Annual report and accounts 2012/13 - Homerton University Hospital

Annual report and accounts 

2012/13

Homerton University Hospital NHS Foundation Trust 

Annual Report and Accounts 

2012/13 

Presented to Parliament pursuant to Schedule 7, 

paragraph 25(4a) of the National Service Act 2006

4 ANNUAL REPORT 2012/13


Annual Report and Accounts 


This Annual Report follows best practice in corporate reporting by articulating our 

strategy; reporting back on our performance against strategic objectives and national 

targets; and presenting information about our service and financial performance. 

The structure of the report is as follows: 

Contents 

Annual Report 11 

Introduction 7 

consisting of a statement by the Chairman. 

Chief Executive’s report 8 

including our strategic vision, performance against corporate objectives in 

2012/13, and details of our corporate objectives for 2013/14. 

Performance report 13 

including our financial performance and non financial performance against 

national targets. 

Governance report 27 

including details of the Board of Directors, Council of Governors and 

Foundation Trust membership. 

Quality Account 35 

demonstrating our commitment to providing quality care for all patients 

and reporting back on our performance against priorities for quality 

improvement agreed by the Board of Directors, and identifying our 

priorities for 2013/14. 

Finance 105 

including the full Annual Accounts for the financial year 2012/13. 

ANNUAL REPORT 2012/13 5

The new front entrance of the hospital 

Speech and Language Therapist, Clare 

Parsons, atop a double decker bus 

carrying the Olympic Torch 

Matt Hodson receives his Nurse of the Year 

award from TV presenter and newspaper 

columnist Fiona Phillips (see more on page 50) 

Our Welcome Champions 

Page 10 – Dr Roger Amos and the staff in the 

new sickle cell day centre 

A&E Nurse Katherine Helps with a 

young fan prior to the Olympic opening 

ceremony 

Working in the new operating theatre 

Page 34 – Rachel Ozigbo, the Endoscopy 

Clinical Manager and her team in the newly 

refurbished endoscopy unit 

Mr Amit Shah with a state of the art 3D 

monitor which improves the success of 

fertility treatment 

Outpatients volunteer tea ladies, Muriel 

Cooke, Helena Moore and Julie Lampey 

Page 104 – The new operating theatre in action 


Chairman’s statement 

A year of notable achievement finished with change at the top 

and change outside too. The uncertainties resulting from the 

major shift to GP commissioning, the dismantling of PCTs, and 

local authorities taking on the public health role, have all caused 

your Homerton team to think afresh about the challenges 

that come from such major developments. Of course, all of 

that overlays the week-by-week processes of meeting financial 

targets and the renewed drive for quality. 

Financially the Trust is very sound with a useful surplus to be carried 

forward into service development. Periodic inspections have found a 

good standard of care as well and most targets have been satisfactorily 

met. But your Board knows that more services across a wider 

patient area is the only way to protect the Trust from some of these 

uncertainties. 

The Olympics and Paralympic Games were a particular triumph, not 

just for London but for Homerton as a designated hospital. Over 70 

games related patients were treated with efficiency and courtesy 

whilst our staff were able to maintain the ‘usual’ high standards for 

all our patients. The legacy benefits will definitely assist in Homerton’s 

ambitious plans for growth. 

The integration of community services proceeded according to plan 

and further service improvement is in the pipeline. Some of the 

synergies coming from this contract will emerge during the coming 

year, particularly on IT provision. 

We have a new Chief Executive in Tracey Fletcher, promoted from Chief 

Operating Officer after a thorough recruitment process, and she is off 

to a flying start with the full backing of the Board. Our outgoing CEO, 

Nancy Hallett was honoured by being made a Dame in the New Year’s 

Honours List as well-deserved recognition of her crucial role over 13 

years of dedication and inspiration. We wish her well in her retirement, 

although one suspects she will receive many approaches to draw on so 

much expertise built up over a long career and will remain as busy as 

ever. 

I am handing over the Chairmanship to Tim Melville-Ross, who comes 

with a wealth of senior leadership positions in commerce. I thank the 

Board and the Governors for six years of close cooperation and the 

Executive for their understanding and professionalism. I feel proud of 

the excellent status which Homerton has achieved in a challenging 

environment and thank you all for your individual commitment to what 

is a great institution. 

Michael Cassidy CBE 

Chairman 29 May 2013 


Chief Executive’s report 

In this section we profile the principal activities of 

the Trust throughout the course of the past year and 

highlight the progress we have made in developing 

the range and scope of services we provide. We also 

consider the year ahead. 

Our business review is covered in detail in the 

Performance Report followed by our Governance 

Report and Quality Account. The final section of the 

report is the Annual Accounts. 

First words 

Following the retirement of the Trust’s longstanding Chief 

Executive at the end of 2012, I am honoured to have been 

given the opportunity to take up this post and proud to 

bring you this Annual Report 2012/13. 

Our principal activities 

Homerton provides hospital and community services for 

Hackney, the City and the surrounding communities, and a 

bespoke range of specialist services for a wider population. 

The Trust comprises Homerton Hospital; Mary Seacole 

Continuing Care Nursing Home; and community and home 

care services across Hackney and the City. 

We have unconditional registration from the Care Quality 

Commission (CQC). 

The main hospital, which opened in 1986 is based on one 

site. Homerton became an NHS Foundation Trust in 2004, 

under the Health and Social Care (Community Health and 

Standards) Act 2003. The community service provision 

operates from a total of 73 sites of varying sizes and levels 

of occupancy across the London Borough of Hackney. 

Progress in 2012/13 in developing the range and 

scope of services 

Integration of acute and community based 

services 

Through our second year as an integrated acute and 

community trust we have begun to make significant 

progress in developing integrated teams and pathways. 

This has occurred across a range of service areas including 

neonatal and paediatric services with the introduction of 

standardised pre term development pathways, as well as 

bowel and bladder pathways introduced across acute and 

community paediatric teams. 

Adult services have brought together a number of teams 

and services including sickle cell, community respiratory 

support and tissue viability services. Psychology services 

have expanded to provide direct support to a range of 

acute teams through agreed pathways and foot health 

services, and podiatric surgical services are using a single 

referral and assessment process. A single management, 

nursing and governance structure has been introduced 

across acute and community sexual health services. 

Additionally, a range of support services have been also 

integrated, to improve the effectiveness in the use of 

integrated pathways. These areas include safeguarding 

teams, discharge planning teams, advocacy services and 

referrals management and booking services. 

It has been inspiring to witness the enthusiasm and drive 

teams have for this agenda. However, there is still much 

more to do to gain further benefit from integrating a wider 

range of services 

We have worked hard on the modernisation of community 

Information Technology (IT) systems, facilities and buildings. 

On IT the progress is good. Buildings and facilities continue 

to need our attention. 

Service development 

More women have delivered their babies with us this year 

than ever and more people have chosen to be referred 

here for treatment. We have been asked to be the main 

provider of maternity services to specific areas of Waltham 

Forest. We were chosen to be the provider for the IAPT 

programme pilot (Improving Access for Psychological 

Therapies) for children. The health visiting implementation 

plan has been a focus as well as the review of the 

community nursing services resulting in changes to the 

service delivery model and the standard of communication 

with local GPs. 

The Trust were significantly involved in the review of 

intermediate care services across the London Borough 

of Hackney and will continue to work with partner 

organisations to establish and improved model. 

Buildings and equipment 

A sixth ‘state of the art’ operating theatre opened in the 

main complex in the autumn providing additional space 

and technology for bariatric and obstetric services. Our 

new endoscopy unit has opened, incorporating increased 

capacity and improved patient facilities. The refurbishment 

programme for the new sexual health unit is almost 

complete and the team are due to move back early in 

2013/14. 

Many improvements have also taken place within the 

community facilities including a refurbished main entrance 


area at St Leonard’s and a new unit to accommodate the 

Locomotor Services. Improvement work is underway at 

John Scott Health Centre which is due to complete in 

2013/14. Throughout the year there has been significant 

investment made in soft furnishings and decoration across 

the community facilities providing a much needed lift to 

many premises. 

Developments in IT and with the systems we operate, 

particularly for acute services, have also been improved 

considerably. Our acute electronic patient record (EPR) 

system has been moved to a new datacentre and there 

has been a significant upgrade to the base code. This will 

enable the Trust to develop the system further to support 

the delivery of health care services. 

London 2012 Olympic and Paralympic Games 

Although it feels some time ago now, we remain proud 

to have had the opportunity to support the Games in our 

role as an Olympic hospital. The Trust received over 70 

members of the Olympic Family to be assessed and treated 

with the majority of specialties and services being involved 

at some point during the period of both Games. It was an 

incredibly exciting time and one which will not be forgotten 

at Homerton for a while. 

Key objectives 

Our direction of travel is not changing but we are going 

at a faster pace. Our focus remains on getting the 

fundamentals right - ensuring that the people we serve 

get safe, effective, thoughtful health care, within the rules 

that apply to NHS. But we have aspirations beyond this. In 

previous times we have set these out in broad terms - this 

year we are being much more specific about our plans for 

the next three years. These are set out on page 14. 

Principal risks 

Homerton is in good shape and we face the year ahead 

with enthusiasm. We are a high performing organisation 

with a clear sense of purpose. There are of course risks and 

uncertainties ahead. We have new health care legislation, 

the commissioning arena has undergone significant 

change, in London hospital mergers and service changes 

have taken place, and the economic situation remains 

challenging. In setting our corporate goals we have done so 

with these risks in mind. 

Tracey Fletcher 

Chief Executive 29 May 2013 



Annual 

Report 



PERFORMANCE REPORT 

Performance report 

The Trust’s strategic vision in 2012/13 

The core components of our strategic vision have remained 

consistent throughout our foundation trust existence: to 

serve the people of Hackney; to provide a defined range of 

specialist services; to be thriving and sustainable; to improve 

performance continuously; to be characterised by modern 

high quality systems and processes enabled by innovation 

and technology with a comprehensive supporting 

infrastructure and buildings. 

In 2012/13 we defined one overarching strategic goal with 

a number of aspirational objectives. 

Must-do: our core work 

We exist to provide safe, effective, thoughtful NHS health 

care. In order to be allowed to continue to do this we must 

meet legislative and regulatory requirements. Departments 

need to understand what specifically this means for them, 

but to some extent it can be encapsulated as follows: 

maintain compliance with Care Quality Commission (CQC) 

essential standards and those of related agencies; maintain 

compliance with Monitor’s financial and governance 

requirements; comply with legislation relating to fire, 

carbon reduction, equalities; achieve national requirements 

for service delivery, teaching and research. 

In addition, a must-do for us was to fulfil the requirements 

of our 2012 Olympic and Paralympic Games contract. 

Aspire to do: 

We aspire to do the following because we 

believe they are important to our future and we 

will focus time and energy on them. 

i. Quality and safe for patients 

To provide the public with confidence that Homerton 

is a very safe hospital by maintaining hospital mortality 

markers at a level which demonstrate this to be the 

case and to provide evidence that all of our services 

have the hallmarks of quality and safety. 

ii. 

Expanding the organisation 

To grow the organisation, moving from £230 to £300 

million turnover, through a planned and strategic 

approach to increasing referrals and establishing new 

services, so that we are confident we are the right size 

for the future. 

iii. Community/hospital integration 

To be an exemplar organisation for community health 

and hospital services integration by fulfilling our 

integration programme and associated informatics 

and premises plans. This will support us to retain the 

contract for the provision of community services for 

Hackney and the City beyond 2015. 

iv. Short waits 

To be a ‘short-wait’ organisation, with all patients 

being offered an appointment for a consultation or 

investigation within four weeks. Patients for urgent 

consultations will continue to wait no more than 

two weeks and those presenting to the emergency 

department attended to within four hours. 

v. Communications with patients, GPs and professionals 

To be exemplary in our engagement with the 

patient, GP and key professionals in relation to every 

interaction with our services; ensuring consultation and 

investigation reports are conveyed to patient, GP and 

professionals within five working days; and summaries 

from inpatient stays and emergency attendances 

shared within 24 hours. 

vi. Preparing and supporting our staff 

To prepare staff for Homerton of the future by ensuring 

everyone is clear on their contribution to making 

this organisation and their service better, through 

programmes which develop service line management, 

clinical leaders and the ability of staff to achieve the 

Trust’s goals. 

Performance against corporate objectives 


During the course of 2012/13 we have recorded a number 

of achievements: 

1. Further developed fully integrated services between the 

hospital and community health services. 

2. Through our Quality Account demonstrated that 

patient safety and quality of care were at the forefront 

of our work. 

3. Through a total of four routine CQC inspections 

demonstrated safe and effective care for our patients. 

4. Improved patient experience through our ‘Welcome 

2012’ programme. 

5. Achieved our financial targets without compromise to 

quality standards, allowing us to invest further in our 

buildings, equipment and services. 

6. Sustained performance against all measures. 

ANNUAL REPORT 2011/12 2012/13 13

7. Grew and developed services in response to 

commissioner and patient choice, and using the 

opportunities provided by integration with community 

services. 

8. Received Department of Health recognition for the 

partnership work between health visitors and Hackney 

Learning Trust in developing a model for two year 

review for all children in Hackney and the City. 

9. New buildings or redevelopments for our endoscopy, 

elderly care, operating theatres, and sickle cell services 

were all completed. The new Department of Sexual 

Health is in development. 

10. We were in the top 20% in the country for staff feeling 

satisfied with the quality of work and patient care they 

are able to deliver. 

11. Introduced state of the art equipment into our 

neonatal intensive care, imaging and fertility units. 

12. We successfully fulfilled our contractual requirements 

as a designated hospital for the London 2012 Olympic 

and Paralympic Games which took place on our 

doorstep. 

We may not have achieved everything we set out to do 

but our year has been a successful one. We did not get 

everything right, every time, for every patient and client, 

and this we must continue to strive to do. We do know 

that overall our hospital and community services worked 

well, providing safe, effective, thoughtful care for those in 

need. 

Corporate objectives 2013/14 

Our corporate objectives for 2013/14 and beyond are 

designed to guide staff, services and departments in setting 

their work programme for the year. These objectives follow 

on from the work programme identified for 2012/13. 

i. Maintain and improve on legislative and regulatory 

requirements 

We exist to provide safe, caring and effective health 

care. In order to be allowed to continue to do this we 

must meet legislative and regulatory requirements. 

Departments need to understand what specifically 

this means for them, but to some extent it can be 

encapsulated as follows: maintain compliance with 

CQC essential standards and those of related agencies; 

maintain compliance with Monitor’s financial and 

governance requirements; comply with legislation 

relating to fire, carbon reduction, equalities etc; 

implement the applicable recommendations following 

the publication of the Francis Report; achieve national 

requirements for service, teaching and research. 

ii. Quality service provision and safe for patients 

To provide the public with confidence that Homerton 

is a very safe hospital by maintaining Hospital Mortality 

markers at a level which demonstrate this to be the 

case, and to provide evidence that all of our services 

have the hallmarks of quality and safety. 

iii. Expanding the organisation 

To grow the organisation, moving from £255 to £300 

million turnover, through a planned and strategic 

approach to increasing referrals and establishing new 

services, so that we are confident we are the right size 

for the future. 

iv. Community/hospital integration 

To be an exemplar organisation for community health 

and hospital services integration, by fulfilling our 

integration programme and associated informatics and 

premises plans. 

v. Communications and engagement with patients, GPs, 

commissioners and professionals 

To be exemplary in our engagement with the patient, 

GP and key professionals in relation to every interaction 

with our services; communicate with patients, carers 

and the public about the Trust services; be transparent 

and open in presenting service information, data 

and feedback; build on our relationships with 

commissioners, stakeholders and influencing bodies. 

vi. Staff and organisational development 

To prepare staff for Homerton of the future by ensuring 

everyone is clear on their contribution to making 

this organisation and their service better, through 

programmes which develop service line management, 

clinical leaders and the ability of staff to achieve the 

Trust’s goals. 

Principal risks and uncertainties facing the Trust 

All of the principal risks identified by the Trust are 

monitored regularly through standing reports to the Risk 

Committee and Trust Board. 

Key risks identified include the following: 

• risks associated with the condition of community 

health service buildings posing a risk to the ability 

to deliver clinical services and meeting regulatory 

compliance in these locations (in-year risk) 

• Clostridium difficile - potential breach of DH target of 

no more than seven cases in 2012/13 (in-year risk) 


QUALITY ACCOUNT 

• MRSA Bacteraemia - breach of DH target of no more 

than one MRSA bacteraemia in 2012/13 and monitor 

target of six (in-year risk) 

• risks to Trust business associated with the health 

economy reconfiguration in north east London (in-year) 

• risks to Trust business associated with commissioner-led 

actions (both in-year and future risk) 

• risks associated with the Olympic travel change 

impacting on access to the Trust (in-year risk) 

• risk to organisational continuity due to senior 

management changes (in-year risk). 

The Trust has plans in place to mitigate the above risks 

which were monitored by the Risk Committee and Trust 

Board. 

The Trust’s risk registers and governance processes are 

designed to assess the impact of identified risks on the 

Trust’s plans, and ensure that they are appropriately 

mitigated or managed. 

The Board of Directors has reviewed the risks that may 

prevent the Trust from achieving its objectives, complying 

with its Terms of Authorisation and achieving the operating 

and financial plan over the review period. 

Homerton’s Olympic Games 

Homerton was one of the hospitals funded and 

designated to provide medical care throughout 

the Olympic and Paralympic Games. Homerton 

Medical Director John Coakley looks back on what 

happened: 

Homerton was one of several hospitals designated to 

care for people at the Games but our specific role was 

to care for members of the ‘Olympic Family’ - properly 

accredited team athletes, trainers and officials. 

We were on Games alert from Monday July 9 – two 

and a half weeks before the opening ceremony - to 

Wednesday September 12, three days after the closing 

of the Paralympics. 

Throughout the period we had three senior managers 

designated as Hospital Olympics and Paralympics Liaison 

Officers (HOPLOs). This small senior team maintained 

close links with the Olympic Park Polyclinic and worked 

closely alongside our normal hospital site management 

team. By running a ‘dual’ team we ensured that 

Olympic-related activity had no effect on the day-to-day 

running of the hospital. 

All patients referred from the Olympic Park Polyclinic 

came to our emergency department. This ensured 

that athletes and team officials were seen quickly on 

arrival and were managed in a designated area of the 

department. 

A resuscitation bay was used if a patient required 

urgent medical attention or intervention and a 

discrete examination room was made available for 

less ill patients. Patients who required admission were 

managed on our 2012 ward accorded to athletes and 

team officials. 

Where possible, we aimed to ensure that patients could 

return to the ‘field of play’ as quickly as possible. 

The work generated by the Games was actually greater 

than originally planned, but we are pleased to say that 

we coped with the demand and the range of clinical 

activity without it impacting on day to day services to 

our local patients. Everything worked well. 

During the Olympics and Paralympics, we treated 71 

accredited patients from 43 nations. 

Other accredited personnel, including members of 

the world’s media, were also seen in the Homerton 

Emergency Department on a ‘non-fast track’ basis. The 

total number seen over the games time period was 87 

over and above the accredited individuals. 

Overall providing cover for the Games was a positive 

experience for us, and the hospital staff coped well with 

the additional work. Feedback from ‘Olympic Family’ 

members was extremely positive. 

Homerton 

2012 hospital 


Review of financial performance 

The Trust achieved an Income & Expenditure (I&E) surplus 

of £3.8m for the financial year 2012/13 (before an 

impairment loss of £3.5m), which exceeds the planned 

for surplus of £2.6m. The main source of income for the 

Trust is contracts with commissioners in respect of health 

care services, the Trust’s main commissioner being City and 

Hackney Primary Care Trust. 

The impairment to our tangible fixed asset value was due 

to a reduction in market value of the Trust estate. It should 

be noted that the impairment does not have any impact 

on our financial risk rating, and is excluded from the I&E 

figures shown below. 

A comparison of planned and actual performance is shown 

in the table below. 

Income 


Plan £m 


Actual £m 


Variance £m 

Clinical contracts 212.4 221.4 9.0 

Other income 27.9 34.2 6.3 

Total income 240.3 255.6 15.3 

Expenses 

Pay (161.7) (167.4) (5.7) 

Non pay (66.6) (75.4) (8.8) 

Total expenses (228.3) (242.8) (14.5) 

EBITDA* 12.0 12.8 0.8 

Depreciation and 

amortisation 

(6.2) (5.7) 0.5 

PDC dividends (3.4) (3.2) 0.2 

Net interest 0.2 (0.1) (0.3) 

Net surplus 

before 

Impairment 

2.6 3.8 1.2 

*Earnings Before Interest, Tax, Depreciation and Amortisation. 

The I&E surplus was achieved with additional income 

generated from higher than expected levels of day case, 

elective and outpatient activity. Activity and income for our 

neonatal and special care baby unit also exceeded plans. 

Income from non-patient activity was also above plan for 

education and training and for services provided to other 

organisations. Expenditure was above planned levels mainly 

due to the costs of delivering increased activity. 

The Trust achieved £9.2m of savings during the year as part 

of its Quality, Innovation, Productivity and Prevention (QIPP) 

agenda. Projects included staffing and skill mix reviews, 

more efficient use of our capacity and procurement 

initiatives to secure better prices and contractual terms from 

suppliers. 

The Trust’s liquidity position remained strong, partly 

due to ongoing slippage in the capital programme and 

also achieving a greater than planned surplus. Capital 

expenditure totalled approximately £9.2m, including: 

£3.1m on medical equipment; £2.1m related to the 

expansion of the endoscopy suite, and £1.3m on an 

additional theatre. The cash balance held by the Trust at the 

end of the financial year was £29.6m. 

The Trust achieved a financial risk rating score of 4 from 

Monitor which was better than planned. 

The Trust strives to pay all suppliers in line with the agreed 

terms for each supplier but in any event no later than 30 

days from receipt of goods or services or the invoice date if 

later. During the financial year to 31 March 2013 the Trust 

paid 89% of all non-NHS suppliers, by volume, within 30 

days. 

The Trust remains in a relatively strong financial position 

having achieved or exceeded its planned level of surplus in 

recent years. We are also projecting surpluses in each of 

the next three years. 

As a result of these surpluses, careful planning, and a 

degree of slippage in the capital programme, the Trust has 

accumulated significant cash resources. We also have a 

working capital facility of £10m. 

The Trust’s treasury management strategy is routinely 

reviewed by the Finance and Performance Committee, 

a subcommittee of the Board. The Committee has not 

identified any immediate liquidity concerns. We are 

confident that we have sufficient funds to remain as a 

going concern – that is for at least the next 12 months. 

The Trust has complied with the cost allocation and 

charging requirements set out in HM Treasury and Office of 

Public Sector Information guidance. Accounting policies for 

pensions are set out in note 1.4 to the accounts and details 

of senior employees’ remuneration can be found on page 

130 of the Annual Accounts. 



Declaration on health care income 

Section 43(2A) of the NHS Act 2006 (as amended by the 

Health and Social Care Act 2012) requires that the income 

from the provision of goods and services for the purposes 

of the health service in England must be greater than its 

income from the provision of goods and services for any 

other purposes. The Trust complies with this requirement as 

can be seen in the following table: 

£’000 

Health care income 253,722 

Non-health care income 1,804 

Income outside of scope 49 

Total income 255,575 

The Trust has included within “health care income”: all 

income from contracts for patient services; all income 

for the supply of health workers to other bodies, and all 

income for the use of the Trust’s buildings and facilities 

where it is from another NHS body engaged in the 

provision of health care. 

The Trust has included within “non-health care income”: 

income from private patients; rental income from nonhealth 

care bodies; income from overseas visitors; 

income from the provision of a nursery facility, and other 

miscellaneous non-health care related income. 

“Income outside of scope” is a donation offsetting the 

costs of an outreach worker. 

Counter fraud policies and procedures 

The Trust has a counter fraud policy for dealing with 

suspected fraud and corruption, and other illegal acts 

involving dishonesty or damage to property. Staff can 

contact nominated officers in confidence if they suspect a 

fraudulent act. The nominated officers are the Director of 

Finance and our local counter fraud specialist, RSM Tenon 

(until 31 March 2013) and Parkhill (from 1 April 2013). 

Regulatory ratings 

In line with Monitor’s Compliance Framework each 

foundation trust must submit an annual plan including 

detailed financial forecasts for the three years ahead by the 

end of May each financial year. 

Monitor use the information in the plan submitted by 

foundation trusts to evaluate the risk of failure to comply 

with the Trust’s Terms of Authorisation and to assign risk 

ratings covering financial and governance. 

Explanation of ratings 

Financial risk rating—when assessing financial risk, Monitor 

assigns a financial risk rating using a scorecard comparing 

key financial metrics on a consistent basis across all NHS 

foundation trusts. 

The risk rating is intended to reflect the likelihood of a 

significant breach of the Terms of Authorisation. 

The financial indicators used to derive the financial 

risk rating incorporate individual metrics comprising 

achievement of plan; underlying performance; financial 

activity and liquidity which are each rated 1 (high risk) to 5 

(low risk). 

Governance risk rating—Monitor’s assessment of 

governance risk is based predominantly on NHS foundation 

trusts’ plans for ensuring compliance with their Terms of 

Authorisation but will also reflect historic performance 

where this may be indicative of future risk. 

Monitor considers the following elements when assessing 

the governance risk rating—legality of constitution; 

growing a representative membership; appropriate 

board roles and structures; service performance; clinical 

quality and patient safety; effective risk and performance 

management; cooperation with NHS bodies and local 

authorities; and the provision of mandatory services. 

Monitor rates governance risk using a graduated system 

of green, amber/green, amber/red and red, where green 

indicates low risk and red indicates high risk. 

Performance is reviewed in-year by Monitor. The nature and 

frequency of their review is based on each trust’s risk scores, 


with those foundation trusts rated at a higher level of risk 

required to report more often and in greater detail. 

Summary of performance 

The tables below show Homerton’s risk rating scores for 

2011/12 and 2012/13. 

2011/12 Annual 

Plan 

Financial risk 

rating 

Governance 

risk rating 

Q1 Q2 Q3 Q4 

3 4 4 4 4 

Green Green Green Green Amber/ 

Green 

Review of non-financial performance 

Patient activity 

In 2012/13, the Trust has continued to experience an 

increase in demand for its clinical services. The table below 

provides a summary of observed activity levels against the 

agreed contractual baselines. 

Category 2011/12 

activity 

A&E attendances 

(including PUCC) 


plan 


activity 

% 

above/ 

below 

plan 

111,533 110,481 119,867 8.5% 

2012/13 Annual 

Plan 

Financial risk 

rating 

Governance 

risk rating 

Q1 Q2 Q3 Q4 

3 4 4 4 4 

Green Green Green Amber/ 

Green 

Amber/ 

Green 

Financial risk rating 

For 2012/13 the planned financial risk rating of 3 was 

exceeded with all key financial targets met. 

Governance risk rating 

In the first two quarters 2012/13 the Trust was rated 

“green” for governance risk. The “amber/green” rating 

for Homerton in Q3 and Q4 2012/13 was due to the Trust 

exceeding the Trust national mandated target and the 

Monitor de-minimus target of 12 cases of hospital acquired 

C.difficile infection. 

Hospital (acute) 

non-elective 

spells (including 

deliveries) 

Hospital outpatient 

attendances 

Hospital (acute) 

Elective spells 

Adult community 

services – 

attendances and 

contacts* 

Children’s 

community services 

– attendances and 

contacts* 

Adult critical care 

and rehabilitation – 

occupied bed days 

Neonatal critical 

care – occupied 

bed days 

Direct access 

diagnostics 

(radiology, 

pathology, cardiac) 

UNIT – tests 

Other (inc. fertility, 

regular attenders, 

therapies and 

podiatry) – 

attendances 

30,912 30,297 33,086 9.2% 

258,498 258,665 272,320 5.3% 

18,047 18,019 18,491 2.6% 

315,496 287,972 277,145 -3.8% 

287,416 239,831 239,796 0% 

26,189 28,040 29,361 4.7% 

13,960 13,860 13,992 1.0% 

902,833 908,768 955,312 5.1% 

14,522 14,432 16,212 12.3% 

* The Trust is continuing to review the way in which community 

activity is defined and recorded 



Non-elective activity 

Emergency services have experienced a significant level of 

increased demand in 2012/13. Attendances to the Trust’s 

emergency department and primary and urgent care centre 

have exceeded the contract plan by 8.5%, which has been 

a significant factor in the increased level of non-elective 

admissions. 

With regard to emergency department attendances, the 

observed growth in 2012/13 compared to the previous year 

was 4.3% and for attendances to the primary and urgent 

care centre the observed growth was 15.3%. The increased 

activity is for both City & Hackney and out of borough 

patients. 

Increases against the contractual plan in non-elective 

activity occurred in both adult medical specialties (21.5%) 

and paediatric medical specialties (16.3%), whereas 

non-elective surgical admissions (5.6%) and gynaecology 

admissions (-19%) were under plan in 2012/13. 

Maternity activity 

In 2012/13, activity relating to deliveries has exceeded the 

contract plan by 5.3%. However, a significant factor in this 

is related to the Trust’s maternity services having expanded 

to reflect the wider population it now serves as a result of 

a north east London reconfiguration of maternity services. 

The reconfiguration has resulted in Homerton being the 

primary provider for an increased number of Waltham 

Forest GP practices. The Trust also experienced a small 

increase in City & Hackney deliveries against plan (1.8%). 

Planned care activity 

The Trust has experienced significant (+5% or more) 

activity over and above its contractual plan for outpatient 

first attendances in 2012/13 in the following specialties 

(excluding maternity): 

• gastroenterology 

• cardiology 

• neurology 

• rheumatology 

• general surgery 

• genito-urinary medicine (walk-in service) 

However, outpatient first attendance activity has been 

significantly (-5% or more) under plan in the following 

specialties: 

• paediatric dermatology 

• paediatric ENT 

• general medicine 

• ophthalmology 

• oral & maxillofacial surgery 

• diabetic medicine 

Day case activity was 2.5% above the contractual plan in 

2012/13. Activity in general surgery and gastroenterology 

are the main contributing specialties to this with growth of 

over 25%. The increased activity predominantly relates to 

diagnostic endoscopy activity. 

Activity in urology has significantly reduced; however, this 

is as a result of activity being undertaken in an outpatient 

setting in line with best practice. The contracted activity 

level was not met in some other surgical specialties 

including trauma & orthopaedics, ear, nose and throat 

surgery, and oral & maxillofacial surgery. 

Similar to day case activity, elective activity was also above 

plan, and in the high volume specialties, the plan was 

exceeded in general surgery (14.1%) and trauma and 

orthopaedics (31.7%), but under plan in gynaecology 

(-9.4%). 

Community services 

As a result of increased demand, capacity has been 

increased in some such as the vision clinic within 

community paediatrics and children’s physiotherapy, 

resulting in activity exceeding the plan. The school nursing 

team has increased the number of non-face to face 

contacts to clients/parents to discuss immunisations. 

As a result of the increased maternity activity, the newborn 

hearing screening service experienced an increase in activity 

over what was originally planned. The community advocacy 

service also saw an increase in demand from community 

services and primary care reflecting the diverse population it 

serves and its language needs. 

Adult critical care and rehabilitation 

Activity in 2012/13 has exceeded the contractual plan in 

both critical care and general rehabilitation. Contributing 

factors to this are the increase in non-elective admissions 

in general as well an increase in non-elective admissions in 

geriatric medicine. 

The activity in neuro-rehabilitation was as planned, 

although stroke rehabilitation activity was 8.3% under 

plan despite the new Haringey stroke rehabilitation service 

exceeding plan by 14.6%. However, the number of stroke 

patients admitted (excluding Haringey) was also less than 

planned. 


Neonatal critical care 

Although the overall activity in neonatal critical care was 

only slightly above plan (1%), there were significant 

variances against the plan by level of care. Special care 

activity was less than planned, as was intensive care activity; 

however, high dependency care exceeded by a third. 

Direct access diagnostics 

As in previous years, 2012/13 saw the demand for a 

number of direct services exceed the plan. Direct access 

radiology activity – plain x-ray and non-obstetric ultrasound 

– was 15.7% above plan while demand for direct access 

pathology services exceeded plan by 4.8%. 

Our operational performance 

The Trust performed strongly in 2012/13. Our average 

waiting time for an outpatient appointment was 6.7 weeks. 

Our average wait for elective or day surgery was 11.1 

weeks. 

The following table sets out performance against certain 

key targets on a cumulative basis for the year as a whole 

although we, as with all foundation trusts, are required 

to report to Monitor on a range of measures in-year on a 

quarterly basis. Further information on performance against 

quality standards is included in the Quality Account. 

Key Performance Indicators 


Target 


Performance 

A&E patients discharged < 4hrs 95% 96.6% 

Cancer waiting list 2011/12 

2 Week Wait 93% 95.7% 

31 Day Target 96% 100% 

62 Day Target 85% 89.3% 

Infection control 

MRSA 1 2 

Clostridium difficile (C.diff) 7 13 

18 Week RTT indicator 

Admitted (95th percentile) 90% 95.4% 

Non Admitted (95th percentile) 95% 99.9% 

Incomplete 92% 98.4% 

The Trust was set challenging targets with regard to MRSA 

and C.difficile infection (CDI). This year our target, not to be 

exceeded for MRSA bacteraemias, was one case. For CDI 

the target, not be exceeded was seven cases. 

