Annual Report 2007 / 2008 - South West London and St George's ...

Our year
Annual Report and Accounts 2007/08
Helping people take back
control over their lives
Annual Review 07 / 08 1

contents
Chairman’s welcome 3
Chief Executive’s introduction 4
About us 5
Our vision 6
Our services 7
Our objectives and our performance 21
Financial review 34
Remuneration 41
Our Board 43
Did you know?
21,766
3,830
2,700
720
£170m
21,766 people are
currently receiving
treatment and care
from the Trust in
the community
We had
3,830 inpatient
admissions
in 2007/08
We employ
about
2,700 staff
We have
720
inpatient beds
Our annual
budget is
£170 million
2 South West London and St George’s Mental Health NHS Trust

Meeting major challenges
Welcome from the Trust’s Chairman
This is a very exciting time for
the Trust. As is obvious with
the major building work going
on at Springfield University
Hospital we are forging ahead
with the construction of the
Wandsworth Acute Unit.
This is the first phase of
implementing the overall
vision for the 80-acre site.
Looking forward, in 2009 we hope
to become an NHS foundation trust
providing health and social care. This
means giving an opportunity for local
people to join us as members and
become involved in our decision making.
Through the members the Trust will be
more accountable to the local people
we serve and to our partners, including
the borough councils.
We continue to face major challenges
and to help meet these we have
appointed two new non-executive
directors (NEDs) with strong professional
backgrounds. Iain McCusker, a
chartered accountant, and Susan
Dark, the managing director of
Nikko Healthcare, will be using their
independence, skills and experience to
help plan and oversee Trust services.
As well as our two new NEDs we have
welcomed two new executive members
of the Board – Kim Goddard, Director
of Nursing and Governance, and Dr Ben
Nereli, our new Medical Director, further
strengthening the executive and clinical
leadership of the Trust.
I would like to thank all members of the
Board for their contribution in the last year.
I believe we have a very strong and talented
executive team led by Peter Houghton.
Most of all I want to thank the staff of
the Trust, both those who have direct
contact with the people we serve
and also those who work tirelessly
in the background. On behalf of the
Board and everyone who uses our
services, thank you.
John Rafferty
Chairman
3

Improving clinical care
Introduction by the Chief Executive
The past year has seen the
Trust make real progress,
with notable achievements
in important areas.
These include: the work we have
undertaken to improve the quality
of the environment for service users
and staff; our increasing profile in the
local community and the media as we
attempt to engage with people from
diverse communities and to tackle the
stigma associated with serious mental
illness; and our sound management of
the Trust finances, now recognised in
an improved rating by NHS London.
In my introduction to last year’s report
I said that delivering safe and effective
clinical care was a top priority. This
remains so and is the key theme of this
year’s report. I am delighted that we
have achieved real improvements over
the past year as we said we would.
These would not have happened unless
we had involved service users, carers
and other stakeholders in our work
and been determined to learn from our
experiences and from others.
I will single out three examples:
Service users told us in surveys that they could not always get the help they
needed in a crisis. Thanks to the efforts throughout the year of staff and
managers in each borough, we now have crisis and home treatment teams
and early intervention teams in place from April 2008.
The improvement programme that has been implemented in our forensic unit,
the Shaftesbury Clinic, has ensured a safer, more effective and responsive service
for service users. Staff have spent much time reflecting on the problems of
the past, learning from experience elsewhere, and introducing new working
practices.
The first phase of the redevelopment of Springfield began in autumn 2007
with the start of the building work for the new Wandsworth Acute Unit.
This will provide a new Psychiatric Intensive Care Unit and an admission ward
for adults who are acutely ill. Clinical teams and service users are working with
the builders and designers to ensure that the very best practice is incorporated
from elsewhere, both in the UK and abroad.
Looking to the year ahead, the Board
has four overriding priorities:
First is the need to continue raising
standards and delivering health and
social care performance targets.
This will improve the quality and
effectiveness of the care and support
we provide for service users and carers.
Second is to continue to manage
our finances well, ensuring that we
deliver value for money and meet our
obligations as stewards of
public resources.
Last, and by no means least,
is the work we need to do to become
a foundation trust.
Finally, I would like to thank three
groups of people without whom
the achievements of the past year
would not have been possible: service
users and carers for their ideas and
honest feedback; our staff for their
commitment and creativity; and our
commissioners and partners for their
active engagement in the transformation
of services we want to achieve.
Third is to deliver the Springfield
Regeneration Programme successfully
so that we can significantly improve
the environment in which we provide
treatment and care at Springfield
University Hospital and elsewhere in
the Trust.
Peter Houghton
Chief Executive
4

About us
South West London and St George’s
Mental Health NHS Trust was formed in
1994 but our history goes back much
further. Our services began on the site of
Springfield University Hospital in Tooting
(the Trust’s headquarters) 170 years ago.
Today we provide mental health and
social care services to a population of
about one million people across the five
London boroughs of Kingston, Merton,
Richmond, Sutton and Wandsworth and
specialist services for people throughout
the United Kingdom.
We provide a full range of services
for children, young people, adults
and older people including:
• mental health services for adults and
older people
• mental health services for people who
have had contact with the criminal
justice system
• specialist children’s services
• learning disability services
• substance misuse services
• community and inpatient services
for people with drug and alcohol
problems
• other specialist mental health services,
such as eating disorders.
We work with a range of partners
including local authorities, primary care
trusts, GPs and other statutory and
voluntary services to deliver care and
support to people in their homes and
from hospital and community bases. The
Trust also provides training, education
and research with four academic
institutions. We deliver statutory social
care to people with mental health needs
in south west London on behalf of the
five boroughs we serve.
Our main inpatient sites are Springfield
University Hospital, Tooting; Tolworth
Hospital; Queen Mary’s Hospital,
Roehampton; and Sutton Hospital.
Becoming a foundation trust
We remain committed to becoming
a foundation trust and our plan is to
achieve this by spring 2009.
Becoming a foundation trust will give
us more control over our future. We
will have greater financial freedoms to
develop new services that focus on the
needs of local people and improve the
treatment and care we provide.
As members, local people, and those
who use our services and the people
who care for them will have a greater
say in how we develop our services.
They will have greater opportunities
to be consulted on existing services
and future plans. We will be able to
use members’ feedback to improve
our services by using the care and
treatments that work best.
Above:
The Trust’s headquarters
Springfield University Hospital
Right:
Joining the Trust
Journalist and broadcaster Sir Trevor
McDonald signs up to become a member
5

Our vision
Our vision is a future in which people with mental health problems
have the same opportunity as other citizens to participate in and
contribute to our communities.
Our values
The most important people in our
services are those who use them
and their relatives, friends and carers.
The most important resources that we
have are the staff that provide their
care and support.
In all our actions, we will recognise
and value the diversity that exists in
our services and our local community
and strive to ensure equality of access,
experience and outcome irrespective
of race or ethnicity, disability, age,
gender, sexuality or religious belief,
or place of residence.
We will treat everyone with dignity and
respect, involve them in decisions that
affect them and provide them with
whatever information they feel will
help them.
In all that we do we strive for excellence,
equity and the efficient use of resources.
Our purpose
The Trust recognises that everyone
with mental health problems faces the
challenge of retaining or recovering a
life that is as meaningful, satisfying and
valued as possible.
The purpose of the Trust is to help
people with mental health problems to
do the things they want to do, live the
lives they want to live and access those
opportunities that all citizens should take
for granted.
To achieve this purpose we will work
in partnership with those who use our
services, their relatives, carers and friends
and other stakeholders to:
• foster hope in those whom we
serve and do our best to ensure that
everyone’s experience of using our
services is a positive one
• provide effective treatment and help
people to take back control over their
problems and their lives and the help
they receive
• improve people’s life chances by
promoting their health, safety and
wellbeing and assisting them to access
the opportunities that they value:
homes, jobs, friends, relationships,
education, social pursuits, leisure
activities and spiritual possibilities
• undertake teaching and research, to
enable us to continue to do this work
for those who will use our services in
the future
• cultivate a workforce that is
committed to pursuing our vision
and purpose and ensure they have
the support and development
opportunities they need to do so.
Above:
Mobile technology
Delivering improvements in
community services
6 South West London and St George’s Mental Health NHS Trust

Our services
Left:
Reaching black and minority
ethnic patients and their families
Admiral Nurse Vincent Goodorally led our
award-winning project on dementia which
won a national Care Services Improvement
Partnership (CSIP) award
Some of our proudest moments in 2007/08:
• The Government’s Social Exclusion
Task Force chose us as one of 12
national pilot sites to provide a
new service for chronically
excluded adults
• Two wards at Springfield University
Hospital were accepted on the Star
Wards programme for mental health
trusts, a national programme which
aims to improve acute inpatients’
daily experiences and outcomes.
To win a place on the programme,
wards need to demonstrate a
sufficiently high level of nursing
practice, user and carer focus and
access to therapies and activities on
the ward
Left:
Staying healthy
At Southbank House residents grow
their own vegetables
• Our vocational services (see page
12) were cited as an example of good
practice by the Sainsbury Centre for
Mental Health, the Royal College
of Psychiatrists and (in a Health
Service Journal article) by the NHS
Confederation, which also mentioned
our involvement of service users
• Our Early Intervention Service (see
page 11) won a BUPA Foundation’s
national Clinical Excellence award
for its success in getting more than
80 per cent of the young people it
sees back into work or education
after a first experience of a psychotic
illness
• We were chosen as one of only
eight sites nationwide to pioneer
a new £4.95 million project
sponsored by the Health Foundation.
Co-creating Health aims to transform
the traditional doctor/patient
relationship. The Trust is one of
only two pilot sites focusing on
mental health
• The Trust became one of only ten
pilot projects in England to introduce
a new form of treatment known
as Multisystemic Therapy (MST).
MST is based on a family therapy
approach which has been used for
many years in the USA, and has been
particularly successful in working with
adolescents with serious anti-social
behaviour and their families
• A project, based in Kingston, to
reach black and minority ethnic
(BME) patients and their families in
Kingston, was the winning entry,
nationwide, in the Recognising
Diversity category at the Care
Services Improvement Partnership
(CSIP) Positive Practice Awards
• Our pioneering annual Happy Soul
Festival (see page 19) engaged black
and minority ethnic communities
using arts, events and films with
mental health themes
• One of our staff won the Nursing
Standard Mental Health Nurse of
the Year award (see page 17).
Annual Report and Accounts 07 / 08 7

Child and adolescent mental health services
a consultant psychiatrist’s story
Like many psychiatrists
working in multidisciplinary
child and adolescent mental
health services (CAMHS), Dr
Ann York, Consultant Child
and Adolescent Psychiatrist
at Richmond Royal Hospital,
has to cope with relentless
demands on her team’s
services, the pressure of
targets and lack of time.
Under her leadership, her team has
developed an innovative service
model which is cited as a model of
good practice in the National Service
Framework for Children update report.
Together with a consultant psychiatrist
at Hertfordshire Partnership Foundation
Trust, she has continued to develop
and describe this model for managing
demand and capacity to deliver high
quality services to children and families.
Ann put what she had learned and
developed into a book – The 7 HELPFUL
Habits of Effective CAMHS and the
Choice and Partnership Approach –
with a supporting website at www.
camhsnetwork.co.uk. She has also
worked with hundreds of clinicians,
managers and commissioners in the
UK, and overseas, on how they can
apply the model to their services.
Ann says: “The model uses demand
and capacity theory as applied to
CAMHS, and incorporates the NHS
Institute’s 10 High Impact Changes for
Services Improvement and Delivery,
the Department of Health’s New Ways
of Working in Mental Health and Our
Choices in Mental Health alongside user
choice and care planning frameworks.
In our own and other services the result
has been enhanced clinical effectiveness
and team working, with improved user
engagement and choice.
“We started running service improvement
workshops four years ago at the request
of colleagues and increasingly were asked
to talk about what we were doing in our
own clinical teams. I find it enormously
exciting that this service model started
here in Richmond in 2000 and we have
helped other services become more
efficient and effective for the benefit of
users and staff.
8

