissue samplesfrom patients, to diagnose disease in patientsat the hospital and on behalf of GPs and otherhealth professionals across south west London.

The Chemical Pathology, Haematology andViral Serology laboratories are combiningtogether in modern, purpose-built

accommodation on the St Georges siteto form a blood sciences laboratory.

This will house state-of-the-art diagnosticequipment and robotics to enable a fasterand even more comprehensive service to beprovided.

The Pathology Department has establisheda molecular diagnostics laboratory to takeadvantage of the new developments in

molecular biology for the investigation ofdiseases.

Cellular Pathology carries out around 23,000tests on cells from cancer patients every year,along with tests on 400 autopsy specimens.

In May 2007, the laboratory was refurbishedfor the first time since it opened in the 1970sand a new automatic processing machine wasinstalled.

The group also runs the Chemical Pathologydepartment, a modern, well-equippedlaboratory open all day every day, performingchemical analysis of blood, urine and otherbody fluids to diagnose diseases and prevent,diagnose, treat and monitor heart disease

and cancer.

Haematology and Blood Transfusion offersa blood testing service to Trust hospitalsand GPs and the Protein Reference andImmunopathology Unit is one of three supra-regional assay services in the UK for specificprotein analysis.

Medical Microbiology, the study of micro-organisms which cause disease, provides a

24-hour diagnostic and clinical service for theTrust and local GPs and also takes referralsfrom within the London region and south eastEngland.

Peter Foot, lead biomedicalscientist said:

The refurbishment of the laboratoryhas made a big difference to the waywe work, and we are hoping newtechnology will have a similar effect.


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17Infection control 17

Sister Leilani Chishti (foreground)with Senior Infection ControlNurse, Poh Yong Tan, who said:

Every member of staff atSt Georges should feel proudof the progress we have madereducing the risk of infection.

We are never complacent and

will carry on looking at ways ofimproving patient safety andreminding everybody who worksat or visits the hospital thatinfection control is everybodysresponsibility.

Infection control is central to everything atSt Georges, and messages about reducing therisk of infection are drummed into staff, visitorsand patients.

Sinks and hand-washing gel are availableat the entrance to every ward, and there arecampaigns reminding people at the hospitalhow important it is to avoid spreadinginfections such as MRSA and C.diff.

This work is reflected in the low number ofinfections recorded at the Trust. The numberof cases of C.difffell by 13.7 per cent 20 percent more than the target set by Wandsworth

Teaching PCT.

Cases of MRSA bacteraemia have alsodramatically reduced. In total, the Trustrecorded 24 cases in 2007/08 compared to75 cases last year, and for the past 15 months(Dec 2006April 2008) there has not beena single case of the bloodstream infection in

patients in our general intensive care unit,where patients are the most vulnerable toinfection.

Members of the Infection Control Team visitwards regularly to ensure everything that canbe done is being done, and monitor dataabout the infections to ensure that whenoutbreaks do occur, they are containedeffectively.

The Trusts deep cleaning programme, ensuringevery nook and cranny of wards is given athorough clean, goes above and beyond whatwas required by the Department of Health.

While some hospitals have already concludedtheir programmes, the rolling St Georges deepcleaning project is still visiting wards regularly,to ensure the highest standards of cleanlinessare maintained.

In March 2007, St Georges was one of the fewhospitals so far to be given the all clear in a newinspection regime to assess breaches of the hygienecode. The results from the unannounced inspectionby the Healthcare Commission were part of an on-the-spot check on 120 trusts in England. St Georgeswas given three greens, meaning that the HealthcareCommission found no breaches of the duties of thehygiene code they examined.

To reduce hospital infections further the Trust is alsoinvesting in a further antibiotic pharmacist to regulatethe use of antibiotics and the Trust is also one of afew hospitals in the UK to offer new screening todiagnose MRSA within two hours of testing.+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +


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18/19


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Care andrehabilitationSt Georges was one of the first hospitalsto offer stroke patients rapid access toclot-busting drugs, which reduce therisk of paralysis if they are administeredquickly enough. Stroke patients arenow given CT scans within 30 minutesof arriving at A&E


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20Stroke

More and more stroke patients are being sentto St Georges, where they are being given anew treatment that can reduce brain injuryand offer possible cure from stroke.

The treatment, called thrombolysis, uses aclot-busting drug that if delivered within threehours, can break up blood clots before they actto destroy the parts of the brain that controlmovement and speech. The stroke thrombolysisservice started in 2004 during office hours forlocal residents but since September 2007,St Georges has been treating stroke patientsfrom across south west London 24 hours aday, seven days a week.

Because there is not much time to deliver

the drug, staff work quickly and efficiently toconfirm the stroke diagnosis. Paramedics carryout a screening test to detect possible strokesymptoms before passing the patient to A&E,where they are sent for an urgent brain scan.

The scan checks whether the stroke is causedby a blood clot obstructing flow of blood andoxygen into the brain or a haemorrhage.Patients with acute stroke due to blood clotsand not bleeds are given the drug.

Dr Geoffrey Cloud, consultant stroke physicianat St Georges, said: Ive lost count of thenumber of people who have been broughtinto hospital urgently, in the early stages of

suffering a major brain injury due to strokeand that have benefited from thrombolysis.They have often lost the ability to speak ormove one side of their body, but within hoursof the treatment everything returns to normalor greatly improves. We can make people

whole again.

Dr Cloud said the treatment is only possiblebecause of teamwork throughout the Trustand within the stroke service, which also runsa specialist neuro-rehabilitation centre.

During 2003 the acute stroke service sawaround 20 patients every month, but thenumber has grown to some 75 per month asSt Georges reputation for excellence in stroke

care has grown, and the hospital has beenrecognised as a regional and national strokereferral centre.

St Georges offers a comprehensive strokeservice, treating inpatients, outpatients andday cases.

The Royal College of Physicians SentinelAudits rated St Georges as having one of thebest services in the NHS from 2004 to 2008.

Patients are being discharged earlier andgetting back to their normal lives sooner. Thenumber of deaths caused by stroke has beenfalling.

Dr Geoffrey Cloud, consultantstroke physician, says:

We can now get people through

the front door of the hospital,up to the scanner and administerthe drug, all within 30 minutesof arrival.

Back on her feetSylvia Vernel, 85, (on pages 18/19) was admitted tothe Acute Stroke Unit after she collapsed at home.

Within days she was out of her bed and lookingforward to being discharged. She said:

I thought Id had a fall, I had no idea it was astroke. A friend called an ambulance for me, whichcame very promptly and took me to A&E. The staffthere diagnosed me and brought me here to theStroke Unit.