We had two patients develop MRSA bacteraemia this year 

and we had a total of 13 patients developing a CDI. 

The infection control team continues to work together with 

staff and patients to reduce the risk of further cases. Further 

details regarding the actions being taken to minimise 

hospital acquired infections is detailed in our Quality 

Account. 

Patient care 

The Trust’s Patient Experience Strategy, launched in 

September 2011, offers a clear structure to ensure patients, 

users, the membership and staff are involved in planning 

improvements and giving their views regarding the quality 

of services provided by the Trust. 

The strategy was developed following a large listening 

exercise whereby the views of patients, users, members, 

staff and Governors were sought. It combines the 

previous Patient and Public Engagement Strategy and the 

Membership Strategy into one simple framework. 

Detail regarding the quality of patient care and patient 

satisfaction is included in the Trust Quality Account. 

Complaints 

There have been slightly fewer formal complaints from 

patients in 2012/13 than in the previous year; the Trust 

received 239 complaints in 2012/13 compared to 253 

received in 2011/12. Figure 1 shows comparisons with 

previous years. 

By the end of March 73% of these complaints had been 

completed within 25 days. 

Five complaints were referred to the Ombudsman. One of 

the complaints referred was rejected; the remaining four 

are currently under review. 

A total of 94 (39%) complaints were upheld. 

Figure 1: Total formal complaints April 2010 – March 2013 by 

month 

35 

30 

25 

20 

15 

10 

5 

0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 

2010 2011 2012 



The complaints that patients raised were about the 

following aspects of care: 

Complaints 2012/13 by areas of concern 

All aspects of clinical treatment 112 

Attitude of staff 34 

Communication/information to patients 

(written and oral) 26 

Appointments, delay/cancellation 

(outpatient) 12 

Admissions, discharge and transfer 

arrangements 11 

Patients' privacy and dignity 10 

Transport (ambulances and other) 10 

Failure to follow agreed procedure 8 

Others 16 

Total: 239 

They were distributed over the following service areas 

Complaints 2012/13 by area 

Outpatient 112 

Inpatient 73 

Accident and emergency 30 

Maternity 18 

Elderly (geriatric) 3 

Other community health 3 

Total: 239 

Changes to practice have been made as a result of some 

complaints for example: 

• Changes have been made in literature available to 

patients and education of staff, to ensure there is 

consistency in changing anticoagulation medication 

prior to surgery. 

• Education of staff has been carried out, which is being 

supported by guidelines (in production) to ensure 

that any concerns regarding a baby and their ability 

to breast feed are detected quickly after birth so that 

appropriate action can be taken. 

• Following several complaints relating to the time 

patients have had to wait for transport services, it was 

discussed with the company Medical Services that the 

length of delays was unacceptable. Four extra drivers 

have been employed to collect patients attending 

Homerton, St. Leonard’s and the community. The 

monitoring of the contract with Medical Services has 

also been reviewed. 

• Following complaints about care on the elderly care 

unit, a review took place and changes were made to 

the nursing structure which revised the senior support 

arrangements. 

Working with staff 

The number of people directly employed by Homerton 

grew from 3,354 (3,078 wte) in 2011/12 to 3,522 in 

2012/13 (3,222 wte) (data as at year end). Excluded from 

these numbers are pre and postgraduate health care 

practitioners who were placed with us for training, and 

catering and domestic personnel provided under contract. 

In the national staff survey for 2011/12 and 2012/13 we 

remained in the top 20% for ‘recommending the Trust as a 

place to work and receive treatment’. 

Staff performance and support 

Performance against workforce indicators overall remains 

consistent, with the Board and the service managers 

receiving monthly performance information. The 

establishment has grown by 5% in the last year while 

vacancy levels have fallen by 2.6%, thereby indicating 

increased recruitment activity. There have been 510 new 

starters over the last 12 months. 

There has been a small increase of 0.2% in average 

sickness absence rates in the last year from 3.5% to 

3.7%. The Trust is reviewing its policies and procedures for 

managing sickness absence and has set up a new 24 hour 

counselling service (Care First), alongside existing onsite 

occupational health services. In addition, the Trust will 

implement a targeted plan to reduce sickness absence by 

0.5% over 2013/14. 

The Trust’s staff influenza vaccination campaign resulted in 

1,195 staff vaccinated, including 39.6% of frontline staff, 

putting the trust in the top 10 performing acute trusts in 

London. 

The Homerton Health Works initiative continues, offering 

exercise and lifestyle improvement activities for staff. Other 

staff benefits include child care support, social events and 

staff discounts. 


Staff involvement and engagement 

We have established mechanisms to ensure the 

involvement of staff and staff representatives in the 

planning and development of services. A ‘Team Brief’ 

system operates which cascades key messages across the 

Trust on a monthly basis. This is complemented by a staff 

newsletter, Homerton Life, and item specific briefings. Pay 

slip attachments (or personal letters) are also used where 

assurance is required that 100% of staff have received 

information on a specific matter. For example, Homerton 

will implement the Workplace Pensions and Autoenrolment 

legislation from 1 July 2013 and information has 

been disseminated to all staff on eligibility and the process. 

The Joint Staff Consultative Committee and the Local 

Negotiating Committee (for doctors) are well established. 

All elected Staff Governor positions are filled and their 

participation in Council of Governors meetings supported. 

Staff survey 

The Trust’s staff survey response rate for 2012/13 has 

increased from 42% to 45%. 

In the ‘staff engagement’ category we continued to be 

in the highest 20% for the country, we were one of the 

highest 20% in ‘staff recommend’ Homerton as place to 

work and as a place to be treated’ and ‘staff motivation to 

work’. Strong performance was shown in ‘staff ability to 

contribute towards improvements at work’. These continue 

to be encouraging results. 

There are areas where improvements need to be made. 

Our action plan will include a focus on the bottom ranked 

scores set out below and we will seek to simplify appraisal 

documentation and increase completion rates. We must 

ensure our staff feel safe and we will look at how we can 

reduce instances of staff reporting abuse, bullying and 

discrimination from patients and, in some instances, other 

staff. 

2011/12 2012/13 

Trust Nat. Ave Trust Nat. Ave 

Change 

Staff survey response rate 

42% 53% 45% 46% + 3% 

Top 4 ranking scores 



Change 

Work pressure felt by staff (lower the score the better) 2.95 3.12 2.74* 3.08* -0.21 

Percentage of staff feeling satisfied with the quality of work 

and patient care they are able to deliver (higher the score the 

better) 85% 74% 89% 78% +4% 

Percentage of staff reporting good communication between 

senior management and staff (higher the score the better) 38% 26% 43% 27% +5% 

Percentage of staff agreeing that their role makes a difference 

to patients (higher the score the better) 92% 90% 95% 89% +3% 

*Scale summary score 


Bottom 4 ranking scores 


Change 

Percentage of staff appraised in last 12 months (higher the 

score the better) 74% 81% 70% 84% -4% 

Percentage of staff experiencing discrimination at work in last 

12 months (lower the score the better) 19% 13% 18% 11% -1% 

Percentage of staff saying hand washing materials are always 

available (higher the score the better) 53% 66% 47% 60% -6% 

Percentage of staff experiencing harassment, bullying or abuse 

from patients, relatives or the public in last 12 months (lower 

the score the better) 20% 15% 34% 30% +14% 



Education and related activities 

Work-streams have been put in place within the Learning 

and Development department during 2012 / 13 to deliver 

on the following key areas of activity. 

Statutory and mandatory training 

The Trust produced a Statutory and Mandatory Training 

booklet. This was distributed to circa 4,225 staff (all 

employed staff and bank staff) using data provided from 

the Electronic Staff Record (ESR). 

Corporate induction 

The Corporate Induction Programme has been redesigned 

and will be implemented during 2013 to ensure a higher 

compliance with the CQC and (National Health Service 

Litigation Authority) NHSLA standards. 

Welcome 2012 

The Welcome 2012 project was launched to improve the 

perception patients and visitors had of the Trust and ensure 

that all staff are making every contact count towards 

developing a loyalty to the Trust from patients, visitors, 

stakeholders and staff. 

The Trust utilised its NHS London Joint Investment Funding 

to commission Lambeth Career College to deliver an Edexel 

Btec Level 2 Award in Customer Service. The training is 

being delivered six hours a week over a four week period 

and comprises: 

Unit 1: Understanding good customer service. 

Unit 2: Delivering good customer service. 

Unit 3: Planning for self-development in customer service. 

Apprenticeships 

NHS London announced an initiative during July 2012 

for up to £1 million to embed apprentices in workforce 

development and share good practice within the NHS in 

London during the 2012/13 financial year. 

Homerton was successful with two NHS London bids 

equating to £153,700 or 15.4% of the available funding. A 

project group was established to recruit circa 10 health care 

assistant apprentices and 10 estates apprentices. After a 

rigorous sector work based academy selection process that 

saw 310 applicants apply for the estates apprenticeships, 

10 apprentices commenced in the Trust on the 18 March 

2013. 

University Technology College 

The Trust has engaged with the first University Technical 

College (UTC) in London that is based in Hackney. The 

UTC offers 14 - 19 year old students a specialist course of 

study designed in partnership with employers, skills sector 

agencies and universities. The UTC specialises in health and 

digital technologies, giving today’s young people the skills 

they need to succeed in tomorrow’s workplace. 

Learning and development provision for 2013 

A Learning and Development scheme of work identifying 

the programmes to be provided across the Trust in 2013/14 

has been created. We have adopted a blended approach to 

train, making use of the Trust’s intranet. 

NHSLA inspection 

The Trust Learning and Development Department worked 

with colleagues to produce solutions that assisted with 

the Trust achieving level 2 compliance with the NHSLA 

standards. 

Nurse and midwifery education 

Our leadership development programmes have proved 

very popular with staff. One tailored to community staff 

was satisfactorily delivered. Work based projects were 

completed and presented to managers and senior staff. 

A similar programme is now underway for midwives and 

acute care staff. 

In conjunction with City University, we had our annual 

Nursing and Midwifery Council (NMC) monitoring 

evaluation in December 2012. The review process 

encompassed midwifery, nurse prescribing and specialist 

community public health nursing. 

We have received 5/5 ‘good’ in evaluations during this 

monitoring. The reviewers were impressed with the 

following: 

• The dedication and high standard of student support 

offered by practice teachers. 

• Strong partnership working between Trusts and City 

University London. 

• The high standard of practice teacher registers and 

triennial reviews. 

• Diversity and strengths of the east London learning 

environment; and the robust student learning 

experience. 

• Good systems in place for practice teacher to student 

allocation - i.e. we are meeting NMC guidelines. 

Our nursing and midwifery led research project ‘Raising 

the Roof’ is now in its second year. We continue to focus 

on nurses and midwives and expanding to allied health 

professions leading on research and remaining patient 

focused and person centered. The research support is based 

on advancing practice that embraces four components: 

Research and publication support; Doctoral study; masters 

in research and research seminars; and workshops. 


This year we have six nurses at various stages of their 

doctorate programmes researching on obesity, respiratory, 

stroke, nursing education, adult and child safeguarding. 

There have been several presentations at national and 

international conferences and articles published raising the 

profile of Homerton in research. 

We developed a bespoke access to nursing degree 

programme in conjunction with Hackney College for 

13 nursing assistants who enrolled in it over two years. 

It prepares the candidates to undertake nurse training 

at degree level. We also ensure that all our nursing and 

midwifery assistants are competent by ensuring that they 

attend essential skills training course and complete a 

competency booklet. 

Newly qualified staff continue to undergo preceptorship for 

the first six months of joining us to ensure that they learn 

the Homerton way of delivering quality patient care. 

Our adult wards have the same method of assessing, 

planning and implementing care given to patients 

through the priorities of care nursing model developed 

at Homerton. Nursing documentation audits continue to 

demonstrate improvement and consistency for integrated 

reporting. 

Medical education 

In 2012/13 the Trust continued to demonstrate its 

commitment to the delivery of undergraduate and 

postgraduate education. The annual inspections 

undertaken by Bart’s and The London School of Medicine 

and Dentistry, North East Thames Foundation School and 

the London Deanery were all positive. 

The Simulation Centre won awards for its work in 2012 

and continued to bring in income in excess of £100,000 

to the Trust. This has been used to enhance and improve 

facilities as well as expand our growing portfolio of 

educational opportunities. The work of the Centre was 

presented at international level in May 2013. The Trust 

hosted its second annual Simulation Conference in 

December 2012. The Newcomb Library won a prize for 

increasing usage of resources by medical students and 

an award for good practice in marketing. Key resource 

initiatives include the move from print to e-journals and 

provision of diagnostic decision-making tools UpToDate and 

BMJ Best Practice. 

The Trust continues to see a good number of medical 

students who have undertaken placements at the Trust 

choosing to return to Homerton for foundation programme 

or specialty training. A number of our recent consultant 

appointments have been doctors who undertook training 

posts at Homerton. 

Research and development 

Homerton actively participated in several National Institute 

for Health Research (NIHR) Portfolio and non NIHR Portfolio 

studies during 2012/13. A total of 2,110 patients were 

recruited to NIHR portfolio studies between 1 April 2012 

and 31 March 2013. Several more patients were recruited 

to non NIHR portfolio studies during the same period. 

Involvement in clinical research demonstrates the Trust’s 

commitment to improving the quality of care we offer and 

to making our contribution to wider health improvement. A 

total of 80 clinical staff, across 24 medical specialties were 

Principal Investigators of 173 research projects approved by 

a research ethics committee during the period April 2012 to 

the end of March 2013. 

The Trust is part of the Harmonising Permission for 

Research Pilot Project which was launched at the end of 

October 2012. The project aims to support the ambitions 

of the Department of Health and Commercial research 

partners by providing a streamlined approach to obtaining 

NHS permission. It is based upon the concept of one 

review, one costing; one contract and one study set up 

fee for all commercial research projects that are going 

to be conducted within the Central and East London 

Comprehensive Local Research Network. 

A neonatal consultant was awarded an NIHR Research 

for Patient Benefit (RfPB) grant for £31,358 to study the 

management of hypotension in preterm infants. This is the 

first NIHR grant award registered at Homerton. 

In the last year 129 publications have resulted from our 

involvement in research, which shows our commitment and 

desire to improve patient outcomes and experience across 

the NHS. 

Equality and diversity 

The Board Executive lead for equality and diversity is the 

Chief Nurse & Director of Governance. The Equalities 

Report 2012 and our Equality Objectives are available from 

our website at www.homerton.nhs.uk. All publication 

duties have been met. 

We chose our equality objectives by considering evidence 

from patient and public feedback, complaints and Patient 

Advocacy and Liaison Service (PALS) enquiries, as well as the 

results of the national staff and patient surveys. 



Our objectives are to: 

• to establish a Governor-led equality and diversity group 

in order to lead and champion our programme of work 

related to equality and diversity 

• to foster an organisation which understands the 

cultural needs of our patients and staff through a series 

of activities including a cultural awareness campaign 

• to build on our work to ensure the needs of patients 

with learning disabilities are met when receiving 

healthcare by promoting the MENCAP ‘Getting it Right 

Charter’ for learning disabilities 

• to participate in the MIND / Rethink mental illness 

‘time to change’ campaign to tackle stigma and 

discrimination by changing attitudes and behaviour 

towards mental health problems. 

Summary of Trust workforce and Foundation Trust membership diversity data (2011/12 & 2012/13 staff data taken from the Trust’s Equality 

and Diversity Report as at 30th Sept 2011 & 30th Sept 2012 respectively) 

Staff Membership 

2011/12 % 2012/13 % 2011/12 % 2012/13 % 

Age Age 

16-25 230 7 228 7 17-21 72 1 65 1 

26-35 1041 31 1062 32 22-29 420 6 386 5 

36-45 904 27 895 27 30-39 735 11 773 11 

46-55 774 23 779 23 40-49 717 11 744 10 

56-65 337 10 342 10 50-59 511 7 561 8 

66+ 31 1 33 1 60-74 481 7 552 8 

75+ 185 3 203 3 

Not stated Not stated 3,698 54 3,979 55 

Total 3,317 3,339 Total 6,819 7,263 

Ethnicity Ethnicity 

White 1,488 45 1,496 45 White 2,256 33 2,290 32 

Mixed 74 2 86 3 Mixed 198 3 202 3 

Asian or Asian 

British 495 15 477 14 

Black or Black 

British 1,055 32 1,062 32 

Asian or Asian 

British 560 8 578 8 

Black or Black 

British 1,198 17 1,237 17 

Other specified 107 3 95 3 Other specified 233 4 244 3 

Not stated 93 3 94 3 Not stated 2,374 34 2,712 37 

Undefined 5 0.1 - - 

Total 3,317 3,339 Total 6,819 7,263 

Gender Gender 

Male 776 23 780 23 Male 2,326 34 2,394 33 

Female 2,541 77 2,559 77 Female 4,134 60 4,397 61 

Undisclosed 359 5 472 6 

Total 3,317 3,339 Total 6,819 7,263 

Recorded 

Disability 34 1 57 2 

Recorded 

Disability 30 0.4 44 0.6 


Policies in relation to disabled employees and 

equal opportunities 

Our services and employment practices must be accessible 

and fair to all; employees and service users must be 

treated with respect and not subject to any form of 

discrimination, harassment or victimisation on the basis 

of age, disability, gender reassignment, marriage and civil 

partnership, pregnancy or maternity, race (this includes 

ethnic or national origins, colour or nationality), religion or 

belief (including lack of belief), sex and sexual orientation. 

These are known as the nine protected characteristics of 

the Equalities Act 2010. We are committed to promoting 

equality of opportunity and eliminating discriminatory 

practice. 

Stakeholder relations 

The Trust continues to have strong relationships with 

stakeholders within the NHS, Local Authority and education 

partners as well as community and patient representative 

groups. The City and Hackney Clinical Commissioning 

Group is now established as the lead health commissioner 

for the Hackney and City populations. We are engaged in 

the development of the Health and Wellbeing Board for 

Hackney. The Trust is also an executive partner of University 

College London Partners. 

Key stakeholders have nominated representatives on 

the Council of Governors which also includes elected 

representatives of members of the public living in our local 

boroughs and Trust staff. 

The Trust has a statutory duty to collaborate with partners 

in health and social care. We have representation at 

the monthly Hackney Health Overview and Scrutiny 

Commission meetings, which are held in public, providing 

them with regular service and performance updates. 

Sustainability report 

The NHS Sustainable Development Unit’s “Saving Carbon, 

Improving Health” sets a target for NHS trusts to reduce 

their carbon emissions by at least 10% between 2007 and 

2015. Work on replacement of the time expired oil fired 

boilers for gas and low carbon combined heat and power 

began at the end of the year and should come on line in 

December 2013. The new boilers should achieve the NHS 

10% reduction target and significant financial savings of 

approximately £0.6m per annum. The staff engagement 

campaign was updated for NHS Sustainability Day on 

28 March 2013 with posters put up outside the Trust 

main entrance and at the entrance to the staff canteen. 

Feedback has been positive as the “Green at Homerton” 

campaign captures staff actions which combined are 

supporting the Trust’s vision to be an exemplar in the 

delivery of sustainable health care. Summary environmental 

performance is shown in the table below. 

Non-financial data 

Financial data(£k) 

Type 2011/12 2012/13 2011/12 2012/13 

Utilities 

Water (m3) 

Electricity (MWh) 

Gas (MWh) 

Oil (MWh) 

83,137 

9,892 

3,145 

18,426 

87,154 

11,477 

3,876 

22,266 

148 

1,054 

185 

889 

160 

1,240 

189 

1,056 

Total 2276 2,645 

Waste 

Residual (tonnes) 

Recycling*(tonnes) 

Clinical (tonnes) 

Offensive (tonnes) 

High temp 

Incineration(tonnes) 

488 

88 

252 

96 

36 

546 

66 

196 

169 

Total 960 1022 193 178 

45 

*65% Waste to Energy, 29% Recycled, 6% landfill 

Water consumption has increased due to endoscopy and 

extra laundry provision at the Trust. 

Electricity consumption has increased which reflects more 

clinical activity from the new MRI scanner and endoscopy 

department. 

Oil consumption has increased in line with the prolonged 

cold winter. Gas consumption has increased which also 

reflects weather and new areas of the Trust such as 

endoscopy and laundry provision. 

The total amount of waste generated by the Trust has 

increased slightly which reflects increased activity and new 

clinical services. The “offensive” waste or non infectious 

waste stream has increased by 75% with a corresponding 

decrease in infectious clinical waste produced which as a 

result has saved the Trust around £9,000. 

Recycling has decreased due to a misconsignment issue in 

which the waste stream was temporarily suspended at the 

Trust. 

The Trust’s carbon footprint, associated with emissions 

from energy, waste, water and business travel, has risen by 

around 17% against the previous year from 10,920tCO2 to 

around 12,760tCO2. This is mainly due to the cold winter 

increasing use of oil and gas and increased clinical activity 

driving demand for electricity, in particular the new MRI 

scanner and endoscopy unit. 

- 

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- 

- 

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Governance report 

The following disclosures relate to the Trust’s governance 

arrangements and illustrate the application of the main and 

supporting principles of Monitor’s Code of Governance (the 

Code). 

It is the responsibility of the Board of Directors to ensure 

that the Trust complies with the provisions of the Code or, 

where it does not, to provide an explanation which justifies 

departure from the Code in the particular circumstances. 

For the year ending 31 March 2013 the Trust complied with 

all the provisions of the Code. 

Board of Directors 

Composition of the Board 

The Board of Directors had six Executive and seven Non- 

Executive Directors including the Chairman on 1 April 2012. 

The Board of Directors is accountable to the membership 

via the Council of Governors. The Board provides 

leadership to the hospital and sets the strategic direction 

of the organisation. The Board decides upon matters of 

operational performance, risk, assurance and governance. 

Board members are invited to attend Council of Governors’ 

meetings and joint Board meetings are held twice a year to 

discuss strategic plans. 

In 2012/13 the Board had the following members - 

Non-Executive Directors: 

Chairman, Michael Cassidy (until Mar 2012); Deputy 

Chairman and Senior Independent Director, Stephen Hay 

(until Aug 2012), Prof Michael Keith (until Feb 2012), 

Deputy Chairman and Senior Independent Director, Imelda 

Redmond, Prof Christopher Griffiths, David Stewart, Sir 

John Gieve and Vanni Treves (from April 2012) 

Executive Directors: 

Nancy Hallett, Chief Executive (until Dec 2012); Tracey 

Fletcher, Chief Executive (from Jan 2013) Dr John Coakley, 

Medical Director and Joint Deputy CEO; Tracey Fletcher, 

Chief Operating Officer and Joint Deputy CEO (until 

Dec 2012); Charlie Sheldon, Chief Nurse & Director of 

Governance; Jo Farrar, Director of Finance; Dylan Jones, 

Chief Operating Officer (from and Jan 2013); and Cheryl 

Clements, Director of Workforce and Education (until April 

2012) 

The term of office for Non-Executive Directors is three 

years. Following this term, and subject to satisfactory 

appraisal, a Non-Executive Director is eligible for 

consideration by the Council of Governors for a further 

uncontested term of three years. The appointment process, 

undertaken on behalf of the Council of Governors by a 

Nominations Committee, is outlined in Section 13 of the 

Trust’s Constitution. 

The Chairman and Non-Executive Directors can also be 

removed by the Council of Governors. The removal of 

a Non-Executive Director requires the approval of threequarters 

of members of the Council of Governors. Details 

of disqualification from holding office of a Director can be 

found in the Constitution. 

The Executive Directors hold permanent NHS contracts 

subject to NHS terms and conditions and are appointed by 

a Nominations Committee. 

Balance of Board membership & independence 

The Board of Directors is satisfied that its balance of 

knowledge, skills, and experience is appropriate to the 

Board and its sub-committees. The Board collectively 

considers that it is appropriately composed in order to fulfil 

its function and remain within its Terms of Authorisation. 

Non-Executive Directors meet the independence criteria laid 

down within the Code. 

Performance evaluation 

The annual appraisal of the Chairman involves collaboration 

between the Senior Independent Director and the Vice 

Chairman of the Council of Governors to seek the views 

of both Executive Directors and Governors. Executive 

Directors have an annual appraisal with the Chief Executive. 

The performance of Non-Executive Directors is evaluated 

annually by the Chairman. Overall Board performance is 

also evaluated. 

Board meetings 

The Board meets regularly, on average once a month. 

Special meetings are convened as and when required. 

There were 11 ordinary meetings during 2012/13. 

Attendance at Board of Directors’ meetings 

Brief details of each Board members’ record of attendance 

at Board meetings are shown below. 

Non-Executive Directors 

Meetings 

Michael Cassidy 11/11 

Imelda Redmond 10/11 

David Stewart 11/11 

Prof Chris Griffiths 6/11 

Sir John Gieve 9/11 

Vanni Treves 10/11 

Prof Michael Keith* 7/9 

Stephen Hay** 4/4 

*left the Trust in February 2013 

**left the Trust in August 2012 


Executive Directors 

Meetings 

Tracey Fletcher*, Chief Executive/Chief 

Operating Officer 10/11 

Nancy Hallett, Chief Executive** 8/8 

John Coakley, Medical Director 11/11 

Charlie Sheldon, Chief Nurse & Director of 

Governance 11/11 

Jo Farrar, Director of Finance 10/11 

Dylan Jones, Chief Operating Officer*** 3/3 

Cheryl Clements, Director of Workforce and 

Education**** 0/1 

*appointed as CEO Jan 2013 

**finished working for the Trust in Dec 2012 

***appointed in Jan 2013 

**** finished working for the Trust in April 2012 

Members of the Board of Directors 

Non-Executive Directors 

Michael Cassidy CBE, Chairman 

Mr Cassidy held the post of Chairman since December 

2006. He was appointed by the Council of Governors 

to serve for a further three year term in 2009, which 

completed in December 2012. This was extended by 

the Council of Governors until March 2013 pending the 

appointment of the new Chairman. Mr Cassidy has been a 

City lawyer for 35 years. In addition, he has served on the 

Board of quoted property companies and UBS limited. Mr 

Cassidy is the chair of the Museum of London. 

Mr Cassidy chaired the Remuneration Committee. He was 

a member of the Risk Committee and also sat on the Trust’s 

Charitable Funds Committee. 

Imelda Redmond CBE, Senior Independent Director 

and Deputy Chair 

Ms Redmond was re-appointed by the Council of 

Governors to serve for a second three year term in 2011, 

which completes in 2014. She is the Director of Policy and 

Public Affairs at Marie Curie Care. She was awarded a CBE 

in 2010 for services to disadvantaged people. Ms Redmond 

is a member of the Audit Committee. 

Professor Chris Griffiths 

Professor Griffiths was re-appointed by the Council 

of Governors to serve for a second three year term in 

2011, which completes in 2014. He is a Professor of 

General Practice at Queen Mary College, University of 

London. Professor Griffiths is also a General Practitioner. 

Professor Griffiths is a member of the Infection Prevention 

and Control Committee and Finance & Performance 

Committee. 

David Stewart 

Mr Stewart was re-appointed by the Council of Governors 

to serve for a second three year term in 2011, which 

completes in 2014. He is a fellow of the Institute of 

Chartered Accountants and a fellow of the Institute 

of Directors and was the Partner in charge of the 

Central London office of Coopers and Lybrand (now 

PricewaterhouseCoopers). Mr Stewart chairs the Audit 

Committee. 

Sir John Gieve 

Sir John Gieve was appointed by the Council of Governors 

in 2011. He currently holds a number of chairman and 

directorships for a range of private and third sector 

organisations including Chair of the Clore Social Leadership 

Programme. Sir John chairs the Finance & Performance 

Committee. 

Vanni Treves 

Mr Treves was appointed by the Council of Governors 

in 2012. He was for many years Senior Partner of 

Macfarlanes, a leading firm of Solicitors, and also has a 

broad experience of industry and education. Mr Treves 

was awarded the CBE in 2012. Mr Treves chairs the Risk 

Committee. 

Stephen Hay 

Mr Hay was re-appointed by the Council of Governors 

to serve for a second three year term in 2009, which 

completed in August 2012. 

Professor Michael Keith 

Professor Keith was re-appointed by the Council of 

Governors to serve for a second three year term in 2010, 

which completed in February 2013. 

Executive Directors 

Tracey Fletcher, Chief Executive 

Ms Fletcher re-joined the Trust in 2010 as Chief Operating 

Officer, having previously been with Homerton Hospital 

for many years. She has extensive experience in health 

care management. Ms Fletcher was appointed as Chief 

Executive Officer in January 2013. Ms Fletcher sits on the 

Charitable Funds Committee, Risk Committee and Finance 

& Performance Committee. 



Dame Nancy Hallett, Chief Executive 

Dame Nancy had been Chief Executive since 1999. 

She joined the Trust in 1993 as Director of Nursing and 

Patient Services, and later became the Director of Service 

Development. She was awarded an OBE in 2004 for 

services to health in Hackney and was made a Dame of the 

British Empire in the 2012 New Year Honours. Dame Nancy 

retired from the Trust in December 2012. 

Dr John Coakley, Medical Director, Deputy Chief 

Executive 

Dr Coakley has been an intensive care consultant at 

Homerton since 1992. He became Medical Director of 

Homerton in 1998, having previously been Director of 

Postgraduate Medical Education. Dr Coakley sits on the 

Charitable Funds and Risk Committees. 

Professor Charlie Sheldon, Chief Nurse & Director 

Governance 

Professor Sheldon joined the Trust in June 2010. A 

Registered General Nurse, he was previously Chief Nurse 

at the Royal National Orthopaedic Hospital NHS Trust. He 

is an Honorary Professor: School of Health Sciences, City 

University. Prof Sheldon sits on the Infection Control and 

the Risk Committees. 

Jo Farrar, Director of Finance 

Mr Farrar joined the Trust in March 2010. He previously 

worked as acting Chief Executive of NHS London’s Provider 

Agency, and Head of Compliance at Monitor. Mr Farrar 

trained as a chartered accountant at KPMG. Mr Farrar 

chairs the Charitable Funds Committee and is a member of 

the Finance & Performance and Risk Committees. 

Dylan Jones, Chief Operating Officer 

Mr Jones was appointed Chief Operating Officer in January 

2013. Previous roles at Homerton include Divisional Director 

of the Integrated Medical and Rehabilitation Services 

Division (2011 to January 2013) and General Manager for 

the General and Emergency Medicine Division (2008-2011) 

He is a member of the Finance & Performance Committee. 

Cheryl Clements, Director of Workforce 

Mrs Clements joined the Trust in June 2009 and left in April 

2012. 

Register of Directors’ Interests 

Some of our Directors hold interests that may be relevant 

or material to NHS business matters. All Directors declare 

those interests in the Register of Directors’ Interests. The 

register is available for inspection by members of the 

public. Anyone who wishes to see the Register of Directors’ 

Interests should make enquiries to the Foundation Trust 

Secretary on 0208 510 7321. There have not been any 

material relationships that have influenced individual 

Director’s roles. 

Audit Committee 

Membership and attendance 

The Audit Committee is chaired by David Stewart, a Non- 

Executive Director, (previously Stephen Hay until Aug 2012) 

and includes two other Non-Executive Directors – Imelda 

Redmond and Prof Michael Keith (until Feb 2012). It met 

four times in 2012/13 

Title 

David Stewart (Chair) 3/3 

Stephen Hay (Chair)* 1/1 

Imelda Redmond 3/4 

Michael Keith ** 2/3 

*left the Trust in Aug 2012 

**left the Trust in Feb 2012 

Attendance at meetings 

How the Audit Committee discharges its 

responsibilities 

The Audit Committee’s primary purpose is to conclude 

upon the adequacy and effective operation of the Trust’s 

overall system of control. It is directly accountable to the 

Board. The Committee assures the Board of Directors that 

probity and professional judgement are exercised in all 

financial matters. It advises the Board on the adequacy of 

the Trust’s systems of internal control and its processes for 

securing economy, efficiency and effectiveness. 

Auditors 

The external auditors for Homerton are Deloitte LLP, 

appointed by the Council of Governors in July 2011. 

Their fees for audit services undertaken in 2012/13 were 

£69,000. Deloitte’s accompanying report on our financial 

statements is based on their audit conducted in accordance 

with International Financial Reporting Standards and the 

Financial Reporting Manual issued by Monitor. Their work 

includes a review of our system of internal control which 

is used to inform the nature and scope of their audit 

procedures. 

The Trust’s external auditors may perform non-audit 

work where the work is clearly audit related and the 

external auditors are best placed to do that work. For such 

assignments the Audit Committee approved protocol 

is followed which ensures all such work is properly 

considered. The processes in place ensure auditor objectivity 

and independence is safeguarded. 


As far as the Directors are aware, there is no information 

relevant to the audit which has not been disclosed to 

the auditors. The Directors have taken all the steps that 

they ought to have taken as a director in order to make 

themselves aware of any relevant audit information and to 

establish that the NHS Foundation Trust’s auditor is aware 

of that information. 