Responding to children
and young people
“To help others adapt the model to
their own services we’ve named it CAPA
– the Choice and Partnership Approach
(see below). CAPA – which is cited in the
Healthcare Commission’s forthcoming
Value for Money study – puts into practice
many of the 7 HELPFUL Habits and sits
well with the evidence of factors that
improve outcomes for children with
mental health problems. We encourage
teams to adapt this flexible approach
to their own circumstances so that they
can help users to have choices and to be
directly involved in care planning.
“Other clinical teams are finding that CAPA
also works for them. This clinical system
that evolved from what the Trust has been
doing in Richmond CAMHS is now being
widely implemented across the UK and as
far away as New Zealand and Australia.”
Below left:
Managing demand and capacity
Ann York with members of her team in Richmond
our
approach
The Choice and Partnership
Approach (CAPA) is a clinical
system that helps CAMHS to
do the right things (working
towards goals the family and
young person wants)
• with the right people (with
clinicians with the right skills)
• at the right time (in a timely
manner without waiting lists)
and to provide a service that
is user-focused, accessible and
evidence-based.
Each of the five boroughs
served by the Trust has
a child and adolescent
mental health team
working to deliver
responsive, effective
and appropriate care to
children and young people
and their families and
carers. As well as the CAMHS clinics, our staff
work in a wide range of settings to ensure that
our services are targeted at those most in need.
The Trust has a number of specialist services
for children and young people. These include:
an inpatient adolescent service and adolescent
assertive outreach team; a specialist learning
disability outpatient service; a child and
adolescent inpatient and targeted outpatient
eating disorder service; and a national deaf
service for children.
The Trust’s CAMHS work to provide clinically
effective, high quality services which are
delivered by highly skilled, committed and
qualified child and adolescent mental
health professionals.
Our services work to NICE (National Institute for
Health and Clinical Excellence) guidance where
it is available and use routine outcome measures
such as Health of the Nation Outcome Scales for
Children and Adolescents to measure outcomes
for our service users. This ensures that the
treatment we offer is effective and appropriate.
Our services for children and young people are
supported by the Trust’s clinical lead for CAMHS as
well as by a governance manager. Structures are
in place which allow us to review best practice.
Services are always planned in partnership with
the relevant local primary care trust and local
authority and delivered through the multiagency
children and young people’s plans.
Annual Report Annual and Review Accounts 07 // 08 9

Early intervention
a service user’s story
Naomi, 21, is one of 160
young people being helped
by our Early Intervention
Service after a first episode
of psychosis.
Naomi says: “After I was
first sectioned five years ago
I was transferred to Early
Intervention. For most of that
time Rachel has been my care
coordinator. She’s really good
and always asks questions to
work out what I’m doing. We
meet regularly to talk about
what’s stressing me out and
what my plans are.
“Rachel helped me write an advance
directive of what I want to happen if I
get unwell but she also helps prevent
me getting ill. She asks my friends and
family how I’m doing. My family meet
her regularly to look at my ‘relapse
plan’ – how to stop me getting unwell.
She also goes over it with staff in the
supported housing Early Intervention
found for me.
“Rachel made it easier for me to talk
about how not taking my medication
led to my being readmitted. My illness
was caused by smoking weed, and not
eating or sleeping properly. I’ve now
given up drugs – and cigarettes – and
feel much more lively and awake. I’m on
a mood stabiliser, helping me keep on
one level rather than being ecstatically
happy. I used to be angry and have a
bad temper. I’ve calmed down a lot.
To stay well I go to bed by midnight and
don’t study through the night.
“The Early Intervention team found my
degree course and get me any extra
help I need. I take education seriously
– before, I couldn’t wait to leave school
and get a job. I used to work as well as
study but when I’m hectic I get stressed.
I didn’t realise I could have Disability
Living Allowance and a Freedom Pass
– Rachel sorted it out.
“My relationship with my family is
improving – Rachel’s helped strengthen
the bond between me and my mum.
“I’m now in control. No one
will tell me off if I don’t take
the tablets but I know what
the consequences will be.
And I can negotiate with
Rachel about how much
medication I should be on.
“The Early Intervention team never
put me down or say what I do is weird
– anyone can become unwell. I can
contact them with issues or problems
and have a crisis line to call if I need to.
Without them I’d have been a stubborn
brat.
“I don’t plan to get admitted again.
I’d miss out on so much – particularly
my freedom. The Early Intervention team
have helped to tackle my illness early.
I know people who are still in the
hospital ward when I return and I
wouldn’t want to be in their situation.”
.
Above:
Now in control
Naomi with her care
coordinator Rachel Langley
10 South West London and St George’s Mental Health NHS Trust

Our award-winning
Early Intervention Service
The Trust’s Early Intervention Service focuses on
people aged 17 to 30 who have been experiencing
the symptoms of psychosis for the first time. The
most well known type of psychosis, schizophrenia
can affect young people at a crucial stage in their
development.
Studies have shown that with sustained treatment,
over 80 per cent of individuals achieve symptomatic
remission from a first episode of psychosis within six
months. However, intervening early in the first few
years of illness is critical in maximising the potential
for recovery and in preventing relapse.
80%
Studies have shown
that with sustained
treatment, over 80 per
cent of individuals achieve
symptomatic remission
from a first episode
of psychosis within
six months. However,
intervening early in the
first few years of illness is
critical in maximising the
potential for recovery and
in preventing relapse.
The Trust adopted early intervention in 2001, when
there were only nine other services nationally.
Initially encompassing a small service across Merton,
Sutton and Wandsworth, it grew incrementally
over the next six years with a particular focus
on employment and education. This combines
vocational rehabilitation with medical care to
encourage people to take up work or study
opportunities as soon as possible after they have
recovered from their initial treatment. As a result,
81 per cent of those seen by the service, working
alongside an employment specialist from the Trust,
were back at work or in mainstream education
within 18 months as part of their recovery.
For its achievement in bucking a national trend,
the Service received a
Clinical Excellence award
in November 2007 from a
medical research charity,
the BUPA Foundation.
The original service was
increased substantially as
a result of the Trust’s Adult
Service Reviews in 2007/08, and has now been
disaggregated into a Sutton and Merton team and
a separate Wandsworth team to enable a greater
borough focus. To meet local need, a team was
also established in Richmond during 2007/08,
with support from the primary care trust and the
borough council. By the end of the year the team
had its full caseload target of 71 patients.
Annual Report and Accounts 07 / 08 11

Individual placement and support
a vocational service manager’s story
Adults with mental health
problems often see the ability
to return to work or education
as a yardstick of their recovery.
The Trust has been recognised for many
years now as a pioneer in developing
effective services that support them
to do this. Most recently the Trust
was cited as a model of good practice
by the Royal College of Psychiatrists
in their report on Mental Health
and Employment as part of the
Government’s review of the health of
Britain’s working age population.
The Trust has implemented in Kingston,
Merton and Wandsworth the Individual
Placement and Support (IPS) approach
to vocational rehabilitation. The IPS
approach is the most widely studied and
effective method of helping people with
severe mental health problems to gain
and retain paid employment. The overall
goals of this evidence-based practice
are to assist service users in finding
jobs consistent with their preferences
and skills, and to support their efforts
in working. Research suggests this
improves their chances of recovery.
Miles Rinaldi, the Trust’s Head of
Recovery and Social Inclusion, says:
“A key principle of the IPS approach is
the integration of employment support
and clinical services. This means that an
employment specialist works as part of
a community mental health team and
service users have access to this specialist
as well as to psychiatrists, psychologists,
nurses, social workers, occupational
therapists and other care providers.
“All staff within the team collaborate
together to provide support to address
the service user’s health and social care
needs, including retaining or gaining
employment, mainstream education
or voluntary work. Research that the
Trust was involved in shows that people
with mental health problems in paid
employment experience positive changes
in self identity, increased quality of life
and reduced hospital admissions.”
One of the success stories that Miles cites
is that of Marsha, 31, who had always
wanted to work in a hairdressing salon.
Miles says: “When diagnosed
with schizophrenia Marsha
thought she would never
be able to work, but her
care coordinator recognised
that with support from the
employment specialist and
himself, she could achieve
her goal.
12 South West London and St George’s Mental Health NHS Trust

Investing for the future
at Springfield
integrated
services
“The employment specialist met with
Marsha and after a brief vocational
assessment a vocational plan was
developed. Within a short time she began
working in a salon, with day release to
attend college to train as a stylist.
“Marsha met regularly for support with
the employment specialist, who also
liaised with Marsha’s care coordinator
and psychologist. The employment
specialist and care coordinator provided
ongoing support to enable Marsha to
overcome a number of problems that
arose as she adjusted to working life.
Marsha qualified and continues to
work as a stylist.”
Above left:
Service users have
access to an employment
specialist on the
community mental
health team as well
as to psychiatrists,
psychologists, nurses,
social workers,
occupational therapists
and other care providers.
Integrating employment
support and clinical services
Miles Rinaldi
In the coming year a
decision will be made on
whether our 170-year-old
site at Springfield University
Hospital will receive the long
awaited investment it needs
for the future.
The Springfield
Regeneration Programme will provide stateof-the-art
new mental health facilities while
simultaneously upgrading other areas of the site
with new amenities for the community, new homes
and a new public park.
This will be a complex and lengthy task but its
primary aim is quite simple: to strengthen the Trust
as a centre of excellence in mental health care by
providing the best possible treatment environment
for Springfield University Hospital and its service
users. There will be challenges but the opportunity
it presents to the Trust, its partners and the
surrounding community is unprecedented.
The consultation on how this centre of excellence
will be created is ongoing. The project is currently
at the ‘outline planning’ stage and separate, more
detailed planning applications for the new facilities
will be made later as the consultation progresses. As
with the new Wandsworth Acute Unit (scheduled
for completion in Spring 2009 in the first phase of
the Springfield Regeneration Programme), staff,
service users and carers will all play a part in shaping
how the facilities can best meet everyone’s needs.
The upgrading of the Trust’s facilities will not just
be limited to Springfield. Significant improvements
are also being planned for Tolworth Hospital in
Kingston and further refurbishment works are also
in the pipeline for other parts of the Trust’s estate.
The Trust recognises the real benefits that a
therapeutic environment can bring to the healing
process and in the design of these new and
upgraded facilities it will endeavour to create the
most appropriate surroundings possible.
Annual Report and Accounts 07 / 08 13

Wellbeing service
a nurse adviser’s story
Improving physical health
can be an important factor
in helping people recover
from mental illness as they
tend to have worse physical
health than the general
population and poorer access
to appropriate healthcare
services. The Trust’s mental
health workers have a key
role to play in this.
Gardner Gwashavanhu, a wellbeing
nurse adviser in Richmond, works
collaboratively with the local GP practice,
the multi-disciplinary team and service
users to provide and promote physical
assessments and health screenings.
He also gives presentations on wellbeing
and physical health across Richmond
to teams such as senior nurses’ forums
and helps organise wellbeing days for
inpatient teams.
Gardner says: “I provide a weekly inhouse
clinic on a one-to-one basis. Every
month we offer all clients check-ups for
blood pressure and blood sugar levels,
advice on managing side-effects and
monitoring of their body mass index
(BMI). We also offer practical advice
to individual clients on managing
weight loss.
“Our Healthy Lifestyle group meets
weekly and provides help with healthy
eating options, weight management and
cutting back smoking. The proportion
of clients in the group who smoke has
dropped from 90 per cent to 70 per cent
and 71 per cent say they are now more
confident about their physical health
and wellbeing. A recent evaluation of
our client group highlighted that 86 per
cent of those who attend the weekly
group session have changed their
eating habits.
“Our daily one-to-one walks and the
peer-led sessions have also been a
success. The average BMI of clients
attending these sessions has fallen from
27.6 to 24 over a three-month period
and they have all regained fitness.
By working collaboratively with our
client group, we have managed to get
half of the female clients into local gyms,
where they have kept up attendance
for 10 months.
Below :
Promoting
a healthy
lifestyle
Gardner
Gwashavanhu (left)
with Anthony
14 South West London and St George’s Mental Health NHS Trust