The process didnt seem to take long and I thinktheir prompt response could have reduced thechance of the stroke leading to a debilitating injury.

There was some paralysis on the left side of my faceand body to start with but thats gone now. WhileIve been here Ive had some physiotherapy andtheyve taken me off to see if I can walk up and

down stairs, which happily I can.I was brought in on a Sunday and Im hoping I canbe discharged within a week.+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +


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TRAUMA PATIENT


Orthopaedics, 5th floor, St James Wing

REPORT

Occupational therapist Susan Menzies (above,right) is one of a team of specialists who helppatients like Jackie to adjust to life back homebefore they are discharged.

She is part of a team of four with around28 patients on Holdsworth Ward and GunningWard, helping them to get used to day-to-daytasks such as climbing stairs and putting ontheir clothes.

She said: There are a lot of tasks that peopletake for granted, but when youre recoveringfrom a serious injury they can become incrediblydifficult.

Were here to help patients adjust to life outsidehospital and we work alongside physiotherapiststo bring them back to health.

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22Cardiology

The modern Atkinson Morley Wing providesemergency care, diagnosis, medical treatmentand outpatient services for all heart disorders.

In 2006, St Georges was named as the heartattack centre in south west London as itprovides a 24-hour emergency angioplastyservice, enabling life-saving surgical treatmentto be given quickly to heart attack patients.

There are five state-of-the-art catheter labs,where thin, flexible tubes that enable the heartto pump blood can be inserted into arteriesfollowing a heart attack.

The department provides a nurse-led RapidAccess Chest Pain Clinic where patientsreferred by a GP can get a complete heartcheck in a single visit, including an electro-cardiograph or ECG which records theelectrical activity of the heart and assessesheart rhythm.

St Georges is a national referral centre andteaching centre for repairing holes in theheart, caused when the opening which allows

blood to bypass the lungs in an unborn child

fails to close after birth or there is a defect inthe wall of muscle separating the chambersof the heart.

The Cardiology Department has aninternational reputation for electrophysiology,the study of the electrical activity in the body,and for fitting artificial pacemakers whichregulate the rhythm of the heart. There is adedicated clinic to help patients who havebeen fitted with pacemakers operate andmaintain the devices correctly.

St Georges Cardiology Department is staffedby nine Trust consultants and nine other

consultants from the South West LondonCardiac Network, which includes Epsom &St Helier, Kingston, Mayday and Queen Maryshospitals and five primary care trusts coveringsouth west London and Surrey.

In December 2007, the cardiologyteam at St Georges carried out itsfirst aortic valve replacementwithout open heart surgery.

The valve is inserted via a catheterin the patients groin, which meansthat this treatment could now beavailable to patients whose ageor medical condition means openheart surgery is out of thequestion.

In 2007, the Healthcare

Commission named St Georgesas one of the safest hospitals inwhich to undergo heart surgery,finding 97.6 per cent of patients

survived.+ + + + + + + + + + + + + + + + + + + + + + + +


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23

Matron John Moroney with WardClerk, Suzy Williams, says:

Staff are pleased with thedifference the Productive WardModel programme is making.

Releasing time to careA quiet revolution is taking place on wardsacross St Georges as staff look at every aspectof how they work and where they could

improve efficiency.

The idea of the Productive Ward Model isreleasing time to care. By encouraging staffto stop and think about how the ward couldwork more efficiently, the programme ishelping staff to resolve the annoying, time-consuming problems that make it harder forthem to carry out their duties.

John Moroney, matron at the busy Richmond

Ward, said: We see an average of 20 patientson this ward every day, so every second countsfor staff.

Before Productive Ward there were areaswhere efficiency was being lost, for exampleif somebody needed to give an IV drip to apatient theyd have to go to one room for the

drip, another room for the stand and anotherroom for the solution.

Now weve improved the way things are

done and all the items are stored in the sameplace. Thats saving people hours every week,which helps reduce stress and increase ourcapacity.

The ward has introduced boards on whichcoded patient information is stored, so staffcan keep track of what needs to be done foreach patient, and information about how wellthe ward is performing is displayed on anotherboard, reassuring patients and boosting staff

morale.

Zoe Packman, who is leading the ProductiveWards project, said: As they see the differenceits made to other wards, staff acrossSt Georges are really getting behind theprogramme. The feedback so far has beenvery encouraging.

Productive Ward Model

Fourth best hospital for mortality ratesSt Georges was judged fourth best hospital formortality rates and fifth best teaching hospital inthe 2007 Dr Foster Good Hospital Guide.

The Guide highlighted that patient death rateshad fallen 13 per cent between 2004/05 and 2005/06,

one of the highest reductions recorded in the yearsedition.

In 2005, St Georges became the first hospital in thecountry to publish its mortality rates for all clinical

specialties via its website.+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +


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24/25


On the wardWork is underway to improve maternityservices at St Georges, with theintroduction of a new home-from-homenatural delivery unit and an action planbeing put in place to improve womensperceptions of the service


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26Caring for mum

Around 5,000 babies are born at St Georgesevery year, and the Trust is striving to providebetter, safer maternity services.

In March 2007 St Georges was one of only16 trusts in the country to gain the ClinicalNegligence Scheme for trusts top rating forthe systems it has in place to protect patientsafety and manage risk.

However, in January 2008 the Trust wascriticised in the Healthcare Commissionsnational review of maternity services, basedon a survey which asked women whetherthey were happy with services provided.

The report said women should be able to seea health professional earlier in their pregnancies,and that more support should be given towomen to help them feed their babies.

Work is underway to address these problems.

In January, 2008, the Carmen Suite, for womenwho want to give birth with little or no medical

intervention, opened. Births can be carried outin pools, without epidural drugs.

St Georges offers specialist clinics for teenagemums and for women with medical conditionssuch as diabetes.

The hospital is a tertiary referral centre,providing women with complicated pregnanciesspecialised care not available at other hospitals.High risk obstetric cases from across the UK

are referred to St Georges, which has theregional neonatal intensive care unit.

Midwife Marion Louki, fromthe Carmen Suite, said:

Women are told they can have

a natural birth when they are atantenatal classes.

The response from patients hasbeen phenomenal, they appreciatethe home-from-home atmosphereof the unit, and the knowledgethat if they need medicalassistance, the hospitals facilitiesare on hand.

New mum Ade Pairi, 36, (page 24/25) had her firstchild at the Carmen Suite and was delighted to havea relatively easy delivery.

Elijah was born at 3.25am on August 1, 2008and mum Ade said:

I was so pleased to be able to give birth withoutan epidural. I had no pain relief at all.