Nominations Committee of the Council of Governors 

The Nominations Committee of the Council of Governors 

comprises public and staff Governors and is chaired by the 

Trust Chairman. Its purpose is to select the Non-Executive 

Directors. In the case of recruiting a new Chairman, the 

senior independent Director replaces the current Chairman 

for interview purposes. The Committee selects a candidate 

whose is appointed by the Council of Governors. 

There were two meetings of the Nominations Committee 

of the Council of Governors in 2012/13 which met to agree 

the extension of the outgoing Chairman’s term of office 

for three months pending the appointment of the new 

Chairman. The Committee subsequently met to appoint 

the new Trust Chairman. 

Nominations Committee of the Board of Directors 

The Nominations Committee of the Board of Directors 

comprises members of the Board of Directors and is chaired 

by the Trust Chairman. This Committee appoints the 

Chief Executive and Executive Directors of the Trust. The 

Committee meets annually to review the Board structure, 

size and composition, and to give consideration to 

succession planning and identify the skills and knowledge 

of the Board. The Committee must also meet as part of the 

process of appointment for executive directors. 

The Committee met in 2012/13 to review the Board 

structure and to appoint the Chief Executive Officer and 

Chief Operating Officer. 

Both Nominations Committees work to common principles 

and share similar procedures. 

Remuneration report 

For the purposes of this report the disclosure of 

remuneration to senior managers is limited to Executive and 

Non-Executive Directors of the Trust. 

In accordance with the Constitution the remuneration 

of the Executive Directors is determined by the Executive 

Director Remuneration Committee comprising the 

Chairman and Non-Executive Directors. The remuneration 

of the Chairman and Non-Executive directors is determined 

by the Non-Executive Remuneration Committee of the 

Council of Governors. 

Both committees work to common principles and 

procedures. Remuneration levels are set taking into account 

the requirements of the role, market rates, the performance 

of the Trust, internal comparability and affordability. No 

individual is involved in any decision that affects his or her 

own remuneration. Both committees adopt the principles 

of good governance in setting remuneration, and take into 

account a wide range of pay guidance across other public 

sector and relevant independent organisations to inform 

the process. 

The Executive Director Remuneration Committee advises 

on any major changes in employee benefit structure in the 

Trust and ensures that contractual terms on termination 

and any payments made are fair to the individual and the 

organisation. Both committees are authorised to obtain 

external or other professional advice on any matters within 

their terms of reference, with due regard to probity and 

cost. Both committees consider Board performance and 

individual performance as part of the remuneration review. 

The Trust does not award performance bonuses. 

Executive Directors are required to give six months’ notice 

to terminate their employment contracts. Non-Executive 

Directors are required to provide one month’s notice. 

All directors have permanent contracts. Non-Executive 

Directors are appointed for a period of three years in 

accordance with the Constitution. 

The Trust currently carries a provision of £465k for early 

retirements relating to ex-members of staff. 

The Remuneration Committee of the Council of 

Governors met once in 2012/13 to consider Non-Executive 

remuneration. No pay inflation award was given to Non- 

Executive Directors. 

The Remuneration Committee of the Board of Directors 

met once in 2012/13. The Chairman and all Non-Executive 

Directors were in attendance. The meetings were also part 

attended by the Chief Executive and Interim Director of 

Workforce for the purpose of providing advice or services 

to the committee that materially assisted the committee 

with the matters before them. The Committee agreed pay 

awards for the Chief Executive, Chief Operating Officer and 

Chief Nurse 

Salary and pension entitlements of senior managers are 

available in the Accounts pages 130-131. 


Chief Executive 

29 May 2013 



The Council of Governors 

How the Board of Directors and the Council 

of Governors operate 

The Council of Governors represents the interests 

of the local community defined as public and 

staff who are Foundation Trust members, and 

shares information about key decisions with 

membership. 

There are 26 Governors under the leadership of 

the Trust Chairman including: 

• 14 Public (elected) -10 representing Hackney, 

2 representing the City of London and 2 

representing adjoining boroughs; 

• 6 Staff (elected) - 4 representing clinical staff 

and 2 representing non-clinical staff; and 

• 6 Partnership Governors (appointed) - 

nominated from 5 partnership organisations. 

The Governors act as a link between the Board 

of Directors and the membership. The opinion 

of the Council of Governors is sought by the 

Board of Directors on key strategic issues. The 

Council of Governors is invited to review issues 

of importance at its meetings and advise the 

Chairman of their views. The Chairman ensures 

that these views are considered at the Board of 

Directors’ meeting as part of the decision-making 

process. 

The Council of Governors and the Board of 

Directors meet jointly twice a year. The agendas 

developed for those meetings reflect the issues 

both parties need to discuss. In particular 

the joint meeting enables Board members to 

understand the views of the Governors and 

members. Executive Directors regularly attend 

Council of Governors meetings to gain an 

understanding of the views of Governors and 

the membership constituencies they represent. 

The Governors held six meetings in 2012/13 

including two joint meetings of the Council of 

Governors and the Board of Directors, and the 

Annual Members’ meeting. There were two 

extra Council of Governors’ meetings during the 

year to approve the appointments of the new 

Chief Executive and the Chairman. The Trust 

Constitution requires the Council of Governors to 

meet at least three times a year. 

The following table summarises the record of Governor attendance at 

Council of Governors’ meetings. 

Name 

Constituency 

Date elected or 

appointed 

Attendance* 

Michael Cassidy Chairman N/A 5/8 

Clyde Baker Public (Hackney) Sept 2010 (1st term) 4/8 

Eli Kernkraut Public (Hackney) Sept 2011 (1st term) 6/8 

Patricia Bennett Public (Hackney) Sept 2010 (1st term) 7/8 

Suri Friedman Public (Hackney) Sept 2010 (2nd term) 7/8 

Talaat Qureshi Public (Hackney) Sept 2012 (2nd term) 6/8 

Jude Williams Public (Hackney) Sept 2011 (1st term) 6/8 

Jamie Bishop Public (Hackney) Sept 2009 (1st term) 2/3 

Florence Public (Hackney) Sept 2009 (2nd term) 1/3 

Osaigbovo 

Christopher Sills Public (Hackney) Sept 2011 (1st term) 3/3 

(1 year) 

Sarah Weiss Public (Hackney) Sept 2011 (3rd term) 6/8 

(2 year) 

Stuart Maxwell Public (Hackney) Sept 2012 (1st term) 4/5 

Julia Bennett Public (Hackney) Sept 2012 (1st term) 4/5 

Joe Lobenstein Public (Hackney) Sept 2012 (1st term) 2/5 

John Bootes Public (City) Mar 2010 (1st term) 5/8 

Geoffrey Rivett** Public (City) Sept 2010 (3rd term) 8/8 

Fatmata Sesay Public (Outer) Sept 2011 (1st term) 0/2 

Eric Sorensen Public (Outer) Sept 2011 (1st term) 7/8 

Dr Katherine Staff (Clinical) Sept 2011 (1st term) 5/7 

Coyne 

Val Dimmock Staff (Clinical) Sept 2010 (1st term) 3/8 

Mr Andrew Ezsias Staff (Clinical) Sept 2011 (1st term) 6/8 

Ros Constable Staff (Clinical) Sept 2011 (1st term) 7/8 

Henry Muss Staff 

Sept 2011 (1st term) 4/8 

(Non Clinical) 

Robert Duke Staff 

Mar 2010 (1st term) 5/7 

(Non Clinical) 

Jonathan Hackney Appointed Oct 2011 1/8 

McShane Council 

Deborah James Queen Mary Appointed Feb 2010 0/4 

Westfield 

Gareth Moore City of London Appointed Jul 2009 2/8 

Dr Lesley 

Mountford 

Prof. Stan 

Newman 

East London Appointed 2004 3/8 

and City 

City University Appointed Jan 2011 0/8 

*If individuals joined or left the Council of Governors during the financial year, 

the number of meetings they could attend has been adjusted accordingly. 

A total of eight meetings including two joint meetings of the Council of 

Governors and Board of Directors were held in 2012/13 

**Nominated lead Governor 


A register of interests is maintained in relation to the 

Governors. This is available for viewing from the Trust 

offices. 

If there is a dispute between the Council of Governors and 

Board of Directors, the Chairman, in the first instance, will 

endeavour to resolve it. If the Chairman cannot resolve it, 

the Senior Independent Director and the Vice Chairman 

of the Council of Governors will together attempt to 

resolve the issue. Should the Senior Independent Director 

and the Vice Chairman of the Council of Governors fail 

to resolve the conflict, the Board of Directors, pursuant 

to section15(2) of Schedule 7 of the Act, will decide the 

disputed matter. 

Public and staff Governors are elected by the membership. 

Elections are held in accordance with the election rules, 

as stated in the Constitution, using a single transferable 

vote system. Elections for vacancies in three constituencies 

(Hackney, City and Staff (non-clinical)) were held this year 

to replace those Governors who had resigned or completed 

their term of office in accordance with the transition 

schedule. The elections were administered on behalf of the 

Trust by Electoral Reform Services Limited. 

Foundation Trust membership 

The Trust is committed to recruit a membership that is 

representative of age, gender, sexuality, disability and ethnic 

background, thus reflecting the community it serves. There 

is no set limit on the number of people who can register as 

members within the eligibility criteria. 

The Patient Experience and Engagement Committee will be 

overseeing the recruitment and involvement of members 

through the Membership Development Strategy. 

The overall public and staff membership has increased over 

the past year with 555 new members recruited and 168 

members leaving. 

At year start 

(April 1st 

2012) 

New 

members 

Members 

leaving 

At year end 

(March 31st 

2013) 

Public 4656 215 79 4792 

Staff 2220 340 89 2471 

Total 6876 555 168 7263 

The public constituencies – Hackney, City and Outer – are 

broadly representative of the areas from which the majority 

of patients come to Homerton. 

Membership is open to any member of the public over the 

age of 16 who lives in the London Borough of Hackney, the 

City of London or the outer area. The outer constituency 

includes Tower Hamlets, Waltham Forest, Newham, 

Redbridge, Barking, Havering, Camden, Islington, Haringey, 

Enfield, Lambeth, Southwark, Westminster and Epping 

Forest District. There is no separate patient constituency. 

Active membership is highest within the London Borough 

of Hackney. The staff constituency is divided into clinical 

and non-clinical staff categories. Any staff on permanent 

employment contracts or those who have worked at the 

Trust for at least 12 months, including contractual staff 

or those holding honorary contracts, will be welcomed as 

members unless they choose to opt out. 

A representative membership 

Our membership strategy for 2012-2014 outlines our 

vision for a representative and engaged membership. The 

following four key objectives are set out: 

• to increase the overall number of members who are 

representative of our patients and local community 

• to strive for the composition of membership to reflect 

the diversity of the local community with a focus on 

recruiting young people and people with disabilities 

• to engage the local community through health and 

social care events 

• to ensure members receive appropriate 

communications to improve their understanding of the 

services delivered by the Trust and its relationship with 

the local community. 

The public membership continues to be largely 

representative of the local population in terms of ethnicity 

and gender. The Hackney 2010 Census data has been used 

for comparison of the local population, as the majority of 

Trust’s patients live in the borough with the majority of 

public members in the Hackney constituency. 

The Trust is able to closely monitor its membership through 

the membership database using the information supplied 

by the members on their application forms. The application 

form is available online via the Trust website and at public 

areas across the Trust. Ongoing analysis and review of 

membership enables the Trust to undertake detailed 

demographic analysis of the membership, and identify 

where gaps exist in recruitment. 

In 2012/13 three Memberlink newsletters were sent to all 

public members providing information and news about the 

Trust’s services. 



Get in touch 

If a member of the public wishes to contact a governor 

they can do so via members@homerton.nhs.uk or by 

phoning the Trust Offices on 020 8510 5221. 

A member of the team will then put the query 

through to a Governor. 

The Council of Governers in early 2012 



Quality 

Account 




Quality Account 2012/13 

Contents 

1.0 Overview 

1.1 Statement from the Chief Executive 

Quality achievements 2012/13 

2.1 Progress against the Quality Account 2012/13 

2.2 CQUINs 2012/13 

Review of quality performance – regulatory and 

national targets and requirements 

3.1 National targets and regulatory requirements 

3.2 National Outcome Framework 

3.3 Patient reported outcome measures 

3.4 Research and audit 

3.5 Survey outcomes 

3.6 Complaints 

3.7 Updates from clinical teams on changes to practice 

Quality priorities for 2013/14 

4.1 Quality Account 2013/14 

4.2 CQUINs 2013/14 

Consultation and comments received 

Statement of Directors’ responsibilities in respect of the Quality 

Account 

Appendix 1 CQUIN values 

Appendix 2 Progress on 2012/13 CQUINS 

Appendix 3 National audits 

Appendix 4 Trust response to national audit reports 

Appendix 5 Selection of actions from local audit 

Appendix 6 Limited assurance statement from external auditors 


Quality Account 2012/13 

Welcome to the Homerton Hospital NHS Foundation 

NHS Trust’s Quality Account for 2012/13. 

The Quality Account is a summary of our performance in 

the last year in relation to our quality priorities and national 

requirements. We have incorporated feedback from clinical 

teams showing how they have changed the way they 

deliver care in order to improve the quality of services for 

patients in hospital and the community. Finally we set out 

our quality priorities for 2013/14. 

For many people Homerton is their local hospital and 

community provider of care. You and your families have 

had or will have contact with the Trust for different reasons. 

We are working to make sure that the quality of care you 

receive from us in hospital, in the community and in your 

home is what you need when you need it. 

For Homerton, quality is safe, effective health care that you 

experience as being supportive, caring and compassionate. 



Statement from 

the Chief Executive 

Introduction and welcome 

I am pleased to present our Quality Account for 2012/13, 

our second as a combined acute and community NHS 

Foundation Trust. The safety and quality of the care we 

provide to patients has to be the number one priority for 

our Board, staff and Governors. 

In this document we report on the work undertaken to 

maintain and improve the quality of care we provide and 

set out related plans for the year ahead. It is prepared in 

line with the requirements set out in the Quality Accounts 

legislation (part of the Health Act 2009) and Monitors 

annual reporting guidance. 

The information presented in the Quality Account is 

accurate and true to the best of my knowledge. 

2013/14 

In terms of our quality programme for 2013/14 much will 

continue to be determined by national requirements or 

those set by the commissioners of health services. These 

are the must-dos for any NHS trust. Our Quality Account 

objectives challenge us to go beyond our must-dos. These 

are now set before you. In compiling these we have taken 

into account many factors but importantly we have linked 

them more closely than we have done in other years to the 

Trust’s corporate objectives and to the opportunities that 

we believe the QUEST programme will bring. 





Over the past year we have made improvements in the 

way we measure and assess for quality and safety in 

health care. New approaches have been introduced, such 

as the national Safety Thermometer providing measures 

of harm. There is not a single measure that can give a 

definite picture. To understand the quality and safety of 

care provided by the Trust to patients can only be judged 

by a range of measures. We use these range of measures, 

interpret the findings carefully whilst continuing to 

challenge ourselves to keep testing the evidence. 

During 2012/13 we continued to see some positive 

indicators of safety and quality at Homerton. The detail 

of all these indicators are provided in the following pages 

however, one measure merits highlighting below. 

The Trust received two unannounced inspection visits by 

the Care Quality Commission (CQC) in 2012/13 to the main 

Homerton Hospital site and Mary Seacole Nursing Home. 

In both instances we met the standards required for all six 

criteria assessed by the CQC. 

There is of course, continuing need and opportunity to 

make improvements across all service areas. We are a 

member of the NHS QUEST programme. This is a quality 

benchmarking programme open to foundation trusts 

with a strong track record in quality improvement and an 

ambition to be in the best. Further engagement in this 

programme will be a focus of the forthcoming year. 


Quality achievements 


2.1 Progress against Quality Account 

priorities 2012/13 

Priority 1 

Reduce harm to patients caused by pressure 

ulcers, falls, urinary catheter infections, and 

venous thrombo-embolism (VTE) identified 

within the Safety Thermometer Harm Free Care 

Programme 

The Trust participates in the National Safety Thermometer 

Programme, collecting data on patients in relation to: 

• pressure ulcers 

• falls 

• urinary catheter infections 

• venous thrombo-embolism (VTE). 

Data is collected on all adult, paediatric and neonatal 

inpatients and those being visited by the adult community 

nursing team on one specific day every month. This is a 

point prevalence survey and indicates trends over time. 

Once the data is collected it is then entered into the safety 

thermometer software and uploaded to a national portal. 

Since June 2012 we have collected a full set of data on 

between 500 and 700 patients every month. 

Trends identified over the last year are reflected in the 

following sections. 

National data has been collected from 185,000 patients 

up to March 2013 with 590 organisations involved. These 

organisations include NHS hospitals, community care, 

private providers and some mental health providers. This 

data can give some perspective to Homerton’s results. 

Pressure ulcers 

Pressure ulcers are measured in two ways by this survey: 

• patients who have an existing pressure ulcer (fig 1), and 

• patients who have developed a new pressure ulcer 

(fig 2), whilst in our care (hospital or community). 

Figure 1: Percentage of all patients with a pressure ulcer at the 

time of the survey (existing and new) 

Percentage 

Some patients had existing ulcers before they came into 

Homerton acute or community care. The Homerton 

average for patients with a pressure ulcer on the day of the 

survey is 3.56% and the average from the national data 

is 5.81%. This indicates that the number of Homerton 

patients with any type of pressure ulcer, on the day of the 

survey, is lower than the national average. 

Figure 2: Percentage of patients with a new pressure ulcer on the 

day of the survey (ulcer developed in our care). 

Percentage 

16 

14 

12 

10 

8 

6 

4 

2 

0 

3.5 

3 

2.5 

2 

1.5 

1 

0.5 

0 

May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 

All care settings Hospital Community Nursing home 



The average percentage of patients assessed that had 

developed pressure ulcers (of any grade) in the care of the 

Trust was 0.87%. This is equivalent to about five patients. 

This records pressure ulcers of all grades. 

Data from the national safety thermometer shows an 

average of 1.37% of patients had a new pressure ulcer on 

the day of the survey. 

This information has been reviewed and addressed by the 

Board throughout the year. 



Figure 3: Number of pressure ulcers reported as clinical incidents, 

April 2012 to March 2013 

25 

Pressure ulcers (grade 2 and above) - hospital and community acquired 

Total incidents 

20 

15 

10 

5 

0 

Apr 12 May Jun Jul Aug Sep Oct Nov Dec Jan 13 Feb Mar 

Issues have been raised by serious incident investigations 

into pressure ulcers and last year we reported that the 

Trust had introduced a policy for the prevention and 

management of pressure ulcers in hospital and community. 

This policy contains a competency document that is to be 

completed by clinical nursing staff. 

The tissue viability team ensures that senior staff are 

properly trained to address the issue of pressure ulcers. The 

following groups have completed the assessment: 

• all ward managers in the hospital 

• all district nurses in the community. 

The ward managers are in the process of ensuring all their 

staff complete the training (with the support of the tissue 

viability clinical nurse specialist). Progress is monitored by 

the Patient Safety Committee. 

Regular training continues in relation to the prevention 

and management of pressure ulcers for staff in acute and 

community areas and our nursing home. 

Falls 

The second element of the safety thermometer is the 

number of patients who have fallen within a care setting 

(hospital, nursing home or their home if in receipt of 

community nursing care) and been harmed as a result of 

the fall (fig 4). Harm means any type of harm, from a bruise 

to a more serious injury. 

Figure 4: Percentage of patients who had fallen in a care setting 

and sustained an injury, within the 72 hours preceding the survey 

5 

4.5 

4 

3.5 

3 

2.5 

2 

1.5 

1 

0.5 

0 


Percentage 

All care settings Hospital Community 

Nationally the falls rate in the safety thermometer is 1.07%. 

Homerton’s average is 1.06%, which is in line with the 

national picture. 

The Trust strategic falls group meets every two months 

and reviews information relating to falls. This includes all 

investigations and the length of stay data for patients who 

have fallen in hospital. Measures being taken to reduce falls 

include: 

• investigating whether a falls pathway document can be 

devised and be part of the electronic patient record 

• regular training for staff carried out by the inpatient 

falls coordinator 

• auditing patient records to review the completeness of 

the falls risk assessments and care plans 

• reviewing all orthopaedic inpatients over the age of 

65 by a geriatrician to ensure medical problems are 

assessed and that patients receive a falls risk, bone 

health and cognitive assessment 

• appointing a new geriatrician which has allowed 

capacity in the Bryning falls clinic to be doubled so that 

people can be seen more quickly following a fall. 


Urinary tract infections 

This element of the safety thermometer relates to patients 

who have a urinary catheter in place, and have developed a 

urinary tract infection (UTI) (fig 5). 

for VTE on the day of the survey. Figure 7 shows patients 

given prophylactic medication to prevent VTE. 

Figure 7: Pertcentage of hospital patients who have been given 

prophylactic medication to prevent VTE. 

Figure 5: Percentage of patients who had a urinary catheter in situ 

and had a urinary tract infection on the day of the survey. 

Percentage 

1.2 

1 

0.8 

0.6 

0.4 

0.2 

Percentage 

70 

60 

50 

40 

30 

20 

10 

0 


Given Not given Not appropriate 

0 


Hospital 

The only area where this was reported to have occurred 

was to patients in hospital. The percentage of patients 

affected was low. The average at Homerton was 0.26% 

- this is half the national average at 0.56% Infection is a 

known possible complication of having a urinary catheter. 

The safe care of these patients is essential to keeping this 

rate low and aiming to reduce it further. This information 

has been shared with all ward areas. 

Venous thrombo-embolism (VTE) 

The final element of the safety thermometer is the data 

collected on venous thrombo-embolism (VTE) 

The first graph (fig 6) shows the number of patients (in the 

hospital) who were risk assessed 

Figure 6: Percentage of hospital patients who were documented 

as being risk assessed for VTE after admission. 

Percentage 

90 

80 

70 

60 

50 

40 

30 

20 

10 

0 


Assessed Not assessed Not applicable 

Not all patients were documented as risk assessed at the 

time the survey was carried out. The average was 81%. 

Data from the national safety thermometer indicate that on 

average across the country 50% of patients were assessed 

These figures indicate that an average of 50% of patients 

were given VTE prophylaxis (medication to prevent a 

blood clot) on the days of the Safety Thermometer 

data collection. During 2013/14 further audits will be 

undertaken to understand this better. Nationally 32% of 

patients were given VTE prophylaxis according to the safety 

thermometer data. 

Other data that is collected nationally indicates that we had 

the following VTE risk assessment rates from April 2012 to 

September 2012. 

2012/13 Q1 92% 

2012/13 Q2 91.5% 

2012/13 Q3 91.1% 

Nationally collected Q 4 data has not yet been released. 

This data is calculated from the number of inpatients 

admitted during a month and the numbers who were risk 

assessed on admission – this is the data for all patients, not 

a sample. 

Comparison with the highest and lowest rates of VTE risk 

assessment at other trusts is shown in table 1. 

Table 1: VTE risk assessment rates at Homerton compared to the 

lowest and highest rates in trusts across England. 

Risk assessment rate 

Financial quarter Lowest Homerton Highest 

Q1 2012/13 80.8 92 100 

Q2 2012/13 80.9 91.5 100 

Q3 2012/13 84.6 91.1 100 

Source: http://transparency.dh.gov.uk/2012/01/15/vte-information/ 



Homerton considers that this data is as described for the 

following reasons; the Trust focused on increasing VTE risk 

assessment rate last year and the rate has remained above 

90% in each quarter. 

Homerton has taken the following action to improve this 

rate, and so the quality of its services; VTE compliance is 

reviewed monthly by the Medical Director. Any areas that 

are falling below the expected rate are contacted and 

required to review their processes. 

Locally collected data shows consistent compliance 

with VTE risk assessment of adult patients within 24 hours 

(table 1.1). 

Table 1.1 Percentage of adult patients risk assessed by VTE with 

24 hours of admission to hospital in 2012/13 

Harm free care measurement 

The data collected on the four harms is combined to give a 

harm free care percentage; this calculation is carried out by 

the Safety Thermometer software. Over the last 11 months 

our harm free care rate had averaged 93.6% across the 

organisation (fig 8). 

Percentage 

Figure 8 Harm free care rates at Homerton for all settings 

100 

90 

80 

Month 


Apr 92.4% 

May 92.1% 

Jun 91.6% 

July 91.7% 

Aug 92.7% 

Sep 90.0% 

Oct 90.5% 

Nov 91.0% 

Dec 91.8% 

Jan 92.6% 

Feb 89.9% 

Mar 90.9% 

2012/13 average 91.4% 

% of patients risk 

assessed in 24 hrs 

70 



The average harm free care rate on the national Safety 

Thermometer is 83.8%. Whilst we are above the national 

average, the rate of harm free care percentage that we aim 

to achieve is 95%. 

The information the clinical teams have collected has been 

fed back to them; teams have been sent their own data, 

the overall data for their type of area (acute/community) 

and the Trust data. This information is discussed in team 

meetings. Local teams are able to identify actions that 

are most appropriate to improve harm free care for their 

patients. The actions being taken in relation to this will be 

included in the Divisional reports that are reviewed at the 

Quality Improvement Committee. 


Priority 2 

Demonstrate improvements in safety by 

continuing to deliver a programme of work 

relating to: urgent care, end of life care and 

clinically led coding, using the Standardised 

Hospital Mortality Indicator (SHMI) as a measure. 

Summary Hospital Level Mortality Indicator 

(SHMI) 

This national measure gives an indication of whether the 

mortality rate of our patients is above or below what is 

expected when compared to a national baseline. Data 

produced by the NHS Information Centre in April 2013 

(covering the period October 2011 to September 2012) 

indicates that the trust mortality rate for the past year was 

within the expected range. 

The SHMI is banded for each trust as follows: 

1 – where the trust’s mortality rate is ‘higher than expected’ 

2 – where the trust’s mortality rate is ‘as expected’ 

3 – where the trust’s mortality rate is ‘lower than expected’ 

Our SHMI is banded at 2, the value, 0.93 is as expected. 

In the previous data sets our SHMI was as follows : 

Data Covering January 2011 to December 2011 = 0.96 

Data covering April 2011 to March 2012 = 0.97 

Data covering June 11 to July 12 = 0.98 

This compares to the highest and lowest SHMI rates in the 

country as follows (table 2). 

Table 2: Homerton SHMI data compared to highest and lowest 

NHS and Foundation Trusts in England for the last four reporting 

periods (these time periods overlap) 

Time period of 

SHMI rate 

SHMI report 

Lowest Homerton Highest 

Jan 11 - Dec 11 0.69 0.96 1.24 

Apr 11 to Mar 12 0.71 0.97 1.24 

July 11 to June 12 0.78 0.98 1.25 

Oct 11 to Sept 12 0.68 0.93 1.21 

Source: https://indicators.ic.nhs.uk 

The highest and lowest scoring trusts are the same 

organisations across all four time periods. 

The percentage of our admitted patients during October 

2011 to September 2012 with a palliative care coding was 

0.5% (last year 0.1%) 

The percentage of patients that died with a palliative care 

coding was 19.4 % (last year 2.7%). This increase is in line 

with the national average (see below). 

The SHMI national statistics for the period from 1 October 

2011 to 30 September 2012: 

• 10 trusts had a SHMI value categorised as ‘higher than 

expected’ 

• 18 trusts had a SHMI value categorised as ‘lower than 

expected’ 

• 114 trusts had a SHMI value categorised as ‘as 

expected’ 

• The percentage of patient admissions with palliative 

care coded at either diagnosis or specialty level is 

approximately 1.0 per cent 

• The percentage of patient deaths with palliative 

care coded at either diagnosis or specialty level is 

approximately 18.9 per cent 


following reasons; we have maintained our SHMI in the “as 

expected” range. The Medical Director reviews the data so 

that mortality rates within the different specialist areas can 

be monitored. If there are anomalies in clinical coding the 

relevant corrections are made. The data for patients who 

have sustained a fractured neck of femur is currently being 

reviewed. 

Homerton has taken the following actions to improve this 

score, and so the quality of its services, by: 

Care review 

• The Medical Director and the Chief Operating Officer 

are reviewing the Urgent Care Pathway as part of the 

NHS London Quality and Safety pathway assessment 

published in February 2013. This assessment is a 

review of London hospital-based acute medicine and 

emergency general surgery services. Homerton took 

part in the assessment, has reviewed the results and is 

developing an action plan. 

Reflecting care and treatment accurately in clinical 

coding 

• Coding data about the patient’s diagnosis and mode 

of admission to Homerton contributes to the SHMI. It 

is vital to ensure that patients are correctly identified 

as either non-elective or planned (elective). Focused 

work on specific types of patient has occurred so 

that these patients’ admissions are coded correctly 

e.g. admissions to Mary Seacole Nursing Home and 

patients transferred from other health care facilities to 

Homerton. 



• We have enhanced the capability of the coding team 

to use the most comprehensive data to code stays 

in the Neonatal Intensive Care Unit by using the 

information from the shared national database where 

the details and treatment of all premature babies is 

held. (This database is called SEND) 

• Patients transferred to Homerton from other hospitals 

are now correctly coded as non-elective admissions. 

Review 

In the coming year the Medical Director and Chief Executive 

will ensure that mortality review meetings are formalised 

across the Trust. 

Patient safety incidents 

Incident reporting is encouraged for all adverse events 

in the Trust. These can range from a near miss to those 

where the patient suffered harm. In the last three years 

our incident reporting rate has increased. According 

to the National Patient Safety Agency and the NHS 

Commissioning Board increased reporting is considered to 

be a positive indicator of a healthy safety culture, giving 

organisations the chance to learn and improve. 

In the last three years staff have reported increasing 

numbers of patient safety incidents as shown in table 3. 

Table 3: Total patient safety incidents reported by financial year 

Financial year 

Total patient safety 

incidents reported at 


10/11 3458 N/A 

Percentage 

increase in 

reporting 

11/12 4168 20% 

12/13 4643 11% 

We report 8.05 incidents per 100 admissions. The top 

quartile has a range from 8.1 incidents per 100 admissions 

to 18 incidents per 100 admissions. 

Where harm has occurred organisations record the degree 

of harm the patient sustained as the result of a patient 

safety incident. 

In terms of the harm sustained by patients as a result of 

patient safety incidents, year on year in at least 77% of the 

incidents reported in the Trust the patient came to no harm. 

For no harm and minor harm combined the percentage is 

95%. 

From the data that is available nationally (table 4) shows 

Homerton in comparison to other trusts of a similar size 

and in terms of numbers of incidents recorded as severe 

harm/death. 

Table 4: Incidents recorded as severe harm/death (actual numbers) 

Total severe harm/death incident 

recorded by Trust of a similar 

size to Homerton 

Time period Lowest Homerton Highest 

April 11 - Sept 11 0 23 95 

Oct 11 - March 12 0 25 70 

April 12 - Sept 12 0 23 67 

The data above is taken from the nationally available data 

published by the National Reporting and Learning System 

(NRLS). 

Some of the incidents from April to September 2012 have 

been reviewed and revised in the Trust, in terms of the 

actual harm resulting from a patient safety incident, as 

investigations took place. The classification of the harm 

of an incident may be subject to investigation which may 

result in the classification being changed. This change may 

not be reported externally and the data held by a trust may 

not be the same as that held by the NRLS. Therefore, it may 

be difficult to explain the differences between the data 

reported by the Trust as this may not be comparable. 

Due to the review of the harm rate the Trust currently has 

14 records that have been identified as severe harm for 

April to September 2013. 

Data has not been released by the NRLS for the last six 

months of the year. 

Data held in the Trust for the full year April 2012 to March 

2013 shows a total of 25 severe harm/death incidents 

(these are all severe harm). This is 0.54% of all reported 

patient safety incidents. 


following reasons; care is taken to ensure that the data 

exported to the NRLS is accurate. Any harm sustained 

as the result of a patient safety incident is part of this 

information. It is a priority for all staff to take all measures 

possible to reduce the risk of harm to patients that are in 

our care. If a patient is harmed it is essential that this is 

reported immediately so that all necessary actions to treat 

the patient can be taken. 


rate, and so the quality of its services, by: 

• ensuring staff are trained to give safe care, in line with 

the “compassion in practice” expectations 

• encouraging high rates of incident reporting 

• monitoring the quality of data on the incident reports 

• investigating when things do go wrong to ensure that 

systems and processes are improved and made safer as 

a result 


• continuing to be open and honest with patients and 

their relatives if something has gone wrong. 

Serious incidents (SI) 

Some of the incidents that are reported are serious incidents 

or potential serious incidents – we often undertake a full 

root cause analysis into a potential serious incident. 