Our new acute unit
for Wandsworth
“My role has also given me
the opportunity to share my
knowledge of engaging with
people with mental illness
with other nursing staff in
Richmond’s inpatient units.
“I have also managed to maintain
a co-working partnership and share
knowledge with other professionals
such as community dietitians,
community diabetic nurses and GP
nurse practitioners as well as mental
health nurses in the Trust.
“Promoting physical health need not be
a complex task. The aim is to encourage
service users to take up more exercise by
creating activity and leisure groups that
enable them to do so.”
86%
of those who attended
our weekly Healthy
Lifestyle group session
have changed their
eating habits, according
to a recent evaluation.
The Trust celebrated the
‘topping out’ of its new
Wandsworth Acute Unit
at Springfield University
Hospital in March 2008.
The special ceremony, led
by Ruth Carnall, Chief
Executive of NHS London,
was witnessed by around
70 staff and user/carer representatives and a
number of distinguished guests including the
Mayor of Wandsworth.
The event was a milestone in the construction
of this state-of-the-art facility which, when
complete, will replace John Meyer and Bluebell
wards with a 10-bed psychiatric intensive care
unit and an 18-bed adult acute admission ward.
The new wards will have private bedrooms with
en-suite facilities, comfortable dining, recreation,
reception and visitors’ areas, and direct access to
open space. There will also be new facilities for
outpatient services and clinical teams.
The £22.9m project will be completed by
February 2009, with patients moving into the
new building in March. It is being managed by
a multi-disciplinary project team with the full
involvement of clinicians, service users and carers.
To take full advantage of the new facility, new
models of care are being designed that will be
fully implemented by the time the new wards
open. These will include a greater focus on
recreational and therapeutic activities as part
of an individual client’s care plan and a more
structured daily routine, making use of flexible
communal spaces as well as more secluded areas.
Service users will also have 24-hour access to
drinks and snacks and will be able to receive
visitors in private.
The new facilities will provide an environment
of a high standard, offering service users a
balance between security and inclusion. It will be
designed to maximise service users’ therapeutic
experience and to promote privacy and dignity,
and will potentially improve recovery times.
15

Zoning
a carer’s story
When Rebecca’s boyfriend was
discharged from hospital she
suddenly found herself in the
role of carer and wondered
how she would cope. “I felt
that if we were going to have
a future together I needed
strategies to help keep him
well,” she said.
“We attended a Springfield Hospital
open day where consultant nurse
Catherine Gamble told us how the Trust
now has a ‘traffic-light system’ called
zoning. This uses green, amber and
red colours to share information about
the state of clients’ safety and level
of risk. The aim is to increase clinical
effectiveness.
“Green indicates patients who
are stable; amber signifies
people who are unwell and
need some additional support;
and red shows clients who are
high-risk or in crisis.
“Catherine explained how making
information available in this way helps
prevent clients from relapsing and
improves services for them and
their families.
“I felt this could be useful, so we asked
the consultant psychiatrist to refer us.
We had several visits from Catherine
and a social worker, Sinead Dervin, first
to take a history of what happened and
then to look back at the months leading
up to the last hospital admission. My
boyfriend and I each had homework
to do independently – setting out his
thoughts, behaviours and feelings up
to his becoming unwell. We came
back together to compare notes
– and this was very helpful.
“A year and a half after his stay in
hospital, my boyfriend had been well
for six months and, as planned, was
discharged from the community mental
health team.
“He now came under his GP’s care but
he needed someone to keep an eye
on him. Zoning helped find a toolkit
that wasn’t just dependent on me.
What came through was that his manic
behaviour was masking depression, low
self esteem. Through our discussions
I began to understand that vulnerability,
and to talk about my own feelings too.
“The emphasis is on prevention, looking
at what people can do for themselves
and how families can help them.
If you support people in green and their
families you will have fewer hospital
admissions and carers are more likely to
stay on board in their caring role. I now
find it easier, on a day-to-day basis,
to identify what’s normal and what’s a
sign of becoming unwell and to help
my boyfriend get from mild amber
back into green. And we feel sufficiently
confident about the future that we’ve
been able to start a family together.”
Above right:
More confident
about the future
Rebecca with her boyfriend
and their baby son
16 South West London and St George’s Mental Health NHS Trust

Zoning in the Trust
The Trust is aiming to become the first mental
health trust to introduce the zoning traffic-light
system to all its service areas. During the year
there was a 23 per cent growth in the numbers
of teams which had adopted zoning. Every team
across the Trust is now using the zoning approach
in some way and more than half of them have
now fully implemented it.
Zoning supports better team working and risk
management, using regular reviews of individual
service users’ needs and providing continuity
throughout their care. It helps staff prioritise
high-risk cases and gives teams a common
language for them to engage users and carers
– helping prevent clients from relapsing while
improving services for them and their families.
This fits in with the Trust’s recovery approach to
mental illness.
Our success on zoning was
recognised in March 2008 when
Catherine Gamble, Consultant
Nurse at the Trust, won the
Nursing Standard Mental Health
Nurse of the Year award for
her work in implementing the
approach.
Right:
Mental
Health Nurse
of the Year
Catherine Gamble
innovative
system
The Trust now has a
‘traffic-light system’
called zoning.
Annual Report and Accounts 07 / 08 17

Talking therapies
a graduate mental health worker’s story
Waiting lists for psychotherapy
are coming down and the Trust
can give service users more
personalised services based
around their individual needs.
Psychological Therapies in Primary
Care (PTiPC), the Trust’s response to
the government’s Improving Access to
Psychological Therapies (IAPT) initiative,
is making a big difference to the service
we offer to new service users with
depression or anxiety.
The Trust has a PTiPC team in
most boroughs, working alongside
mainstream primary care services.
Clare Watts is a graduate mental
health worker – the equivalent of an
assistant psychologist – in Wandsworth.
She previously worked on the Mood
Manager DVD which was developed
by Wandsworth Teaching Primary Care
Trust in collaboration with the Trust.
Clare says: “Our role is to be the first
point of contact for anyone with mild or
moderate mental health problems who
their GP has referred for psychotherapy.
If their problems are more complex the
GP will refer them to the community
mental health team.
“We start by talking to the person
on the telephone to get a picture
of their problems. Using measures
recommended by NICE (the National
Institute for Health and Clinical
Excellence) we gauge what the main
difficulties are and assess the level of
risk and the need for social support.
We take this information to our weekly
case management meeting with clinical
psychologists where possible treatment
outcomes are discussed.
“For mild to moderate symptoms
we can offer computerised cognitive
behavioural therapy (cCBT), which
can be particularly effective. We use
two packages recommended by NICE
– FearFighter for treatment of anxiety
and Beating the Blues for depression.
These can be accessed at libraries and
community centres. We also facilitate
groups on anxiety, depression, selfconfidence,
and anger management.
“The philosophy behind PTiPC is to
screen people early on and to refer up
to clinical or counselling psychologists
only those whose symptoms are more
complex. The aim is to reduce waiting
lists and give people more options about
what sort of treatment they can have.
“Psychological therapy is now seen as
less about having to see an expert to
sort your problems out for you and more
about guided self-help: what skills do I
need to be able to cope with my mental
health problem if it occurs again?
“People are now being seen
a lot quicker. Within days we
can touch base and assess the
risk. And making that phone
call is a much more human
approach than generating an
appointment letter.”
Above:
A first point
of contact
Clare Watts
18 South West London and St George’s Mental Health NHS Trust

Happy Soul Festival
Working with many local partners across south
west London, the Trust ran two film and arts
festivals in July 2007 and in March 2008 in local
cinemas and community venues.
These week-long Happy Soul Festivals, with new
movies, live music and arts, focused on raising
awareness of mental health among the black
and Asian communities of Kingston, Merton,
Richmond, Sutton and Wandsworth, who
had proved hard to reach via standard health
promotion methods.
Happy Soul attracted large numbers of people
from the African-Caribbean, Asian and Korean
communities, exploring the difficult subject of
mental health and what it means to them.
More than 200 of those attending the second
Happy Soul Festival were surveyed. They
responded very positively, with 53 per cent
saying that their attitudes to mental health had
changed as a result of attending a festival event.
Described by the Department of Health’s
Delivering Race Equality programme as an
example of national good practice, our Happy
Soul Festivals helped the Trust to forge new
relationships with community partners across five
London boroughs, and to find new and effective
ways of communicating with BME communities.
Our success was
recognised by the
Department of
Health and the
NHS Institute for
Innovation and
Improvement’s
Health and Social
Care Awards, with
the presentation,
in April 2008, of a Mental Health and
Wellbeing Award to the Trust’s Equality
and Diversity Team.
Right:
Our Happy Soul Festivals reached
out to local African-Caribbean, Asian
and Korean communities
19

Social care in partnership
a social worker’s story
As an Approved Social Worker,
Mark Standing has the legal
authority to assess people
under the Mental Health
Act. This responsibility – to
determine whether detention
in hospital or a less restrictive
option will best meet a
person’s needs – is something
he doesn’t take lightly.
Mark says: “Social work has a strong
client focus and we always start by
looking, beyond the initial clinical
diagnosis, at the particular social
circumstances that the client is in and
what support networks they have.”
Although employed by Wandsworth
Council, Mark works in the Trust as a
Principal Social Worker, based at Queen
Mary’s Hospital. He provides professional
supervision of the other social workers in
Trust roles in Putney and Roehampton.
“I work in the community mental
health team which includes professionals
from many different disciplines.
They often ask social workers for
advice” he says. “We’ve had training
in mental health law and the other
legislation associated with it and
we’ve also developed knowledge
about housing and benefits.”
One of the Trust’s key responsibilities
is to safeguard vulnerable adults from
harm. Mark says: “Vulnerable adults
sometimes behave in a way that is a risk
to themselves or others, or can be open
to abuse or persuasion to part with their
money. I take a lead in this area of work.
“Many people using mental
health services are entitled
to social care funding, and
increasingly have choices over
how this is spent. They can
receive or control the money
themselves through a direct
payment or individual
budget. I have a key role
in promoting this.”
Mark’s work frequently brings him
into contact with other agencies in the
borough. This might include a case
conference organised by the borough’s
children and families team to discuss
the children being cared for by one
of his clients, or a housing forum
meeting where the housing officers are
concerned about the behaviour of one
of the tenants.
“We also work very closely with
Wandsworth’s carers’ centre” Mark
says. “As well as looking at the needs of
mental health clients we do what we can
to support those caring for them. They
have needs and rights too – perhaps for
more information, for specific services
or just a listening ear. And we can apply
to the local authority on their behalf
for funding to provide respite care –
enabling them to take a short break
from their caring responsibilities. The
Trust needs to work in partnership with
carers and families to support them and
the people they care for.
“I enjoy this job because I feel I can
make a real difference to the lives of
mental health service users and help
them in their recovery.”
Right:
Making a real
difference
Mark Standing
20 South West London and St George’s Mental Health NHS Trust

Our performance in 2007/08
1
At the beginning of 2007/08, the Trust identified six key strategic objectives for the year:
Providing clinical services that are demonstrably
effective and safe
The Chief Operating Officer led a successful review of adult services.
Our implementation of the review’s findings has meant the largest change
in Trust services for 20 years. This has affected most adult community
services, with the jobs of hundreds of staff altered. Since March 2008,
the Trust has provided, for the first time, full Early Intervention and Crisis
Resolution services to the local population. The Trust can now provide the
critical best practice elements that were outlined in the National Service
Framework for Mental Health.
2
3
Alongside these structural changes we trained staff to use Health of the
Nation Outcome Scales (HoNOS). This will allow a universal scale to outline
the changes in the wellbeing of people using our services. HoNOS can now
be recorded on our clinical information system, RiO, and their use will be
expanded in the years to come.
Providing a recovery approach across the organisation
‘Recovery’ is about building a sense of self, meaning and purpose in life
– growing beyond what has happened to you to make the most of your
life. It is about people’s whole lives – not just their problems.
The Trust believes a ‘recovery’ approach will provide the best outcomes
for people using our services. During the year we provided introductory
training to over 1,300 staff and in-depth, three-day training to over 85 staff
to enable them to become recovery experts.
We have also set up a robust programme management structure to sustain
a culture change in the organisation that will promote recovery. The
programme board, chaired by Maresa Ness, the Chief Operating Officer,
and led by Miles Rinaldi who has been appointed Head of Recovery and
Social Inclusion, is now called Recovery and Self Directed Support to reflect
the Trust’s commitment to deliver on local authorities’ personalised care
agenda. We will enable people to use social care monies in more diverse
and creative ways of their choice, supporting that recovery. Each of the five
boroughs we serve now has a lead person and implementation group as
well as committees relating to specific types of client, such as older people
and children/adolescents.
Ensuring the sustainability of services
The Trust was disappointed by its Healthcare Commission rating of ‘Fair’ for
quality of services and ‘Fair’ for use of resources and is prioritising measures
to help improve this. Strategies for every service area were completed
during summer 2007 and were summarised in the Service Development
Strategy (published on our website), which will form a cornerstone of our
application for foundation trust status.
As a result of the Adult Service Review the Trust will for the first time meet
all the critical targets, which should help to improve our rating.
We also competed for six major tenders and Trust managers and clinicians have
been trained in tendering and marketing in preparation for future competition.
“We have also set up
a robust programme
management structure to
sustain a culture change
in the organisation that
will promote recovery.“
Annual Report and Accounts 07 / 08 21