The unit is fantastic. I like the ambience of theplace, it is so new and clean, and the staff have beenextremely friendly and helpful. Id recommend it toanybody who wants to give birth in a more relaxed

setting.+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +


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TRAUMA PATIENT


Holdsworth Ward, St James Wing

REPORT

After two nights at the General Intensive

Care Unit Mrs Ashford was transferred to theHoldsworth Ward, which helps patients withorthopaedic injuries to recover.

She said: This is the first time I can recallbeing conscious for a period of time. The firstnight was traumatic as I had some very scaryhallucinations, as a result of the high levelsof morphine Id had.

I remember crying out with fear, and nursescoming to my bed to comfort me and reassureme everything was all right. I spent the next

couple of weeks on the orthopaedic ward andthe nurses were remarkable, they were soprofessional.

They work very hard and are so passionate

and caring; I never heard one of them complain.After I had been on the ward for a few days,the hospital physio team helped me get out ofbed and get dressed, they helped me to standup and hold onto a Zimmer frame.

I still had the x-frame around my pelvis, andI could not put any weight on my left side. I canremember the look of joy on my familys faceswhen the physio pushed me into the waitingroom, where they were waiting to see me.

My thanks go to all the staff in the NHS that

have helped me and my family, especially all thekind hard working cheerful nurses and surgeonswho work at St Georges hospital. I could nothave asked for better care and I cant thankthem enough.

27


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28

PAEDIATRIC PATIENT

Alfie PettengellLOCATION

Nicholls Ward, Lanesborough Wing

REPORT

Consultant paediatric surgeon Mr Zahid Mukhtar(above) said: Alfie was brought to the hospitalaged just two weeks and taken via A&E to thePaediatric Intensive Care Unit. He was desperatelyunwell and emergency surgery was his only hopefor survival. After resuscitation and stabilisationby the intensive care team he was taken straightto theatre, our elective surgery cases cancelledto make space for him in theatre.

It was touch and go as to whether he wouldsurvive. He had unusual developmental cystsattached to his intestine which had causedhis entire small bowel to twist several times,stopping the flow of blood, causing ischaemia.

This was a catastrophic finding. The cystswere removed and the bowel untwisted withthe hope that it would recover from the injury.

After a stormy postoperative course, Alfiemade a good recovery but was still unable tofeed, being nourished through intravenousnutrition.

Unfortunately a subsequent operation foundthat almost all of the small bowel had perished.

He is now left with only 40cm of the smallintestine, which is the minimum a child needsto survive.


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29Staff survey

Working at St GeorgesSt Georges wants to be a magnet for talentedstaff as its services and facilities improve.

The Trust is one of the biggest employers insouth west London, offering life-long learningand career development to more than 5,700people.

During 2007 the Healthcare Commissioncarried out a survey looking at the highs andlows of working in hospitals across the country.

St Georges achieved five key scores in the top20 per cent of trusts, but also four in the worst

20 per cent.More St Georges staff took part in the survey,49 per cent of the sample of 500 staffcompared with 37 per cent during 2006/07.Areas where the trust scored well incomparison with others were:

Three quarters of staff (75 per cent) said theyhad taken advantage of one of the flexibleworking options provided.

On the quality of job design clear jobcontent, feedback and staff involvementSt Georges scored 3.38 out of a possible 5.

On work pressure how much staff feel theirworkload is larger than they can cope withthe Trust scored 3.07 out of 5.

On positive feeling within the organisation including team working, supervision,communication and staff involvementthe Trust scored 2.94 out of 5.

On the issue of experiencing physical violence9 per cent of staff across the Trust said theyhad experienced violence from patients,service users or relatives.

However, the Trust scored significantly worse

than the national average in five areas: Staff appraisal rate

Staff with personal development plans

Health & Safety training

Work related injuries

Harassment and bullying.

A survey of inpatients carried out by the HealthcareCommission during 2007 ranked St Georges as being

seventh out of 44 trusts in London and the southeast for patients overall experience of their care.

St Georges scored within the top 20 per cent in

eight areas including patient information, waitingtimes and nurses and doctors washing their hands.

However, the Trust was listed in the lowest 20 percent of trusts in three areas including the provisionof mixed sex-wards.+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +


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OperatingefficientlyChanges to working practices and betterday-to-day organisation are helping theoperating theatres at St Georges toincrease the number of procedures carriedout every day


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32More operations in less time

In July the Trusts first procedureusing a surgery robot was carriedout. Theatre manager AlbertoCastrillon said:

The robot is used for keyholesurgery and can be used for gallbladder removal, prostate removal

and many other procedures. It isextremely accurate and proceduresare easier to carry out thanLaposcropies. I think this is thefuture of surgery for this kindof procedure.

Dr Gillian Farnsworth, consultantanaesthetist, said:

The theatres are getting busierall the time. As the number of

patients being referred fromICU increases we are doing morecomplicated procedures, and we

are doing a lot more surgeryon elderly people and cancer

patients.

The way the 26 operating theatres atSt Georges are used has improved over the lastyear, leading to a big increase in the numberof procedures carried out.

A review carried out during 2006 showedthat while the Trust was carrying out on average28,000 operations every year, the theatreswere only in use for 78 per cent of the time.

Routine elective procedures were sometimesbeing performed during evenings andweekends, which meant staff were beingpaid overtime for scheduled operations,and no advance planning was being put into

compiling the theatre list, which says whichprocedures should be carried out where.

The review ruled that the way operatingtheatres were being run was expensive andinefficient, and that it was causing delays forpatients.

An action plan was drawn up, with the goalof putting theatres into use for 85 per centof the time.

The plan included measures to introduce adedicated senior theatre nurse to act as a floormanager, helping to ensure the best possibleuse was being made of the facilities, and that

session days should finish earlier, to encourageprocedures being carried out more quicklywith appropriate bookings being made inthe theatres list.

A short stay unit, the Gray Ward, was set upfor patients who did not need to spend toomuch time on the wards, and a pre-operativeassessment unit was established, to speed upthe process of patients being checked over

and booked in.Since the review there have been fewercancellations and the number of procedurescarried out has increased to more than 31,000during 2007/08.

Now the Trust is looking at ways of increasingcapacity in theatres further, as the number ofpatients being seen increases and more andmore trauma patients are sent to St Georges.


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36/60

34More than just surgery at the Bariatric Unit

Surgery changed my lifeIn March 2006 patient Laura Ripley was givenjust four months to live unless she lost weight.

The 21-year-old weighed 38 stone and was

told her life depended on losing half of herbody weight.