There is a national definition of a serious incident; please 

see the information on this web page for further details 

http://www.nrls.npsa.nhs.uk/resources/?entryid45=75173 

In the last year we have reported 64 serious incidents to 

the Trust Board, our commissioners and NHS London – this 

compares to the previous two years 2010/11 – 37, 2011/12 

- 65 

These incidents have covered a variety of issues. The top 

three categories for the last two years have been: 

• Pregnancy/peri-natal incidents 

• Pressure ulcers hospital 

• Pressure ulcers community 

Pregnancy/perinatal incidents 

There is a mandated list of incidents (from NHS London 

until April 2013) that must be documented as SIs and 

investigated. These include unexpected admission of a 

new baby to the neonatal unit who requires the support 

of a ventilator or admission of a mother to the intensive 

care unit. These are investigated to ensure that all 

appropriate actions were taken and to ensure that any 

learning from each incident is identified. A proportion of 

investigations (about a quarter of the final reports from last 

year) established that no errors in clinical care were made 

and that all actions taken to care for the woman during 

pregnancy and delivery were appropriate. 

The main change to the service that has been introduced 

this year is the 24 hour staffing of the assessment area 

in the delivery suite so the all women who attend are 

reviewed by a qualified midwife within 15 minutes. The 

women can then be cared for in the most appropriate area: 

delivery suite, the birth centre or the obstetric assessment 

unit (which is also staffed 24 hours a day by midwives) 

depending on her condition. 

Pressure ulcers 

See page 41 for action relating to pressure ulcers. 

Never events 

In the last year Homerton has reported two never events 

(there were three in the previous year). These are clinical 

incidents identified by the Department of Health as 

“incidents that are considered unacceptable and eminently 

preventable.” Department of Health Never Events list 

2012/13. Please see https://www.gov.uk/government/ 

publications/the-never-events-list-2012-to-2013 for the 

entire list and more information. 

The two never events from this year involved a retained 

superficial dressing post procedure and a patient who was 

fed using a nasogastric tube that was incorrectly placed. 

Both of these incidents have been fully investigated. 

The first incident has led to changes on the electronic 

operating theatre system so that all dressings used can 

be documented; a change to process to ensure this 

information is checked at each stage of the patients care 

and education of junior staff. 

The report on the second incident has just been 

completed and actions will be taken in line with the final 

recommendations. 

Source: Homerton Risk Management database and National 

Reporting and Learning System hosted by Imperial NHS Trust via 

http://www.nrls.npsa.nhs.uk/patient-safety-data/ 

Safeguarding 

Safeguarding children 

In July 2012 the safeguarding children team reported to 

the Trust Board to give assurance on the processes in place 

to ensure we are protecting children with whom we come 

into contact. 

All staff employed at the Trust, who have direct contact 

with any patient, have a Criminal Records Bureau (CRB) 

check prior to employment. Staff working with children 

have an enhanced level of CRB check which is rechecked 

every three years. 

All the Trust child protection policies are reviewed every 

three years or more frequently if national policy changes; 

the most recent review was in March 2012. 

The Trust has a process in place for following up children 

who miss outpatient or community appointments in any 

specialty to ensure their care and health are not affected. 

In addition the Trust has a system in place for ‘flagging’ or 

identifying children on the electronic patient record where 

there are known safeguarding concerns. 

The Trust has named professionals for safeguarding. They 

are clear about their role, have sufficient time and receive 

relevant support and training to undertake them. 



All staff have level 2 child safeguarding training as part of 

their Trust induction. Other specific groups of staff working 

with children have level 3 or 4 training as appropriate to 

their role. Table 5 shows the percentage of eligible staff 

have been trained at each level: 

Table 5: Percentage of eligible staff trained in child safeguarding. 

Child safeguarding training % eligible staff trained 

Level 1 94.8% 

Level 2 76.4% 

Level 3 77.8% 

Level 4 80% 

Homerton’s level 1 training (for all staff) is currently carried 

out as part of Trust induction; this helps staff to recognise 

types of possible abuse of adults and what to do if they 

suspect it. 

Table 6: Percentage of eligible staff trained in adult safeguarding 

Adult protection training % eligible staff trained 

Level 1 95.09% 

Between 21 May and 1 June 2012 there was an integrated 

inspection of safeguarding and looked after children’s 

services in the London Borough of Hackney by the 

Care Quality Commission and the Office for Standards 

in Education, Children’s Services and Skills (Ofsted). 

Safeguarding services were rated ‘good’ overall as were 

services for looked after children. 

Safeguarding Adults 

The Trust has a senior nurse in the role of safeguarding 

adults lead. She teaches staff about adult safeguarding at 

the appropriate level for their role. The training includes 

the Mental Capacity Act and local procedures if there is 

suspicion that an adult may be at risk. 

The Trust uses a self-assessment and assurance framework 

(SAAF); the aim of which is to support health services to 

meet safeguarding adult responsibilities. It helps provide 

assurance and accountability for the organisation, 

commissioner, partners and patients about arrangements in 

place to safeguard adults. 

Twenty-one areas of care were assessed for 2011 and 

2012. The Trust was effective in 16 areas scoring green, 

compared to 10 in 2011. There were five areas scoring 

amber “working towards”, compared to eight in 2011, 

there were no red scores (unacceptable) for 2012 compared 

to two reds in 2011. 

An action plan has been devised to address all amber areas; 

this is monitored by the Safeguarding Adults Committee. 

Results of SAAFs across London have been published and 

Homerton compares favourably with other London trusts. 

Common issues relate to: Deprivation of Liberty Safeguards 

(DOLS), clinical supervision of safeguarding, feedback from 

family carers/patient experience and those involved in 

health-led investigations. 


Priority 3 

Ensure that, where national clinical guidelines 

have been produced by the National Institute 

for Health and Clinical Excellence (NICE) which 

are relevant to the care we provide, we can 

demonstrate we are using them in everyday 

practice. 

NICE guidelines 

NICE guidance is broad ranging and affects a significant 

proportion of our services. Some cover the entire patient 

pathway, others relate to specific treatments with specific 

medications. 

Over the last year we have reviewed all new NICE guidance 

to see which is relevant to our practice. 

The following new guidance has been released by NICE: 

19 clinical guidelines (one not relevant), 29 interventional 

procedures (24 not relevant), 13 technology appraisals 

(none relevant), five public health (all relevant) and two 

medical technologies. 

At this time (end March 2013) a total of 172 guidelines 

definitely apply to our services. This is fewer than last year 

because three clinical guidelines and 12 interventional 

procedures that had been reviewed by the Trust audit 

lead and considered on first review to be relevant have 

subsequently been identified as not relevant by specialist 

teams. 

We have been liaising with the relevant clinical staff in order 

to establish whether the NICE guidelines are being used in 

practice. The current position is as shown in table 7. 

In the case of some guidance the Trust can only achieve 

partial implementation because there may be elements of 

the service that we do not provide or there are other (more 

up to date guidelines) that are being followed. 

The three we have listed as partially implemented are: 

Clinical guidelines 

• Stroke – The Trust is largely compliant with NICE but 

follows the European Stroke guidance as it is more 

up to date. New NICE Stroke guidance is due to be 

published later in 2013. 

• Transient loss of consciousness in adults and young 

people – We are compliant with NICE guidance 

however the majority of patients are discharged back 

to their GP for specialist referral. This is currently 

accepted as safe practice. 

Medical technologies 

Please note medical technologies are relevant only if 

an organisation is already using the specific piece of 

equipment being referred to. 

• Use of the MIST therapy system for the promotion 

of wound healing in chronic and acute wounds. This 

therapy is currently only used in specific circumstances 

in the community; it is not used in the hospital. 

Table 7: NICE position March 2013 

Type of guideline 

Relevant 

guidance 

Number fully 

implemented 

Number 

partially 

implemented 

Action plan working 

towards full 

implementation 

Number with 

clinicians for feedback 

on implementation 

Currently 

assessing 

relevance 

Clinical guidelines 113 79 2 16 16 2 

Interventional procedures 33 19 0 13 1 5 

Technology appraisals 15 15 0 0 0 0 

Public health guidelines 9 2 0 4 3 15 

Medical technologies 2 1 1 0 0 4 



The 33 guidelines where clinicians are working towards 

implementation means that elements of the guidance are 

in place and there is an action plan within the specialty to 

achieve full implementation. 

Our progress over the year for guidance that has been fully 

implemented is shown in the table 8. The percentage is the 

same as last year. 

Table 8: Percentage of NICE guidance fully implemented from 

March 12 to March 13 

Type of Guideline 

Clinical 

Guidelines 

Interventional 

Procedures 

Technology 

Appraisals 

Public Health 

Guidelines 

Medical 

Technologies 

Percentage of 

relevant guidelines 

fully implemented 

March 2013 

70%* 70% ** 

58% 35% 

100% 100% 

Percentage of 

relevant guidelines 

fully implemented 

March 2012 

22% Not stated in 

2012 

100% Not stated in 


*During this year two clinical guidelines that we had previously 

fully implemented have been revised and upgraded – we are 

working towards implementation of these newly released 

guidelines. Feedback is awaited from clinical teams on 16 

guidelines. 

** The percentage of fully implemented guidance for 2012 has 

been restated. 2012 figures included two partially implemented 

guidelines. These have been removed from the calculations. 

Seventeen audits have been carried out by departments 

in the past year against their use of NICE guidelines; 

these covered a range of care including: bariatric surgery, 

critical care rehabilitation, nutrition and care of patients 

with diabetic foot ulcers. In any audit where a shortfall in 

practice was identified an action plan was put in place. 

Priority 4 

Reduce hospital readmissions 

28 day re-admissions (as a percentage of all 

complete inpatient episodes) 

The national data on re-admission rates and how Homerton 

compares is shown in table 9. This data is calculated by 

identifying: 

• The number of inpatient episodes that are emergency 

admissions within 0-27 days (inclusive) of the last, 

previous discharge from hospital. The following are 

excluded; obstetrics, mental health or cancer. 

Table 9: Readmissions within 28 days: patients aged over 16 

Homerton compared to national standard percentage and the 

highest and lowest rates in other NHS and Foundation Trusts 

(where no concerns were indicated about validity of the data) 

National 

Standardised 

percentage 

readmissions 

Lowest 

% 


% 

Highest 

% 

2008/09 10.09 6.99 11.06 15.84 

2009/10 11.16 7.3 11.17 15.13 

2010/11 11.42 7.14 12.04 14.09 

Source:https://indicators.ic.nhs.uk/download/NCHOD/ 

Data/03N_523ISP4ADP_11_V1_D.xls 


following reasons; our readmission rates are just above 

the national average. These comparisons do not take into 

consideration the areas within which trusts function or 

the demographics of the population. This data also does 

not indicate whether the readmission was related to the 

patient’s previous admission or for a different unrelated 

problem. 

Local data for 2012/13 indicates readmission rates within 

30 days (national exclusions applied). Table 10 over page 

shows this information broken down by type of admission 

by month. This gives a more detailed picture. 


Table 10: readmissions to Homerton within 30 days by month 

Readmission Rate 

within 30 Days 

Post Elective 

Admission (%) 

Post Day case 

Admission (%) 

Post Emergency 

Admission (%) 

Apr 12 May 12 Jun 12 Jul 12 Aug 12 Sep 12 Oct 12 Nov 12 Dec 12 Jan 13 Feb 13 March 13 

2.8 3.9 2.9 2.7 4.0 3.0 2.4 2.8 2.7 3.7 2.7 2.8 

1.9 2.2 1.5 2.0 1.8 1.5 1.5 1.6 1.9 1.4 1.4 2.1 

13.6 14.2 14.0 14.3 15.1 12.5 13.9 12.7 14.5 13.3 14.8 16.6 


rate, and so the quality of its services: 

• clinical leads in each division review a weekly list of 

readmissions 

• trends for emergency and non-emergency 

readmissions are monitored monthly and reported to 

the divisional performance meetings 

• the Trust audit lead is currently conducting an audit of 

readmissions 

• in paediatrics readmitted patients are reviewed and 

reasons for re-admission established and addressed 

• integration work between community and hospital 

paediatric teams is considered to be helping prevent 

readmissions – this will be measured in the coming 

year to see if improvements are demonstrable. 

Source: https://indicators.ic.nhs.uk/download/NCHOD/ 

Data/03N_523ISP4ADP_11_V1_D.xls and local data from 

the Homerton Information Team 

Acute COPD early responders service (ACERS) 

Matthew Hodson, Nurse Consultant at Homerton and 

part of the ACERS team, was presented with the Nursing 

Standard Nurse of the Year 2013 award at a ceremony held 

at the Victoria and Albert Museum in March 2013. 

The breathing space clinic also won the Innovations in 

Respiratory Award on the same evening. Matthew helped 

set up the breathing space clinic at St Joseph’s Hospice with 

Dr Jon Martin and Rebecca Jennings in 2011 for patients 

with advanced chronic obstructive pulmonary disease 

(COPD). The clinic helps patients manage their illness, 

control symptoms, improve their outlook and plan for their 

future. 

Matthew and the ACERS team have raised the profile of 

COPD in the borough and have given patients with this life 

limiting condition another option to plan for the future. 

ACERS works closely with community colleagues such as 

general practitioners and community matrons. Patients can 

be referred to the service and if appropriate will be assessed 

at home by a COPD specialist nurse and/or physiotherapist 

and started on appropriate treatment. If a decision to admit 

to hospital is made, the team follows patients’ progress and 

assists an early discharge back home. 

The graph below shows the positive effect the ACERS team 

has had on reducing patient readmissions at both 28 and 

90 days. 

Figure 9: Readmission rates for COPD patients at 28 and 90 days 

40 

35 

30 

25 

20 

15 

10 

5 

0 

28 days 90 days 

1 year 2 years 

Treatment can be delivered safely at home and the 

outcomes are as good as, if not better than, remaining in 

hospital. 

Here are some comments from patients treated by the 

team as part of the pulmonary rehabilitation programme in 

the last year: 

“The best thing to ever happened to me” 

“Everything about the programme was positive, the staff 

were very caring and un-patronising and my only regret is 

that it has come to an end” 

“This programme is to be continued all the while because 

it is useful and helpful for the COPD patients” 

“Very glad to have the opportunity to understand COPD 

and how to cope with it. Thanks to all the staff” 

“I would encourage anyone to attend this programme as it 

has helped me so very much to understand and cope with 

COPD. I am looking forward to carrying on what I’ve learnt 

with breathing exercises/physical exercises and the follow 

on group” 

The more that patients learn about their lung condition 

the better they are at recognising when things are going 

wrong. This will allow patients to seek intervention earlier 

and prevent things getting worse. 



Priority 5 

Sharing care and treatment information with 

patients. 

There have been a variety of activities across the Trust 

to share care and treatment information with patients. 

The effectiveness of all these activities can be reflected 

in patients’ responses to national surveys and Picker 

questionnaires. Below is a summary of the actions being 

taken to address this priority in Divisions and specialist 

areas. 

Integrated Medical and Rehabilitation Services 

(IMRS): community 

In the community nursing teams a scheme is being piloted 

to use the RIO system (community patient information 

system) to send automatic updates to a patients general 

practitioner following a visit from a community nurse. 

The five themes the updates will cover are: 

• The assessment outcome following the community 

nurses first visit 

• Significant changes in the patient’s condition 

• Changes in medication or nursing treatment plan 

• Referrals made to other services 

• Discharge of the patient from the service including 

discharge destination 

The pilot will take place from March 2013 in four practices. 

If it is successful it will be rolled out to all the practices. 

Copying clinic letters to patients 

For the last six months the following specialties: respiratory, 

dermatology, podiatry and hypertension, have been 

ensuring that all letters sent to patients GPs are copied to 

the patient. This practice already happens in cancer services, 

obstetrics and gynaecology. 

An audit of the practice of copying letters to patients was 

carried out at the end of April 2013. 

The audit reviewed letters in the four medical specialities 

that were sent out in March 2013. The results showed 

that of the fifty letters selected for review; in hypertension, 

dermatology and podiatry 100% had been copied to 

patients, the respiratory team had copied 98%. 

All specialties are being sent a questionnaire to identify 

existing areas of good practice in terms of sharing letters 

with patients. An action plan for roll out of the sharing 

information in this way will be developed. 

Children’s Services Diagnostics and Outpatients 

(CSDO): paediatrics 

Starlight children’s ward has been working with the surgical 

teams to improve the feedback received from parents 

indicating that they would like more information to help 

them prepare for their child’s admission and to understand 

the treatment options. Information for children and parents 

on having a general anaesthetic and information to help 

them prepare for admission are now given to parents and 

children when they are given a date for surgery. We have 

seen an improvement in satisfaction from parents and 

children in this area above the national average. 

Surgery Women’s and Sexual Health (SWSH): 

urology 

Five patients who attended the trans-rectal ultrasound clinic 

(TRUS) and 13 who attended a flexible cystoscopy clinic 

were asked if they had been provided with written patient 

information on the procedure. 

Of the five who attended for TRUS, four had received 

written information and one had been given a verbal 

explanation of the procedure. 

Of the 13 patients attending for a flexi cystoscopy, none 

had been given any written information on the procedure 

but all had had a verbal explanation. Four patients would 

not have benefited from having a leaflet as two would 

not be able to read English; one patient was unable to 

read and one patient had had a flexible cystoscopy many 

times so didn’t need any information. If a flexi cystoscopy is 

booked via one of the admission staff, a leaflet is sent with 

the appointment letter. As a result of this small review of 

patients, the specialist nurse for urology has ensured that 

all urology clinical staff have leaflets available to give to 

patients on TRUS and flexi procedures. 

The Purple Book for patients with learning 

difficulties 

The Learning Disabilities service is currently carrying out 

an audit on the uptake of the Purple Book among service 

users who live alone or with elderly carers. This audit will be 

extended to cover patients in contact with acute services 

– we will be able to report back on this audit in the next 

quality account. 

The Learning Disabilities service is now working in the acute 

Trust as well as in the community to provide education and 

support to staff on wards. 


The Trust is currently consulting with service users and 

local community service networks, through the Trust ‘User 

Engagement Group’, on whether to align the Purple Book 

with the Hospital Passport used by Barts Health. One 

version of this type of document across North East London 

would improve information sharing and communication. 

Patient information 

The Patient Information Development Group (PIDG) reviews 

all patient information produced within the Trust. The 

process includes a readers group, made up of patients, 

who ensure that the information is understandable and 

straightforward. 

A total of 69 patient information resources (leaflets, advice 

sheets and booklets) have been through the PIDG. In 

addition, 28 leaflets relating to specific surgical procedures 

have been purchased by the Operative Services Manager, 

from an external company. This information is for use by 

the surgical teams as part of the consent process. These 

leaflets have been reviewed by the PIDG and the Homerton 

logo and relevant phone numbers added. 

The Cancer Services clinicians give an information 

prescription to patients. This allows patients to access the 

relevant information from a variety of sources. Clinicians are 

able to document and track the information provided at 

key stages of consultation and treatment pathways. 

All patient information resources are accessible via clinicians 

and the Trust Website. The titles are being added to 

the patient information directory to ensure there is one 

repository for all Trust resources. 

The planned upgrade of the Trust website and the intranet 

will enable measurement of the number of times these 

patient information resources are used. 

Responsiveness to patients’ personal needs 

The concept of responsiveness to personal needs has 

been defined by a composite score of the answers to five 

questions in the inpatients survey. The data has been made 

public so that comparisons to other organisations can be 

made. One of the questions relates to whether the patients 

felt they were involved in decisions about care, this relates 

directly to patients having correct and accurate information 

in order to be involved in care decisions. 

The five questions are: 

• Were you involved as much as you wanted to be in 

decisions about your care and treatment? 

• Did you find someone on the hospital staff to talk to 

about your worries and fears? 

• Were you given enough privacy when discussing your 

condition or treatment? 

• Did a member of staff tell you about medication side 

effects to watch for when you went home? 

• Did hospital staff tell you whom to contact if you were 

worried about your condition or treatment after you 

left hospital? 

Homerton’s performance in relation to this composite of 

five questions, in England and the highest and lowest 

scores of other NHS organisations is shown in table 11. 

Table 11: Percentage scores, responsiveness to personal needs 

Responsiveness to personal needs – average 

weighted score 

Year England Lowest Homerton Highest 

2009/10 66.7 58.3 62.4 81.9 

2010/11 67.3 56.7 64.6 82.6 

2011/12 67.4 56.5 62.5 85 


following reasons: We are aware that for the national 

survey results our scores are lower than we would like. A 

low response rate, a diverse and mobile population may 

contribute to what we regard as disappointing scores. Local 

survey activity which asks the same questions has shown 

substantially higher scores. 

Homerton intends to take the following actions to improve 

this percentage and so the quality of its services: 

• Ensuring that the real time responses to these 

questions are built in to our improvement plans. This 

will allow us to take more timely action in response to 

what our patients saying. 

• The Trust is also taking staff views into account as well 

as patients’ as we think there is a correlation between 

them. 

• We are taking a multi-pronged approach through the 

Patient Experience and Engagement Strategy. 

Source: https://indicators.ic.nhs.uk/download/Outcomes%20 

Framework/Data/NHSOF_4.2_I00685_D_V4.xls 



Priority 6 

We will improve the effectiveness of 

discharge from our care 

The actions taken across the Trust to improve effective 

discharge from our care, in Divisions and specialist areas, 

are identified below; 

IMRS: community 

Community team leaders and matrons now attend 

meetings to review patients’ care and plans for their 

discharge from hospital. Following these meetings the 

community team leaders and matrons introduce themselves 

to any patients who require district nursing input and are 

for imminent discharge from hospital. Each ward has an 

allocated social worker to ensure care packages are set up 

robustly and in a timely manner. 

There is also a process in place for wards to refer patients to 

district nursing teams via secure shared electronic means to 

speed up discharge. The district nurses now have cards with 

their contact details on to give to patients. The patient then 

knows who will be looking after them once discharged and 

how to contact them. Details of any patients discharged 

after 7pm are phoned through to the manager on call so 

that they can ensure there is no delay in getting care to the 

patient. 

There have been some incidents reported in relation to the 

discharge of patients where things have not gone smoothly. 

These are all looked into by the relevant lead nurse and 

actions taken to address any issues. 

IMRS: hospital 

All patients are transferred to the discharge lounge on day 

of discharge - the lounge is managed by a staff nurse and 

a health care assistant until 6pm. They can ensure that 

the patient’s discharge is streamlined and coordinate any 

activities that are required in order for patients to leave 

hospital in a timely way. 

The dedicated discharge lounge porter is able to ensure 

that the medications patients need to take home are 

obtained as soon as they are ready from the pharmacy, to 

prevent unnecessary waits. 

We have also used a local taxi firm, for appropriate 

patients, to expedite their discharge. 

SWSH 

On the surgical wards audits have been carried out to 

ensure that the hospital staff and the electronic patient 

record holds the patients correct next of kin details, to 

enable effective contact should it be necessary. 

All patients are given the ward telephone number and their 

hospital number when they leave the ward in case they 

need to ring for advice after discharge. 

All patients are given information prior to discharge about 

their condition and any restrictions/ limitations they should 

expect once they are at home and information about their 

follow up clinic and an appointment. 

CSDO: paediatrics 

In October 2012 the paediatric team changed their practice 

so that families go home with their child’s discharge 

summary from Starlight paediatric ward in order to improve 

the information parents have about their child’s recent 

spell in hospital. Before this, discharge summaries were 

completed after a child’s discharge and were not sent to 

the parents. 

The paediatric team are now making efforts to complete 

the summary at the time of the child’s discharge to give to 

the family when they leave the ward. 

This work has involved the medical and nursing teams, the 

ward clerk and administration team. Informal feedback 

from parents has shown that they appreciate being given 

the letter and it has proved helpful if they need to return to 

accident and emergency or when they come to clinic. It also 

allows for the information to be sent to GPs more quickly. 

If, for whatever reason, it has not been possible to give a 

copy of the letter to the family at discharge, they are sent a 

copy in the post. 

Audit results showed that in September 2012 only about 

30% of summaries were completed and given to parents/ 

carers within 24 hours of discharge. 

A repeat audit in November 2012 showed that 73% of 

summaries were completed and given to parents/carers 

within 24 hours of discharge. 

Joint working hospital and community 

There are now joint management arrangements across 

the community children’s nursing team (CCNT) and the 

Starlight nursing team with one Senior Nurse across both 

areas. This has enabled closer working relationships 

between community and hospital teams and more 

children are being discharged from hospital earlier into 

the care of the CCNT. There is currently no data available 

to demonstrate improved discharge rates, but this will be 

monitored in the year ahead to review progress and identify 

further changes that can be made. 


CSDO: neonates 

The neonatal team have been working to reduce the length 

of stay of babies living in Hackney who have been cared 

for in the neonatal unit after birth. There is a dedicated 

community neonatal nursing team who provide support 

for parents and babies on discharge, together with a 

new approach to discharge planning by the team. The 

average length of stay has reduced in 2012/13 by 4.5 days 

compared to 2011/12. 



2.2 Commission for Quality and Innovation 

(CQUINs) 

This year CQUIN schemes will drive quality with some of 

the Trust’s income linked directly to the achievement of 

quality improvement goals. These goals are agreed with 

our commissioners to ensure that our planned quality 

improvements reflect the quality issues important to 

patients, carers and staff. 

In 2012/13, 2.5% of the Trust’s income (approximately £5.1 

million) is related to achieving the quality improvement 

and innovation goals agreed between Homerton, our 

commissioners NHS North East London and the City and 

our specialist commissioners through the Commission for 

Quality and Innovation payment frame work. In 2012/13, 

the Trust held three major contracts that included a variety 

of CQUIN schemes – the acute services contract, the 

community health services contract and the specialised 

services contract. 

At the time of producing this report, the Trust’s 

achievement rate is not yet known; however, it is expected 

to be in the region of 60%. 

Further details of the agreed goals for 2012/13 and for the 

following 12-month period are available online at: http:// 

www.institute.nhs.uk/commissioning/pct_portal/cquin.html 

See Appendix 1 for details on CQUIN values. 

Update on progress 2012/13 CQUINs 

CQUIN schemes can cover one or more elements of quality; 

patient safety, clinical effectiveness and patient experience. 

The CQUINs generally contain several requirements which 

necessitate compliance to improve care and achieve 

payment at the end of the year. 

Patient safety 

Six CQUINs covered patient safety, three contained 

elements of effectiveness and two covered all three 

elements, so included patient experience. They are: 

• venous thromboembolism (VTE) 

• dementia care 

• safety thermometer (acute and community) 

• cancer staging 

• older people’s care – nutrition 

• discharge communication. 

We have been successful in meeting most of the 

requirements of these CQUINS. Some of the results will 

be confirmed in the final quarter of year 2012/13. The 

older people’s care – nutrition scheme has shown excellent 

results through the year due to the nutrition and dietetics 

team working with the nursing teams. Safety Thermometer 

compliance has been effective in the acute hospital. There 

was a reduced level of information being returned for 

the community in quarter 3 of the year but this has been 

resolved and all patients are being surveyed on the data 

collection day. 

The dementia CQUIN required 90% of eligible patients to 

have an abbreviated mental test, a dementia assessment 

and be referred on to a specialist if necessary. The 

percentage of patients assessed has increased over the year 

but not to the required 90%. 

The cancer staging data has been achieved, with 90% 

of relevant patients having cancer staging data in their 

healthcare records; this figure has been maintained 

consistently through the year. 

We have improved discharge communications with GPs by 

using a new electronic system. Copying letters to patients 

is happening routinely in four specialties; there are plans for 

this to be rolled out to all next year. 

Clinical effectiveness 

Five CQUINS were related to clinical effectiveness (two of 

these also have a patient experience element). 

• Smoking cessation – prior to surgery 

• Health visiting – new birth visits and developmental 

checks 

• Reduction in “do not attends” (DNA) in four 

community specialties (DNA is the code used when a 

patient has an appointment but does not come to it 

and has not contacted the speciality to inform them.) 

• Neonatal care 

• HIV 

For these schemes where data is available (some remain 

outstanding) we have partially achieved the CQUIN 

requirements. For example with smoking cessation 

the referral rate to the service has been variable across 

specialties with oral and maxillofacial, respiratory and 

cardiology referring the most patients. The focus next year 

will be to increase the referral rate for general surgery 

patients. 

The requirements of the CQUIN were almost achieved by 

the health visiting team. They have a detailed action plan in 

place to further improve the care of children from zero to 

five years of age. 


www.homerton.nhs.uk 

A new system of reminding patients about appointments 

has been commenced in some areas – where it is being 

used the DNA rate has dropped. 

The neonatal care CQUIN concerned ensuring there is a 

neonatal community nurse in place to support parents 

and babies on discharge from the special care unit and a 

reduction in the number of term babies admitted to the 

unit. An in-depth review of the admission of term babies is 

being carried out in partnership with maternity services; our 

admission rates are in line with the national average for a 

regional neonatal unit. 

Data on whether the number of HIV patients who have 

consented for information to be shared with their GP and 

who are having their medications delivered to their home is 

awaited. 

Patient experience 

The remaining CQUINs cover patient experience only. They 

are: 

• patient experience in hospital and community (adults 

and paediatrics) 

• patient experience in maternity. 

These CQUINS are based on questions in national surveys 

(except the community ones which have been administered 

locally using a modified version of the questions used for 

the inpatient patients experience measurement). 

The overall response to the 2012 inpatient survey in relation 

to these questions is being evaluated. 

The required increase in improvement was met in the 

paediatric inpatient survey. Six questions related to: 

information about surgery, children being involved in their 

care, confidence in nurses and feeling safe on the ward. 

The required improvement to the questions on the patient 

experience survey in the community was not achieved. The 

information collected in the surveys is being reviewed by 

the services in order to determine improvement actions. 

The required increase in improvement was not achieved 

in the maternity survey – there are details on actions to be 

taken on page 63. 

The details on the requirements of these CQUINs and 

progress to date can be found at Appendix 2. 

A56323 HUH Night Time BLIND 60x110 P1:A3 Poster 4 Col XP6.qxd 14/1/13 1:48 Page 1 

Homerton University Hospital 

NHS Foundation Trust 

Do not 

enter. 

Patients’ 

mealtime. 

Please recognise protected mealtimes and 

do not enter unless: 

You have urgent clinical 

business on the ward 

You want to help patients 

to eat their food 

Message to Homerton 

You say... 

we act 

Homerton Welcome 



Review of Quality 

Performance – Regulatory 

and national targets and 

requirements 

3.1 National targets and regulatory 

requirements 

The Trust is required to regularly monitor its position against a number of performance targets set by the Department of 

Health. Table 12 shows the Trust’s position for 2012/13 against the required target 

Table 12 - Trust position against national performance targets for 2012/13 - acute and community targets 


Actual year to 

date 


Target 

Emergency care patients seen in

MMR - Age 2 


Actual year to 

date 


Target 

Measles, Mumps and Rubella 86.5% 83% 

DTaP/IPV - Age 5 

Diphtheria, Tetanus, Polio, Pertussis 78.0% 75% 

MMR - Age 5 

Measles, Mumps and Rubella 79.7% 75% 

Breast Feeding 

National Target (Contract Threshold) 

Breastfeeding 

Breastfeeding coverage (%) at 6-8 weeks 98.0% 95.10% 

Breastfeeding prevalence (%) at 6-8 weeks 84.1% 81.80% 

Meticillin Resistant Staphylococcus aureus 

(MRSA) 

This year our target, not to be exceeded for MRSA 

bacteraemias, (a blood stream infection with MRSA whilst 

in hospital) was one case. 

We had two patients develop MRSA bacteraemia this year. 

The infection control team continues to work together with 

staff and patients to reduce the risk of further cases. 

The infection control team provide ongoing training for 

staff, raise awareness of the need for clean hands in staff, 

patients and visitors and monitor compliance with hand 

hygiene requirements. 

All patients are screened either prior to or on admission to 

hospital for MRSA. Work continues in relation to invasive 

devices such as drips and drains to reduce the risk of 

patients developing an infection. 

Clostridium difficile (C.diff) 

A total of 13 patients developed C.diff infection in hospital 

last year. 

Our C.diff rate per 100,000 bed days is available from the 

national data up to the end of March 2012. The figures for 

the preceding years indicate the improvements we have 

made in reducing the number of patients developing C.diff 

in hospital. 

Homerton’s performance compared to other NHS Trusts 

with the highest and lowest rates of C.diff in the country 

are shown in table 13. 

Table 13: Homerton C.diff rate per 100,000 bed days in 

comparison to the highest and lowest from NHS trusts and 

foundation trusts in England 

C.diff rate per 

100,000 bed 

days 

Year Lowest Homerton Highest 

2008/09 0 32.8 133 

2009/10 0 17.3 84.4 

2010/11 3.2 7.6 69.9 

2011/12 0 6.9 51.6 

Homerton considers that this data is as described for 

carrying out the following reasons: the Trust has focused 

on ensuring infection rates remain low and has robust 

processes in place both to prevent infections and take 

appropriate actions if any infection is identified. 

Homerton has taken action to improve this rate, and so the 

quality of its services, by carrying out the following: 

• Hand hygiene continues to be a vital part of combating 

infection at the Trust. All clinical areas audit their hand 

hygiene every two weeks and the results are displayed 

on the Trust intranet. These audits show that the Trust 

average for staff washing/using alcohol gel on their 

hands is 90%. There are some areas that are achieving 

100% on each audit, and these audits show a steady 

improvement on last year when we were cleaning our 

hands 85% of the time. 

• Good antibiotic prescribing with regular audits to 

monitor compliance. 