Our performance in 2007/08
4
5
6
Maximising the value of the estate
High capital charges and backlog maintenance costs make our large and
old estate a financial burden. During the next three to five years the Trust
intends to dispose of unnecessary buildings, lease others and redevelop
the Springfield site to create modern and flexible mental health facilities,
as outlined in an Estates Strategy during the year. The Wandsworth Acute
Unit, currently being built, will open in 2009.
Creating a workforce that is fit for purpose
To provide modern services the Trust needs to modernise the workforce,
and to ensure that there is strong leadership at all levels and that staff are
adequately trained and supported to perform their duties. During the year
we introduced ‘development centres’ to help current staff understand their
own professional development needs. We also introduced assessment
centres to ensure a rigorous and effective assessment of new clinical staff
wishing to work for the Trust.
The Electronic Staff Record we have introduced will provide comprehensive
staffing information to aid effective management and streamline human
resource processes.
Maintaining financial balance
We have built on our good record of delivering financial balance by
achieving the required surplus to support our foundation trust application
and the Healthcare Commission’s reviews of our performance. The Trust
has developed a more business-oriented approach and is planning for new
business opportunities, especially those afforded by the vacant space in the
estate.
The summary annual accounts are set out on pages 37 to 39.
“During the next
three to five years
the Trust intends to
create modern
and flexible mental
health facilities.”
Below:
Making performance
information more
accessible
Demonstrating The Pulse,
our new data warehouse
As well as progress against its strategic
objectives, the Trust has sought to
make performance information more
accessible to managers and clinicians.
During the year, we introduced
‘The Pulse’. This provides real-time
activity information to staff on a range
of performance measures, allowing
them to see information relating to their
own work, their team’s practice and
the Trust’s performance. In this way, we
hope to make performance reporting
relevant and helpful to the people who
are delivering the services as well as
those monitoring the services.
The Trust is proud to be one of the
few mental health organisations to
continually monitor service users’
experience of our services. The
Director of Quality Assurance and
User/Carer Experience, Dr Rachel Perkins,
has repeated the survey for a further
year, allowing us to monitor
changes in how services are received and
highlight areas that need improvement.
Poorly performing teams from the
first survey have shown substantial
improvements in key areas of the service
user experience and the survey has now
proved a critical tool in assuring the
quality of these services.
We also expanded the range of
performance measures to include key
support services. For example, the
Estates and Facilities department can
now demonstrate their performance,
which shows that they complete 92 per
cent of maintenance tasks within the
expected timescale.
22 South West London and St George’s Mental Health NHS Trust

Annual health check
Two years ago, the Healthcare Commission introduced its system for assessing and
rating the performance of all NHS healthcare organisations in England. Aimed at
driving improvements in healthcare for service users, it provides an annual health
check and is designed to give service users a comprehensive view of how the Trust
is performing in a wide range of areas including safety, cleanliness, planning for
emergencies and managing finances.
All NHS organisations receive a two-part scoring – the first part looks at the quality of
its services and the second part looks at how well an organisation uses its resources.
For 2006/07, the Trust received a ‘fair’ rating for both its quality of
services and its use of resources. A number of Trust-wide initiatives
have been introduced to strengthen the Trust’s compliance and to
help us improve our rating for 2007/08, including:
• completion of a review of the Trust’s adult services. This aims to provide our service
users with prompt, safe, accessible and effective treatment and support based on the
best evidence available, consistent with individual preferences and priorities
• implementation of a quality improvement programme. This builds on examples of
excellent practice taking place across the Trust and focuses on ‘dignity and respect’,
‘informing and communicating’ and ‘involving and valuing’
“prompt, safe,
accessible and effective
treatment and support”
• participation in a national programme, led by the Royal College of Psychiatrists,
which should improve prescribing practice across the Trust
• completion of an extensive review of the Trust’s forensic services
• promotion of recovery and facilitating social inclusion, recognising that everyone
with mental health problems faces the challenge of retaining or recovering a life
that is meaningful, satisfying and valued
• development of a management development training programme available to
all Trust staff
“promote recovery
and facilitate social
inclusion”
• achieving a 100 per cent score for a Level 1 assessment against a series of risk
management standards led by the NHS Litigation Authority, demonstrating that the Trust
is doing its reasonable best to manage risk in line with its Risk Management Strategy.
In April 2008, the Trust submitted its final declaration against the 24 national core
standards for the period 2007/08 to the Healthcare Commission. Progress has been made
against a number of the core standards since the previous year, including improvements
to the provision and quality of service user and carer information.
There is still more that needs to be done before we are compliant with all the core
standards. The Trust has made significant progress towards ensuring all our buildings
meet the Healthcare Commission’s criteria. The Trust has opened two new single-sex
wards and improved inpatient services for older people in Wandsworth and Merton,
opening a refurbished ward segregated by gender. However, the Trust awaits the
completion of the Wandsworth Acute Unit (see page 15) to enable us to declare
compliance against all the core standards.
Annual Report and Accounts 07 / 08 23

Our objectives for the next three years
Over the past year the Trust has made good progress in reconfiguring community
teams to deliver targets and has improved the quality and effectiveness of its
forensic services.
In the next three years the Trust plans to make significant changes in seven
key priority areas. The first three priority areas will transform the quality and
effectiveness of our services and the next four constitute enabling strategies to
underpin this transformation.
1
2
3
4
Embedding recovery and self-directed care
The Trust provides exemplary vocational services that are the basis for the
introduction of the recovery approach to care. The Trust’s approach has been
refined during 2007/08 and we will continue to train staff and manage the
outcomes of the approach. We expect this model to be extended into housing
and social care domains in the medium term.
We will embed the recovery approach into all aspects of our service
development and delivery. This will include ensuring that all staff have at
least received the introductory training. The impact of this way of working will
become increasingly apparent in all service plans and will have a growing
impact on service user outcomes.
Providing clinical services that are demonstrably effective
and safe
The Trust has successfully created the full range of teams required under
the National Service Framework to meet best practice guidance. To support
developments in clinical practice, the Trust has focused on improving the
recording of diagnosis and has introduced RiO (the new clinical electronic
information system whereby care professionals can plan, schedule and record
treatment and can access up-to-date information easily). We are currently
implementing the Health of the Nation Outcome Scale (HoNOS), which is a
tool for measuring improved outcomes resulting from health and social care
interventions for people experiencing mental health problems.
These developments will prepare us for robust outcome reporting in the future
and enable us to plan our services better.
Ensuring that we attain targets
Changes in clinical delivery have enabled us to meet the National Service
Framework team targets from April 2008. We now fully meet the key targets
for mental health. Over the coming year we will meet caseload and activity
targets and aim to improve our annual health check and Auditors’ Local
Evaluation rating.
Becoming a foundation trust
Preparatory work undertaken in 2007/08 has provided a robust infrastructure
for our foundation trust application. We believe that the changes we have
already made will equip us to become a successful and effective foundation
trust in a year’s time. Work to engage service users, staff and external
stakeholders is well underway and we have embedded the strategic direction of
working towards this goal within all our planning for the year.
“We believe that the
changes we have
already made will
equip us to become
a successful and
effective foundation
trust in a year’s time.”
24 South West London and St George’s Mental Health NHS Trust

5
6
Developing our estate
As we shift our resources more towards daycare and care in the
community, the need for inpatient admission has continued to decrease.
Although the rate of decrease is slowing down, the Trust has reduced
its adult bed numbers by 27 per cent over the past five years, which has
affected the clinical and financial viability of smaller inpatient sites. The
Trust is working with local commissioners collectively to identify a way
forward which achieves an effective balance between local access for
service users and carers and clinical safety and cost effectiveness.
These objectives are encapsulated within our Estates Strategy, a key
element of which is the regeneration and redevelopment of the Springfield
Hospital site. The overall programme may take up to 20 years to realise but
concrete steps will be taken in 2008/09 to ensure momentum is achieved
to take this ambitious and exciting programme forward.
Creating a workforce that is fit for purpose
To provide modern services the Trust needs to remodel the workforce,
and to ensure that there is strong leadership at all levels and that staff are
adequately trained and supported to perform their duties.
The Trust has implemented a programme of assessment and development
centres during the year to ensure that staff have the skills and support
needed to perform their duties. The rollout of the Knowledge and Skills
Framework (KSF) has been completed during the year under review and
the Electronic Staff Record is currently being introduced across the Trust.
“We are committed
to implementing
New Ways of Working
for all staff.”
Over the next five years, service users will increasingly be supported on a
daily basis by workers trained in the recovery approach.
7
This is reflected in our commitment to implementing New Ways of
Working for all staff. Consequently, the new Medical Director and
the Director of Nursing and Governance, along with the Heads of
Occupational Therapy, Psychology & Psychotherapies and Social Work,
will be remodelling the multi-professional team in close collaboration
with the Director of Human Resources and the borough service directors.
Maintaining financial balance
The Trust has a good record of delivering financial balance. We are
developing a more business-oriented approach. By understanding our costbase,
and by ensuring income through signing service level agreements
early in the year, we are underpinning the delivery of effective and
sustainable services in the years to come.
These priorities are monitored and assured by a compliance framework
overseen by the Board and the requirement to fulfil our statutory duties.
We have also put in place new structures to ensure compliance with
equalities legislation and to ensure that the experience of service users
and carers is integral to planning at all levels within the organisation. The
Clinical Services Development Programme assures service user input into
service development and Service User Experience Audits provide robust,
continuous information on service users’ views.
Above:
Adil Akram
Adil, who works at the Trust,
is Walport Academic Clinical
Fellow and Specialist Registrar in
Psychiatry and also a documentary
film-maker. Adil’s film, Over my
Left Shoulder, tells the story of
a mother of two young sons,
who was treated at Springfield’s
Mother and Baby Unit for
post-natal depression
Annual Report and Accounts 07 / 08 25