She embarked on a healthy eating plan, run bySt Georges Bariatric Unit, which is made up ofspecialist surgeons, consultant endocrinologists,bariatric dietitians and psychiatrists. The BariatricUnits multi-disciplinary team works closelywith patients to create a treatment and weightmanagement programme.

The unit was recently named as the South EastCoast Specialised Commissioning Groupspreferred provider. This group includes allprimary care trusts in London, Kent, Surrey,Sussex and Middlesex and offers a number

of surgical options including gastric banding,gastric bypass and sleeve gastrectomy.

Laura, whose mother died of obesity, said:I knew I had to do something about my

condition. Dr Reddy, my consultant, explainedthe benefits of having the surgery and what itwould mean in terms of restricting my diet forthe rest of my life.

Marcus Reddy, bariatric consultant whoperformed Lauras surgery, said: Weight losssurgery for patients like Laura can be usedwhere despite many attempts to lose weightthere is difficulty in sustaining the weight loss.The benefits are clear that metabolic problems

such as diabetes, musculoskeletal conditionssuch as back pain and ultimately life expectancyare all improved or even restored.

Laura (left) before and aftersurgery explains how sheovercame her weight problem:

By working with Dr Reddyand the team Ive been able to

completely change my eatinghabits and lifestyle. Ive evenbeen to see Take That in concert.In June I completed the Race forLife and its all thanks to the

support I have received fromstaff at St Georges.


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35Here for you

The Patient Advice and Liaison Service atSt Georges was contacted 3,750 times duringthe year, an increase of 16 per cent on theprevious year.

The team, which deals with problems orconcerns patients may have with the Trustsservices, has a target to deal with 80 per centof queries within a week and it beat the target,resolving 91 per cent within seven days.

More than 1,700 enquiries were requestsfor information, including requests from staff,and over 600 patients contacted the team todiscuss communication issues at the Trust.

During the year PALS launched a new page onthe intranet, which provides staff with an easyway to access information about the team,interpreting services, customer care trainingand resources available to help patients.

There were several queries about difficultygetting through to the Central Booking Systemand other outpatient areas, and there wereconcerns about accessing patient transport.

PALS staff have acted as a liaison betweenpatients and the services, and put forwardsuggestions for improvements drawing onpatients experiences of using the services.

The team delivered customer care trainingon an ad hoc basis to wards and departmentsand in conjunction with the Training andDevelopment Department.

The Voluntary Services Department placed 200volunteers at the Trust during the last year, helping

people to get involved in making the hospital abetter place for patients, visitors and staff.

The volunteers staff information desks and corridors,provide trolley services of books and refreshments towards and clinics, and perform basic administrativeand clerical tasks.

For the third year, trained volunteers have beenhelping elderly patients and stroke patients at mealtimes.

During 2008 the Cabinet Office for the Third Sectorprovided funding for 11 volunteer training sessionsat South Thames College, on topics includingManaging Challenging Behaviour, Mental Health

Awareness and Equality and Diversity.

The Bereavement Services Department providestraining for Trust staff and offers support to thefamily and friends of patients who die. During

2007/08 it dealt with 1,345 deaths and arranged118 funerals, 35 of them for adults and 83 for babies.+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +


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LeadinginnovationNew technologies such as St Georgesrobot pharmacy are helping the Trustto see a greater number of patients thanever before, while freeing up time forclinicians to spend time on the wards


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38Robot pharmacy

Heather Fowler, Patient ServicesManager and Gary Donald, Deputychief pharmacist, the team behindthe new Lanesborough WingPharmacy robot

New technology is helping the Pharmacydepartment at St Georges to save money andfreeing up time for pharmacists to spend onthe wards.

The department has one of the biggest andbusiest pharmacy robots in Europe, sortingthrough 33,000 prescriptions every month andputting them into batches to be dispatched tothe wards.

There is a conveyor belt full of medicines,which are fed into the robot. The machinepicks up the medicine and looks for its barcode,then works out how big its package is. It then

works out where it has space on its shelves fora box that big, and sends it there through aseries of conveyor belts and robotic arms.

When it is not busy, the robot tidies itself up,moving the boxes of medicines around theshelves to free up more space. It is reducingcosts by making sure medicines closest to theiruse by dates are used first, keeps track of stocklevels and reduces the risk of the wrong

medicine being chosen by mistake.

Deputy chief pharmacist Gary Donald said:The robot went live in November 2007, andhas already saved us 500,000. We expect itto save 240,000 every year going forward.

Its a far more efficient system than havinghuge stockpiles of medicines high up onshelves, and people climbing up on laddersto find them.

It has freed up time for pharmacists to goon ward rounds, which is helping to improvepatient care.

The department is working to use the robot

for dispensing outpatient prescriptions, to makethe dispensing service more efficient and cost-effective.

The Trust also invested heavily in developingthe pharmacy manufacturing unit, which isable to produce life-saving treatments suchas chemotherapy and total patient nutrition.These medicines can be sold to other Trusts,providing extra income for St Georges.


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39Dr Anton Joseph and the Bubble syringe

The bubble needle in action (above),Dr Anton Joseph, inventor of thebubble needle, said:

The training and experience gainedat St Georges made a significantcontribution to this invention. Imthankful for the co-operation, supportand encouragement I received fromthe department of radiology, theTrust and for the opportunity todevelop this procedure for thebenefits of the patients.

Invention delivers safer biopsiesFormer St Georges Consultant Radiologist,Dr Anton Joseph, has been named overallwinner of the London NHS Innovator Awards2007.

The title was awarded for the invention ofthe Bubble Needle, a new technique devised

by Dr Joseph, which makes it much easier forclinicians to see the needle very clearly duringultrasound guided biopsy procedures, whichare used in the diagnosis of cancer.

Dr Joseph came up with the idea whileworking at St Georges when he observedbubbles rising from soluble aspirin tabletsdissolving in water.

He invented the novel echogenic needle

coating, now fully patented which is ahydrophilic coating, containing effervescentmaterials, producing tiny bubbles resulting inthe multidirectional scattering of theultrasound waves.

This not only makes the angle at which theneedle is inserted much less critical, but alsoincreases visibility making the procedure moreaccurate, easier and safer. As the bubblesremain visible in the area for several minutesonce the needle has been removed, a secondbiopsy can be easily carried out from adifferent site if required.

Receiving the award, Dr Joseph said:Marie Grant, Deputy Chief Executive &Director of Operations & Performance, wasextremely supportive of this work. Im alsograteful to the Lord for the inspiration for thisinvention. I am also deeply indebted to TWIfor producing a working model and to thededicated team at NHSIL for their efforts tomarket the product.

Because the technique makes ultrasoundguided biopsies quicker and more accurate,the number of procedure carried out everyyear looks set to increase significantly.