• Education, training and support of staff by the 

infection control team. 



• Development of new protocol for patients suffering 

with diarrhoea and how to assess and treat them. 

• Introduction of a multidisciplinary ward round to review 

patients with C.diff. The team is made up of infection 

control nurses, a microbiologist, a gastroenterologist, 

dietitians and the antibiotic pharmacist. These patients 

are monitored and followed up by this team for the 

rest of their stay in hospital. 

Source: http://www.hpa.org.uk/Topics/InfectiousDiseases/ 

InfectionsAZ/ClostridiumDifficile/EpidemiologicalData/ 

MandatorySurveillance/cdiffMandatoryReportingScheme/ 

High impact interventions (HIIs) 

We are continuing with the activities we highlighted in last 

year’s report that have a high impact on reducing the risk 

of infection related to care. These are specific activities for 

defined interventions that involve how to carry out that 

care and how to measure that it has been done correctly. 

Using this approach keeps the risk of infection to patients 

low. The HIIs that we use include: 

• central venous catheter care (insertion and ongoing 

care) 

• peripheral venous catheter care (insertion and ongoing 

care) 

• prevention of surgical site Infection (pre-operative and 

peri operative care) 

• urinary catheter care (insertion and ongoing care) 

• clinical equipment decontamination (not contaminated 

and HCAI). 

All clinical teams collect data on how they are carrying 

out the HIIs. This has been extended this year to some 

of the Trust’s community teams. The results are reviewed 

by the infection control team monthly and in 2012/13 

they continue to show high levels of compliance with 

interventions. If the results do show a reduced level of 

compliance the infection control team work with the 

clinical team in reviewing practice and supporting staff to 

ensure that high levels of compliance are achieved. This 

method of continuous monitoring ensures that we know 

that high standards of practice are being achieved and if 

not we can act on them quickly. 

3.2 National outcomes framework 

The national outcomes framework covers five domains; all 

care provided by Homerton covers one or more domains: 

• preventing people from dying prematurely 

• enhancing quality of life for people with long term 

conditions 

• helping people recover from episodes of ill health or 

following injury 

• ensuring the people have a positive experience of care 

• treating and caring for people in a safe environment 

and protecting them from avoidable harm. 

3.3 Patient reported outcome measures 

Patient reported outcome measures (PROMs) evaluate 

quality from the patient perspective. They currently cover 

four clinical procedures: PROMs calculate the improvements 

to a patient’s health, as they perceive it, after surgical 

treatment using pre and post-operative surveys (at 

least three months after groin hernia and varicose vein 

operations, or at least six months after a hip or knee 

replacement). Homerton does not carry out varicose vein 

operations. 

Completion of the pre-operative PROMs questionnaire is 

voluntary for the patient and their consent to participate 

must be granted for the data to be processed and used. 

The completed pre-operative PROMs questionnaires are 

transferred securely to the Department of Health contractor 

responsible for collating all of the information, where the 

forms are scanned electronically and traced to obtain the 

patient’s NHS number. In a separate database the preoperative 

PROMs questionnaires are linked securely to 

specific databases. 

After three or six months, depending on procedure, the 

Department of Health contractor posts out the follow-up 

post-operative questionnaire to the patient’s home. Once 

the form has been completed by the patient and returned, 

it is electronically scanned and linked with the pre-operative 

data. It is only then that the data can be analysed. 

In last year’s Quality Account we reported on data up to 

December 2011. We have been in contact with the Health 

and Social Care Information Centre (HSCIC) to confirm that 

the post op questionnaires have been received. The HSCIC 

have questionnaires for groin hernias – but because there 

are fewer than five patients who have responded the data 

is not shown on the national spread sheet (and would be 

unreliable for statistical analysis). 


In terms of hip and knee replacements, although we have 

had 60 patients (from April to November 2012) who have 

agreed to complete the pre op questionnaire, no patients 

have yet completed a second questionnaire. So there is no 

data available for this year. 

The Trust only has control over the pre-operative part of this 

process; a Department of Health contractor manages the 

post-operative part. 

Data released on 9 May 2013 shows performance from 

April 2012 to December 2012. 

• Patients who had undergone a groin hernia repair - 

only 12 patients returned both questionnaires – so this 

information is not considered statistically significant. 

• Patients who had their hip replaced - fewer than five 

patients returned both questionnaires so no data is 

available. 

• Patients who had their knee replaced – no patients 

returned both questionnaires so no data is available. 


following reasons; 

There is a built in time delay in patients responding to the 

second questionnaire and some patients may choose not to 

complete it. 


rate, and so the quality of its services. We are reviewing the 

current process used to encourage patients to complete the 

first and second PROMs questionnaire and make changes as 

necessary to improve response rate. 

Source for information: http://www.hesonline.nhs.uk/Ease/ 

servlet/ContentServer?siteID=1937&categoryID=1632 

3.4 Audit and research 

National audits: Homerton acute care 

involvement in national audits 

During 2012/13, 54 national clinical audits and three 

confidential enquiries covered NHS services. 

Of these, 37 national clinical audits and three confidential 

enquiries covered services that Homerton provides. 16 

national clinical audits were not applicable to the Trust 

(services we did not provide). 

During 2012/13 Homerton participated in 36 (97%) 

national clinical audits and three (100%) national 

confidential enquiries of the national audits and national 

confidential enquiries in which it was eligible to participate. 

Homerton did not participate in one national clinical audit 

(Parkinson’s disease) because the recommendation from 

the audit was that trusts should only participate in alternate 

years. As Homerton participated in 2011 it will next 

participate in 2013. 

The national clinical audits and national confidential 

enquiries that Homerton participated in and for which data 

collection was completed during 2012/13 including the 

number of cases submitted to each audit or enquiry as a 

percentage of the number of registered cases required by 

the terms of that audit or enquiry are listed at Appendix 3. 

National audit reports – our response 

The Trust reviewed the 23 reports that were published in 

relation to national clinical audits during 2012/13. Appendix 

4 shows the action being taken or planned as a result of 

review of the report to improve the quality of health care 

provided. 

Local audit 

Homerton reviewed 110 local clinical audits and is taking 

action as a result to improve the quality of health care 

provided. Appendix 5 provides a selection of actions taken 

from audits carried out in the Trust. All of these actions have 

been completed. 

Research 2012/13 

The total number of patients receiving NHS services 

provided or sub-contracted by the Trust recruited to National 

Institute for Health Research (NIHR) portfolio studies 

between 1 April 2012 and 28 February 2013 was 1,821. 

Several more patients were recruited to non NIHR portfolio 

studies during 2012/13. 

Involvement in clinical research demonstrates the Trust’s 

commitment to improving the quality of care we offer and 



to making our contribution to wider health improvement. A 

total of 80 clinical staff, across 24 medical specialties were 

principal investigators of 173 research projects approved by 

a research ethics committee during the period April 2012 to 

the end of March 2013. 

Participating in research ensures that our clinical staff 

stay abreast of the latest treatment possibilities and 

active participation in research leads to successful patient 

outcomes. 

• The INFANT Study which is researching the use of 

decision making support software to establish if this 

can help midwives and doctors improve the care they 

provide in response to abnormalities of the babies 

heart rate during labour 

• The Molecular Genetics of Adverse Drug Reaction 

Study that is identifying genetic factors which influence 

adverse reactions with the aim of developing genetic 

tests to help predict individual susceptibility to adverse 

reactions, demonstrates the Trust’s commitment to 

offering the latest medical treatments and techniques 

• Likewise the Trust continues to learn how we can 

improve the support given to the patients through 

studies such as People’s Views about HIV and its 

treatment. The study is investigating the reasons 

people decline treatment for HIV and developing ways 

of supporting people with HIV to help them get the 

most from their treatment 

• The Trust is part of the Harmonising Permission 

for Research Pilot Project which was launched 

at the end of October 2012. The project aims to 

support the ambitions of the Department of Health 

and Commercial research partners by providing a 

streamlined approach to obtaining NHS permission. 

It is based upon the concept of one review, one 

costing, one contract and one study set up fee for 

all commercial research projects that are going to 

be conducted with the Central and East London 

Comprehensive Local Research Network. 

• The neonatal research team are part of a study looking 

at patterns of early colonisation of the small and large 

bowel and immune development in the preterm infant. 

A neonatal consultant was awarded an NIHR Research 

for Patient Benefit (RfPB) grant for £31,358 to study the 

management of hypotension in preterm infants. This is the 

first NIHR grant award registered at the Trust. 

In the last year 129 publications have resulted from our 

involvement in research, which shows our commitment and 

desire to improve patient outcomes and experience across 

the NHS. 

3.5 Survey outcomes 

National Inpatient Survey 2012 

The National Inpatient Survey was sent to 804 patients who 

were discharged from our acute hospital in June, July or 

August 2012. The expected response rate for the National 

Patient Survey is 60% (approx 500 responses). Across the 

country a total of 64,500 patients responded to the survey, 

this is a response rate of 51%. 

Homerton had responses from 280 patients - a response 

rate of 34.83%. 

The breakdown of Homerton patients responding to the 

survey is shown in table 14. 

Table 14: Demographics of Homerton National Survey 

respondents compared to national respondents 

Homerton% National 

(all trusts)% 

Male 46 46 

Female 54 54 

Age 

Aged 16-35 14 7 

Aged 36-50 21 13 

Aged 51-65 26 25 

Aged 66 and older 38 55 

Ethnicity 

White 53 90 

Multiple ethnic group 3 1 

Asian or Asian British 10 3 

Black or Black British 20 1 

Not known 13 5 

The responses to the questions have been calculated to give 

scores out of 10 for each question and show whether our 

results are; the same, better or worse than the scores of 

other trusts in the survey. 

Compared to last year’s survey we have no statistically 

significant lower scores and we have higher scores in 

questions relating to: 

• patients’ involvement in decisions about their care 

• being given enough privacy when being examined or 

treated and 

• being treated with respect and dignity while in the 

hospital. 


We do have areas of concern from the survey where scores 

have been consistently low and/or performance is said to 

be worse than other trusts, for example: “In your opinion, 

how clean was the hospital room or ward that you were 

in?” or “When you had important questions to ask a nurse, 

did you get answers that you could understand?” 

However when these questions have been asked of 

patients on the Picker survey locally the responses have 

been good, the year to date figures show; 

93% of patients stated that their room/ward was very clean 

or fairly clean. 

93% of patients stated that they received answers they 

could understand when they had important questions to 

ask a nurse. 

Where we are aware of a deficit in patient experience we 

will be working to improve. 

The priorities set out by the Chief Nurse related to the 

compassion in practice plan will influence how all patients 

experience our services (not just inpatients), particularly the 

activities for priority area five which is about “Making every 

patient contact matter”. 

Maternity survey 2012 

In August 2012 we repeated the survey of women’s 

experience in maternity services. The results of the survey 

were received early March 2013. 

The survey was completed by 131 women, which is a 

response rate of 41%. The survey covered all aspects of 

their care during pregnancy, delivery and the postnatal 

period. The five questions in table 15 made up the 

maternity CQUIN. 

Table 15: Detail on results from the maternity survey 

The results in the brackets are the results for 2010/11. The 

commissioners set a target of a 10 point improvement in 

all questions. We made between a three and an 8.2 point 

improvement in all five CQUIN questions; this was not 

enough to achieve the CQUIN this financial year. 

The areas that we focused on improving were: 

• increasing the consistency of information given to 

women prior to consenting for tests, this has been 

discussed at the Hackney Maternity Board meeting 

which is chaired by a local GP. GPs have equal 

responsibility, with midwives and hospital based 

obstetricians, for this aspect of antenatal care. 

In 2012/13 the results from the survey indicate that this 

continues to be a problematic area with no improvement 

seen; the plan is to present the information again to the 

City and Hackney Maternity Board to agree a strategy. 

Improving consistency in the advice given by midwives 

and carers regarding women breast or bottle feeding their 

babies. In 2012/13 we saw improvements in this area; 

however, we aim to improve further as it still scoring below 

the national average from all trusts. 

Looking at ways we can increase the percentage of women 

who feel that in the postnatal period they were treated 

with respect and kindness. In 2012/13 again we saw 

improvements in this area; however still below the national 

average of all trusts. 

This year the CQC are re-running the triennial national 

maternity survey on all women who gave birth in February 

2013. The results will be available early autumn 2013. 

The final survey report will be shared with staff and 

an action plan developed to address areas of concern. 

The action plan will be monitored at the Maternity Risk 

Management and Clinical Governance Committee. 

Question Response category 11/12 survey 

result (baseline 

2010 results) 

B13. If you saw a midwife for your antenatal 

check‐ups, did you see the same one every time? 

D3. After the birth of your baby, were you given 

the information or explanations you needed 

D4. After the birth of your baby, were you treated 

with kindness and understanding? 

E4. Thinking about feeding your baby (breast 

or bottle) did you feel that midwives and other 

carers gave you consistent advice 

F12. Overall how would you rate the care 

received after the birth 

All trusts 

2010 result 

Target for 

improvement 

12/13 

% Yes always 9% (17.2%) 20% +11% 

% Yes always 41% (44.3%) 51% +10% 

% Yes every time 42% (46.6%) 59% +17% 

% Yes always 30% (34.4%) 37% +7% 

% Excellent 18% (21.4%) 31% +13% 



Improvements to the maternity department 

In December 2012 the Department of Health (DH) had 

a £25 million budget which maternity units across the 

country were invited to apply for to enable physical 

improvements to their departments. The Homerton 

maternity team asked women, their partners and staff 

what improvements they would like to see if the bid 

was successful. The maternity team were successful in 

securing £350,000 from the Department of Health for 

improvements, which will include: 

• two further static birthing pools in the birth centre 

• conversion of a delivery suite room for a static pool 

with electronic monitoring; this facility will assist 

women who have a higher risk pregnancy but want a 

water birth to be able to have that option at Homerton 

on the delivery suite 

• changes to the plumbing in order to be able to use 

inflatable pools more easily in a number of rooms on 

the delivery suite 

• upgrading of: 

- showers and toilets on the post natal ward 

- kitchens 

- milk kitchens 

- nursery – where new baby checks are carried out 

- the midwifery station (to improve flow of work) 

- storage facilities on the wards 

- different chairs will also be purchased – this 

is in readiness for trialling of 24 hour visiting 

for partners. This trial will start in July, run for 

approximately six weeks, then be formally 

evaluated. 

These improvement works will take place over the next few 

months. 

Picker surveys (patients) 

The Trust started a near real time patient experience 

feedback programme in February 2012; a team of 

interviewers (volunteers and members of the patient 

experience team) carry out interviews with patients using 

the hand-held electronic tablets, interviewing patients at 

the point of care and post care. This technology enables the 

Trust to capture patient feedback on a continuous basis, 

quickly highlighting areas of need as well as feeding back 

positive news to the Trust. For community services feedback 

has been collected using questions that were developed 

with Picker’s support. The responses from patients were 

collected on paper and entered into the hand held devices 

later. This was due to complications connecting the devices 

to Picker in the community. 

Since starting the feedback programme in February 2012, 

the Trust has seen positive results emerge. Cleanliness and 

privacy are measures that the Trust is performing well on 

and this trend has continued into Quarter 4. 

However, the following overall scores have shown a 

downward trend in Q4 compared to Q3: 

• Inpatients – 42% of patients were bothered by noise at 

night – 9% more than Q3 

• Inpatient follow-up (patients telephoned at home) 

- 48% of patients stated that their discharge was 

delayed 2% more than in Q3 

• Outpatients – 48% of patients stated they were not 

given a choice of appointment times, 20% lower 

• Mealtimes - 67% of patients rated the food as very 

good or good, 7% lower 

Areas where quality improvement initiatives are being 

reviewed at the Patient Experience Committee are: 

• the food the patients receive 

• communication and information measures 

• noise at night for inpatients 

• helping patients when they need help 

• discharge processes 

• waiting times in outpatient department and clinics. 

The following results show improved scores in Q4 

compared to Q3: 

• 75% of patients rated their care as excellent or very 

good, 6% better 

• 86% of patients in outpatients said that they always 

received answers they could understand when they 

had questions to ask clinicians, 10% better 

• 100% of patients reported that the department was 

very clean or fairly clean, 3% better 

• 81% of patients reported that doctors were always 

courteous and thoughtful, 6% better 

• 92% of patients reported that they were always 

treated with respect and dignity, 5% better 

• 80% of inpatients stated that doctors always gave 

them understandable answers, 10% better 

The Divisions have responsibility for organising their action 

plans in a way which fits in with their divisional structures 

and processes. This will link with the Quality Accounts and 

issues that have been highlighted by the Governors. 


Outpatients 

Feedback from Picker over the last three quarters 

has shown that patients are finding their way to the 

department without problems, they are greeted in a 

friendly way by the reception staff, consider they have 

enough time with the clinician, are getting answers they 

understand and would recommend Homerton to their 

friends and family. 

The area the survey results have shown we are not doing 

so well on, is the time patients have to wait beyond their 

appointment time without having an explanation. The 

outpatient team have an action plan to improve this area of 

concern. 

The team monitor this patient experience action plan every 

month at a team meeting – the key theme is to improve 

patients’ waiting times so the appointment time reflects the 

time they are seen. 

The team are carrying out a specific patient waiting times 

audit in conjunction with Picker. They select two specialties 

each month and capture times for each step of the journey 

and feed this information back to divisions. 

The team ensure that patients are told verbally and 

information is displayed on a white board about delays of 

more than 15 minutes to the clinical running time. This 

includes recording when the update was last put on the 

board. 

The nursing staff inform the reception team about delays so 

that patients can be informed when they arrive. 

New wall plaques containing information about the 

department and waiting times have been put up. 

If the team running the clinic are more than 30 minutes 

late, this information is fed back to the service managers 

so they can investigate and put risk reduction measures in 

place. 

In March 2013 the central bookings team will carried out a 

telephone survey with patients to gauge their experiences 

of using the call centre. Picker will provide full analysis of 

the results. 

CSDO: Community and hospital advocacy service 

In November 2012, 111 clients across hospital and 

community settings were asked their views on the advocacy 

service. Feedback was overwhelmingly positive with all 

respondents stating that: the bilingual advocates explained 

things in an understandable way; they definitely felt the 

advocacy service helped them; and they would definitely or 

probably recommend the service to family and friends. 

Comments from service users included: 

‘I am happy with the support. All of them are cheerful and 

friendly.’ 

‘I am very pleased with the interpreting services provided at 

schools and hospitals. I wish this service will continue.’ 

‘Thank you for the service. I am very happy and feel more 

confident now that I can get help with the language to be 

able to communicate my ailments and/or problems. Thank 

you very much.’ 

SWSH urology 

25 urology patients attending urology outpatient clinics 

were either observed in clinic or asked after they had been 

seen in clinic if they had: 

• been spoken to courteously 

• received an introduction from the doctor or nurse using 

their name and job title and 

• been addressed by their preferred name. 

All 25 patients answered YES to the above questions. 

Cancer patient experience survey 

The most recent national cancer survey results were 

published in August 2012; this survey covered all adult 

patients (aged 16 and over) with a primary diagnosis of 

cancer who had been admitted to an NHS hospital as an 

inpatient or as a day case patient, between 1 September 

2011 and 30 November 2011. 

The response rate to this survey at Homerton was 51% and 

represents the views of 20 patients. The national response 

rate was 68% (71,793 respondents). 

Cancer services have been reorganised and are being led 

by an organisation called London Cancer. Homerton is part 

of this network and is working to improve patient access, 

experience and outcomes. 

With such a low response rate, it was difficult to establish 

potential service improvements that could be made to 

particular specialties. So the cancer services team at 

Homerton are going to arrange a cross-specialty cancer 

patient focus group, within the next three months. This 

should help us gain insight into patients’ experiences and 

take forward any necessary actions. 

Source: 2011/12 Cancer Patient Experience Survey 



Colorectal cancer patients’ experience of care 

The colorectal multidisciplinary team carried out a survey 

amongst patients between June and December 2012. The 

questionnaire was based on the questions in the national 

cancer survey. The questions related to: patient experience, 

including diagnosis and treatment; the key worker; 

communication; information; and aftercare. 

Responses to the questionnaire were received from 24 

patients. The main findings were: 

• all patients were happy with their level of involvement 

in treatment planning 

• all patients felt they were treated with courtesy and 

respect in the treatment planning phase 

• 92% felt they understood the treatment options fully 

• 92% felt they had enough privacy when discussing 

treatment options 

• 87% felt the information they were given about the 

‘outcome of their treatment’ was ‘about right’, the 

remaining patients wanted more 

• information about aftercare: 

- 91% reported feeling it was sufficient 

- 63% reported feeling it was relevant 

- 63% reported feeling it was given at the 

appropriate time. 

The team are considering a review of post op care on the 

wards and a review of aftercare information. 

Source: Local survey by Colorectal cancer team 

User satisfaction at City and Hackney Young 

People’s Service (CHYPS Plus) 

An audit was undertaken in 2011 to see what the users of 

this service felt. 

The audit found that CHYPS Plus staff were providing a 

care environment that met the needs of the young people. 

Young people liked using CHYPS Plus services because 

they felt they were respected and the facility felt safe and 

welcoming. Most importantly, they felt strongly that their 

confidentiality was always maintained. They however felt 

they had to wait to be served, and the facility needed to be 

refurbished with additional toilets, a TV and more pictures. 

The recommendations from this audit were implemented in 

2012/13. 

• New CHYPS Plus leaflets and promotional 

merchandise have been ordered to publicise the 

service and distributed widely (schools, GP surgeries, 

commissioning GPs) 

• TVs and clocks were ordered and installed in both 

clinics 

• Information on young people’s care is cascaded to 

GPs only with young people’s consent 

• Pictures and artwork were purchased for waiting areas 

in consultation with young people 

• A new clinic was opened in Hackney College to reduce 

waiting times. Also a further consultation was taken 

with young people regarding opening times. As a 

result clinic times have changed to increase access by 

over 70%. 

National staff survey 

This year staff gave us positive feedback in the staff survey. 

387 staff responded (this is a 45.1% response rate – slightly 

higher than last year and comparable to the national 

average response rate of 45.6%) 

A total of 79 questions were used in both the 2011 and 

2012 surveys. Compared to the 2011 survey, the Trust is: 

• significantly WORSE on 0 questions 

• significantly BETTER on 12 questions 

• the scores show no significant difference on 67 

questions. 

Compared to the national average the Trust was better in 

32 questions – the top four were: 

• staff felt there were enough staff in the organisation to 

do their job properly 

• appraisal/performance review: left feeling work valued 

• senior managers did try to involve staff in important 

decisions 

• senior managers did act on staff feedback. 

Our answers were worse than the national average for the 

answers to the following 

• staff who had not had an appraisal in the last 12 

months 

• staff who have, in the last three months, come to work 

despite not feeling well enough to perform duties 

• staff who have been subjected to harassment, bullying 

or abuse from patients/service users, their relatives or 

members of the public 

• staff who had experienced discrimination from 

patients/service users, their relatives or other members 

of the public. 


In the following areas we are above the national average 

and have shown improvement against the 2011 survey 

results. 

Less staff thought the following statements were true: 

• No training in how to handle violence to staff/patients/ 

service users 

• No training in how to deliver a good patient / service 

user experience 

• Not able to do my job to a standard I am pleased with 

• Not enough staff at organisation to do my job properly 

• Dissatisfied with opportunities to use skills 

• Do not know who senior managers are 

• Communication between senior management and 

staff is not effective 

• Senior managers do not try to involve staff in important 

decisions 

• Care of patients/service users is not the organisation’s 

top priority 

There were no areas where staff experience had diminished 

since the 2011 survey, but the areas where we are below 

the national average were: 

• percentage of staff feeling pressure in last three 

months to attend work when feeling unwell 

• percentage of staff putting themselves under pressure 

to come to work despite not feeling well enough. 

In 2012 staff also reported that 74% of them would be 

happy with the standard of care provided by this Trust if a 

friend or relative needed treatment. This is higher than the 

national average response of 63% to this question. This 

result also puts us in the upper quartile of all acute Trusts 

for this response from staff. 

Comparison of Homerton’s performance in relation to other 

Trusts over time is shown in table 16. 


following reasons: the actions taken in response to last 

years staff survey, including the setting up of both the 

statutory and mandatory training and the equality and 

diversity group, has improved responses to the relevant 

questions. The Trust has appointed a staff wellbeing officer 

who will pursue activities and group work for motivating 

staff. The Trust has also been inspected by the CQC and 

the NHSLA in the past year – staff are fully involved in these 

inspections/assessments, the results of which are shared 

with them. 


rate, and so the quality of its services, by ensuring that 

the action plan to address staff concerns will be led by an 

executive lead and a staff Governor: 

• A communication strategy for sharing the survey 

(and actions) with staff, managers and staff side 

representatives. 

• Ensure that actions are monitored at the divisional 

performance meetings and a quarterly report on 

progress goes to the Board of Directors, Council of 

Governors and Clinical Board. 

• That Joint Staffside Committee, the Equality and 

Diversity Group and the Motivating Staff group are 

fully engaged in supporting this work. 

• For the Picker “real time staff feedback” process to be 

aligned to monitor progress against areas for action as 

well as information from PALS, complaints and patient 

surveys. 

Table 16: Homerton’s performance in relation to: whether staff 

would be happy with the standard of care if a friend or relative 

needed treatment. 

This is sum of the agree and strongly agree 

answers as a percentage 

Year All acute trusts Lowest Homerton Highest 

2010 67 38 75 89 

2011 62 33 72 83 

2012 63 35 74 94 



3.6 Complaints 

There have been slightly fewer formal complaints from 

patients in 2012/13 than in the previous year; the Trust 

received 239 complaints in 2012/13. Figures 10 and 11 

show comparisons with previous years Trust wide. 

By the end of March 73% of these complaints had been 

responded to within 25 days. 

A total of 94 (39%) complaints were upheld. 

Five complaints were referred to the Ombudsman. One of 

the complaints referred was rejected; the remaining four 

are currently under review. 

Figure 10: Total formal complaints April 2010 – March 2013 by 

month 

35 

30 

25 

20 

15 

10 

5 

0 

Figure 11: shows the complaint figures cumulatively for the 

previous three years 

300 

250 

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 

2010 2011 2012 

The complaints that patients raised were about the 

following aspects of care: 

Table 17: Complaints 2012/13 by areas of concern 

All aspects of clinical treatment 112 

Attitude of staff 34 

Communication/information to patients 

(written and oral) 

26 

Appointments, delay/cancellation (outpatient) 12 

Admissions, discharge and transfer 

arrangements 

11 

Patients’ privacy and dignity 10 

Transport (ambulances and other) 10 

Failure to follow agreed procedure 8 

Others 6 

Patients’ property and expenses 4 

Appointments, delay/cancellation (inpatient) 3 

Aids and appliances, equipment, premises 

(including access) 

Personal records (including medical and/or 

complaints) 

Policy and commercial decisions of trusts 1 

Totals: 239 

They were distributed over the following service areas 

Table 18: Complaints 2012/13 by area 

1 

1 

200 

150 

100 

50 

0 

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 

2010 2011 2012 

Outpatient 112 

Inpatient 73 

A&E 30 

Maternity 18 

Elderly (geriatric) 3 

Other community health 3 

Totals: 239 


Changes to practice have been made as a result of some 

complaints, for example: 

• Changes have been made in literature available to 

patients and education of staff, to ensure there is 

consistency in changing anticoagulation medication 

prior to surgery. 

• Education of staff has been carried out, which is being 

supported by guidelines (in production) to ensure 

that any concerns regarding a baby and successful 

breast feeding are detected quickly after birth so that 

appropriate action can be taken. 

• Following several complaints relating to the time 

patients have had to wait for transport services. 

Medical Services were informed that the length of 

delays was unacceptable. Four extra drivers have been 

employed to collect patients attending Homerton, St 

Leonard’s and the community. The monitoring of the 

contract with Medical Services has also been reviewed. 

• Following complaints about care on the elderly care 

unit a review took place and changes were made to 

the nursing structure which revised the senior support 

arrangements. 

Patient Advice and Liaison Service (PALS) 

The PALS service received 1023 enquiries during the year 

– this is 116 fewer than last year. The average number of 

PALS enquiries over the last three years has been 1116. 

These enquiries came from patients, carers, family members 

and members of the public. 

The top 10 enquiries are shown in figure 12: 

Figure 12: Top 10 enquiries to PALS on 2012/13 

200 

180 

160 

140 

120 

100 

80 

60 

40 

20 

0 

Positive feedback 

Communication 

Administration 

Attitude of staff 

Medical care 

Information requested 

Other 

Transport 

Availability of service 

Nursing care 

PALS often receive positive feedback about department/ 

services and in some cases specific members of staff. 

Positive comments, communication and requests for 

information are often in the top three categories of queries, 

figure 13 shows how the ratio of these issues has changed 

over time. 

Figure 13: Comparison of queries about positive feedback, 

communication and requests for information. 

350 

300 

250 

200 

150 

100 

50 

0 

2010/11 2011/12 2012/13 

Communication Information Positive 

requested 

feedback 

This group of queries made up 22-23% of all PALS 

enquiries in the last three years 

3.7 Updates from teams/departments 

on changes to practice and how this has 

improved quality of service. 

Acute services in the Integrated Medical and 

Rehabilitation Services Division 

Elderly care unit (ECU) 

In January 2012 the elderly care unit was set up by merging 

Aske Ward and the acute rehabilitation unit. ECU is a 

dedicated 56 bedded unit with a remit to provide on-going 

consultant geriatrician - led Clinical Geriatric Assessment 

(CGA) within a multidisciplinary framework for the care of 

complex frail elderly patients. 

The ward reconfiguration and presence of a “geriatrician 

at the front door” provides an enhanced and uniform 

structured pathway for the delivery of care for the frail 

elderly patient admitted to Homerton. Research has shown 

that the CGA approach demonstrates improved outcomes 

for patients particularly following an emergency admission. 

Measures to monitor performance and quality were agreed 

when the ward opened. Length of stay (LOS) of patients 

on ECU (compared to the previous ward configuration) 

was expected to have increased with the streamlining of 

older patients onto the ward. However the data shows 

that the LOS has remained static, this might be considered 

to be an overall improvement in LOS for this group of 

patients. Evidence shows that complex patients are being 

streamlined from the acute care unit to ECU, this way 

they only have one ward transfer and then are cared for 

together. 



Other quality measures: pressure ulcer incidence, falls, 

patient and staff satisfaction have been reviewed; there has 

been no increase in falls causing injury or of pressure ulcer 

incidence compared to the previous ward configuration. 

There is a significant amount of training and development 

being carried out with nursing and therapy staff to ensure 

the correct risk assessment and prevention measures are 

put into place to reduce the risk of any injury to patients on 

ECU. 

Patient and staff satisfaction feedback has been positive. 

There has been a measurable increase in the amount of 

contact time between therapists and patients on ECU 

compared to the previous ward configuration. 

On 6 February 2013 ECU was one of the areas the CQC 

inspectors visited when they came to the Trust to review the 

standards relating to: respecting and involving people who 

use services, care and welfare of people who use services, 

safeguarding people who use services from abuse, staffing, 

supporting workers and assessing and monitoring the 

quality of service provision. The Trust was found to meet all 

the standards and was fully compliant. 

The CQC reported that the patients on the unit received 

care that met their needs and was delivered in a respectful 

manner, with dignity and respect, staffing levels were 

adequate and staff received training and support. 

Patients reported that they felt safe and systems were in 

place to monitor the quality of the service and respond to 

issues that needed improvement. 

The unit has faced challenges in the pilot phase with 

changes to the nursing leadership and vacancies in nursing 

and therapies posts. These elements have affected the 

unit’s ability to function completely effectively. Stable and 

consistent staffing is required to support this model of 

working. 

Consideration has been given to whether to continue 

with the ECU or change back to the previous ward 

configuration. The ECU annual report concludes that the 

ECU model should continue with some recommendations 

relating to staff reconfiguration and continued 

development of staff to support the specialised care that 

ECU delivers to frail, elderly patients. 

Source: ECU annual report March 2013 

Elderly care unit – Practice development project 

This project will enhance the skills and knowledge of staff 

caring for older people in hospital; and will allow for the 

development of a competency framework for the nursing 

staff on ECU. 

The senior nurse, ward manager and practice development 

project lead met with the staff, who all felt that they 

needed specialist training to enhance their skills and 

knowledge in caring for the older adult. 

The nursing assistants and junior registered nurses will be 

assessed using competencies in care of the older adult. 

There are 13 core competencies and three knowledge 

competencies. Staff will be supported to achieve 

competencies within a six month time period. The first 

group of staff will begin assessment in March 2013. 

Source: Senior Nurse IMRS 

Surgical rehabilitation team (SRT) 

The Trust has long recognised the importance of 

involvement of doctors and therapists skilled in elderly care 

medicine in the management of patients with hip fractures. 

All of these patients are managed under the joint care of 

an orthopaedic surgeon and an elderly care consultant. This 

project seeks to replicate this model across the whole of 

surgery. 