Overview
Forensic service
Our forensic service partly re-opened
in June 2007 and fully reopened in
August, following the conclusion of
the Making Connections review led
by Professor Tony Maden. The review
examined the performance of the service
and its relationship with psychiatric
intensive care units and challenging
behaviour rehabilitation services within
the Trust. The review team’s report
and recommendations demonstrated
the considerable service improvement
achieved over the past year in procedural,
relational and environmental security.
Professor Maden commented that
the management of the service had
been transformed and that systems
and attitudes had changed completely,
indicating that the forensic service is not
only more effective but a happier place
in which to work. Eighteen of the review
team’s recommendations have been
completed successfully. Significant progress
has been made on two of the remaining
three objectives – to create a rotation
scheme for Band 5 nursing staff in forensic
wards and to establish a single challenging
behaviour service across the Trust. We will
seek to achieve these in the coming year.
The sole outstanding recommendation is
that the forensic service should establish
a multi-disciplinary group of advanced
practitioners to lead a specialised
substance misuse treatment programme.
After investigation it was agreed that
current resources would not permit such
a development but it remains a priority
for the future.
Promoting equality
The Trust is implementing its
Disability Equality Scheme action
plan, directed at promoting disability
equality in employment and in the
services we provide. We have made
progress towards making the physical
environment more accessible and each
borough is addressing ways in which it
can further meet the needs of people
with mobility and sensory impairments
and long-term health conditions.
The Trust also has a Gender Equality
Scheme and has been addressing
the requirements of the new age
discrimination legislation and also the
need to promote equality for lesbian,
gay and bisexual staff and service users.
The Trust is an equal opportunities
employer and welcomes job applications
from people who have experienced
mental health problems. Our User
Employment programme facilitates
access to employment within the
organisation for people who have
themselves experienced mental health
problems. It has supported more than
150 employees with mental health
problems in 180 job roles in the Trust.
Since 1999 at least 17 per cent of newly
recruited employees have had personal
experience of mental health problems. In
2007/08 the figure for new recruits had
risen to 24 per cent. People with mental
health problems have been employed at
all levels of the organisation and within
all the mental health professions.
Delivering race equality
in mental health
In Delivering Race Equality, the
Department of Health said that by
2010 mental health services should
be characterised by:
• less fear of mental health services
among black and minority ethnic
(BME) communities
• increased satisfaction with services
• a reduction in the rate of
admission of people from BME
communities to psychiatric
inpatient units
• fewer violent incidents
• a reduction in the use of seclusion
• the prevention of deaths in mental
health services following physical
intervention
• increased BME access to
counselling and psychological
therapies
• more active outreach and working
with BME communities to promote
access and the delivery of culturally
sensitive services.
We also have race equality responsibilities
as an employer to promote equality
of opportunity among our workforce
irrespective of race (and also gender or
disability). Our workforce, our professions,
and the ethnic profile of junior and senior
positions should largely reflect the ethnic
profile of our local community.
The delivery of race equality represents
huge challenges for the Trust as a service
provider and as an employer.
Talking to BME populations about their
perspectives and needs is the most
important thing in delivering ethnically
sensitive services. But mental illness
can be a taboo subject in some of
our cultures – and so the incidence
of mental illness gets hidden within
communities. Individuals who need help
at an early intervention stage, but are
26 South West London and St George’s Mental Health NHS Trust

not able to access treatment, may then
develop severe mental illness. Mental
health services, including our own,
consistently show a higher proportion of
BME patients detained under the Mental
Health Act than would be expected from
the population profile.
As a Trust, we have organised the Happy
Soul Festival (see page 19) to engage
and raise the mental health awareness of
our local BME populations. This involved
running film and arts events with mental
health themes, and discussions with
BME role models and celebrities. Our
most recent Happy Soul events attracted
1,200 members of the public.
We employ community development
workers to engage with and provide a
link between BME populations and the
Trust. Their work with communities is
tireless and is an important contributor
to our responsibility to delivering race
equality. For instance, we are now
able to provide information in many
languages about mental illnesses and
the services we provide.
The Trust’s Race Equality Steering Group
develops action plans and monitors
their progress against a number of key
race equality indicators. We are seeing
positive trends in the use of seclusion;
the experience of BME patients on our
wards; and the use of restraint. However,
there is still much work to do in areas
such as use of the Mental Health Act.
We will continue to challenge our
processes as an employer. For instance,
some of our professions (such as
nursing) are currently over-represented
by people from BME groups while
others (such as psychology) are underrepresented.
Some of this disparity is a
reflection of our wider society but we
must continually question ourselves if
we are going to accept the challenge of
delivering race equality.
Left:
We value our staff
Community Psychiatric Nurse
Joyce Mutabeni (left) with Christine
in the art room
Valuing our staff
The fifth annual NHS staff survey took place in autumn 2007. Survey
questionnaires focusing on 26 key areas were sent to a random sample
of our staff. The survey’s results are important to us in providing feedback on
how our staff feel about the organisation they work for. In this most recent
survey staff told us that things had improved in nine important areas.
In particular, staff indicated that they felt more valued because the quality
of work-life balance had improved, they received more support from their
immediate manager and their job satisfaction had increased. The improved
results also include a reduction in the number of staff working extra hours and a
reduction in the percentage of staff reporting work pressure.
We are also pleased that 81 per cent of our staff received relevant training,
learning and development during the year under review. This is a great
improvement on the previous year and puts us in the highest 20 per cent of
mental health and learning disability trusts. Giving staff the opportunity for the
right development and learning is a vital part of our workforce strategy and we
will continue to strengthen and build on this.
Early last year we ran a number of focus groups to find out how we could
enhance our welcome to staff joining the Trust. Our new-look two-day induction
programme has proved very successful and gives those joining us more time to
get to know the organisation.
Our annual good practice marketplace event, which is also open to the public,
provides a unique opportunity for networking and self-directed learning by staff.
This year’s event, attended by over 340 people, was our largest ever, with over
60 display stalls showcasing good practice and inspirational innovations in mental
health services. It was followed by our 2007 Quality Awards ceremony where
over 200 invited guests honoured outstanding service, dedication and innovation
by Trust staff. There were 16 awards, with 46 teams or individuals making the
shortlist. In total, 87 people nominated their colleagues for special recognition
– a 53 per cent increase on the previous year.
During the year we completed the implementation of the Electronic Staff
Record (ESR) project and many staff in the Finance, Human Resource and IM&T
departments worked together to ensure this could happen. The next phase of
work is now underway and as a result our ability to forecast useful trends, for
example track vacancy rates and training undertaken, will improve.
During the year we have reviewed a number of new HR policies including
managing sickness absence and our bullying and harassment (dignity at work)
policies. We have put processes in place to support staff in raising any concerns
they may have through the proper channels.
Throughout the year we have continued to work as closely as we can with staff
representatives to achieve improvements and changes to the services we provide.
We have received positive feedback that we are involving staff more fully.
However, we know that we have more to do in this area and we will be working
on a revised partnership agreement with union and staff representatives in the
next couple of months. We will also continue to develop our ways of informing
and involving staff at all levels of the organisation on issues that affect their
employment and the strategy and business of the Trust.
Annual Report and Accounts 07 / 08 27

Overview
Communicating
with staff
During the year we continued
to update our staff on key
developments at the Trust through
our weekly briefing by email to
all staff, our quarterly newsletter
Trustwide, a monthly team briefing,
and monthly site briefings.
Our intranet, Quick, has proved to be a
vital communication tool in conveying
messages quickly to our staff who
are based at more than 90 different
sites. In response to staff feedback we
relaunched Quick in March 2008. The
redesigned intranet has a more newsoriented
home page with links, which
are easier to use, to the most popular
pages and sections.
Working with
our partners
The Trust has a long history of
involving those who use our services
and their relatives, friends and
carers. We aim to include our service
users in all aspects of our operation
and future development.
We also believe we can provide better
care through working in partnership
with a range of other organisations from
the public and independent sectors.
During the year, our most successful
new service programmes have been the
result of effective partnership working.
Examples include:
• with Secure Healthcare, the
tender to provide mental health
and substance misuse services to
Wandsworth Prison
• our Adults who are Chronically
Excluded (ACE) programme with
a range of agencies including
probation, primary care and social
services and funded by the Social
Exclusion Task Force
• our Co-Creating Health
programme with Wandsworth
Teaching Primary Care Trust and
the Health Foundation.
We have a major partnership with social
services in Kingston, Merton, Richmond,
Sutton and Wandsworth and we strive
to ensure that health and social care is
provided through integrated, coherent
teams. These teams help to minimise
the difficulties for those experiencing
mental health problems by ensuring
that statutory sector resources can be
accessed together in one place. This
has been enhanced in services for
older people during the year with full
integration of community teams in all
areas. These partnership arrangements
are governed by formal agreements.
The four primary care trusts (PCTs)
covering the five boroughs we serve
provide the majority of mental health
care, especially for common mental
health problems, through GP surgeries.
They also commission secondary services
for their populations from the Trust. This
dual relationship means the Trust has
close links with the PCTs. The Trust has
service level agreements with all local
PCTs to cover the provision of generic
services and agreements with PCTs
throughout London and nationally to
provide specialist mental health services.
In providing support for people
experiencing mental health problems,
particularly around vocational and
advocacy services, the Trust has active
partnerships with several agencies in
the independent and voluntary sectors,
including Rethink, Sound Minds
and MIND.
We also work closely with the police and
acute hospitals, as well as local academic
organisations, which help meet the
education and training requirements of
our staff as well as providing support for
research and development.
Above:
Working in partnership
Linda Lutchmayah, Ward
Manager in the Phoenix Unit at
Springfield University Hospital
28 South West London and St George’s Mental Health NHS Trust

Listening to our
service users
To improve our services, we have
to understand people’s experience
of using them. Every year we ask
people who have used our services
to complete, anonymously, a
questionnaire. This information is then
fed back to teams within the Trust to
develop action plans for improving the
service they offer.
We are very grateful to the 1650
people who returned questionnaires
in 2007/08:
• 91 per cent said that the service
they received was ‘good’, ‘very
good’ or ‘excellent’
• at least 80 per cent said that
their doctor, nurse and other
professionals they saw listened to
them carefully and treated them
with dignity and respect.
In comparison with the surveys
conducted in 2006/07, there were
improvements in a number of important
areas including:
• the extent to which people felt
they had a say in decisions about
their treatment and care and had
their diagnosis fully explained
to them
• the proportion of people who
knew the name of their care
coordinator
• the proportion of people who
had an out-of-hours telephone
number they could call in an
emergency and the proportion
who got through immediately
when they called.
In addition to our local surveys, the
Healthcare Commission organises its
own national survey, using a random
sample, of people using mental health
trust services – and the improvements
observed in local surveys are reflected in
the Commission’s published results.
To help organisations compare their
performance with that of other trusts,
the Healthcare Commission produces
‘benchmark indicators’ in four key areas:
patient dignity, involvement in care
planning, care coordination and out-ofhours
help.
On these indicators, South West London
and St George’s Mental Health NHS Trust
performed better than all other London
mental health trusts. In comparison with
other London trusts, a higher proportion
of those using our services said that:
• staff treated them with dignity
and respect
• they were involved in decisions
about their care plan
• they could get help out of hours
when they needed it.
In only one other London trust did a
higher proportion of people know the
name of their care coordinator.
Despite this success we know that there
is more that we can do to improve
people’s experiences of our services.
Over the coming year we will strive to
further improve the information that we
provide to people, and do our best to
ensure that everyone feels fully involved
in decisions about all aspects of their
treatment and support and gets the help
they need when they are in crisis.
Improving the
hospital environment
Having a safe, clean and modern
environment for our inpatient
facilities is important to service
users’ recovery. As well as the
major development work for the new
Wandsworth Acute Unit, developments
over the last year include:
• enhancements to a number of
wards, including the opening of
the newly refurbished Crocus ward
at Springfield University Hospital
• upgrading and refurbishment of
more than 20 patient bathrooms
and toilets as part of our Quality
Improvement Programme
• the continuation of our
programme of refurbishment and
redecoration in the Trust’s main
buildings.
We have continued to implement
the Estates Strategy to help achieve
our aim that all our buildings should
be to a recognised acceptable standard
by 2017.
Going green
The Trust has continued to
implement a number of measures
to address the green agenda. These
have included:
• setting up an Energy Action Group
to ensure that energy is conserved
and utilised in the best possible
way. We have continued to
promote energy awareness among
staff and are investing in a number
of capital schemes that will reduce
energy consumption
• implementing a Green Travel Plan
that has included a Cycling to
work event and promoting cycling
generally across the Trust. The
Trust has now joined the London
Cycling Scheme which works with
the Trust to promote the benefits
of cycling. As part of the Plan
we will install additional cycling
facilities such as showers and
secure cycle shelters
• introducing a recycling scheme at
Springfield in April 2008. We will
roll it out across the Trust during
2008/09.
Annual Report and Accounts 07 / 08 29