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The number of C.diffcases was 415, belowthe target of no more than 433. This representsa 13.7 per cent reduction on the previous year,above the target of 10 per cent.

CleanlinessPatient Environment Action Teams fromthe National Patient Safety Agency undertakeannual assessments of the food provided atthe Trust, along with the environment andprivacy and dignity for patients. This yearsassessment indicated an improvement inthe food provided at the Wolfson site fromacceptable to good, and privacy and dignity

at the Wolfson is now coded as good.

QualityThe NHS Litigation Authority (NHSLA) hasintroduced new Risk Management Standardsfor Acute Trusts (RMS) to replace the ClinicalNegligence Scheme for Trusts for generalservices. The Trust was assessed for level 2compliance with the RMS for Acute Trusts inDecember 2007 and was successful. This is

a significant achievement, as good riskmanagement is important for improvingthe protection of patient care. This level ofcompliance will be applicable for three years.

Patient complaintsDuring 2007/08, 71 per cent of complaintswere responded to within 25 days, below thetarget of 85 per cent.

EfficiencyThe number of operations cancelled for non-clinical reasons in 2007/08 increased from2006/07 by 5 per cent, from 666 to 698.

However, 95 per cent of these patients whowere cancelled were re-admitted within 28days, an improvement on 83 per cent in2006/07.

We will be working hard during the current

year to make sure that every patient who iscancelled is readmitted within the 28 dayperiod.

More patients are being treated than ever atSt Georges, while the length of time peoplewait for more procedures is being reduced.We are ahead of national targets in several

areas, and working to improve in areas wherewe are falling short.

Access to treatmentsA great deal of work has gone into ensuringpatients at St Georges are seen within18 weeksof being referred by a GP.

In March St Georges was one of the firsthospitals in the country to meet the national

target, which states that 95 per cent of out-patients and 90 per cent of inpatients and daycases should receive treatment within 18 weeksof referral. The deadline for complying withthe target is December 2008.

The Trust maintained a 13 week maximumwait for all first outpatients appointments, andonly three inpatients had to wait longer thanthe 26 week inpatient national waiting timestandard during 2007/08.

During 2007/08 the Trust achieved threenational cancer targets. All urgent GP referralsare seen within two weeks, and 100 per centof cancer patients waited no longer than 31days from diagnosis to the start of treatment.

St Georges also exceeded the 95 per centtarget for patients starting treatment within62 days of a GP referral, performing at 98 percent throughout the year.

During 2007/08 the percentage of patientswho spent less than 4 hours in A&E fromarrival to admission, transfer or discharge was97.33 per cent, narrowly missing the 98 percent target.

SafetyThere were 24 MRSA bacteraemias (bloodstream infections) during 2007/08, within the

Trusts target of having no more than 37. Thisis a reduction of 74 per cent since the baselinein 2003/04.

40Performance


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41

4,998Babies delivered

up 3%

28,311Day cases seen

down 1%

60,689Inpatients admitted

up 4%

448,657Outpatient appointments

up 5%

100,214A&E attendances

up 1.7%


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42Board of Directors

Mrs Marie GrantDirector of Operations & Performance/

Deputy Chief ExecutiveNo Register of Interest

Mr David AstleyChief ExecutiveNo Register of Interest

The Board of Directors at St Georges Healthcare NHS Trust consistsof a Chair, Chief Executive, eight full-time Executive Directors andfive part-time Non-Executive Directors.

The role of the Board is to oversee the strategic direction of thehospital and ensure the Trust delivers effective financial controland high-quality, patient-centred care.

The Board meets in public every two months to discuss the runningof the hospital and the Trusts performance. Staff, patients andmembers of the public are all welcome to attend these meetingsand raise any questions to the hospitals senior managers.

Mrs Naaz CokerChairMemberLondon South sub-committee,ACCEA (Advisory Committee onClinical Excellence Awards)BMAs Carbon CouncilPatronThe Jewish MuseumVice PresidentMedactAssociation MemberOxfamTrusteeRoyal Society of ArtsPatronSt Georges KidneyPatients AssociationCouncil Member

St Georges University of LondonChairShelter

Mr Paul MurphyDeputy Chairman

Board memberNambbarrrie Tea Company,Northern IrelandChairmanTwinings, North America (Twinings ispart of Associated British Foods, whichmay provide supplies to the NHS)


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Dr Geraldine WaltersDirector of Nursing andPatient InvolvementVisiting ProfessorBuckinghamshire ChilternsUniversity College (salaried)ChairLondon Network for Nursesand Midwives (unpaid)MemberBoard of Governorsof RCN Institute (unpaid)

Mr Mike RappoltNon-Executive DirectorGovernorRaynes Park High SchoolShareholderPA Consulting Groupand various shareholdings(< 1% of Company)ChairmanWimbledon Civic Theatre Trust

Ms Valerie MooreNon-Executive DirectorLay MagistrateDepartment of Constitutional AffairsInner London Youth PanelDepartment of Constitutional AffairsLay MemberCross-Rail Discretionary Purchase Panel(appointed by Secretary of State forTransport)PartnerMoore Adamson CraigPartnership LLP

43

Mr Christopher StreatherMedical DirectorMemberNew Healthcare Network, occasionalcontributor to MPs Briefings

Dr Colin ReevesInterim Executive Director of Finance

(from October 2007May 2008)No Register of Interest

Dr Graham HibbertNon-Executive DirectorNo Register of Interest

Professor Sean HiltonNon-Executive DirectorChairmanAnglo-European Chiropractic College

Mrs Helen GordonDirector of Human Resources

No Register of Interest

Mr Neal DeansDirector of Estates and FacilitiesNo Register of Interest

Dr Rosalind Given-WilsonMedical DirectorNo Register of Interest

Mr Michael BaileyMedical DirectorNo Register of Interest

Mr Colin GentileExecutive Director of Finance and

Turnaround (to October 2007)External MemberAudit Committee,Horniman Museum (unpaid)


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44Financial summary

Staff at St Georges should all take credit for the work to turnthe Trust around. It is thanks to their hard work that we are nolonger living beyond our means.

In 2004/05, the Trust spent 21.7 million more than it received.The Trust took action and a year later this overspend had beencut to 11.6 million. By the following year, this had beenreduced further still to 2.9 million, and by the close of 2007/08it was our aim to bring the Trust into financial balance. We wentone step further than this, and achieved a small surplus of

5.9 million.This accomplishment is due entirely to the resolve of cliniciansand managers at all levels of the Trust. Using their ideas,involvement and motivation, we have identified the causes ofthe Trusts long-standing financial troubles and found many ofthe solutions.