Established in February 2013, the surgical rehabilitation 

team provides multidisciplinary assessment of patients 

before they have surgery to ensure they are fully prepared 

in terms of their medical, physical, nutritional and 

social needs. We then provide medical and therapeutic 

interventions during the operation in order to help patients 

regain their function as soon as possible and minimise their 

length of stay. 

The team assists in discharge planning and the transfer 

of patients back into the community and continue 

rehabilitation for a period of up to six weeks. We 

particularly focus on frail elderly patients as we know they 

are more likely to develop complications around the time 

of surgery, have longer stays and need more intensive 

rehabilitation. 

The team consists of: physiotherapists, occupational 

therapists, specialist nurses, a dietitian, rehabilitation 

assistants and a consultant geriatrician. 

The SRT works closely with colleagues in the anaesthetic 

and surgical teams to identify appropriate patients for 

comprehensive multidisciplinary geriatric assessment 

before their surgery via a one stop clinic. In this clinic we 

review the patient’s medications and medical problems. 

The team provides each patient with a tailored exercise 

programme and nutritional plan. Occupational therapists 

assess the need for a home visit and provide the patient 

with equipment as required in order to reduce delays after 

surgery and anticipate need. 

The SRT then sees these patients on the ward after their 

surgery, plans their discharges, and follows them up in the 


community. We work hand in hand with the first response 

duty team to support patients in the early post discharge 

period ensuring they regain independence as soon as 

possible. 

Source: Consultant Geriatrician lead for SRT 

First response duty team (FRDT) 

Members of the FRDT work both in hospital and the 

community, their aims are: 

• Rapid assessment of patients in the Emergency 

Department and the acute care unit (ACU) to facilitate 

rapid, safe discharge from hospital and prevent 

unnecessary admissions to hospital. 

• Rapid assessment of patients in the community 

(these patients are usually referred to FRDT by their 

GP) to assist in keeping them at home and prevent 

unnecessary admissions to hospital. 

The total number of referrals to the service (i.e. hospital and 

community referrals) continues to increase. 

• Total number of referrals to FRDT from 

Jan-Dec 2011 = 1772 

• Total number of referrals to FRDT from 

Jan-Dec 2012 = 2155 

This represents a 21.6% increase in total 

referrals to FRDT 

• Total referrals to FRDT from 

Apr 2012 – March 2013 = 2126 

This represents an increase of 12% in referrals 

compared to the year before 

The work of FRDT assists people to be cared for in the most 

effective way and helps patients to stay at home unless 

there is an overriding clinical need for them to be admitted 

to hospital. 

FRDT is collaborating closely with the new surgical 

rehabilitation team. 

Source: Occupational Therapist FRDT 

Falls and bone health 

In conjunction with the developments of the elderly care 

unit and the surgical rehabilitation team, other changes 

have been taking place to ensure effective assessment 

of patients’ bone health and prevention of future falls. 

This is particularly relevant in older patients admitted with 

a broken leg (fractured neck of femur). The following 

changes have taken place to care for patients admitted to 

hospital with a fractured neck of femur: 

• There is a fracture neck of femur strategy group 

that meets regularly. The group has representation 

from: anaesthetics, orthopaedics, geriatrics and the 

emergency department with the consultant and nurse 

involvement. 

• An audit of care given to all patients who died with 

a diagnosis of fractured neck of femur from October 

2011- October 2012 was undertaken in February 

2013. The audit showed that while the 30 and 60 day 

mortality rate was within the expected range for this 

group of patients, improvements were needed in terms 

of geriatrician review – this has been addressed by the 

appointment of another geriatrician. 

• Pain relief in the emergency department for these 

patients was reviewed and femoral nerve blocks are 

now a standard option for patients with a fractured 

neck of femur. There are plans to carry out a full audit 

cycle into the use of nerve blocks by the end of August 

2013. 

• The emergency department has participated in 

the College of Emergency Medicine national ED 

management of fractured neck of femur audit. 

• There are new inflatable mattresses being stored in the 

emergency department for patients with a fractured 

neck of femur; this is to help with the reduction of risks 

of pressure ulcers. 

• We continue to participate in submitting data to the 

National Hip Fracture database for each patient with a 

diagnosis of fractured neck of femur. 

• The emergency department physicians are developing 

a fellowship in geriatric emergency medicine. 

Source: Lead consultant geriatrician 

Cardiology 

The cardiology team split from the acute care unit (ACU) 

in November 2012, when the cardiology unit became 

an independent unit. There is now a cardiology specific 

fully established nursing team, managed and supported 

by a senior charge nurse and a junior sister. This has led 

to improved continuity of care for patients and enabled 

a number of processes e.g. ward routine and lines of 

communication to be streamlined and become more 

effective. 

The unit has introduced an ultra-filtration service from 

January 2013. This is a treatment involving the removal of 

excess fluid from patients with heart failure via a filtration 

machine. This is a relatively new treatment within the UK 

with only a handful of trusts currently providing it. 

One of the main advantages to this treatment is that it can 

significantly reduce a patient’s length of stay in hospital and 



decrease the possibility of re-admission. Currently this is 

a specialist service that is only available on the Cardiology 

unit; the nursing team have been trained so that they have 

the knowledge and skills to provide this treatment safely 

and effectively. 

Source: Senior Nurse IMRS 

Haemoglobinopathies (sickle cell and 

thalassaemia) 

This service has made some significant changes to practice 

in the last year it has: 

• Collaborated with the NHS Institute for Improvement 

and Innovation on an experience based design project 

(more information below) 

• A Psychology Service for this group of patients was 

implemented in July 2012; see below. 

• A Social Care Liaison Officer was appointed in July 

2012. This post has a strong public health focus aimed 

at reducing re-admission rates by addressing some 

of the health issues experienced by the sickle cell 

population, which impair their health and wellbeing. 

This is achieved by providing advice, advocating for 

and assisting patients with concerns relating to their 

housing, employment, childcare and other social issues 

and signposting patients to the relevant statutory and 

voluntary agencies in City and Hackney. 

• A second consultant for the service was appointment 

in July 2012 

• The medical day unit facilities were expanded and the 

staffing levels increase in July 2012 

• A nurse led haemoglobinopathy therapy outpatient 

clinic started in December 2012 

Sickle cell psychology service 

The integrated psychology sickle cell service consists 

of three part-time psychology staff and aims to 

demonstrate the benefits of integrated psychological 

care for patients with sickle cell disease (SCD) through 

improved psychological health and wellbeing, improved 

levels of social and occupational functioning and of selfmanagement 

of pain and other aspects of SCD. 

There has been a reduction in re-admission rates as a 

consequence of improved links between acute, community 

and primary care services whose interventions include 

one to one psychological therapy for identified problems 

(such as panic, anxiety, depression,) pain management, 

adjustment disorder, Homerton Hospital based groups 

(“Living well with sickle cell”), ward-based “drop-in” 

sessions, helping people find the most appropriate services 

for other problems they may have. 

In the first six months of the project, 81 patients have 

undertaken a psychological screening assessment with 

53% reported clinically significant symptoms of anxiety 

and 68% clinically significant symptoms of depression. 

65% of all patients screened have taken up the offer of 

psychological support, or have been advised which other 

services are appropriate for them. 56% of the patients 

that attend the hospital frequently have engaged in direct 

psychological work or liaison work to help them into the 

most appropriate level of care. 

Source: Haemaglobinopathies annual report 

Experience based design project in sickle cell 

disease 

Experience based design is a methodology developed 

by the NHS Institute for Innovation and Improvement. It 

describes the core principles as: a partnership between 

patients, staff and carers, an emphasis on experience rather 

than attitude or opinion, narrative and storytelling approach 

to identify ‘touch points’, an emphasis on the co-design 

of services, systematic evaluation of improvements and 

benefits. 

The approach involves four phases which are: capturing, 

understanding, improving and measuring the experience. 

In addition, the approach aims to train staff in this approach 

and techniques which could then be used in other 

departments in the organisation. 

The first phase started in April 2012 when an event was 

held with patients, staff, and GPs to explain the project 

and start mapping areas identified as being of concern to 

patients and staff. From April to December collaborative 

work has continued and three main projects are under way: 

• Empowerment and advocacy. 

• Support packages. 

• Discharge planning. 

From an update in March 2013 there are at least 22 

separate elements of how care and the patient’s experience 

is different now, compared to before the project. These 

include the following: 

• Patients are more involved in their care and there has 

been an improvement in staff and patient experience. 

• The opportunity for staff members to meet as a team 

and discuss specific issues has been beneficial and 

resulted in improved dialogue and closer working 

relationships between team members. 


• Patients report that they feel their voice is being heard 

more. 

• A series of workshops for patients on specific topics is 

now running every three months – these are generally 

well attended and patients have been able to input 

into the choice of topics. 

• There is a Sickle Cell Disease specific discharge plan on 

the electronic record including a list of all the important 

follow up dates for the person leaving hospital, and 

follow up instructions to the community team. 

• We have started monthly nurse-led clinics in the 

community in conjunction with the local GP service. 

The first two clinics have taken place with 75 – 100% 

attendance. 

Source: Divisional Operations Manager IMRS 

HIV team 

The HIV team have been collaborating with other teams in 

the Trust to ensure that Homerton consultants are trained 

to use Preview (the database used in the Department of 

Sexual Health) so they have access to a patient’s full history 

when patients are admitted. 

The team have been co-ordinating the HIDES research 

project that will provide extra funding to gastroenterology 

and colposcopy services, for HIV testing in clinical indicator 

diseases. This is a Europe wide study that looks at patients 

with newly diagnosed HIV in specific clinical indicator 

diseases; we are looking at patients with Hepatitis B and C 

and anal cancer. 

The team have also rolled out point of care HIV testing 

to 30 GP practices in Hackney. More GPs’ surgeries now 

provide point of care HIV testing (results in one min). Thirty 

practices have chosen this option and were supported by 

HIV update sessions and training. 

Source: HIV Liaison Nurse 

Critical care outreach team (CCOT) 

This team is made up of experienced critical care nurses, 

whose purpose is to: 

• avert admission of patients to the intensive care unit 

(ICU) 

• facilitate transfers of patients from the ICU 

• transfer critical care skills to ward teams. 

The team carried out an audit in September 2012 to review 

the use of the adult observation chart on nine general 

wards. 

The charts and records of 228 patients were reviewed by 

the team to answer four essential questions: 

• was the required frequency of observations prescribed 

on the chart? 

• were the observations recorded as prescribed? 

• was the patient’s alertness recorded as part of the 

observations? 

• was the patient’s care escalated as required? 

The expected target for these questions is 100%; the 

results were variable, resulting in the following averages 

across the Trust: 

• was the required frequency of observations prescribed 

on the chart? 63% 

• were the observations recorded as prescribed? 6% 

• was the patient’s alertness recorded as part of the 

observations? 73% 

• was the patient’s care escalated as required? 70% 

There was variation between ward areas. Some wards had 

very high scores with seven out of nine achieving 100% for 

care being escalated as required. One ward achieved 100% 

on the last three questions. 

There were wards where improvements were required 

and the ward managers are responsible for leading these 

improvements. 

Ward managers have been provided with a report for their 

area with advice and support from the critical care outreach 

team on how to follow this up. The ward managers have 

been requested to carry out a weekly random review on 

the observation charts of six patients and send this data to 

the nurse consultant for evaluation. 

The team have re-audited and the results are being 

analysed. Source: Audit report CCOT 

Diabetes team 

The Homerton diabetes team has been successful 

in winning an award in 2013 run by Quality in Care 

Programme Diabetes. They won “highly commended” 

for their entry into the Best Primary and /or Community 

Initiative of the Year. 

The team won the award this year for the project they 

implemented over the last two years, to improve the control 

of blood sugar of patients with diabetes in the community. 

In 2008/09 City and Hackney, Newham and Tower Hamlets 

were all in the bottom 20% of performing PCTs in terms of 

diabetes care measured using the Quality and Outcomes 



Framework (QOF). Four elements were implemented to 

improve this in City and Hackney: 

• Patient education 

• Diabetes intervention teams (DITs) - diabetes resource 

packs were developed containing the learning 

outcomes and resources developed by the diabetes 

intervention teams. These were made available to all 

practices. 

• Medical education 

• Diabetes specialists in primary care 

Results 

The impact of the intervention has been so great that in 

the QOF data from 2010/2011 City and Hackney was the 

eighth best performing PCT area in London. 

The figures demonstrate that more patients in City and 

Hackney have better controlled diabetes that they did 

before the initiative. The patients where blood sugar control 

has improved are less likely to have the complications of 

diabetes such as cardiovascular disease, kidney disease and 

problems with their vision. 

Patient response to the structured education and the ease 

of access to specialist support in GP surgeries has been 

entirely positive, with patients feeling more comfortable 

accessing these services in the community rather than at 

the hospital. 

As a result of the improved performance of the PCT in the 

time period, there has been parliamentary interest in how 

this change was implemented. The improvements have also 

led to a visit from the National Audit Office as part of the 

Health Value for Money Audit. 

One of the GPs involved in the initiative has written: 

“Homerton diabetes centre has a team of diabetes 

specialist nurses who visit all practices in City and 

Hackney. They provide an important link between the 

practice and the hospital. They are able to see complex 

patients in the practice to optimise their management 

including commencing insulin. They regularly meet with 

and feedback to practice staff providing a useful conduit 

for clinical information and an opportunity for informal 

education. In addition, a team of diabetic dietitians also visit 

all practices to support this process, offer dietetic advice 

to individual patients and run group education sessions 

including expert patient. This comprehensive, supportive 

‘hands-on’ approach has resulted in improved glycaemic 

control across the CCG area.” 

Feedback from a patient 

“Sometimes going to see the DSN or dietitian can be a 

cause for concern, especially if things haven’t been going 

well but somehow, being seen in the local clinic, is familiar 

ground and less stressful. The patients also feel they are 

getting the best possible advice from the experts who deal 

with diabetes day in day out. I think the fact that the clinics 

have such low DNA rates compared to the hospital clinics 

shows how popular they are with patients. 

“At a time when the NHS is under so much pressure it has 

been fantastic to see the DSNs and dietitians have so much 

commitment to this initiative. I think the positive results 

we have all seen have really been a boost to them at this 

time and has probably helped with sustaining this initiative. 

They really do want to offer the best service possible to the 

people of City and Hackney.” 

The team were also shortlisted in March 2013 for a further 

award: Care Integration Awards 2013 in the Diabetes Care 

category. 

Children’s Services, Outpatients and Diagnostics 

Division 

Health visiting 

In February 2011 the Health Visiting Service for City of 

London and London Borough of Hackney was chosen 

as one of 26 trusts to be an early implementer site 

for the Department of Health call to action for Health 

Visiting nationally. This was to support the development 

and implementation of a new service, which included 

recruitment and retention of staff to increase the number 

of health visitors overall to 4,200. This was a two year 

national early implementer site programme that ended in 

February 2013. 

The revised health visitor vision defines four levels of service, 

together with child safeguarding, to be delivered by the 

health visitors and their teams. The levels are: 

• Community - to ensure families are aware of and 

empowered to use the range of health and community 

services available in the locality, including Sure Start 

• Universal - health visitors and their teams deliver the 

Healthy Child Programme to ensure a healthy start for 

children and families 

• Universal plus - A rapid response from health visitors 

when specific expert help is required e.g. post natal 

depression 

• Universal partnership plus - Ongoing support from the 

health visiting team and local services 


Safeguarding - Health visitors form part of high intensity 

multi-agency teams providing services for families where 

there are children with safeguarding and child protection 

concerns. 

The programme has led to a number of improvements 

including: 

• improved training and development of student 

health visitors, using a long arm approach to training. 

Specialist practice teachers and trainee practice 

teachers to support increased student numbers. 

• Prior to 2011 the number of students trained was 

between one and three per year. In 2011/12 the Trust 

trained 10 student health visitors. 

Feedback from the Nursing and Midwifery Council (NMC) 

visit on the 5 December 2012 to review student health 

visitor training stated that the following impressed the 

reviewers: 

• The dedication and high standard of student support 

offered by practice teachers 

• Strong partnership working between the Trust and City 

University London 

• The high standard of practice teacher registers and 

triennial reviews 

• Diversity and strengths of the east London learning 

environment; and the robust student learning 

experience 

• Good systems in place for practice teacher to student 

allocation - i.e. we are meeting NMC guidelines. 

• That there are a wide range of teaching and 

assessment strategies in place both in clinical and 

university settings 

• Students are fit for practice at the end of the 

programme 

The new model has also supported new ways of working 

to improve access uptake in areas of the healthy child 

programme. The Trust and Hackney Learning Trust are 

‘pilot partners’ for the national integrated two year review. 

In January 2013 Una O’Brien, the Permanent Secretary at 

the Department of Health, visited Hackney to see how the 

project works in practice. Positive feedback was provided 

which can be summarised in this comment: 

“What really stood out for her was the way you absolutely 

put the child at the heart of everything you do, and she 

was particularly impressed by the work behind the joint 

27 month assessment.” 

Although it is too early to confirm the impact of this 

integrated review, it is hoped that this will lead to early 

intervention for those children with developmental 

concerns, which will lead to better health outcomes for 

children. 

A staff development programme was commenced 

focussing on Early Intervention and Parenting. The 

SOLIHULL programme was launched in October 2012 

and delivered by the psychology team at the Trust. The 

programme continues to provide regular support to 

practitioners. The Solihull approach is a highly practical 

way of working with families within a robust theoretical 

structure. 

The programme can be used in three ways: 

• to support parents process emotion 

• to help with understanding of how parents and 

children interact 

• to help parents understand their child’s behaviour and 

enable them to work with the child. 

This way of thinking and working within the Trust is 

still relatively new and under constant evaluation by the 

psychology team; however it is expected that it will improve 

the quality of assessments and increase the understanding 

of individual family needs. 

A recent pilot joint CQC/Ofsted inspection of multi-agency 

arrangements for the protection of children carried out 

from 21 February - 6 March 2013 acknowledged a variety 

of areas in which health visiting contributed to ensure that 

children’s needs were met. 

The final report stated: 

• There is clear guidance for Homerton staff on the 

arrangements for children who have been identified 

as vulnerable and in need of additional support, but 

who do not meet the threshold for referral to children’s 

social care……….The Trust maintains a database of 

all children and young people known to be at risk 

on a child protection health review (CPHR) database 

which is routinely reviewed in safeguarding supervision 

meetings ensuring that appropriate action is taken to 

secure early help and protection such as referral to the 

sexual exploitation group. (Page 7 section 17) 

• GP link meetings with health visitors are forums that 

effectively promote the coordination of care across 

teams and agencies. (Page 7 section 18) 



Neonatal intensive care unit (NICU) and special 

care baby unit (SCBU) 

Parents’ support group 

A parents’ support group was set up with help from the 

charity BLISS in February 2012. The group meets once a 

week and is run by one of the senior sisters and a parent 

volunteer from BLISS. The group discusses different topics 

each week that are pertinent to having a premature baby. 

The group provides advice and support to parents who 

have a baby on the unit. The parents have the opportunity 

to meet each other in an informal setting, talk about and 

share their experiences. Parents who have had babies on 

the unit several months/years ago have also attended and 

talked about ‘life after NICU/SCBU’. The feedback has been 

very positive and has also enabled parents to be aware of 

links/support groups available in the community after their 

baby has been discharged. 

Plan to improve breast feeding rates on the 

neonatal unit 

A long term strategy for the neonatal unit is to improve 

breast feeding support and rates. This is in response to 

feedback from parent questionnaires compiled over the 

past 12 months. Alongside the maternity services the unit 

will aim for Baby Friendly accreditation in 2014. 

The award of Baby Friendly accreditation is highly valued 

and is only awarded after a rigorous external assessment 

process has been passed. To be “baby friendly” a 

maternity/neonatal unit must provide evidence that they 

have implemented standards as set by the UNICEF UK Baby 

Friendly Initiative. 

This is an accreditation programme based on the Global 

World Health Organisation/UNICEF Baby Friendly Hospital 

initiative. The health and well-being of all babies is at the 

heart of the initiative. 

An audit will be carried out to assess staff knowledge of 

breastfeeding and supporting mothers who have a baby on 

the neonatal unit. Following the results of this audit an inhouse 

training programme will be developed incorporating 

the UNICEF UK Baby Friendly Initiative best practice 

standards for establishing and maintaining lactation and 

breastfeeding in neonatal units. 

We have increased the amount of dedicated nursing 

support for breast feeding to provide a seven day service 

of breast feeding support. We are also reviewing current 

breastfeeding guidelines and purchasing more equipment 

to enable mothers to express at the cot side. 

Paediatric speech and language therapy 

The Hackney Speech and Language Therapy Service was 

positively referenced in the Bercow Review of services for 

children and young people (0-19) with speech, language 

and communication needs (SLCN) 2008. The report set 

out 40 recommendations to improve services; the action 

plan within the Government response set out a range 

of initiatives to improve services for children with SLCN. 

One of these projects offered funding for commissioning 

pathfinders to look at service provision. City and Hackney 

SLT service (pre-merger with Homerton) was one of 

16 successful pathfinders chosen to look specifically at 

reporting on services to multiple commissioners. 

Having embarked upon an 18 month project, the initial 

funding was withdrawn, however the service decided 

to continue the project with education partners at the 

Hackney Learning Trust. They made contingency plans to 

cover costs and clinical work due to the potential benefits 

to children and families from the project. The result is 

H-PoD, a bespoke outcome measurement tool that records 

the impact of interventions and creates an individual report 

on all patients. 

In 2012 the team have continued to work with the 

Hackney Learning Trust and individual schools to provide 

additional speech and language programmes as part of 

the schools ‘buy in’ programme. In 2012 the service saw 

an increase of 26% in this work, reflecting the quality 

and value of the programmes to school children. This 

year the first annual reports to individual schools using 

the H-PoD outcome measurement tool and activity data 

will be produced. These reports will provide data that 

demonstrates the benefits to children of the service. 


4.0 Priorities for improvement 

and statements of assurance 

from the Board 

During 2012/13 Homerton provided 68 NHS services which 

are grouped into three clinical divisions as illustrated in Table 

19. (Two of these services are outpatients only) 

Table 19 – Homerton Clinical Divisions 

Children’s Services, Diagnostics and Outpatients (CSDO) 

Integrated Medical and Rehabilitation Services (IMRS) 

Surgery, Women’s and Sexual Health Services (SWSH) 

Each Clinical Division comprises acute and community 

services. 

The Trust has reviewed the data available for the quality 

of care in the 68 NHS services. This information has come 

from a range of sources including: local and national 

audits, patient surveys, national targets, locally agreed 

performance measures and last year’s Commissioning for 

Quality and Innovation (CQUIN) targets. 

The income generated by the NHS services reviewed in 

2012/13 represents 100% of the total income generated 

from the provision of NHS services by Homerton for 

2012/13 – this income is divided into two contracts; an 

acute and a community contract. 

Quality and safety is monitored in each clinical Division with 

regular review of infection control, incidents, complaints, 

litigation, implementation of new guidance relevant to the 

specialty, progress on audits and feedback from patients. 

Each Division reports quarterly on this activity to the Quality 

Improvement Committee chaired by the Medical Director. 

Information received by the Trust Board 

The Trust Board receives the following monthly information: 

• Performance against national targets with plans for 

improvement if there are concerns in relation to any 

particular targets. 

• Key performance indicators which are a measure 

of how well we are providing services to patients 

including waiting times for outpatients and inpatients, 

the average length of stay in particular patient groups 

and targets for the timely care of patients with known 

and suspected cancer. 

Quarterly quality report 

This report produced by the Medical Director and Chief 

Nurse is a detailed quarterly report that provides the Board 

with information on: 

• patients’ experiences (detail from surveys and audits) 

• complaints, litigation, incidents and PALS (CLIP) 

• staff experience 

• updates on specific projects (for example work being 

done by the falls steering group, safeguarding adults 

committee) 

• serious incidents 

• hospital acquired infection rates 

• local and national audit 

• mortality rates 

The report includes details of actions that are being taken 

to address any areas of concern. 

Care Quality Commission (CQC) registration 

Homerton is required to register with the Care Quality 

Commission and its current registration status is registered 

with no conditions. 

The Care Quality Commission has not taken any 

enforcement action or required Homerton to take any 

compliance actions during 2012/13. 

Homerton has been subject to routine inspections in 

2012/13 as follows: 

• Mary Seacole Nursing Home on 8 January 2013 

• Homerton University Hospital NHS Foundation Trust 

headquarters (comprising Homerton Hospital and 

all the services provided by the Trust in community 

locations including those delivered in patients’ homes) 

on 6 February 2013. 

• integrated inspection of Safeguarding and Looked 

After Children’s Services in the London Borough of 

Hackney 21 May to 1 June 2012. 

The Trust was found to be compliant with all of the CQC 

Essential Standards of Quality and Safety Outcomes 

assessed at Mary Seacole Nursing Home. CQC inspectors 

found that improvements had been made to the care 

provided at the Nursing Home following the routine 

inspection carried out in October 2011. The inspection 

report contains positive comments from some of the 

residents and their families such as, “this is number one 

care”, “staff try their best” and “staff know me well. They 

are very respectful”. 



The CQC inspectors examined compliance at Homerton 

Hospital against six of the CQC essential standards, and 

concluded that the hospital was meeting all of these 

standards. The inspection focused particularly on the 

maternity unit and the elderly care unit. 

CQC found that patients and relatives were predominantly 

positive about their experiences at Homerton. Some of the 

patient comments captured during the inspection included 

a patient on the maternity unit who said: 

“I’ve never had any problem. That is why I keep coming 

here.” 

Another patient said: “The midwives are very nice. They 

helped me with breastfeeding… I felt really supported.” 

Patients and relatives in the elderly care unit were also 

mainly positive, telling the inspectors that “the nurses are 

looking after me nicely, and encourage me to eat and get 

strong.” 

The integrated inspection of Safeguarding and Looked 

After Children was led by the Office for Standards in 

Education, Children’s Services and Skills (Ofsted) and 

involved CQC as the regulator for health services. 

Safeguarding services were rated ‘good’ overall as were 

services for Looked After Children. The multi-agency 

inspection team noted that: 

‘The contribution of health agencies is good. There is good 

and appropriate engagement with the City and Hackney 

Safeguarding Children Board and the wide range of 

subgroups…There is a track record of effective partnership 

working which has been further advanced with multidisciplinary 

team meetings and the highly-valued joint 

health and social care meetings that focus on child in need 

cases’. 

Ofsted also used Hackney as a test site for developing 

a new way of assessing child protection. This pilot 

exercise involved inspectors from the CQC, Her Majesty’s 

Inspectorate of Constabulary, Her Majesty’s Inspectorate of 

Probation, and Her Majesty’s Inspectorate of Prisons. The 

inspection was carried out at short notice and took place 

between 21 February and 6 March 2013. Inspectors rated 

the overall effectiveness of the multi-agency arrangements 

for the protection of children and young people in the 

London Borough of Hackney as outstanding. Although the 

results of the inspection will not be published by Ofsted, 

Homerton staff are using the experience and findings to 

improve working practices across Trust services. 

Statement on data quality 

The Trust’s Data Quality Policy has been implemented, 

defining the standards that must be applied to all databases 

within the Trust (in line with the standards set by the 

Connecting for Health Quality and Assurance Programme 

for Data Quality). 

The data we produce to verify our position must be of the 

highest quality. Data is regarded as being of high quality if 

it is: 

• accurate 

• up to date 

• free from duplication 

• free from confusion 

• comprehensive 

• valid 

• available when needed 

• stored securely and confidentially. 

The Data Quality Committee has been reviewed; the Trust 

now has an Electronic Patient Record (EPR) Management 

Group which is chaired by the Associate Director for IT. This 

group reports to the Informatics Committee chaired by the 

Chief Operating Officer. 

Over the last year Homerton has taken the following 

actions to improve data quality: 

• Intensive work has been undertaken specifically to 

review the quality of data surrounding outpatient 

activity. 

• Mandatory data was reviewed on a regular and 

ongoing basis, for errors 

• A suite of reports was developed which detect errors in 

order that they can be identified and corrected. 

• Staff were consulted and involved with reviewing 

working practices and standard operating procedures, 

to identify why any errors were occurring 

• Training for staff using the IT systems is under review 

to ensure that staff have the most robust training 

available to help minimise errors. 

• Regular monitoring and support for staff have resulted 

in improved quality data. 


Trust data that was submitted for national use 

The Trust submitted records during 2012/13 to the 

Secondary Uses Service (SUS) for inclusion in the Hospital 

Episode Statistics (HES) which are included in the latest 

published data. The percentage of records in the published 

data that included patients’ valid NHS numbers was: 

- 95.9% for admitted patient care 

- 97.8% for outpatient care, and 

- 87.4% for accident and emergency care. 

Data which included the patients valid General Medical 

Practice Code was: 

- 100% for admitted patient care 

- 100% for outpatient care 

- 100% for accident and emergency care. 

Payment by results 

As part of the Audit Commission’s Assurance Framework 

for 2012/13, the Trust was subject to a local audit 

programme targeting admissions with major complications. 

The audit this year has been on a specifically targeted 

sample and is not representative of all activity at the Trust. 

The error rate* in the latest published audit for that period 

for spells with an error affecting price (clinical coding) was: 

5.8% 

Primary diagnoses incorrect 6.0% 

Secondary diagnoses incorrect 24.4% 

Primary procedures incorrect 22.2% 

Secondary procedures incorrect 15.2% 

These results should not be extrapolated further than the 

actual sample audited: 

Total sample size was 100 finished consultant episodes 

(FCEs)** 

Targeted sample chosen: Admissions with major 

complications 

*This audit was of 100 patient records in 2012/13 of a predetermined 

(by the Audit Commission) selection of complex 

HRG spells. The audit showed that of this sample 5.8% had the 

inaccurate code for the patient’s episode of care recorded. 

Information governance (IG) 

The Trust’s Information Governance overall score for 

2012/13 was 77%. This is graded as not satisfactory. 

This figure is an improvement on last year (71%) but trusts 

are expected to achieve Level 2 in all areas in order to be 

graded as satisfactory. Homerton is now at Level 1 for just 

one area. This is an improvement on 2011/12 where three 

areas were at Level 1. 

The standard the Trust has self-assessed as being at Level 1 

is: 

• Improvements in training - trusts are required to 

demonstrate that 95% of staff have had IG training 

every year. 

The percentage of permanent staff that completed training 

this year is 38%. Improvements to the training process has 

led to the increase, by linking the training to appraisals and 

producing the statutory and mandatory training manual. 

For next year, individuals will be contacted to be informed 

that they have not completed their training and will be 

given a deadline. 

The actions to improve training are monitored by the 

Information Governance Committee. 

During 2012/13 the Trust has implemented the Fairwarning 

system, which is a proactive monitoring system for users 

access to electronic systems. EPR was the first data source 

for which Fairwarning was implemented. Alerts are 

generated and staff are spoken to about any suspicious 

activity. 

**A Finished Consultant Episode is the period of time during 

which the patient was cared for by one consultant. A patient 

could have more than one consultant episode during their hospital 

stay if care was transferred to another consultant. 



4.1 Quality priorities for 2013/14 

In this section we have detailed our quality improvement 

priorities for hospital and community health services and for 

our teaching and research activities. 

It is important to us that we set priorities for the coming 

year in consultation with our partners in care. In February 

2013 we consulted with Governors (including staff 

governors), commissioners, LINks and the overview and 

scrutiny committees of Hackney and the City of London to 

determine quality priorities. 

Information from the consultation was fed back to the Trust 

Board with the recommendation of retaining all six of our 

existing quality improvement priorities and adding two new 

ones. 

SAFE 

Priority 1 Reduce harm to patients caused by pressure 

ulcers, falls, urinary catheter infections, and 

venous thrombo-embolism (VTE) identified 

within the Safety Thermometer Harm Free Care 

Programme. 

Priority 2 Demonstrate improvements in safety by 

continuing to deliver a programme of work 

relating to: urgent care, end of life care and 

clinically led coding, using the Standardised 

Hospital Mortality Indicator (SHMI) as a measure. 

EFFECTIVE 

Priority 3 Ensure that, where national clinical guidelines 

have been produced by the National Institute 

for Health and Clinical Excellence (NICE) which 

are relevant to the care we provide, we can 

demonstrate we are using them in everyday 

practice. 

Priority 4 Reduce hospital readmissions 

Priority 5 Participate in the QUEST clinical work streams 

for: 

- nutrition and hydration 

- medication safety 

- safe handover. 

Priority 6 Improve dementia care 

4.2 CQUINs 2013/14 

For 2013/14, it has been confirmed that the value of 

CQUINs will continue to be 2.5% of the overall Trust 

budget. The four nationally mandated CQUIN areas will be: 

• venous thromboembolism 

• Friends and Family test 

• dementia 

• NHS Safety Thermometer 

At the time of writing, local acute and community CQUINs 

had not yet been discussed or agreed with commissioners, 

and further detail was awaited with regard to specialised 

services CQUINs. 

Further information regarding the 2013/14 national CQUINs 

can be found at http://www.commissioningboard.nhs.uk/ 

files/2013/02/cquin-guidance.pdf 

Table 20: Commissioning for quality and innovation scheme 

(CQUIN) targets 2013/14 acute care 

National 

What are we 

going to do? 