Overview
Going Lean
In striving for excellence, equity and
the efficient use of resources the
Trust is increasingly applying Lean
thinking and Lean techniques in
both clinical and non-clinical services.
Simply put, this means using less to do
more. Lean techniques help us focus on
activities that provide value as perceived
by our ‘customers’ and eliminate parts of
our work that are wasteful.
For clinical services, value is any activity
which improves the patient’s health,
wellbeing and experience. Waste on the
other hand is the time that the patient
spends waiting unnecessarily, or receiving
less effective care or unnecessary tests.
One of many local examples is the
‘Releasing Time to Care’ initiative
currently running on seven wards. The
Trust successfully bid for funding to train
10 frontline staff in this approach. Our
partners in this programme, the NHS
Institute for Innovation and Improvement,
found that across the country nurses
spend less than 40 per cent of their time
on direct patient care.
Giving frontline staff the tools and skills to
look at their own processes and systems
from a Lean perspective aims to turn this
situation around. It makes quality and
waste the concern of every employee,
and gives them the means and authority
to change things. This in turn energises
staff and contrasts with a traditional
approach of quality inspection and driving
efficiencies through cuts.
Information
Management and
Technology (IM&T)
2007/08 was a very productive
year for IM&T. The main
achievements were:
• the development of a new IM&T
Strategy for the Trust
• the completion of the rollout of
RiO (the new electronic patient
record system)
• the further development and
rollout of the ‘data warehouse’
and its associated reporting
tool. The data warehouse brings
together clinical, financial and
workforce datasets and enables
managers and senior clinicians
to view up-to-date performance
reports
• the provision of computers in ward
areas for service users to use. This
provides a facility to support service
users in their recovery and to gain
IT skills
• the implementation of ITIL (IT
Infrastructure Library) – an industry
best practice standard for IT
services. This has enabled the IT
department to improve the quality
of its service
• support for the implementation of
the Electronic Staff Record
• the piloting of mobile technology
in clinical teams
• the approval of a business case to
invest in mobile technology.
The IT Service Desk received national
accreditation (making us the first mental
health trust, and the second London
trust to achieve this) and our IM&T
services were the runners-up in the
national Health Informatics Accolade
Scheme, for the implementation of RiO.
Some other projects which began in
2007/08 will be completed in the coming
year. These include:
• the introduction of smartcards
for staff to use when accessing
computers and national systems
such as RiO
• the upgrading of RiO to version 5
• the rollout of mobile technology to
community-based clinicians
• electronic ordering (e-procurement).
Mobile working
A business case for implementing
mobile technology in community
services was approved by the Trust
Board in December 2007, following a
successful pilot in September.
The Mobile Technology Project is set to
change the way clinicians work. Clinicians
who spend 50 per cent or more of their
working week away from their team base
or Trust site working with clients will use
portable tablet PCs (a laptop-like device),
providing secure wireless access to
electronic patient records (RiO), email and
access to information ‘on-the-go’.
The benefits expected from the Project are:
• reduced travel costs
• more informed clinical decisionmaking
30 South West London and St George’s Mental Health NHS Trust

• increased clinical productivity
• a reduction in clinical risk
• saving of office space
• improvements in work-life balance
• enhancement of the Trust’s image
and reputation
• improvements in service user
confidence.
The deployment of devices and staff
training will begin in May 2008 with the
project scheduled to be completed by
January 2010. Over this period, 1000
tablet PCs will be issued.
Research and
development
The Department of Health (DH)’s
strategy document Best Research for
Best Health was published in 2005.
Since its publication the Trust has worked
conscientiously towards streamlining key
administrative processes in its research
and development work, in line with
emerging DH policy and guidance, and
strengthening existing partnerships with
Royal Holloway, University of London
and Kingston University. It has also
successfully gained a foothold in the
national research arena via local hub
membership of both the DH-funded
research networks in Mental Health
(MHRN) and Comprehensive Local
Research (CLRN). This will validate the
quality and impact of the Trust’s current
research activity and facilitate future
collaborative work, ensuring that they
reflect the true multidisciplinary nature of
service delivery within clinical settings.
The Trust’s commitment to fundamental
policy drivers such as research governance,
quality assurance, cost- and clinical
effectiveness has led to the development
of innovations in diagnostic techniques,
novel treatments and service models, with
material benefits to service users and carers.
In our research and development work we
will continue to enable the development
of good local and national service delivery
models and organisation, along with the
promotion of clinical effectiveness.
Left:
Changing the way clinicians work
Jawad Chaudhry from our Information
Management and Technology department
demonstrates a portable tablet PC
Above:
Providing information,
advice and support
Louise Dymoke, PALS Manager
Our PALS
The Trust’s Patient Advice and Liaison Service (PALS) seeks to resolve
concerns before they escalate into major problems by providing
information, advice and support for service users, their families and
carers. Here are just three examples. (We have changed details to
preserve anonymity and confidentiality.)
• A mother of a 28-year-old inpatient was angry that the cognitive
behavioural therapy in her daughter’s care plan did not seem to have
been carried out. The daughter, however, did not want her to be
involved. PALS played an important role in containing the mother’s
anxieties through listening, supporting and advising her and liaising
with the staff involved. Eventually the mother gained different
insights and her confidence in the service was restored.
• A community patient who was dependent on alcohol was unable to
stop drinking and felt very ill and frightened. After listening to her
concerns PALS offered to tell the community mental health team
about her distress and ask the duty worker or community practice
nurse to contact her.
• A community patient had attended an assessment consultation after
being referred to our services by his GP. However he did not feel
comfortable with the consultant for reasons to do with his illness.
He didn’t want to offend the consultant by telling her his thoughts
but wondered whether he could have a second assessment with a
different consultant. As he had also moved house since the initial
assessment, the resolution of this enquiry involved a considerable
amount of liaison between PALS, the GP and the consultant.
Eventually he was referred to another trust by his GP.
Between April 2007 and March 2008, PALS dealt with 504 enquiries.
You can contact PALS on 020 8682 5915 or at pals@swlstg-tr.nhs.uk
Annual Report and Accounts 07 / 08 31

Overview
Complaints
The Trust welcomes all comments from
patients and sees complaints as an
important source of information about
how we can do things better.
Many improvements have been made as
a result of complaints, including:
• the introduction of customer
service training to tackle concerns
over the attitude of some staff
• the appointment of a patient
information officer as a result of
concerns over a lack of information
given to patient/carers upon first
admission to mental health services.
In 2007/08 we received 167 complaints
and answered 58 per cent within the
national target of 25 working days.
We continue to filter complaints that
can be responded to sooner than the 25
working day guideline by sending them
to the relevant service for direct action.
Our complaints procedures meet the
spirit of the Parliamentary and Health
Service Ombudsman’s Principles of
Remedy but do not formally incorporate
these principles. We shall review the
procedures in the coming year to
achieve this.
Risk training
In response to a number of learning
points from Serious Untoward
Incidents the Trust reviewed its
clinical risk assessment training for
all multidisciplinary staff in 2007.
We developed a new training and
education programme, designed for
all the Trust’s healthcare professionals,
which was launched in April 2008.
The training package involves the
use of specially commissioned films,
produced by the Trust, demonstrating
mental health skills in a variety of risk
assessments and clinical management
scenarios.
It has been designed and is facilitated
by a multi-professional team of senior
clinicians from within the Trust and
operates at a variety of levels:
• Level One: a half-day’s training
on patient safety and clinical risk
introduces the principles of risk
assessment and the responsibilities
related to individual roles within
the team
• Level Two: a one-day, evidencebased
training and education
programme, tailored to the needs
of specific clinical teams
• Level Three: a five-day academic
module, in association with the
Faculty of Health Care Sciences
at Kingston University, providing
greater depth and applied
theory to risk assessment and risk
management and using the same
techniques and resources to focus
on the development of practical
skills in this vital area.
The course evaluation feedback so far
from participants has been very positive.
Risk management
Risk is the threat that an event
or action will adversely affect
the Trust’s ability to achieve its
objectives and to successfully
execute its strategies.
Risk management is the process of
systematically identifying risks, analysing
the likelihood and impact of their
occurrence, and then deciding what
action to take to prevent, minimise,
accept or transfer these risks in a way
that will enable the Trust to minimise
losses and maximise opportunities.
All NHS trusts are required to:
• regularly assess the risks to which
they are exposed
• report that they are taking all
reasonable steps to manage risks
of all kinds
• provide an assurance to key
stakeholders that an effective
system of risk management is
in place.
The Trust’s Risk Strategy (available on
our website at http://www.swlstg-tr.nhs.
uk/uploads/documents/tb07126_-_risk_
management_strategy_2007.doc)
is revised annually and sets out how
we aim to:
• minimise risks to the quality and
delivery of patient care through
creating awareness throughout the
organisation about the importance
of recognising and taking positive
action to manage risks of all
kinds and providing staff with a
clear framework and associated
processes for managing risks
• continue to innovate and pioneer
service developments within a
framework of risk management
• protect the services, reputation,
and finances of the organisation
through a process of risk
identification, assessment,
prevention, reduction, elimination
and transfer.
The management of risks of all kinds is
an essential element in improving clinical
and non-clinical services. It directly
benefits the standard of patient care and
staff satisfaction, and reduces costs.
The importance to the NHS of learning
from previous mistakes and actively
seeking to prevent re-occurrence is
described in An organisation with a
memory (Department of Health Expert
Group, 2000). Out of this the National
Patient Safety Agency developed what it
calls Seven Steps to Patient Safety. The
Trust has worked towards embedding
these principles into its services.
Developing a safety culture and
promoting reporting
There is evidence that when open
reporting and even-handed analysis of
what went wrong are encouraged, in
principle and by example, this can have
a positive and quantifiable impact on the
performance of an organisation.
32 South West London and St George’s Mental Health NHS Trust

The Trust has reviewed its policies
and procedures in reflecting and
encouraging a more open reporting
culture. The Trust has encouraged active
reporting of incidents. In the last two
years the Trust has increased its incident
reporting by 23 per cent and as a result
of sharing, learning and addressing
these issues there has been a 41 per
cent reduction in more serious incidents.
Involving and communicating
with patients and general public
when an incident has gone
wrong
Despite our best efforts mistakes are
sometimes made or our service users
have cause to complain. During 2006 to
2008 we have concentrated on training
staff to be open when things go wrong.
More than 250 staff were trained to
the National Patient Safety Agency gold
standard.
Our ‘Being Open’ policy supports
staff to:
• acknowledge, apologise and
explain when things go wrong
• conduct a thorough investigation
into the incident and reassure
patients and/or their carers that
lessons learned will help prevent
the incident recurring
• provide support to cope with
the physical and psychological
consequences of what happened.
Taking this approach is not always easy
but we believe it is fundamental to the
partnership between patients and those
who provide their care.
Learning and sharing
safety lessons
In order to learn, understand and
develop patient safety solutions,
all serious untoward incidents are
investigated using a root cause analysis
approach. Root cause analysis is a
technique for undertaking a systematic
investigation that looks beyond the
individuals concerned and seeks to
understand the underlying causes and
environmental context in which the
incident happened. The benefits include
a structured and consistent approach
to incident investigation. It shifts the
focus away from individuals and on to
the system to help build an open and
fair culture. It increases awareness of
patient safety issues and helps engage
patients in the investigation. Changes
and recommendations are effected as a
result of identifying the root cause.
Since 2005 over 190 Trust managers
and clinicians received formal training in
using root cause analysis principles.
Personal data-related incidents
There was one personal data-related
incident during the year. A fault was
reported to the Trust’s IT Service
Desk involving a member of staff’s
caseload. In dealing with the fault and
responding to a request from BT to
supply screenshots of error messages
we omitted to remove some patient
identifiable data from the information
we sent them. The error was identified
two hours later and we then sent
amended data to BT with all patient
identifiable information removed.
Emergency planning
Our Emergency Planning committee
meets quarterly, with Board
representation, to address Emergency
and Business continuity planning
throughout the Trust. The committee
also reviews its major incident plans
annually. This meets all national
guidance and is fully compliant with
the NHS Emergency Planning Guidance
2005 and the Department of Health’s
document Mass casualty incidents:
A framework for planning.
We continue to liaise closely with other
trusts, primary care trusts (PCTs) and
local authorities within south west
London through our membership of
Emergency Planning committees. This
multi-agency working is key to effective
planning.
In June 2007 we conducted, without
notice, an internal out-of-hours
communications exercise. We tested
all email, telephone and pager
systems including external agency
emergency contact numbers. This
was in response to the Department of
Health’s Emergency planning guidance
requiring all organisations to undertake
a communications exercise once every
six months.
A Sutton borough business continuity
exercise was conducted in September
2007 at Sutton Hospital’s Chiltern wing.
The exercise, which involved a simulated
fire and utilities failure, involved all the
Sutton borough management team,
Sutton Council, Sutton and Merton PCT
and Epsom and St Helier’s acute trust. A
number of key learning points came out
which have contributed to local business
continuity plans.
The Trust took part in two external
exercises in November 2007. These
were: Exercise Gerhard, a command and
control exercise involving all other health
organisations in south west London,
which enabled us to test our plans and
communication systems; and a Londonwide
desktop exercise, Exercise Phoenix,
which focused on the recovery phase of
a flu pandemic.
We held a series of surgeries for oncall
directors. Twelve directors from
the on-call rota were inducted to the
out-of-hours emergency control room
in Yew ward, outlining their roles and
responsibilities.
The Health Protection Agency runs
Loggist training for team members to
gain experience of recording events as
they unfold in a major incident. More
than 12 managers and administrators
attended a series of these courses
during the year.
Five managers attended a series of
business continuity training courses run
by the Cabinet Office.
Annual Report and Accounts 07 / 08 33