But without a doubt, the past few years have been difficult.We have drilled down further than ever before into the workingsof the hospital to see where we work well and where we do

not. This has meant reducing costs in some areas, while providinginvestment in others to deliver a more efficient and improvingservice.

For example, in our pharmacy we have invested 500,000 in anew state-of-the-art robot to improve the speed and efficiencyof the dispensary, cutting delays and reducing medicine wastageto save the hospital an estimated 240,000 every year, and inpathology we have centralised our laboratories. Common to allthese initiatives is the concept of working smarter.

Year-on-year, patient activity rose this year we treated 20,000more inpatients than four years ago. To meet this rising demand,we must find ways of delivering sustainable improvements inpatient safety and care whilst staying within budget. We areachieving both these objectives.

In 2007/08 St Georges Healthcare NHS Trust achieved a surpluson income and expenditure of 5.9 million.

The Trusts rate of capital cost absorption in 2007/08 was 3.5%which is within the target range of 3%4% set by the NHSExecutive. The Trust met both its Capital Resource Limit andExternal Financing Limit. The following statements representa summary of financial information about the Trust.

With the end of the financial year 2007/08, we have drawn to aclose the remarkable turnaround of St Georges that has broughtthe Trust back to the black for the first time in over seven years.

St Georges Turnaround:Income and Expenditure m

2005 2006 2007 2008

(21.7)

(11.6)

(2.9)

5.9


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45

+ + + + + + + + + + + + + + + + + + + + + + + +

The full accounts are availableon request from:

Director of FinanceSt Georges Healthcare NHS TrustBronte HouseSt Georges HospitalBlackshaw RoadLondon SW17 0QT

T/ 020 8725 1346

St Georges is now a far more efficient organisation and thisimprovement is shown in the Trusts reference costs themeasure by which all NHS trusts are compared. In 2003/04,our reference cost was listed as 117, with trusts scoring less

than 100 indicating financial efficiency. In 2007/08, we areclassed at 101. This improving efficiency moves us one stepcloser to becoming an NHS Foundation Trust and is part of thecontinued development of services at St Georges.

However, there are still financial challenges ahead. We havereduced our accumulated revenue deficit by 5.9 million from2006/07 to 32.1 million, but this historic deficit continues toshadow us. To finance the deficit the Trust secured 34 millionloans in 2006/07 from the Department of Health and NHS

London. Last year the Trust reduced the loans by just over 2m.The outstanding balance of approx 32m is repayable in fourequal annual instalments of 8m over the next four years.

Much like a mortgage, this debt will need to be paid off overthe years to come, but unlike our recent past, we are no longerfinding ourselves in debt at the end of every month. To continuethis momentum, our focus must now change from seekingsavings to generating surplus income from clinical and relatedactivities, and to achieve this the Trust must continue itstransformation.

The Transforming St Georges programme will spearhead thisevolution. Its aim is to deliver high-quality and financially soundservices that will continue the enhancement of patient care atSt Georges. A key stepping stone in our transformation plan isbecoming an NHS Foundation Trust. As a Foundation Trust wewould have greater freedom to develop services in line with theneeds of our patients and more independence to retain thefinancial surpluses we make for reinvestment back into patientcare.

It is our aim to become a Foundation Trust in 2009. To achievethis, we must demonstrate that we are in strong and sustainablehealth, both clinically and financially, and because of the Trustsstrong performance over the past twelve months, attaining theFoundation Trust status is now within our grasp.

Dr Colin Reeves Richard EleyInterim Executive Director of Finance Executive Director of Finance(October 2007May 2008) (from May 2008)


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46Income and Expenditure AccountFor the year ended 31 March 2008

2007/08 2006/07Notes 000 000

Income from activities 3 336,201 313,409Other operating income 4 73,928 70,737

Operating expenses 5 (402,028) (380,723)Operating surplus/(deficit) 8,101 3,423

Cost of fundamental reorganisation/restructuring 0 0Profit/(loss) on disposal of fixed assets 8 5,210 (6)

Surplus/(deficit) before interest 3,417 (27,232)

Interest receivable 1,606 894Interest payable 9 (1,837) (46)Other finance costs

unwinding of discount 16 (34) (34)

Surplus/(deficit) for the financial year 13,046 4,231

Public Dividend Capital dividends payable (7,074) (7,132)

Retained surplus/(deficit) for the year 5,972 (2,901)

All income and expenditure is derived from continuing operations.

2007/08 2006/07000 000

Retained surplus/(deficit) for the year 5,972 (2,901)

Financial Support included in retained surplus/(deficit) for the year NHS Bank 0 0 Internally generated 0 0

Retained surplus/(deficit) for the year excluding financial support 5,972 (2,901)

From 2006/07 onwards the provision of cash brokerage support was replaced by a regime of loans and deposits with theDepartment of Health.

Details of loans received or deposits placed with the Department of Health can be found in notes 14.2 and 15.1 to theaccounts.


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47Balance SheetAs at 31 March 2008

2007/08 2006/07Notes 000 000

Fixed assetsIntangible assets 10 1,948 1,021

Tangible assets 11 258,249 241,902Investments 14.1 0 0

260,197 242,923Current assetsStocks and work in progress 12 5,257 5,275Debtors 13 41,558 39,516Investments 14.2 0 0Cash at bank and in hand 18.3 3,938 111

50,753 44,902

Creditors:Amounts falling due within one year 15 (54,433) (51,470)

Net current assets/(liabilities) (3,680) (6,568)

Total assets less current liabilities 256,517 236,355

Creditors:Amounts falling due after more than one year 15 (23,978) (27,200)

Provisions for liabilities and charges 16 (4,478) (2,956)

Total assets employed 228,061 206,199

Financed by: Taxpayers equityPublic dividend capital 22 131,475 131,672Revaluation reserve 17 121,652 106,970Donated asset reserve 17 15,196 14,424Government grant reserve 17 1,158 856Other reserves 17 1,150 1,150Income and expenditure reserve 17 (42,570) (48,873)

Total taxpayers equity 228,061 206,199

David Astley Richard EleyChief Executive Executive Director of Finance18 June 2008


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48Cash Flow StatementFor the year ended 31 March 2008

2007/08 2006/07Note 000 000

Operating activitiesNet cash inflow/(outflow) from operating activities 18.1 23,192 20,166

Returns on investments and servicing of financeInterest received 1,606 894Interest paid (1,787) 0Interest element of finance leases 0 0

Net cash inflow/(outflow) from returnson investments and servicing of finance (181) 894