Venous 

thromboembolism 

NHS Safety 

Thermometer 

Dementia 

Friends and Family 

Test 

Which element of quality 

does this relate to? 

Safety and effectiveness 

Safety and effectiveness 

Safety 


Regional To be confirmed Safety and effectiveness 

Local To be confirmed Safety, effectiveness and 

experience 

CQUINS for 2013/14 community and specialist services are 

to be confirmed. 

THOUGHTFUL 

Priority 7 Sharing care and treatment information with 

patients. 

Priority 8 We will improve the effectiveness of discharge 

from our care. 


All of these elements will be measured throughout the 

year so that the Trust can show that it is improving the 

experience of the patients, their safety and the effectiveness 

of the services. 

We will report to the commissioners every month to 

demonstrate this improvement. Without reaching the 

agreed targets the Trust will not be paid the money the 

commissioners have attached to these elements of care. 

In the coming year we will also comply with all national 

requirements for improvements in quality. We will continue 

with our involvement in relevant national audit projects 

and maintain our local audit programme. We will carry 

on monitoring complaints and ensure that we learn from 

any adverse events. The Quality and Risk Department will 

support Trust staff in all aspects of quality improvement by 

providing help, support, training and guidance. 

5. Consultation and comment 

on the Quality Account 

The draft Quality Account was sent to the following 

external stakeholders for their comments: 

• NHS City and Hackney Clinical Commissioning Group 

• Hackney Overview and Scrutiny Committee 

• City of London Heath Scrutiny Committee 

• Hackney Health Watch (formerly Hackney LINks) 

• City of London Health Watch (formerly City LINks) 

The draft Quality Account was also available to all 

Homerton staff on the trust intranet for one month. 

Comments and feedback on the draft were invited from 

staff. Information on the paediatric and health visiting 

services were added and local team data updated to 

include the most recent information. 

Responses were received from the following external 

organisations: 

• A joint letter from Hackney and City of London health 

scrutiny committees 

• A statement from NHS City and Hackney Clinical 

Commissioning Group 

• A statement from Hackney Health Watch (formerly 

LINks) 

These responses are published verbatim on the following 

pages. 



Area J, 2nd Floor 

Hackney Service Centre 

London Borough of Hackney 

1 Hillman St 

London, E8 1DY 

Ms Melanie Mavers 

Head of Clinical Quality 

Quality and Risk Department 

1st Floor Brooksby House 


Homerton Row 

London E9 6SR 


Dear Ms Mavers 

RESPONSE TO QUALITY ACCOUNTS FROM HACKNEY AND CITY OF LONDON SCRUTINY 

COMMITTEES 

Thank you for inviting us to submit comments on the Quality Accounts of your Trust for 2012-13. 

We’ve been giving some thought to our role in commenting on Quality Accounts generally and we’ve agreed 

with our scrutiny colleagues at the Corporation of London to send you a joint response. 

We’ve also decided to adopt a more strategic approach to this task and we include below some broader 

questions which we would like you to answer. 

In my letter of 18 March, in response to your enquiry about priorities, we suggested you might give 

consideration to the following issues which came up during the year in Health in Hackney’s work: 

• care after discharge: particularly onward referral to community based services for vulnerable clients e.g. 

dependent drinkers, homeless 

• improving communication standards of doctors and nurses and the feedback back to GPs 

• levels of noise in the wards 

As I explained, Health in Hackney does not meet in May as it is the changeover period when our AGM 

happens and all committee memberships change, therefore we are asking if you will accept written comments 

from us. Our Corporation of London colleagues would be grateful for the same response. 

After considering your draft Quality Accounts we would be grateful for your response to the following general 

issues: 

a. The Homerton has a well deserved reputation but with mergers happening around you, this makes you 

vulnerable as a smaller trust. How much have you examined the issue of how small can you be (compared 

to your neighbours) before you find you are no longer viable and how are you responding to this in terms 

of your long term strategy for the Trust? 

b. How is the creation of the newly merged Barts Health affecting your organisation? 

c. The workforce pressures that come with the current trend for increasing centralisation of treatment 

pathways could make some units in some hospitals no longer viable. How will you respond to these 

emerging trends within the NHS where there are plans for centralising urological cancer surgery provision, 

for example? 


d. The Francis Inquiry has set in train plans to better protect whistle blowers. We feel that while this is 

necessary it is almost more important to ensure that other upward transmission mechanisms for staff to 

report concerns need to be in place so that issues don’t have to escalate to a ‘whistle blower’ stage. What 

actions are you taking here? 

e. When things go wrong do you carry out root-cause analyses and how do you balance ascribing 

responsibility to an individual versus the system and do you feel you get this right? 

f. Which other trusts do you compare yourself to and how? How much is your performance management 

focussed on driving out poor performance and aiming high, rather than merely achieving some small 

improvements, which can then be reported as progress? 

g. How does a retrospective document such as a Quality Accounts link to your future strategy for the Trust 

and where are these links examined? 

h. Are there patients in your hospital today who could be somewhere else and what are you doing with 

partners to improve the quality of care after discharge? 

i. The Patient Reported Outcome Measures (PROM) (page 29) isn’t very effective as response rates are low. 

What can be done to increase response rates such that this data can be statistically significant and so of 

some use? 

j. What, step, if any, is the Trust taking to assess the quality of services provided with the same degree of 

rigour that is applied to assessing cost and accounting for the Trust’s budget? 

k. How much data analysis does the Trust carry out by geographic community? For example, what could you 

tell us about the use of the Homerton by residents who live in the City of London and their satisfaction 

with services? As there is now a separate Health and Wellbeing Board for the City are you making any 

plans to further disaggregate the data you collect between Hackney and other local authority areas or 

even between different geographic areas of Hackney? 

We look forward to receiving a written response and if necessary we can take up any outstanding issues when 

the Homerton presents its next regular update to the Commission. 

Yours sincerely 

Councillor Luke Akehurst 

Chair of Health in Hackney Scrutiny Commission 

cc Common Councilman Vivienne Littlechild, Corporation of London 

Common Councilman Wendy Mead, Corporation of London 

Neal Hounsell, Corporation of London 

Tracey Fletcher, Chief Executive, Homerton 

Charlie Sheldon, Chief Nurse and Director of Governance, Homerton 



Commissioner’s Statement for Homerton 

University Hospital Foundation Trust 2012/13 

Quality Accounts 

NHS City and Hackney Clinical Commissioning 

Group (CCG) are responsible for the commissioning 

of health services from the Homerton University 

Hospital Foundation Trust (HUHFT) on behalf 

of the population of the City of London and 

London Borough of Hackney. We are also the lead 

commissioner for other CCGs across North and East 

London for the Homerton’s services. 

NHS City and Hackney CCG welcomes the 

opportunity to provide this statement on the 

Homerton’s 2012/13 Quality Account. 

On the whole, it is an impressive Quality Account 

and the Trust should be congratulated for both the 

document and the work it represents to improve the 

quality and safety of services for local residents. 

The document is strong on data and is 

comprehensive, detailed and provides a granular 

view of quality at the Trust. We confirm that we 

have reviewed the information contained within 

the Account and checked this against data sources 

where this is available to us as part of existing quality 

/ performance monitoring discussions and it is 

accurate in relation to the services provided. 

However, there is little sense of the Trust’s values and 

approach to quality and how it engages with staff 

and stakeholders to produce the Quality Account 

and decides on its quality objectives. 

We have taken particular account of the identified 

priorities for improvement for the Homerton and 

we would recommend the Trust provides more 

information to patients, local residents and NHS 

professionals on: 

1. Staff engagement in the Trust’s quality initiatives 

and current Quality Account targets. Could 

some information about staff supervision be 

included, what the Trust is doing to address 

issues from the staff survey and, especially post 

Francis, more on how pick up stress in staff 

early? 

2. National in patient survey results – we would 

like to see the actions the Trust will be taking 

to improve patient experience which is of some 

concern and has not improved from 2011/12 

results (including for maternity services); 

3. For the maternity survey results, has the Trust 

considered combining the two categories 

of “yes always” with the next category of 

‘sometimes” to give a more nuanced picture? 

4. Dementia work - we would suggest making 

the dementia assessment form mandatory for 

all eligible patients to strengthen the Trusts 

approach to this important area, especially as 

the Rapid Assessment, Interface and Discharge 

service will be supporting this; 

5. Fractured neck of femur mortality at 1 year - a 

narrative would be useful on how performance 

and quality in this area is being addressed; 

6. Complaints – could the Trust provide 

the percentage of complaints that were 

acknowledged within three working days as 

required in the NHS Constitution? 

7. We have reviewed the content of the Account 

and confirm that this complies with the 

prescribed information, form and content as set 

out by the Department of Health. We believe 

that the Account represents a fair, representative 

and balanced overview of the quality of care at 

HUHFT. We have discussed the development of 

this Quality Account with HUHFT over the year 

and have been able to contribute our views on 

consultation and content. 

8. This Account has been reviewed within NHS 

City and Hackney CCG and by colleagues in the 

NHS North and East London Commissioning 

Support Unit (NELCSU). 

Overall we welcome the vision described within the 

Quality Account, agree on the priority areas and will 

continue to work with HUHFT to continually improve 

the quality of services provided to patients. 

Dr Clare Highton Chair 

NHS City and Hackney Clinical Commissioning 

Group 


Healthwatch Hackney welcomes the opportunity to comment on this detailed and 

impressive report. 

We Welcome 

• The priority of Dementia Care, which is something we have received feedback on from visiting local Care 

Homes. 

• The priority on preventing ulcers and falls, which come up regularly in the Patient Safety Committee, and 

look to see further work to address this in wards, in care homes, and at home following discharge 

• The priorities relating to discharge planning and reducing re-admission. We welcome the work the 

Homerton and the CCG are doing here and the review of Intermediate Care Commissioning. Feedback 

we have received from looking at Homecare illustrates that co-ordinating care planning following 

discharge can be a particular issue, as well as involving families in the planning. 

• The inclusion of patient experience data and patient surveys 

• The setting up of the cross specialism cancer care patient group, and look forward to seeing the result of 

the feedback 

We were sorry to see: 

• That the Patient Experience targets were not met. We did not think the actions set out in p21 to address 

this were clear, other than collecting real time information. But look forward to seeing the results of 

addressing this. 

What we would like to see: 

1. A description of how patients are involved in determining the Quality Priorities 

2. Relating to the Information Priority 

- Pleased to see the reporting of patient involvement question as part of the bundle of questions. Can the 

responses to this question be reported on separately too? And where the patient is unable to be involved, 

responses from families about their involvement? 

- We would like to see figures of whether patients have been given information on how to give feedback 

or to complain 

- If there is a difference throughout this section for patients who do not speak English well. 

3. Dignity and Respect 

We were sorry to see the Dignity and Respect priority go from the list last year, even though the target had 

not been met. We only carried out one Enter and View visit to a Homerton ward this year, and generally 

found it very well run, and patients happy with their care. The issue that came out was about the capacity 

of staff to respond to personal hygiene requests of patients. We generally think that the quality of a 

patients experience at this immediate level is not captured in this report, and we’d like to see that included 

next time 



6. Statement of Directors’ 

responsibilities in respect of 

the Quality Account 

The Directors are required under the Health Act 2009 and 

the National Health Service (Quality Accounts) Regulations 

2010 to prepare Quality Accounts for each financial year. 

Monitor has issued guidance to NHS foundation trust 

boards on the form and content of annual quality reports 

(which incorporate the above legal requirements) and on 

the arrangements that foundation trust boards should put 

in place to support the data quality for the preparation of 

the quality report. 

In preparing the quality report, directors are required to 

take steps to satisfy themselves that: 

• the content of the quality report meets the 

requirements set out in the NHS Foundation Trust 

Annual Reporting Manual 2012/13; 

• the content of the Quality Report is not inconsistent 

with internal and external sources of information 

including: 

- Board minutes and papers for the period April 

2012 to June 2013 

- papers relating to Quality reported to the Board 

over the period April 2012 to June 2013 

- feedback from the commissioners dated 21st May 

2013 

- feedback from governors dated 29th May 2013 

- feedback from Health watch dated 29th May 


- the Trust’s complaints report published under 

regulation 18 of the Local Authority Social Services 

and NHS Complaints Regulations 2009, dated May 


- the national patient survey 2012; published April 


- the national staff survey 2012 published January 


- the Head of Internal Audit’s annual opinion over 

the trust’s control environment dated 29 May 


- CQC quality and risk profiles dated April 2012 to 

June 2013 

• the Quality Report presents a balanced picture of the 

NHS foundation trust’s performance over the period 

covered; 

• the performance information reported in the Quality 

Report is reliable and accurate; 

• there are proper internal controls over the collection 

and reporting of the measures of performance 

included in the Quality Report, and these controls are 

subject to review to confirm that they are working 

effectively in practice; 

• the data underpinning the measures of performance 

reported in the Quality Report is robust and reliable, 

conforms to specified data quality standards and 

prescribed 107 definitions, is subject to appropriate 

scrutiny and review; and the Quality Report has 

been prepared in accordance with Monitor’s 

annual reporting guidance (which incorporates the 

Quality Accounts regulations) (published at www. 

monitornhsft.gov.uk/annualreportingmanual) as 

well as the standards to support data quality for the 

preparation of the Quality Report (available at www. 

monitornhsft.gov.uk/annualreportingmanual). 

The directors confirm to the best of their knowledge and 

belief they have complied with the above requirements in 

preparing the Quality Report. By order of the Board. 

Chairman 29 May 2013. 

Chief Executive 29 May 2013. 


Appendix 1 

Goals agreed with Commissioners: Commissioning for Quality and Improvement payment Framework 2012 – 13 

Acute CQUINs: Values 

CQUIN Brief description Weighting Value 

VTE 1 % patients VTE assessed within 24 hours 7.50% £261,879 

100% value was based on 

12-13 activity and income 

baseline 

VTE 2 

% patients receiving appropriate prophylaxis based 

on safety therm. 

2.63% £91,832 

VTE 3 % RCAs completed for Hospital acquired VTE 2.63% £91,832 

IP Patient Experience Improve responsiveness to personal needs 10.25% £357,901 

Dementia 1 % patients asked dementia screening question 3.42% £119,417 

Dementia 2 % patients who have a dementia assessment 3.42% £119,417 

Dementia 3 

% of patients appropriately referred for specialist 

follow up 

3.42% £119,417 

Safety Thermometer % of eligible patients who are surveyed monthly 10.25% £357,901 

Cancer staging data % of records with complete staging data 4% £139,669 

Nutrition experience 

1 


2 

% patients reporting they did not receive help to 

eat their meals 

% patients reported they not were offered enough 

to drink 

3.41% £119,068 

3.41% £119,068 


3 

Maternity Patient 

Experience 

% MUST assessments carried out 3.41% £119,068 

Improve performance on five questions 10.25% £357,901 

Smoking cessation Implement stop before the op programme 7.75% £270,608 

Discharge 

communication 1 

Discharge 


Discharge 


Improve % of summaries sent to GPs within 24 

hours in A&E/Care of the Elderly (CoE) 

Improve % of discharge summaries that meet 

quality requirements in A&E/CoE 

Increase the % patient copied in to 

correspondence in four specialties 

5.60% £195,536 

5.60% £195,536 

2.80% £97,768 

Paediatric Patient 

experience 

Improve performance on five questions 10.25% £357,901 

Total £3,491,719 



Community CQUINS: value 

CQUIN Brief description Weighting Value 

Patient Experience 

% improvement across adult and children services for 

five questions each 

25% £235,845 

Safety 

Thermometer 

% of eligible patients who are surveyed monthly 25% £235,845 

0-5 Pathway 1 Roll out reporting to remaining teams 7.50% £70,753 

0-5 Pathway 2 Increase data completeness for all HV teams 5% £47,169 

0-5 Pathway 3 Increase % of NB visits within 14 days 6% £56,603 

0-5 Pathway 4 Improve developmental review coverage 6.50% £61,320 

DNA reduction Reduce DNA rates in four community services 25% £235,845 

£943,380 

Specialised: value 

CQUINs Brief description Weighting 

VTE 1 % patients VTE assessed within 24 hours 5.00% £23,906 

IP Patient Experience Improve responsiveness to personal needs 5.00% £23,906 

Dementia 1 % patients asked dementia screening question 1.67% £7,984 

Dementia 2 % patients who have a dementia assessment 1.67% £7,984 

Dementia 3 

% of patients appropriately referred for specialist 

follow up 

1.66% £7,937 

Safety Thermometer % of eligible patients who are surveyed monthly 5.00% £23,906 

NICU 1 Reduce Length of stay 14.00% £66,936 

NICU 2 Reduce inappropriate admissions to NICU 21.00% £100,404 

HIV 1 

HIV 2 

HIV 3 

Increase the % of HIV patients registered with and 

disclosed to a GP 

Increase % of patients who have consented to GP 

letters 

Increase the % of patients who receive ARVs by 

home delivery 

8.75% £41,835 

8.75% £41,835 

8.75% £41,835 

HIV 4 Audit of implementation of HIV QIPP plan 8.75% £41,835 

Dashboards Implement the use of the Neonatal dashboard 10.00% £47,811 

£478,114 


Appendix 2 - CQUINS Progress year to date 

Patient safety 

CQUIN – Safety What were we aiming to do? Did we 

achieve it? 

What is the evidence? 

Venous thromboembolism 

(safety and 

effectiveness) 

• 90% patients VTE 

assessed within 24 hours 

Yes 

It is anticipated that the Trust will have achieved 

this target for all but one month in 2012/13. The 

target has primarily been achieved through the 

implementation of a mandatory form on the Trust’s 

EPR system. In addition, a weekly performance 

report is to be developed to ensure that 

performance is monitored on a weekly basis. 

• 90% patients to receive 

appropriate prophylaxis 

Partial 

Data from VTE prophylaxis has been gathered from 

the Safety Thermometer from June onwards. This 

data shows that under 90% of patients have been 

receiving prophylaxis – it has averaged at about 

67.6%. 

• 90% of hospital 

acquired VTEs to have a 

completed root cause 

analysis 

No 

With the agreement of the commissioners a 

checklist was devised for teams to complete if their 

patient was considered to have had a hospital 

acquired VTE – to date 59.6% have been returned – 

the Medical Director is addressing this issue. 

Dementia 



• identifying and assessing 

patients with dementia 

• 90% of eligible patients 

to have an abbreviated 

mental test 


to have a dementia 

assessment 


appropriately referred for 

specialist follow up 

No 

It is not anticipated that the Trust will achieve this 

target in 2012/13, although the completion rate has 

improved during the year. This improvement has 

been achieved through creating a non-mandatory 

form on EPR as well as developing a daily report that 

identifies which patients require the assessment to 

be completed. 

In 2013/14, the Trust will consider making the 

assessment form mandatory for all eligible patients. 

In addition, clinical staff that will be responsible for 

the completion of forms will be identified and will 

have this responsibility as part of their daily role. 

Safety Thermometer 

(acute and 

community) 

• Reduce harm from : falls, 

pressure ulcers, urinary 

tract infections (patients 

with catheters) and VTE 


to be surveyed on a 

monthly basis 

Partial 

Acute: 100% of eligible patients were surveyed 

each month 

Community: Not all eligible patients were surveyed 

in Q2 

Cancer staging 



• 90% of eligible records 

to have complete staging 

data 

Yes 

The purpose of the staging CQUIN is to incentivise 

the completion of an accurate recording of staging 

data at time of diagnosis for all new stageable 

cancer patients, as a proxy for early diagnosis. 




achieve it? 


A baseline audit was conducted to identify the 

completeness and readiness stage prior to CQUIN 

implementation. The audit identified 60%-70% 

completeness in 2011/12. 

The staging data is collected by the MDT 

coordinators who receive information on staging 

data from various sources. 

The MDT coordinators were trained on staging data 

collection; this included how to identify the various 

type of staging and how to record staging in the 

system. 

The radiologist/pathologist now include staging 

details in the reports of patients who are diagnosed 

with cancer. This was agreed at the cancer 

development group meeting. 

Where patients were investigated for cancer at 

Barts Health, further links were established and 

access was gained to Barts Health Somerset system 

which identifies staging details for Homerton cancer 

patient. 

As a result of the above, the Trust has achieved 

90% consistently throughout the year. 

Older people’s care 

(safety, 

effectiveness and 

experience) 

• Less than 10% patients 

of eligible patients 

reporting they did not 

receive help to eat their 

meals 

Yes 

The CQUIN is based on two questions asked of all 

inpatients over 75. The CQUIN also assesses the 

number of patients in this age range who have 

also had a Malnutrition Universal Screening Tool 

completed with 24 hours. 

• Less than 5% of eligible 

patients reporting 

they not were offered 

enough to drink 

• 80% of eligible 

patient having a MUST 

assessments completed. 

A baseline audit of the CQUIN took place in June 

2013. During 2012/13 the dietetic and patient 

experience team carried out an audit on one day 

a month to monitor progress and put immediate 

action plans in place as needed. It was noted 

during the winter months although the CQUIN 

had been achieved patients mentioned an issue 

with the number and timing of hot drinks. This 

was discussed and changes made in the breakfast 

service to serve the first cup of tea earlier. 

A dietician was allocated to assist the ward staff 

with MUST assessments through a teaching and 

support programme. The success of this has been 

clearly seen through the rising number of MUST 

assessments with appropriate action taken. The 

Trust is also concerned to ensure that all patients 

receive help with meals, nutrition and drinks as 

they require. There is a rolling of programme of 

Picker nutrition audits in place as part of the patient 

feedback strategy 



achieve it? 


Discharge 

communication 

(Safety, 

effectiveness and 

experience) 

• Improve the quality of 

discharge summary 

content in A&E and 

Care of the Elderly 

• Improve the percentage 

of discharge summaries 

received by GPs 

Yes 

In 2012/13, the Trust has invested in the Keystone 

system that enables the Trust to transfer discharge 

summaries electronically on the day of discharge. 

This represents a key improvement in timeliness 

and enables GPs to receive clinical information on 

an almost real-time basis. The system also ensures 

that updated summaries are sent, so if diagnostic 

results are received post-discharge, these can 

be added to the discharge summary knowing 

that the system will then automatically send the 

updated version of the summary. 

• Increase the proportion 

of patients who are 

copied in to clinical 

correspondence sent to 

their GP 

Partial 

With regard to increasing the proportion of 

patients copied in to their clinical correspondence, 

four specialties: respiratory, dermatology, podiatry 

and hypertension, have been copying the patient 

into clinic letters as default since October 2012. 

It is hoped that this approach can be rolled out 

across more services during 2013/14. 

CQUINs –Clinical effectiveness 

CQUIN – effectiveness What were we aiming to do? Did we 

achieve it? 

Smoking cessation • Implement the 

‘Stop before the op’ 

programme and increase 

the level of referrals in to 

the Smoking Cessation 

service from surgical 

services. 

Partial 


There is a strong evidence base demonstrating that 

stopping smoking prior to surgery (even if only a 

reduction) leads to increased recovery response 

post-surgery and reduces the risk of surgical 

complications. Homerton’s smoking cessation 

service targeted the surgical pre-assessment 

patients in 2012/13 to increase the referral rate 

into the service. This has had a limited impact on 

general surgery but a significant impact on Oral 

and maxillofacial surgery (OMFS). 

The focus for 2013/14 will be to increase the 

referral rate for general surgery patients. 

Health visiting 

(effectiveness and 

experience) 

• Roll out full service 

reporting to all Health 

Visiting teams 

• Increase the data 

completeness rates for all 

Health Visiting teams 

• 90% of new birth visits 

to be completed within 

14 days 

Partial 

79% 

66% 

The CQUIN 0-5 pathway pilot was rolled out 

across the six health visiting (HV) teams in April 

2012 and a system for reporting progress against 

key performance indicators (KPIs) put in place. In 

April 2012 data completeness on RIO was 58%. 

There has been significant improvement and by 

the end of March 2013, the position is 75.1%. 

While there has been an improvement in the 

percentage of interventions completed against all 

0-5 pathway KPIs in qtrs1-3 this has not been 




achieve it? 

• 80% of developmental 

reviews to be completed 


achieved consistently across all the HV teams. 

The area of greatest improvement has been 

completion of new birth visits within 21 days. 

An action plan for full achievement of these 

targets to improve the care of children aged 0 to 

5 has been devised by the Head of Nursing and is 

being implemented 

Reduction in do not 

attend (DNAs) 

• Reduce DNA rates 

in four Community 

specialties following 

the implementation of 

an SMS appointment 

reminder system 

Partial 

During 2012/13 the Trust invested in the ‘Envoy 

Messenger for Hospital Trusts’ system to enable 

it to send out appointment reminders by SMS to 

patients. This system is used by approximately 

20% of Trusts in England. 

The system is currently used for the majority 

of the Trust’s acute outpatient and diagnostic 

services. The excluded services are predominantly 

those such as sexual health and fertility services 

for information governance and confidentiality 

reasons. 

This system has also been rolled out to some 

community health services and it is anticipated 

that it will contribute to a significant reduction in 

the DNA rates for all services using the system. 

Neonatal care • Reduce length of stay 

on SCBU through earlier 

discharge to community 

services 

• Reduce the level of 

avoidable admissions to 

NICU 

• Implement the use of the 

National NICU dashboard 

Partial 

The focus for neonatal quality improvements was 

related to length of stay (LOS) of babies who were 

at special care, care level. This included reducing 

length of stay and follow on care provided in 

the community and reducing the number of 

admissions of term gestation babies from our own 

booked mothers. 

The CQUIN looked at babies who were from the 

local area and had all their care at Homerton. 

Over the past year referral and follow on care to 

the community setting has been reviewed. The 

referral rates have remained stable during the 

year. The information from this work will support 

benchmarking for this patient group as there is 

currently no information nationally. 

Discharge at gestational age has decreased slightly, 

but remains challenging for our geographical area 

due to the population mix and deprivation factors. 

Further work is being driven by the outcomes of 

the CQUINs that will include continued focus on 

reduction in LOS. 

At the current time the admission percentage 

for term gestation babies from our own booked 

mothers has been demonstrated to be within the 

national average for regional neonatal units. 



achieve it? 


Internally an in-depth analysis of trends looking 

at reasons for admission is now needed in 

partnership with maternity services; this work will 

take place in the coming months. 

HIV (effectiveness 

and experience) 


of HIV patients registered 

with and disclosed to a 

GP to 70% 


of HIV patients who 

have consented to 

GPs receiving clinical 

correspondence to 95% 

• Increase the proportion of 

HIV patients who receive 

anti retro virals (ARVs) via 

home delivery to 70% 

• Implement the sectorwide 

QIPP plan 

Yes 

Permission to contact the GP is taken during 

first registration. If not given first time, patients 

are asked again during follow up visits. Patient’s 

permission to contact GP is recorded on the Sexual 

Health Patient Administration IT System (PreView). 

If permission is given by the patient, GP name and 

address are entered on PreView. 

If permission to contact the GP is given by the 

patient, the clinician writes to the GP at least twice 

a year. 

All HIV stable patients are encouraged by the 

clinician to receive HIV drugs through a home 

delivery pharmaceutical company. If patients 

decline a patient survey questionnaire is competed 

asking reasons why the patient does not want 

to take part and the patient is encouraged at 

subsequent follow-up visits. 

Each time a patient starts taking a HIV ARV drugs 

for the first time or a current HIV ARV drug regime 

is changed patients are asked for their experience. 

The information collected is used to ensure that all 

patients are being offered the best possible care. 

CQUINs - Patient experience 

CQUIN – patient 

experience 

What were we aiming to do? 

Did we 

achieve it? 



(acute and 

community) 


in paediatrics 

• This is the same national 

patient experience 

CQUIN as the past two 

years with improvement 

on five questions in the 

national survey 

• Improve responsiveness 

to personal needs 

by achieving a 5% 

composite score 

improvement 

• Improve composite score 

across six questions in the 

paediatric inpatient survey 

No 

Acute 

Adult: The five CQUIN national inpatient questions 

are based on the results 2012 National Inpatient 

survey. In 2011/2012 the Trust did not achieve 

the 5% increase. Using the Picker survey devices, 

the Trust has invited all patients who have been 

discharged though the discharge lounge to answer 

the five CQUIN questions. Over 700 patients have 

been surveyed. The results are reported back to the 

divisions through the Patient Feedback Committee 

and improvements have been made since the 

baseline in June. This process has better enabled 

the Trust to monitor patient experience on an 

ongoing basis during the year. 




experience 


Did we 

achieve it? 


• Provide the CCG with 

an action plan outlining 

improvement plans 

TBC 

Paediatric: there was improvement (better than 

trajectory) in the six questions for the inpatient CQUIN. 

The team spoke with children and their parents to 

understand the responses to the questions and then 

implemented targeted actions to address the problems. 

These actions were effective as the re-audit showed 

improvement in all questions. 

Community 

The five patient experience questions were chosen for 

both adult and children community services to reflect 

as much as possible the five national patient experience 

inpatient questions. This allows the Trust to get a picture 

of patient experience across the Trust. Improving patient 

experience is essential to providing patient-centred 

healthcare. A baseline survey across the services was 

carried out in July 2012. 

200 patients who accessed adult services and 37 parents 

who accessed children services responded. Of these 85% 

and 86% respectively resided in Hackney and there was 

an almost equal split between white and ethnic minority 

backgrounds. The community services received a report of 

the CQUIN results. From this they put in place an action 

plan. The CQUIN survey was repeated at the beginning of 

March 2013. 

Repeat survey 

The target for the second survey was that for three 

questions to adults and four to parents of children the 

“yes definitely” responses were at 90%. 

Whilst feedback was overwhelmingly positive (particularly 

in children’s services) 90% was not reached on these 

questions. 

Individual teams are reviewing their data to establish what 

actions they can take to address the responses to the 

questions. 

Patient 

experience in 

maternity 

• Improve composite score 

by an average of 8% on 

the following questions: 

• If you saw a midwife for 

your antenatal checkups 

did you see the same one 

every time? 

• After the birth of your 

baby, were you given 

the information or 

explanations you needed? 

No 

The commissioners had set us a target of a 10 point 

improvements in all questions. 

We made between 3 and 8.2 point improvements in all 

five CQUIN questions; this was not enough to achieve the 

CQUIN this financial year. 



experience 


Did we 

achieve it? 


• After the birth of your 

baby, were you treated 

with kindness and 

understanding? 

• Thinking about feeding 

your baby (breast or 

bottle) did you feel that 

midwives and other 

carers gave you consistent 

advice? 

• Overall how would you 

rate the care received 

after the birth? 



Appendix 3 

Audits Homerton took part in and the amount of information sent in for each audit 

Name of audit 

Percentage of data submitted 

Acute 

Adult community acquired pneumonia (British Thoracic Society) 100 

Adult critical care 100 

Emergency use of oxygen (British Thoracic Society) 100 

National Joint Registry 100 

Non-invasive ventilation - adults (British Thoracic Society) 100 

Renal colic (College of Emergency Medicine) 100 

Severe trauma (Trauma Audit and Research Network) 100 

Blood and transplant 

National Comparative Audit of Blood Transfusion - programme contains the following 

audits, 

a) O neg blood use (2010/11) 

b) Medical use of blood (2011/12) 

c) Bedside transfusion (2011/12) 

d) Platelet use (2010/11) 

100 

Potential donor audit (NHS Blood and Transplant) 100 

Cancer 

Bowel cancer 100 

Head and neck oncology 100 

Lung cancer 100 

Oesophago-gastric cancer 100 

Acute coronary syndrome or acute myocardial infarction 100 

Heart 

Heart failure 100 

National Cardiac Arrest Audit 100 

Long term conditions 

Adult asthma (British Thoracic Society) 100 

Asthma Deaths 100 

Bronchiectasis (British Thoracic Society) 100 

Chronic Obstructive Pulmonary Disease 100 

Diabetes (Adult) 100 

Inflammatory bowel disease 

Includes: Paediatric Inflammatory Bowel Disease Services 

100 

Pain database 100 


Name of audit 

Percentage of data submitted 

Mental health 

National audit of psychological therapies 100 

National Confidential Enquiry into Patient Outcome and Death (NCEPOD) 

Subarachnoid haemorrhage 100 

Alcohol related liver disease 100 

Tracheostomy 

Data collection underway 

until June 13 

Older people 

Fractured neck of femur (College of Emergency Medicine) 100 

Hip fracture database 100 

National dementia audit 100 

Parkinson’s disease (National Parkinson’s Audit) Data not submitted in 2012 

as recommendation is to only 

participate every two years 

Sentinel Stroke 

National Audit Programme (SSNAP) - programme combines the following audits, 

a) Sentinel stroke audit (2010/11, 2012/13) 

b) Stroke improvement national audit project (2011/12, 2012/13) 

100 

Other 

Elective surgery (National PROMs Programme) 

Total response not yet known 

Women’s and children’s health 

Child health 100 

Epilepsy 12 audit (Childhood Epilepsy) 100 

Maternal infant and perinatal 100 

Neonatal intensive and special care 100 

Paediatric asthma (British Thoracic Society) 100 

Paediatric fever (College of Emergency Medicine) 100 

Paediatric pneumonia (British Thoracic Society) 100 



Appendix 4 

Trust response to national clinical audit reports 2012/13 

Name of audit / confidential enquiry 

Date report 

published 

Action taken as a result of recommendations 

Severe sepsis and septic shock (College 

of Emergency Medicine) 

May-12 

In order to be fully compliant an audit was carried out into 

antibiotic administration in sepsis – completed Jan 2012. Local 

training and education of registrars in the importance of early 

antibiotic administration has taken place. The sepsis bundle 

checklist is to be displayed in resuscitation room. 