Resources – financial review
Surplus for the year
The Trust was required by NHS London to achieve a £1.7m surplus for the year
ended 31 March 2008. Despite facing some financial pressures during the year, the
Trust managed to deliver the surplus. The Trust has a good financial record as it has
achieved a surplus each year since being formed.
Financial results – 3 year summary
2007/08
£000
2006/07
£000
2005/06
£000
Operating income 177,222* 168,595 153,480
Retained surplus for year 1,738 2,670 1,532
Financial outlook
The Trust has recently submitted a plan to NHS London showing modest income
growth and surpluses for the next three years and for 2008/09 the budget has been
set on this basis. The Trust faces challenges as it is required to save approximately
3 per cent of its budget every year because clinical income from PCTs is reduced
(after inflation uplifts) in order to achieve the efficiency target set by Department of
Health. The following table shows the next three years’ income and surplus targets:
* Includes £4.4m non-recurrent income
Financial results – 3 year financial plan
2008/09
£000
2009/10
£000
2010/11
£000
Operating income 170,000 171,000 175,000
Retained surplus for year 1,700 1,710 1,750
Operating income
for 2007/08
The majority of the Trust’s income comes
from agreements with primary care trusts
to provide healthcare for people living
within their catchment area, including
£130.2m from the Trust’s four local PCTs,
as set out in the chart to the right.
£22.8m
Other income from activities
£8.8m
Education, training and research
£4.7m
Other non-patient related income
The level of income reported in the
Accounts has increased by £8.6m after
the loss of some clinical income.
The main changes reflect:
• inflation on 2006/07 agreements; and
• repayment of surpluses created in
2005/06 and 2006/07 of £4.4m.
This has been used to meet the loss
of clinical income and also to cover
expenditure on training and estates
development costs.
£10.7m
Local authorities
£21.2m
Kingston Primary
Care Trust
£47.4m
Wandsworth Primary Care Trust
£38.4m
Sutton & Merton Primary Care Trust
£23.2m
Richmond & Twickenham Primary Care Trust
Total £177.2m
34 South West London and St George’s Mental Health NHS Trust

Operating expenditure
for 2007/08
From a total operating expenditure
of £176.0m, 68 per cent of our
expenditure is on staff costs. Our staff
costs were £119.1m (£113.4m in
2006/07), of which £96.9m or 81 per
cent related to staff directly involved
in patient care. The proportion of staff
expenditure relating to staff directly
involved in patient care has remained
between 81 per cent and 82 per cent
since 2001/02. The average number
of staff employed during the year was
2,771 (2,676 in 2006/07).
£15.7m
Depreciation, dividends
and amortisation
£96.9m
Clinical services staffing
£41.2m was spent on services and
consumables supporting patient care.
£15.7m was spent on charges for
capital. The chart on the right shows
how the Trust spent its money in
the year.
£41.2m
Non-pay
£22.2m
Non-clinical staffing
Total
£176.0m
Liquidity/External Financing Limit
The Trust is required to remain within the prescribed external financing limit (EFL).
The Trust managed cash balances throughout the year and maintained a positive
bank balance. At year end the cash balance was £0.5m.
The Department of Health set the Trust an External Financing Limit of £3.4m.
The Trust underspent against this limit by £4.1m due to the slippage on capital
projects. This underspend was agreed with the Department of Health.
Capital resources (Capital Cost Absorption Rate)
This refers to the rate of return achieved on capital investment. As one of its
performance measures the Trust must demonstrate it has achieved an investment
yield (i.e. income generated from its capital investments) of between 3 and 4 per
cent. This measure is calculated by comparing the Trust Debt Remuneration paid with
Average Net Relevant Assets. The Trust achieved a rate of 3.58 per cent for the year.
Annual Report and Accounts 07 / 08 35

Resources – Financial review
Capital expenditure
The Trust is allocated specific funding
for capital expenditure, and is required
to remain within this prescribed Capital
Resource Limit (CRL).
The Trust was set a CRL of £16.9m for
2007/08. The Trust incurred capital
expenditure of £12.5m, an allowed
underspend of £4.4m. This was mainly
due to the slippage on the psychiatric
intensive care unit and the new
Wandsworth Acute Unit projects.
The capital plan for the coming year
is £17.5m, £13.3m of which is for the
Wandsworth Acute Unit due to be
completed in March 2009. The major
capital projects are shown in the table
on the right.
2006/07
£m
2007/08
£m
2008/09
£m
New Wandsworth Acute Unit 2.5 6.7 13.3
Shaftesbury Unit security 0.8
Information Technology equipment 0.8 1.0 0.5
Jasper Ward (refurbishment) 0.8 0.3
Crocus Ward (refurbishment) 0.7 0.3
Other schemes 4.9 3.4 5.0
Gross capital expenditure 9.7 12.5 18.8
Less: book value of disposals -1.1 -1.3
Net capital expenditure 8.6 12.5 17.5
Public Sector Payment Policy – measure of compliance
In addition to the four key financial duties, the NHS Executive requires that Trusts pay their
non-NHS trade creditors in accordance with the CBI prompt payment code and Government
Accounting rules. The target is to pay 95 per cent of non-NHS trade creditors within 30 days
of receipt of goods or a valid invoice (whichever is the later) unless other payment terms have
been agreed with the supplier. The Trust successfully achieved this target for 2007/08.
number
2007/08
£m
2006/07
£m
Total bills paid 54,282 48.9 37.1
Total bills paid within target 51,702 46.9 34.5
Percentage of bills paid within target 95.2% 95.8% 93.9%
Management costs
Management costs 9.4 8.3
Relevant income 177.2 168.8
Percentage of relevant income 5.28% 4.90%
Salary and pension entitlements of senior managers
Full details of senior managers’ remuneration are provided in the Remuneration report
on pages 41 to 42.
Audit arrangements
The Trust’s external auditors for 2007/08 were the Audit Commission, who first
undertook the audit of the final accounts in 2002/03.
The audit fee for the statutory audit and services carried out in relation to the statutory
audit for 2007/08 was £168,000.
As part of the final accounts exercise, each director of the Trust has made a declaration
that, as far as s/he is aware, there is no relevant audit information of which the NHS body’s
auditors are unaware, and s/he has taken all the steps that s/he ought to have taken as a
director in order to make him/herself aware of any relevant audit information.
36 South West London and St George’s Mental Health NHS Trust

The accounts
Summary financial statements
The following statements represent a summary of financial information about the
Trust. The full accounts are available on request from:
Director of Finance and IT
South West London and St. George’s Mental Health NHS Trust
Springfield University Hospital
61 Glenburnie Road
London SW17 7DJ
Telephone 020 8682 6000
Signed on behalf of the Board
Peter Houghton
Chief Executive
Peter Cardell
Director of Finance
A summary of the Trust accounts is shown on pages 37 to 39.
Income and expenditure account
For the year ended 31 March
Figures in £000s
2007/08 2008/09
Income from activities: Continuing operations 163,699 155,449
Other operating income 13,523 13,146
Operating expenses: Continuing operations (166,308) (157,989)
Operating surplus: Continuing operations 10,914 10,606
Profit (loss) on disposal of fixed assets 0 132
Surplus (deficit) before interest 10,914 10,738
Interest receivable 491 464
Interest payable 0 0
Surplus (deficit) for the financial year 11,405 11,202
Public Dividend Capital dividends payable (9,667) (8,532)
Retained surplus (deficit) for the year* 1,738 2,670
Financial target performance 3.6% 3.4%
* No financial support is included in the retained surplus for the year.
Annual Report and Accounts 07 / 08 37

The accounts
Balance sheet
As at 31 March
Figures in £000s
2007/08 2006/07
Fixed assets
Intangible assets 13 112
Tangible assets 288,761 263,954
288,774 264,066
Current assets
Stocks and work in progress 135 176
Debtors: amounts falling due:
after one year 0 0
within one year 8,732 11,787
Investments 0 0
Cash at bank and in hand 498 484
9,365 12,447
Creditors: amounts falling due within one year (14,106) (11,704)
Net current assets (liabilities) (4,741) 743
Total assets less current liabilities 284,033 264,809
Creditors: amounts falling due after more than one year
Provisions for liabilities and charges (89) (116)
Total assets employed 283,944 264,693
Financed by: capital and reserves
Public Dividend Capital 111,276 111,987
Revaluation reserve 162,060 144,033
Donated asset reserve 3,278 3,081
Other reserves 750 750
Income and expenditure reserve 6,580 4,842
Total capital and reserves 283,944 264,693
Statement of total recognised gains and losses
For the year ended 31 March
Figures in £000s
2007/08 2006/07
Surplus for the financial year before dividend payments 11,405 11,202
Fixed asset impairment losses 0 0
Unrealised surplus on fixed asset revaluations/indexation 18,280 16,874
Increases in the donated asset & government grant reserve due to receipt of
donated & government grant financed assets
14 0
Additions/(reductions) in ‘other reserves’ 0 0
Total recognised gains and losses for the financial year 29,699 28,076
Prior period adjustment 0 0
Total gains and losses recognised in the financial year 29,699 28,076
38 South West London and St George’s Mental Health NHS Trust

Cash flow statement
For the year ended 31 March
Figures in £000s
2007/08 2006/07
Operating activities
Net cash inflow from operating activities 21,023 11,900
Returns on investments and servicing of finance
Interest received 491
Interest paid 0 0
Interest element of finance leases 0 0
Net cash inflow/(outflow) from returns on investments
and servicing of finance 491 464
Capital expenditure
Payments to acquire tangible fixed assets (11,122) (8,708)
Receipts from sale of tangible fixed assets 0 1,197
(Payments to acquire)/ receipts from sale of intangible assets 0 (98)
Net cash inflow (outflow) from capital expenditure (11,122) (7,609)
Dividends paid (9,667) (8,532)
Net cash inflow/(outflow) before management
of liquid resources and financing 725 (3,777)
Management of liquid resources
Purchase of investments 0 0
Sale of investments 0 0
Net cash inflow/(outflow) from management
of liquid resources
0 0
Net cash inflow/(outflow) before financing 725 (3,777)
Financing
Public dividend capital received 3,459 3,803
Public dividend capital repaid (not previously accrued) (4,170) 0
Public dividend capital repaid (accrued in prior period) 0 0
Loans received 0 0
Loans repaid 0 0
Other capital receipts 0 0
Cash transferred from/to other NHS bodies 0 0
Capital element of finance lease rental payments 0 0
Net cash inflow/(outflow) from financing (711) 3,803
Increase/(decrease) in cash 14 26
Annual Report and Accounts 07 / 08 39