Capital expenditure(Payments) to acquire tangible fixed assets (17,924) (13,958)Receipts from sale of tangible fixed assets 8,677 1(Payments) to acquire intangible assets (1,000) (623)Receipts from sale of intangible assets 0 20(Payments to acquire)/receipts from sale of fixed asset investments 0 0

Net cash inflow/(outflow) from capital expenditure (10,247) (14,560)

Dividends paid (7,074) (7,132)

Net cash inflow/(outflow) before managementof liquid resources and financing 5,690 (632)

Management of liquid resources

(Purchase) of investment with Department of Health (DH) 0 0(Purchase) of other current asset investments 0 0Sale of investments with DH 0 0Sale of other current asset investments 0 0

Net cash inflow/(outflow) from management of liquid resources 0 0

Net cash inflow/(outflow) before financing 5,690 (632)

FinancingPublic dividend capital received 0 0Public dividend capital repaid (not previously accrued) (197) (34,653)

Loans received from DH 4,800 34,000Other loans received 0 0Loans repaid to DH (6,828) 0Other loans repaid 0 0Other capital receipts 362 1,312Capital element of finance lease rental payments 0 0Cash transferred (to)/from other NHS bodies 0 0

Net cash inflow/(outflow) from financing (1,863) 659

Increase/(decrease) in cash 3,827 27


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49Statement of Total Recognised Gains and LossesFor the year ended 31 March 2008

2007/08 2006/07000 000

Surplus/(deficit) for the financial year before dividend payments 13,046 4,231

Fixed asset impairment losses 0 0

Unrealised surplus/(deficit) on fixed asset revaluations/indexation 16,078 1,534

Increases in the donated asset and government grant reserve

due to receipt of donated and government grant financed assets 1,861 1,312

Defined benefit scheme actuarial gains/(losses) 0 0

Additions/(reductions) in other reserves 0 0

Total recognised gains and losses for the financial year 30,985 7,077

Prior period adjustment 0 0

Total gains and losses recognised in the financial year 30,985 7,077


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50Notes to the Financial StatementsFor the year ended 31 March 2008

3 Income from activities2007/08 2006/07

000 000

Strategic Health Authorities 1,426 247

NHS Trusts 635 569Primary Care Trusts 279,656 260,930Foundation Trusts 630 639Local Authorities 0 0Department of Health 48,253 45,990NHS Other 331 319Non NHS:

private patients 3,117 3,155 overseas patients (non-reciprocal) 535 321 injury cost recovery 1,212 870

other 406 369336,201 313,409

Partially completed in-patient spellsIn accordance with Department of Health guidance, the Trust has recognised income in 2007/08 relating to in-patientspells which were partially complete at 31 March 2008. Projected income of 1,656,000 for these in-patient spells isattributed to the financial year on the basis of the patients length of stay in hospital. This income is included in the totalfor Primary Care Trusts.

Road Traffic ActRoad Traffic Act income is subject to a provision for doubtful debts to reflect expected rates of collection.

Market Forces FactorThe Department of Health income is inclusive of 49,398k in respect of the Market Forces Factor less an amount for PBRtransitional support repayable to the Department of Health of 1,169k. The Market Forces Factor is a central allocationdesigned to address cost differentials relating to geographical location. The Market Force Factor represents the estimateddifference between the cost the Trust incurs in providing NHS services and the income receivable for those services underthe payment by results regime. In 2007/08 the Market Forces Factor increased from 45,612k to 49,398k.

4 Other operating income2007/08 2006/07

000 000

Patient transport services 63 46Education, training and research 52,333 51,502Charitable and other contributions to expenditure

779696

Transfers from donated asset reserve 1,788 1,673Transfers from government grant reserve 64 57Non-patient care services to other bodies 10,918 11,112Income generation 3,251 3,645Other income 4,732 2,006

73,928 70,737


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51

5 Operating expensesRestated

2007/08 2006/07000 000

Services from:

other NHS Trusts 2,021 2,038 from PCTs 1,511 956 other NHS bodies 11,117 11,302 Foundation Trusts 558 757

Purchase of healthcare from non NHS bodies 179 37Directors costs 1,439 1,247Staff costs 256,914 243,837Supplies and services:

clinical 66,787 61,986

general 11,172 9,994Consultancy services 2,053 3,485Establishment 2,684 2,710Transport 2,727 2,929Premises 19,993 19,723Bad debts 637 406Depreciation 14,596 12,547Amortisation 366 209Fixed asset impairments and reversals 0 0Audit fees 247 227

Other auditors remuneration 0 0Clinical negligence 4,277 4,371Redundancy costs 448 984Other 2,302 978

402,028 380,723

Staff costsIn 2007/08 the Trust has included expenditure in staff costs for the following:

1. 873k in respect of annual leave entitlement which employees are permitted to carry forward to the followingfinancial year

2. 1,225k in respect of staff costs paid in arrears in April 2008 which were incurred in 2007/08 eg. overtime,emergency, on-call and locum payments

6.4 Management costs2007/08 2006/07

000 000

Management costs 16,169 15,587Income 410,129 383,726

Management costs as % of income 3.94% 4.06%


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7 Better payment practice codeBetter payment practice code measure of compliance

2007/08 2006/07Number Number

Total Non-NHS trade invoices paid in the year 85,853 170,886Total Non-NHS trade invoices paid within target 67,927 139,335Percentage of Non-NHS trade invoices paid within target 79% 82%

Total NHS trade invoices paid in the year 2,936 19,778Total NHS trade invoices paid within target 1,665 16,164Percentage of NHS trade invoices paid within target 57% 82%

The Better Payment Practice Code requires the Trust to aim to pay all undisputed invoices by the due date or within30 days of receipt of goods or a valid invoice, whichever is later.

7.2 The late payment of commercial debts (Interest) Act 19982007/08 2006/07

000 000

Amounts included within Interest Payable (note 9)

arising from claims made under this legislation 0 0Compensation paid to cover

debt recovery costs under this legislation 0 0

Salary and Pension entitlements of senior managersA. Remuneration

2007/08 2006/07

OtherOther remuneration

Salary remuneration Benefits Salary restated Benefits(bands of (bands of in kind (bands of (bands of in kind

5,000) 5,000) to nearest 5,000) 5,000) to nearestExecutive Directors 000 000 100 000 000 100

Mr David AstleyChief Executive 175180 0 0 5560 0 0Mr Colin GentileDirector of Finance

(to October 2007) 7075 0 0 115120 0 0Dr Colin ReevesDirector of Finance

(from October 2007) 0 110115 0 Mrs Marie GrantActing Chief Executive

(JulyDecember 2006) 2530 0 0Mrs Marie GrantDirector of Operations

and Performance 110115 0 0 105110 0 0Dr Geraldine WaltersDirector of Nursing 100105 0 0 100105 0 0Mr Christopher StreatherMedical Director 2025 120125 0 2025 120125 0Mr Michael BaileyMedical Director 2025 145150 0 2025 140145 0


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53

2007/08 2006/07

OtherOther remuneration

Salary remuneration Benefits Salary restated Benefits(bands of (bands of in kind (bands of (bands of in kind

5,000) 5,000) to nearest 5,000) 5,000) to nearest

Executive Directors 000 000 100 000 000 100

Dr Derek DundasMedical Director

(to November 2007) 1015 8590 0 2025 130135 0Dr Rosalind Given-WilsonMedical Director

(from December 2007) 510 130135 0 0 125130 0Dr Stephen NusseyMedical Director 1520 150155 0 0 165170 0Ms Michelle WhiteInterim Director of Human Resources

(AprilJuly 2007) 2025 0 0 Ms Helen GordonDirector of Human Resources

(from July 2007) 7580 0 0 Dr Trudi KempDirector of Strategy 8085 0 0 Mr Neal DeansDirector of Estates 100105 0 0 95100 0 0

Non-Executive Directors

Ms Naaz CokerChair 2025 0 0 2025 0 0Mr Paul MurphyDeputy Chairman

(from May 2007) 510 0 0 Professor Sean HiltonNon-Executive Director 510 0 0 510 0 0Dr Graham HibbertNon-Executive Director

(from December 2007) 05 0 0 Ms Diane MarkNon-Executive Director

(to October 2007) 05 0 0 510 0 0Ms Valerie MooreNon-Executive Director 510 0 0 510 0 0Mr Michael RappoltNon-Executive Director 510 0 0 510 0 0


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B. Pension benefitsLump sum Total accrued

Real increase at age 60 pension & Real Employersin pension related to related lump Cash Cash increase in Contribution

& lump sum real increase sum at age 60 Equivalent Equivalent Cash toat age 60 in pension at 31/03/08 Transfer Transfer Equivalent Stakeholder

(bands of (bands of (bands of Value Value Transfer Pension2,500) 2,500) 5,000) at 31/3/08 at 31/3/07 Value to nearest

Executive Directors 000 000 000 000 000 000 100

Mr David AstleyChief Executive Director 37.540 222.5225 295300 1,269 1,062 181 0Mr Colin GentileDirector of Finance

(to October 2007) (2.55) 110112.5 145150 543 509 254 0Mrs Marie GrantDirector of Operations

and Performance (3537.5) 142.5145 190195 846 974 (153) 0Dr Geraldine WaltersDirector of Nursing (2.55) 92.595 120125 500 485 3 0Mr Christopher StreatherMedical Director 1012.5 82.585 110115 367 318 41 0Mr Michael BaileyMedical Director 2022.5 172.5175 230235 1,068 933 111 0Dr Derek DundasMedical Director

(to November 2007) (2.55) 162.5165 220225 0 866 (593) 0Dr Rosalind Given-WilsonMedical Director 2022.5 125127.5 165170 689 571 104 0Ms Helen Gordon

Director of Human Resources(from July 2007) (2.55) 8587.5 110115 389 369 119 0Mr Neal DeansDirector of Estates 2.55 7577.5 100105 374 342 24 0Dr Trudi KempDirector of Strategy (2.55) 57.560 7580 252 249 (3) 0Dr Stephen NusseyMedical Director 1012.5 142.5145 190195 865 773 73 0

As Non-Executive members do not receive pensionable remuneration, there will be no entries in respect of pensions forNon-Executive members.

A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued

by a member at a particular point in time. The benefits valued are the members accrued benefits and any contingentspouses pension payable from the scheme. A CETV is a payment made by a pension scheme, or arrangement to securepension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transferthe benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual hasaccrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity towhich the disclosure applies. The CETV figures, and from 2005/06 the other pension details, include the value of anypension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme.They also include any additional pension benefit accrued to the member as a result of their purchasing additional yearsof pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribedby the Institute and Faculty of Actuaries. Real Increase in CETV This reflects the increase in CETV effectively funded bythe employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee(including the value of any benefits transferred from another pension scheme or arrangement) and uses common marketvaluation factors for the start and end of the period.

David Astley Richard EleyChief Executive Executive Director of Finance18 June 2008 18 June 2008


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55Auditors Report

Independent auditors statement to the Boardof Directors of St Georges Healthcare NHS Trust

I have examined the summary financial statement which

comprises the Financial Summary set out on pages 44 to 54.

This report is made solely to the Board of Directors of St GeorgesHealthcare NHS Trust in accordance with Part II of the AuditCommission Act 1998 and for no other purpose, as set out inparagraph 36 of the Statement of Responsibilities of Auditorsand of Audited Bodies prepared by the Audit Commission.

Respective responsibilities of directors and auditorThe Directors are responsible for preparing the Annual Report.

My responsibility is to report to you my opinion on theconsistency of the summary financial statement within theAnnual Report with the statutory financial statements.

I also read the other information contained in the AnnualReport and consider the implications for my report if I becomeaware of any misstatements or material inconsistencies withthe summary financial statement.

Basis of opinion

I conducted my work in accordance with Bulletin 1999/6The auditors statement on the summary financial statementissued by the Auditing Practices Board. My report on thestatutory financial statements describes the basis of our auditopinion on those financial statements.

OpinionIn my opinion the summary financial statement is consistentwith the statutory financial statements of the Trust for the yearended 31 March 2008. I have not considered the effects of anyevents between the date on which I signed my report on thestatutory financial statements, 23 June 2008, and the date ofthis statement.

Susan M ExtonEngagement Lead(Officer of the Audit Commission)

First Floor, Millbank TowerMillbankLondonSW1P 4HQ

9 September 2008


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56St Georges Hospital CharityRegistered charity number 241527

The Trust continues to enjoy a good relationship with St GeorgesHospital Charity, reaping great benefits for patients, staff andthe community. Projects funded by the Charity this year include:

Digital mammography equipment, providing a quicker,more pleasant experience for patients

The refurbishment of the Lanesborough scanning department,creating more space and more privacy for patients

Funding for medical research fellowships for the benefitof future generations

Funding for equipment bags for midwives attending homebirths

St Georges is delighted that some of the projects that theCharity has funded in previous years have been recognised withlocal and national awards.

The Dragon Childrens Centre won a commendation for accessin the Wandsworth Design Awards 2007.

The Walk on the Wild side garden scooped two awards: Awardf

annual report 2007-2008 full

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