The accounts
Independent auditor’s report to the Directors
of the Board of South West London and
St George’s Mental Health NHS Trust
on the Summary Financial Statements
I have examined the summary financial statements set out on pages 37 to 39.
This report is made solely to the Board of South West London and St George’s
Mental Health NHS Trust in accordance with Part II of the Audit Commission Act
1998 and for no other purpose, as set out in paragraph 36 of the Statement
of Responsibilities of Auditors and of Audited Bodies, prepared by the Audit
Commission.
Respective responsibilities of directors and auditors
The directors are responsible for preparing the Annual Report. My responsibility is to
report to you my opinion on the consistency of the summary financial statements
with the statutory financial statements. I also read the other information contained
in the Annual Report and consider the implications for my report if I become
aware of any misstatements or material inconsistencies with the summary financial
statements.
Basis of opinion
I conducted my work in accordance with Bulletin 1999/6 ‘The auditor’s statement on
the summary financial statements’ issued by the Auditing Practices Board. My report
on the statutory financial statements describes the basis of our audit opinion on
these financial statements.
Opinion
In my opinion the summary financial statements are consistent with the statutory
financial statements of the Trust for the year ended 31 March 2008 on which I have
issued an unqualified opinion.
Jon Hayes
Audit Commission
1st Floor Millbank Tower
Millbank
London SW1P 4QH
20 June 2008
40 South West London and St George’s Mental Health NHS Trust

Remuneration report
Remuneration and Terms of Service Committee
The Committee is chaired by the Trust’s Chairman, and the membership comprises
all the non-executive directors. The committee is considered quorate if it has a
minimum of three non-executive directors present.
The Chief Executive attends all meetings of the Committee but is not present for
discussions about his/her own remuneration. The Director of Human Resources acts
as Secretary to the Committee but is not present for discussions about his/her own
remuneration.
The Committee:
• determines the remuneration and
terms of service of the Chief Executive
and those directors that report directly
to the Chief Executive (all other senior
managers are covered by Agenda for
Change)
• reviews the performance of those
directors who report directly to the
Chief Executive, through reports
submitted by the Chief Executive,
Salaries and allowances
no later than May each year. The
Chair will similarly report on the
performance of the Chief Executive
• periodically reviews pay data from
similar organisations in order to ensure
that appropriate arrangements have
been made for the salaries of these
directors
• oversees appropriate contractual
arrangements for such staff, including
the proper calculation and scrutiny
of termination payments, for these
and other senior staff, taking account
of such national guidance as is
appropriate
• meets annually as a minimum, but
may meet on other occasions as may
be required from time to time.
2007/08 2006/07
Name
Title
Salary
(bands of
£5,000)
Other
renumeration
(bands of £5,000)
Salary
(bands of
£5,000)
Other
renumeration
(bands of £5,000)
Mr John Rafferty Chairman 20-25 0 20-25 0
Mr Raficq Abdulla Non-Executive Director (to 31/12/07) 5-10 0 5-10 0
Ms Judith Chegwidden Non-Executive Director 5-10 0 5-10 0
Mr Arthur de Frisching Non-Executive Director (to 31/03/08) 5-10 0 5-10 0
Mr Emir Feisal Non-Executive Director (to 31/12/07) 5-10 0 5-10 0
Prof Roger Horton Non-Executive Director 5-10 0 5-10 0
Ms Elizabeth Owen Non-Executive Director 5-10 0 5-10 0
Dr Diana Rose Associate Non-Executive Director (to 31/10/07) 5-10 0 0-5 0
Dr B E Nereli Medical Director (from 1/11/07) 45-50 15-20 0 0
Dr Debbie Stinson Joint Interim Medical Director (1/05/07 - 1/11/07) 10-15 0 0 0
Dr James Bolton Joint Interim Medical Director (1/05/07 - 1/11/07) 10-15 0 0 0
Dr Deji Oyebode Medical Director (to 30/04/07) 10-15 0 85-90 115-120
Mr Peter Houghton Chief Executive 150-155 0 105-110 * 0
Mr Peter Cardell Director of Finance and IT 105-110 0 95-100 0
Ms Maresa Ness Chief Operating Officer 95-100 0 90-95 0
Ms Sandy Gillett Director of Human Resources 85-90 0 75-80 0
Ms Kim Goddard Director of Corporate Affairs (to 30/06/07) 5-10 0 35-40 0
Ms Kim Goddard Director of Nursing (from 1/07/07) 60-65 0 0 0
Mr Andrew Simpson Director of Planning (to 30/06/07) 15-20 0 0 0
*part-year salary
Annual Report and Accounts 07 / 08 41

Performance arrangements
The performance of executive directors is assessed by the Chief Executive on an
annual basis. The performance of non-executive directors and the Chief Executive is
appraised by the Chair.
Most senior managers have a basic salary which is based on national Agenda for
Change pay and remuneration guidelines. Executive directors remain on local Trust
conditions of service, and their salaries are reviewed annually by the Remuneration
Committee. Executive directors received cost of living increases in line with the Very
Senior Managers’ Pay Framework, and the Remuneration Committee awarded
differential pay increases, based on achievements against objectives (as assessed by
the Chief Executive) and market rates.
Senior managers’ contracts which fall within this remit are all substantive and
permanent. Notice periods are in line with employment law.
Payments to past senior managers
No compensation payments were made to senior managers in the financial year
under review.
Pension benefits
Real
increase
in pension
at age 60
(bands of
£2,500)
Lump sum
at age 60
related to
increase
in pension
(bands of
£2,500)
Total
accrued
pension at
age 60 at
31 March
2008
(bands of
£5,000)
Lump sum
at age 60
related to
accrued
pension at
31 March
2008
(bands of
£5,000)
Cash
equivalent
transfer
value at
31 March
2008
Cash
equivalent
transfer
value at
31 March
2007
Real
increase
in cash
equivalent
transfer
value
Employer’s
contribution
to
stakeholder
pension
Name
£’000
£’000
£’000
£’000
£’000
£’000
£’000
£’000
Mr Peter Houghton 0-2.5 5.0-7.5 45-50 145-150 712 650 31 0
Mr Peter Cardell 2.5-5.0 7.5-10.0 10-15 40-45 N/A N/A N/A 0
Ms Maresa Ness 2.5-5.0 10.0-12.5 35-40 105-110 613 529 49 0
Dr Deji Oyebode 0-2.5 0-2.5 30-35 100-105 569 503 3 0
Ms Sandy Gillett 2.5-5.0 7.5-10.0 25-30 75-80 483 415 40 0
Ms Kim Goddard 5.0-7.5 17.5-20.0 25-30 75-80 371 261 72 0
Mr Andrew Simpson 0-2.5 0-2.5 10-15 35-40 158 134 4 0
Dr B E Nereli 0-2.5 2.5-5.0 20-25 65-70 311 251 22 0
Dr Debbie Stinson 0-2.5 0-2.5 30-35 95-100 505 459 12 0
Dr James Bolton 2.5-5.0 10.0-12.5 25-30 75-80 420 225 66 0
42 South West London and St George’s Mental Health NHS Trust

The Board
Non-executive directors
Executive directors
John Rafferty
Chairman
Appointed December 2004
Peter Houghton
Chief Executive
Appointed July 2006
Judith Chegwidden Vice Chairman
Appointed June 1998; reappointed January 2006
Chair of Audit Committee
• Director of Roskill Information Services Ltd
and of Roskill Consulting Group Ltd
Susan Dark Non-Executive Director
Appointed April 2008
• Managing Director of Nikko Healthcare
Emir Feisal JP Non-Executive Director
Appointed January 2006, left December 2007
Member of Audit Committee
• Associate Managing Editor, The Sunday Times
• Member, Ministerial Advisory Board, The Royal
Parks Agency
• Magistrate, Westminster Bench
• Trustee, Vitalise
Arthur de Frisching Non-Executive Director
Appointed June 2002; reappointed June 2006,
left March 2008
Member of Audit Committee
Professor Roger Horton
Non-Executive Director
Appointed December 2003
Member of Audit Committee
• Vice-Principal of St George’s, University of
London until 30 September 2007
Iain McCusker
Non-Executive Director
Appointed April 2008
Maresa Ness
Chief Operating Officer
and Deputy Chief Executive
Appointed November 2004
• Trustee, Mosaic Clubhouse (charity)
Peter Cardell
Director of Finance and IT
Appointed May 1998
• External member of the University Audit
Committee, Kingston University
• Director, Mosaic Clubhouse (charity)
Professor Mary Chambers
Chief Nurse and Professor
of Mental Health Nursing
Appointed February 2004, left April 2007
Kim Goddard
Director of Nursing and Governance
Appointed 6 June 2007
Appointed Interim Director of Nursing and
Governance on 1 April 2007
Dr Ben Nereli
Medical Director
Appointed 1 November 2007
Dr Deji Oyebode
Medical Director
Appointed July 2002, left 1 May 2007
Elizabeth Owen
Non-Executive Director
Appointed May 2006
Member of Estates Committee
• Legal Adviser – construction industry
Dr James Bolton
Joint Interim Medical Director
Appointed 1 May 2007, left 31 October 2007
Raficq Abdulla
Associate Non-Executive Director
(non-voting)
Appointed September 2006, left December 2007
• Trustee, World without TB
• Trustee, Poetry Society, Planet Poetry, English PEN
Dr Diana Rose
Associate Non-Executive Director
(non-voting)
Appointed October 2006, left December 2007
Dr Debbie Stinson
Joint Interim Medical Director
Appointed 1 May 2007, left 31 October 2007
Sandy Gillett
Director of Human Resources
(non-voting)
Appointed August 2005
• Trustee, Radio Lollipop
Annual Report and Accounts 07 / 08 43

Main Trust locations
M4
M3
TEDDINGTON
HAMPTON
TWICKENHAM
31
BUSHY PARK
HAMPTON COURT
PARK
KEW
GARDENS
2
3
1 4 5
7
6 WANDSWORTH
30
26
KEW
RICHMOND
RICHMOND
29
25
RICHMOND
PARK
KINGSTON
UPON-THAMES
SURBITON
24
HOOK
CHESSINGTON
28
27
NEW MALDEN
KINGSTON
WORCESTER
PARK
BARNES
BARNES
COMMON
ROEHAMPTON
WIMBLEDON
COMMON
PUTNEY
WIMBLEDON
SOUTHFIELDS
23
MORDEN
PARK
WIMBLEDON
PARK
MERTON
RAYNES
PARK
MORDEN
CHEAM
22
21
9
10 8
EARLSFIELD
COLLIERS
WOOD
16
MERTON
18
19
SUTTON
BATTERSEA
PARK
CLAPHAM
COMMON
WANDSWORTH
COMMON
12 13 14
15
SUTTON
BATTERSEA
CLAPHAM
JUNCTION
BALHAM
TOOTING
17
CARSHALTON
TOOTING BEC
COMMON
MITCHAM
MITCHAM
COMMON
BEDDINGTON
PARK
20
11
WALLINGTON
Acre Road
Barnes Hospital
Cheam Resource Centre
Guildhall
Haydon House
Henderson Hospital
Henderson Outreach
Maddison Clinic
Mapleton Centre
Nelson Hospital
Norfolk Lodge
Old Church
Queen Mary’s Hospital
Richmond Royal Hospital
Rose Lodge
Roselands
South Bank House
South Place Day Centre
Springfield University Hospital
St George’s Hospital
St Helier Hospital
St John’s Hospital and Amyand House
St John’s Therapy Centre
Sutton Hospital
Thrale Road
Tolworth Hospital
Wallington Resource Centre
Westmoor House
William Harvey Clinic
Wilson Hospital
York Road
29
3
23
30
8
22
11
31
7
18
15
14
4
2
28
27
26
25
12
16
19
1
10
21
13
24
20
6
5
17
9
Useful contact details
Barnes Hospital 020 8878 4981
Henderson Hospital, Sutton 020 7622 9337
Nelson Hospital, Raynes Park 020 8296 3795
Queen Mary’s Hospital, Roehampton 020 8487 6000
Richmond Royal Hospital 020 8940 3331
Springfield University Hospital, Tooting 020 8682 6000 (Trust headquarters)
Sutton Hospital 020 8296 2000
Tolworth Hospital 020 8390 0102
www.swlstg-tr.nhs.uk
Extra copies of this annual report are available
from the Communications Department on 020 8772 5532.
This report is available in other formats and languages by request.
Please contact the Communications Department on 020 8772 5532.
Let us know what you think of this annual report.
Email us at communications@swlstg-tr.nhs.uk
Produced by Raffertys