Adult asthma (British Thoracic Society) May-12 Discussed internally. No specific changes required, but work is 

continuing to maintain standards of care. 

National Confidential Enquiry into 

Patient Outcome and Death (NCEPOD) 

- Cardiac Arrest Procedures: Time to 

Intervene? (2012) 

Emergency use of oxygen (British 

Thoracic Society) 

Non-invasive ventilation - adults 

(British Thoracic Society) 

Jun-12 

Jun-12 

Jun-12 

Cardiac arrest – The Trust is compliant but will amend the Acute 

Admission Performa to ensure there is formal consultant sign off 

of Do Not Attempt Resuscitation requests. 

Ensure induction training for junior doctors includes oxygen 

prescribing. 

Results reviewed within the department. No outstanding actions 

required 

Head and neck oncology Jun-12 The team have reviewed the report; no changes are required to 

current practice in the light of the audit recommendations. 

Chronic Obstructive Pulmonary 

Disease (COPD) 

Adult community acquired pneumonia 

(British Thoracic Society) 

Inflammatory bowel disease (IBD) 

Includes: Paediatric Inflammatory 

Bowel Disease Services 

Mental Health programme: National 

Confidential Inquiry into Suicide and 

Homicide for people with Mental 

Illness 

Jun-12 

Jun-12 

Jun-12 

Jul-12 

In most parameters that were measured Homerton was better 

than the national average. The COPD team is working on 

improving further by continuing activity throughout the hospital 

and community. 

The results have been presented to the department. Overall 

performance is better than the national average, and work is 

underway to improve the time gap between chest x-ray and start 

of antibiotics. 

The gastroenterologists regularly review the reports from the 

national audit. Practice is in line with the recommendations. 

Reviewed by lead in accident and emergency – there are 

arrangements in place with the local Mental Health Trust. No 

further actions are required. 

Heavy menstrual bleeding (HMB) Jul-12 The Trust is following NICE guidelines - Final HMB report due later 

in 2013. 

Neonatal intensive and special care Jul-12 There were complications with data collection for this audit but 

these have now been addressed. We compare favourably with 

similar organisations. 

National Joint Registry (NJR) Sep-12 Being followed up with orthopaedics. 

National Confidential Enquiry into 

Patient Outcome and Death (NCEPOD) 

- Bariatric Surgery: Too Lean a 

Service? (2012) 

Oct-12 

On review the service is mainly compliant with the 

recommendations. It is working to develop a two stage consent 

process and better electronic information entered into the 

national database. 


Name of audit / confidential enquiry 

Risk factors (National Health 

Promotion in Hospitals Audit) 

Date report 

published 

Oct-12 

Action taken as a result of recommendations 

Reviewed by the Clinical Audit and Effectiveness Committee. A 

suitable person is being allocated to lead on public health issues 

in the Trust. 

Heart failure Nov-12 The Trust has participated fully in the NICOR National Heart 

Failure audit this year. The Trust was at or above the national 

average for all measures in the audit, with the exception of “% 

echo received” where we were 1% below the average at 84%. 

In light of these results, the specialist team feels that no change 

in practice is required currently as the service is already achieving 

good outcomes for patients. We will continue to participate in 

this annual audit and will continue to monitor our clinical practice 

outcomes carefully. 

Bowel cancer Dec-12 NBOCAP is the national colorectal audit report. We continue 

to work to improve our data quality and prepare for the next 

submission. We have added another clinical staff member to 

record the patient level data in real time at the multidisciplinary 

team meeting on a weekly basis. We are submitting surgeon level 

outcome data on 1 June 2013 for 2011/12 period. 

Lung cancer Dec-12 Data completion rates better than most other hospitals in region. 

Results discussed regionally and action plans in place. 

Oesophago-gastric cancer Dec-12 Being followed up with the bariatric team. 

Diabetes (Adult) includes National 

Diabetes Inpatient Audit 

Dec-12 

The diabetes team are largely compliant with the 

recommendations. The team are working to improve the 

timeliness of inpatients with diabetes being reviewed by a 

member of the diabetes team. Work is also in progress to review 

any reported medication errors with these patients. 

Pain database Dec-12 The report has been reviewed; no actions are required as the Trust 

is meeting standards. 

Severe trauma (Trauma Audit and 

Research Network, TARN) 

Monthly 

The data has been reviewed and there are no actions to 

implement. The Trust trauma lead reports regularly on Homerton 

data to trauma network meetings. 

National Cardiac Arrest Audit Quarterly This information is discussed regularly at the Critical Care 

Committee. No changes have been made recently as a result of 

the reports. 



Appendix 5 

Selection of actions taken to improve care as a result of local audits carried out in the Trust 

Local audit title Actions Done 

Antibiotics audit • Send out reminder to all medical teams and pharmacists to ensure 

urinary tract infection treatment duration in patients is followed 

accurately. 

• Continue promoting the appropriate completion of the antibiotic 

prescription chart to comply with stop/review and indication policy. 

• Target wards with particularly low compliance with stop/review and 

indication policy. 

• Reminder sent to teams regarding dosing in surgical patients 

• Monitor pipericillin/tazabactam use and encourage step-down when 

possible. Microbiologist’s rounds weekly to review patients on more 

than seven days of this drug. 

• Help teams recognise patients fit to switch to oral on microbiology 

ward rounds. Potentially identify patients that can be discharged 

earlier. 

• Carry out iv to oral antibiotics switch audit. 

4 

Audit of therapy services 

documentation 

Massive obstetric haemorrhage 

audit 

Audit the use of the 

community falls assessment 

and screening tool in the first 

response duty team 

Are pregnant women informed 

about pelvic floor exercises 

at their ante natal booking 

appointment? 

• Liaise with all therapy team leads to ensure documentation standards 

form part of induction. 

• Documentation standards to be saved on the therapies shared drive. 

• Liaise with all therapy team leads to ensure risk assessments are 

undertaken appropriately. 

• Review of notes in supervision within teams to ensure goals are 

specific, measurable, agreed and realistic with clear timeframes for 

achievement. 

• Review of current literature and update standards and 

documentation guidelines 

• Staff to fill in proformas during event of massive obstetric 

haemorrhage. 

• Copy of massive obstetric haemorrhage proforma to be given to 

Clinical audit midwives. 

• Training day to improve knowledge and skills of staff on massive 

obstetric haemorrhage. 

• Senior therapists in the first response duty team to implement the 

completion of the falls screen during induction to all new staff 

members and emphasize the importance of completing the falls 

screen. 

• Re-audit to assess continuation of identifying falls risk factors and 

onward management. 

• The senior women’s health physiotherapist has liaised with the lead 

midwife for antenatal care. An agreement was made that a booklet 

would be handed out at the 10 week booking appointment to all 

women. The booklet contains information about pelvic floor exercises 

and antenatal care. 

4 

4 

4 

4 


Local audit title Actions Done 

Epidural response time for 

labour epidural analgesia 

• These high standards need to be monitored and maintained. No 

actions are required to improve the service as the standards are 

already being met. A re-audit will be done to ensure standards 

remain high. 

4 

Safe storage of medicines • Report to be emailed to all ward managers: 

- ward managers to share audit findings with their staff 

- ward managers to advise staff to read the Medicines Management 

Policy and NMC standards for Medicines Management. 

• Ward staff to confirm to ward manager that they have read the 

recommended documents. 

• Re-audit all wards to monitor and maintain improvement. 

4 

An audit analysis of 

anaphylaxis presenting at 

Homerton Hospital from 

September 2007 to September 


• Raise awareness of staff in the emergency department via 

presentation in order to ensure more thorough recordings of 

symptoms of anaphylaxis; this is to help assess correct diagnosis in 

future audit. 

• Send audit findings to emergency department staff in order to 

increase awareness of allergy services and the need to refer all 

anaphylactic reaction patients to an allergy specialist. 

4 

Critical care rehabilitation 

competencies for 

physiotherapists 

• Present results to the physiotherapy department during the post 

graduate meeting. 

• Review wording and make appropriate changes to the critical care 

rehabilitation competency framework. 

• Include critical care rehabilitation self-assessment in the yearly on-call 

training and up-date. 

4 



Appendix 6: Limited assurance report from 

external auditors 

Independent Auditor’s Report to the 

Council of Governors of Homerton 

University Hospital NHS Foundation Trust 

on the Quality Report 

We have been engaged by the Council of Governors of 

Homerton University Hospital NHS Foundation Trust to 

perform an independent assurance engagement in respect 

of Homerton University Hospital NHS Foundation Trust’s 

Quality Report for the year ended 31 March 2013 (the 

“Quality Report”) and certain performance indicators 

contained therein. 

This report, including the conclusion, has been prepared 

solely for the Council of Governors of Homerton 

University Hospital NHS Foundation Trust as a body, to 

assist the Council of Governors in reporting Homerton 

University Hospital NHS Foundation Trust’s quality agenda, 

performance and activities. We permit the disclosure of 

this report within the Annual Report for the year ended 

31 March 2013, to enable the Council of Governors 

to demonstrate they have discharged their governance 

responsibilities by commissioning an independent 

assurance report in connection with the indicators. To 

the fullest extent permitted by law, we do not accept or 

assume responsibility to anyone other than the Council of 

Governors as a body and Homerton University Hospital NHS 

Foundation Trust for our work or this report save where 

terms are expressly agreed and with our prior consent in 

writing. 

Scope and subject matter 

The indicators for the year ended 31 March 2013 subject to 

limited assurance consist of the national priority indicators 

as mandated by Monitor: 

• Cancer 62 day waits 

• C.difficile 

We refer to these national priority indicators collectively as 

the “indicators”. 

Respective responsibilities of the Directors and 

auditors 

The Directors are responsible for the content and the 

preparation of the Quality Report in accordance with 

the criteria set out in the NHS Foundation Trust Annual 

Reporting Manual issued by Monitor. 

Our responsibility is to form a conclusion, based on limited 

assurance procedures, on whether anything has come to 

our attention that causes us to believe that: 

• the Quality Report is not prepared in all material 

respects in line with the criteria set out in the NHS 

Foundation Trust Annual Reporting Manual 

• the Quality Report is not consistent in all material 

respects with the sources specified; and 

• the indicators in the Quality Report identified as having 

been the subject of limited assurance in the Quality 

Report are not reasonably stated in all material respects 

in accordance with the NHS Foundation Trust Annual 

Reporting Manual and the six dimensions of data 

quality set out in the Detailed Guidance for External 

Assurance on Quality Reports. 

We read the Quality Report and consider whether it 

addresses the content requirements of the NHS Foundation 

Trust Annual Reporting Manual, and consider the 

implications for our report if we become aware of any 

material omissions. 

We read the other information contained in the Quality 

Report and consider whether it is materially inconsistent 

with the documents specified within the detailed guidance. 

We consider the implications for our report if we become 

aware of any apparent misstatements or material 

inconsistencies with those documents (collectively the 

“documents”). Our responsibilities do not extend to any 

other information. 

We are in compliance with the applicable independence 

and competency requirements of the Institute of Chartered 

Accountants in England and Wales (ICAEW) Code of Ethics. 

Our team comprised assurance practitioners and relevant 

subject matter experts. 

Assurance work performed 

We conducted this limited assurance engagement in 

accordance with International Standard on Assurance 

Engagements 3000 (Revised) – “Assurance Engagements 

other than Audits or Reviews of Historical Financial 

Information” issued by the International Auditing and 

Assurance Standards Board (“ISAE 3000”). Our limited 

assurance procedures included: 

• evaluating the design and implementation of the key 

processes and controls for managing and reporting the 

indicators 

• making enquiries of management 

• testing key management controls 

• limited testing, on a selective basis, of the data 

used to calculate the indicator back to supporting 

documentation 


• comparing the content requirements of the NHS 

Foundation Trust Annual Reporting Manual to the 

categories reported in the Quality Report 

• reading the documents. 

A limited assurance engagement is smaller in scope than a 

reasonable assurance engagement. The nature, timing and 

extent of procedures for gathering sufficient appropriate 

evidence are deliberately limited relative to a reasonable 

assurance engagement. 

Limitations 

Non-financial performance information is subject to more 

inherent limitations than financial information, given the 

characteristics of the subject matter and the methods used 

for determining such information. 

The absence of a significant body of established practice 

on which to draw allows for the selection of different but 

acceptable measurement techniques which can result 

in materially different measurements and can impact 

comparability. The precision of different measurement 

techniques may also vary. Furthermore, the nature and 

methods used to determine such information, as well as 

the measurement criteria and the precision thereof, may 

change over time. It is important to read the Quality Report 

in the context of the criteria set out in the NHS Foundation 

Trust Annual Reporting Manual. 

The scope of our assurance work has not included 

governance over quality or non-mandated indicators which 

have been determined locally by Homerton University 

Hospital NHS Foundation Trust. 

Conclusion 

Based on the results of our procedures, nothing has come 

to our attention that causes us to believe that, for the year 

ended 31 March 2013: 

• the Quality Report is not prepared in all material 

respects in line with the criteria set out in the NHS 

Foundation Trust Annual Reporting Manual; 

• the Quality Report is not consistent in all material 

respects with the sources specified; and 

• the indicators in the Quality Report subject to 

limited assurance have not been reasonably stated 

in all material respects in accordance with the NHS 

Foundation Trust Annual Reporting Manual. 

Deloitte LLP 

Chartered Accountants 

St Albans 






Annual 

Accounts 



ANNUAL ACCOUNTS 


Annual Accounts 2012/13 

Contents 

Foreword to the Accounts 108 

Annual Governance Statement 109 

Statement of Accounting Officer's Responsibilities 114 

Independent Auditor’s Report 115 

Statement of Comprehensive Income for the year 

ended 31 March 2013 116 

Statement of Financial Position as at 31 March 2013 117 

Statement of Changes in Taxpayers' Equity 2012/13 118 

Statement of Changes in Taxpayers' Equity 2011/12 118 

Statement of Cash Flows for the year 

ended 31 March 2013 119 

Notes to the Accounts 120 


Foreword to the Accounts 


These accounts for the year ended 31 March 2013 have 

been prepared by the Homerton University Hospital NHS 

Foundation Trust in accordance with paragraphs 24 & 25 of 

Schedule 7 to the NHS Act 2006. 






Annual Governance 

Statement 2012/13 


1. Scope of responsibility 

As Accounting Officer, I have responsibility for maintaining 

a sound system of internal control that supports the 

achievement of the NHS Foundation Trust’s policies, aims 

and objectives, whilst safeguarding the public funds and 

departmental assets for which I am personally responsible, 

in accordance with the responsibilities assigned to me. I 

am also responsible for ensuring that the NHS Foundation 

Trust is administered prudently and economically and 

that resources are applied efficiently and effectively. I also 

acknowledge my responsibilities as set out in the NHS 

Foundation Trust Accounting Officer Memorandum. 

2. The purpose of the system of internal control 

The system of internal control is designed to manage risk to 

a reasonable level rather than to eliminate all risk of failure 

to achieve policies, aims and objectives; it can therefore 

only provide reasonable and not absolute assurance of 

effectiveness. The system of internal control is based on 

an ongoing process designed to identify and prioritise the 

risks to the achievement of the policies, aims and objectives 

of Homerton University Hospital NHS Foundation Trust, to 

evaluate the likelihood of those risks being realised and 

the impact should they be realised, and to manage them 

efficiently, effectively and economically. The system of 

internal control has been in place in Homerton University 

Hospital NHS Foundation Trust for the year ended 31 March 

2013 and up to the date of approval of the annual report 

and accounts. 

3. Capacity to handle risk 

The Trust has ensured that its risk management system 

receives the appropriate leadership and management. The 

Chief Nurse and Director of Governance is the executive 

lead for risk management at Board level. The Director of 

Finance has delegated responsibility for managing the 

strategic development and implementation of Financial Risk 

Management. All Executive Directors take responsibility for 

risk identification, management and mitigation within their 

areas of work and practice. The Risk Committee, as a Board 

Sub-Committee, takes overall responsibility for coordinating 

and monitoring all risks within the Trust including scrutiny 

of reports from both internal and external sources. A 

number of sub-committees and working groups report 

to the Risk Committee on both clinical and organisational 

risk. Key risks are reviewed by the Board either as part of 

its regular monitoring of performance (e.g. Board receives 

minutes of both the Risk and Audit Committees) or in the 

context of specific issues that arise. 

In particular these are: 

• The Risk Committee, which has been established for a 

number of years, is chaired by a Non-Executive Director 

(NED) and its membership includes the Chairman and 

Trust Executive Directors. The Risk Committee meets on 

a quarterly basis and reports to the Board of Directors; 

• The Risk Committee is kept informed about all aspects 

of risk management by way of reports and minutes 

from the Quality Improvement Committee, Information 

Governance Committee and the Health & Safety 

Committee; 

• The Clinical Risk Manager reports regularly via the 

Head of Clinical Quality and the Head of Governance 

to the Chief Nurse and Director of Governance. The 

Non-Clinical Risk Manager reports to the Director 

of Estates, Facilities and Capital Projects who has 

responsibility for Health and Safety to the Chief 

Executive; and 

• As required by the Trust’s Risk Management Strategy, 

Associate Medical Directors, Divisional Operations 

Directors, senior nurses, and other relevant senior 

managers are responsible for the management of 

risk within the workplace. They foster a culture of 

risk awareness throughout their divisions and ensure 

assessments for all work-based activity are conducted. 

The Trust continues to develop a comprehensive risk 

register, identifying risks at both the Trust and divisional 

level. The Head of Clinical Quality is responsible for the 

maintenance of this register. Risk management training 

is delivered to all staff as part of induction and regular 

training opportunities are provided within the Trust 

to staff at all levels. The programme of risk training is 

subject to continuous internal review. 

4. The risk and control framework 

The Trust has a comprehensive Risk Management Strategy 

(The Strategy) which is reviewed by the Risk Committee, 

approved by the Board of Directors and is available to all 

staff through the Trust’s intranet. The Strategy describes 

the Trust’s overall risk management approach, corporate 

and divisional responsibilities for risk, the risk management 

process and the Trust’s risk identification, assessment and 

control system. It includes guidance on the risk assessment 

matrix used to evaluate risks to facilitate inclusion on the 

Trust’s risk registers. 


Risk management is embedded in the activities of the 

organisation in a number of ways: 

• corporate and divisional objectives are risk assessed as 

part of the annual business planning and performance 

management process; 

• structured processes are used for the completion 

of local risk assessments to populate the Trust’s risk 

register; 

• the Trust is compliant with the NHS Litigation Authority 

Risk Management Standards for both its Acute and 

Maternity Services at Level 2; 

• there are structured processes in place for incident 

reporting, the investigation of Serious Incidents (SIs), 

complaints and litigation cases; and 

• all Executive Directors regularly review the risk register 

to ensure that appropriate action is being taken against 

key risks. 

The Trust continues to carry out ongoing exercises 

to capture both clinical and non-clinical risk data at 

divisional and departmental levels through local risk 

assessments. In addition, ongoing risk assessments form 

part of the departmental arrangements with regard to risk 

management. Best practice is highlighted and shared across 

divisions through; divisional leads, the Quality Improvement 

Committee and the Health and Safety Committee and 

their respective sub-groups. Divisions report quarterly on 

clinical quality, including the processes to manage clinical 

risk, to the Quality Improvement Committee. The key 

elements of the quality governance arrangements are as 

described in Monitor’s Quality Governance Framework; 

strategy, capabilities and culture, processes and structure 

and measurement. The Trust is committed to continuous 

improvement and learning; from incidents and complaints, 

outcomes from audits and the experiences of patients, 

clients and staff. The quality of performance information 

is assessed through data quality reports to divisions and 

regular audit. 

The Trust is registered with the Care Quality Commission 

(CQC) and has a process of self assessment against 

the CQC Essential Standards of Quality and Safety. The 

outcomes of assessments are presented to and monitored 

by the Risk Committee. In addition, further assurance 

is provided by the Audit Committee who commission 

specific reviews by the Trust’s internal auditors and counter 

fraud services. Any areas of concern are risk assessed and 

managed on the Trust risk register. All of the 16 CQC 

Essential Standards of Quality and Safety have an identified 

lead within the organisation and it is their responsibility to 

provide compliance. 

Additional assurance has also been gained through 

participation in CQC special reviews or investigations, 

specifically in the last 12 months: 

• Safeguarding and Looked After Children Inspection – 

May 2012; 

• Mary Seacole Nursing Home Inspection - January 2013; 

and 

• Homerton University Hospital Inspection - February 


All of these inspections were positive and constructive 

feedback was given by the CQC. 

The outcome of these inspections has provided the Board 

with further assurance that the Foundation Trust is fully 

compliant with the registration requirements of the Care 

Quality Commission. 

The Trust has an established process of information 

governance led by the Medical Director. Systems and 

processes have been reviewed, including using the 

Information Governance Toolkit. The Trust declared that it 

has complied with information governance guidelines and 

the Data Protection Act 1998. The Information Governance 

Committee is responsible for monitoring and controlling 

risks to data security. There were no Serious Incidents 

involving data loss or confidentiality issues during the year. 

A comprehensive risk register detailing the principal risks 

to the achievement of the Trust’s objectives was in place 

for the whole of the financial year. These objectives were 

set out in the Trust’s 2012/13 Annual Plan which also 

identified risks to the achievement of those objectives, the 

key controls in place to manage those risks and the sources 

of assurance available to demonstrate the effectiveness 

of those controls. The risk register has been reviewed 

regularly by the Trust’s Clinical Board and Board of Directors 

throughout the year. All of the principal risks identified are 

monitored and reviewed by the Risk Committee at each of 

its meetings and reports are provided to the Board on key 

issues arising. 

Key risks identified include the following: 

• Risks associated with the condition of community 

health service buildings posing a risk to the ability 

to deliver clinical services and meeting regulatory 

compliance in these locations. (in-year risk); 

• C.difficile - potential breach of DH target of no more 

than seven cases in 2012/13 (in-year risk); 

• MRSA bacteraemia - breach of DH target of no more 

than one MRSA bacteraemia in 2012/13 and monitor 

target of six (in-year risk); 



• Risks to Trust business associated with the health 

economy reconfiguration in north east London 

(in-year); 

• Risks to Trust business associated with commissioner 

led actions (both in-year and future risk); 

• Risks associated with the Olympic travel arrangements 

impacting on access to the Trust (in-year risk); and 

• Risk to organisational continuity due to senior 

management changes (in-year risk). 

The Trust has comprehensive plans in place to mitigate the 

above risks which are monitored by the Risk Committee 

and Trust Board. The efficacy of these plans are assessed 

by the Risk Committee which reports to the Trust Board. 

The Trust recognises its risk management approach will not 

eliminate risks totally, but it will provide the organisation 

with a means to identify, prioritise and manage the risks. 

This will provide a balance between the cost of managing 

and treating risk, and the anticipated benefits that will 

be derived. Equality Impact Assessments are undertaken 

for major service changes as well as for policies and 

procedures. There are arrangements in place for working 

with stakeholders and partner organisations, including 

close working with the Trust Commissioners, local General 

Practitioners, the Council of Governors, LINks, NHS London, 

the Corporation of London, and the London Borough of 

Hackney. 

Stakeholders are involved in managing risks which impact 

on them through their involvement in and contributions to 

many aspects of the work of the Trust, including: 

• public and stakeholder representation on the Council 

of Governors; 

• consultation and involvement from the members of the 

Foundation Trust; 

• the National Patient Survey Programme; 

• Hackney Health Local Improvement Network (LINk) 

• Hackney Overview and Scrutiny Committee; 

• The Health and Social Care Partnership Board; and 

• membership of the Local Strategic Partnership. 

5. Pensions 

As an employer with staff entitled to membership of 

the NHS Pension Scheme, control measures are in place 

to ensure all employer obligations contained within the 

Scheme regulations are complied with. This includes 

ensuring that deductions from salary, employer’s 

contributions and payments into the Scheme are in 

accordance with the Scheme rules, and that member 

Pension Scheme records are accurately updated in 

accordance with the timescales detailed in the Regulations. 

Control measures are in place to ensure that all the 

organisation’s obligations under equality, diversity and 

human rights legislation are complied with. 

6. Carbon reduction 

The Trust has undertaken risk assessments and Carbon 

Reduction Delivery Plans are in place in accordance 

with emergency preparedness and civil contingency 

requirements, as based on UKCIP 2009 weather projects, 

to ensure that this organisation’s obligations under the 

Climate Change Act and the Adaptation Reporting 

requirements are complied with. 

7. Review of economy, efficiency and effectiveness of 

the use of resources 

In addition to the financial review of resources within the 

quarterly monitoring returns to Monitor all budget holders 

are provided with monthly financial information to help 

them ensure resources are used economically, efficiently 

and effectively. Monthly finance and performance reports 

are provided for the Board. Internal Audit has an important 

role, as does the Finance and Performance Committee, to 

challenge how resources are used. The Trust also has an 

internal performance management review process which 

provides evidence of performance at divisional level and 

the actions being taken to ensure resources are being 

used effectively and efficiently. In addition the annual 

business planning process, including the requirement to 

identify productivity and efficiency opportunities, provides 

another mechanism to achieve this aim. The Trust also 

has a comprehensive Quality, Innovation, Productivity 

and Prevention (QIPP) progamme in place to identify and 

deliver efficiencies against the Trust target for savings. This 

programme is led by the Chief Operating Officer, progress 

and associated risks are reported to the Board of Directors. 

8. Annual Quality Report 

The Directors are required under the Health Act 2009 and 

the National Health Service (Quality Accounts) Regulations 

2010 (as amended) to prepare Quality Accounts for 

each financial year. Monitor has issued guidance to 

NHS foundation trust boards on the form and content 

of annual Quality Reports which incorporate the above 

legal requirements in the NHS Foundation Trust Annual 

Reporting Manual. 


The Annual Quality Account 2012/13 has been developed 

in line with relevant national guidance and legislative 

requirements. The Quality Account meets the Monitor 

requirement to produce a Quality Report. Assurance over 

the content and quality of the information in the report is 

gained through the following: 

• The Chief Nurse and Director of Governance leads on 

the production of the Quality Account at Board level. 

The Head of Clinical Quality is responsible for drafting 

the Quality Account, managing the consultation 

processes in relation to the draft report (for both 

planning priorities and feedback), and managing the 

process of regular reporting to the Board and the 

Quality Improvement Committee; 

• Plans for the achievement of the main quality priorities 

are developed, reviewed and assured by the Quality 

Improvement Committee and the Board; 

• Consultation is carried out with internal and external 

stakeholders and fed back to the Board before the 

quality priorities are set for the coming year. The 

content of the draft report is reviewed by the Board 

and sent for internal and external consultation 

including the Council of Governors. The Board 

approves the final content of the report; 

• The Trust has a range of policies and procedures 

in place to support the achievement of the quality 

priorities; and 

• The data used for the Quality Account is a combination 

of centrally and locally collected data. All information 

routinely presented to the Board is compiled by the 

Trust’s Information Team. This data is managed using 

the Trust’s Data Quality Policy and processes are in 

place to ensure the data is validated. Other data 

is collected locally by clinical teams using separate 

databases. Internal and external auditors annually 

review three items of data (two national and one local) 

that are in the Quality Account. These reviews cover 

the key areas of accuracy, validity, reliability, timeliness, 

relevance and completeness. 

9. Review of effectiveness 

As Accounting Officer, I have responsibility for reviewing 

the effectiveness of the system of internal control. My 

review of the effectiveness of the system of internal control 

is informed by the work of the internal auditors, clinical 

audit and the executive managers and clinical leads within 

the Trust who have responsibility for the development and 

maintenance of the internal control framework. I have 

drawn on the content of the quality report attached to 

this Annual Report and other performance information 

available to me. My review is also informed by comments 

made by the external auditors in their management letter 

and other reports. I have been advised on the implications 

of the result of my review of the effectiveness of the system 

of internal control by the Board, the Audit Committee and 

Risk Committee, and a plan to address weaknesses and 

ensure continuous improvement of the system is in place. 

In addition, I gain assurance from the following third party 

sources: 

• reports from both the external auditors and the local 

counter fraud specialist; 

• patient and staff surveys; 

• outcomes of Care Quality Commission reviews; 

• NHSLA assessments; and 

• the Trust’s regular reporting to Monitor providing 

additional assurance with regard to compliance with 

our Terms of Authorisation. 

The key considerations of my review of the effectiveness 

of the system of internal control can be summarised as 

follows: 

• The Board has been actively involved in developing 

and reviewing the Trust’s risk management processes 

including receiving and reviewing reports and minutes 

from the Risk and Audit Committees. The Board has 

also reviewed the Risk Register as well as monitoring 

performance objectives via the balanced scorecard; 

• The Risk Committee has overseen the effectiveness of 

all the Trust’s risk management arrangements including 

review and endorsement of the Risk Strategy and the 

ongoing development of the risk register including all 

key clinical and non-clinical risks highlighted by other 

committees; 

• The Audit Committee has been a directing force in 

relation to reviewing the system of internal control 

particularly with regard to corporate risk and counter 

fraud. Internal Audit has reviewed and reported 

upon financial management, quality governance and 

risk management processes, based on an audit plan 

approved by the Audit Committee. The work included 

identifying and evaluating controls and testing their 

effectiveness. Where scope for improvement was 

found, recommendations were made and appropriate 

action plans agreed with management; 

• Executive Directors have ensured that key risks have 

been highlighted, monitored and the necessary action 

taken to address them. Executive Directors were also 

directly involved in producing and reviewing the Trust 

Risk Register; 



• Internal Audit have provided consistent support and 

advice with regard to the system of internal control 

including the ongoing development of the Trust’s risk 

management processes; 

• The Finance & Performance Committee is responsible 

for overseeing performance management and of 

developing the Trust’s longer term financial strategy; 


• The Quality Improvement Committee is responsible for 

the governance and management of clinical risk and 

oversight of improvement. 

Internal Audit’s review of Risk Management has concluded 

that it provides adequate assurance that there is an 

effective system of internal control to manage the principal 

risks identified by the Trust. 

As noted above, the Risk Register identifies gaps in control 

and gaps in assurance in relation to the Trust’s principal risks 

and the actions being taken to address them. 

Conclusion 

My review confirms that Homerton University Hospital NHS 

Foundation Trust has a sound system of internal control 

that supports the achievement of its policies, aims and 

objectives. No significant issues have been identified. 




ANNUAL REPORT 2012/13 113

Statement of Accounting 

Officer's responsibilities 

Statement of the Chief Executive's responsibilities as the 

Accounting Officer of Homerton University Hospital NHS 

Foundation Trust. 

The NHS Act 2006 states that the Chief Executive is the 

Accounting Officer of the NHS Foundation Trust. The 

relevant responsibilities of Accounting Officer, including 

their responsibility for the propriety and regularity of 

public finances for which they are answerable, and for 

the keeping of proper accounts, are set out in the NHS 

Foundation Trust Accounting Officer Memorandum issued 

by Monitor, the Independent Regulator of NHS foundation 

trusts. 

Under the NHS Act 2006, Monitor has directed Homerton 

University Hospital NHS Foundation Trust to prepare for 

each financial year a Statement of Accounts in the form 

and on the basis set out in the Accounts Direction. The 

Accounts are prepared on an accruals basis and must give 

a true and fair view of the state of affairs of Homerton 

University Hospital NHS Foundation Trust and of its income 

and expenditure, total recognised gains and losses and cash 

flows for the financial year. 

In preparing the Accounts, the Accounting Officer is 

required to comply with the requirements of the NHS 

Foundation Trust Annual Reporting Manual and in 

particular to: 

• observe the Accounts Direction issued by Monitor, 

including the relevant accounting and disclosure 

requirements, and apply suitable accounting policies on 

a consistent basis; 

• make judgments and estimates on a reasonable basis; 

• state whether applicable Accounting Standards as set 

out in the NHS Foundation Trust Annual Reporting 

Manual have been followed, and disclose and explain 

any material departures in the financial statements; 


• prepare the financial statements on a going concern 

basis. 

The Accounting Officer is responsible for keeping proper 

accounting records which disclose with reasonable accuracy 

at any time the financial position of the NHS Foundation 

Trust and to enable her to ensure that the accounts comply 

with requirements outlined in the above mentioned Act. 

The Accounting Officer is also responsible for safeguarding 

the assets of the NHS Foundation Trust and hence for 

taking reasonable steps for the prevention and detection of 

fraud and other irregularities. 

To the best of my knowledge and belief, I have properly 

discharged the responsibilities set out in Monitor's NHS 

Foundation Trust Accounting Officer Memorandum. 






Independent Auditor’s report 

to the Board of Governors and Board of Directors of 


We have audited the financial statements of Homerton 

University Hospital NHS Foundation Trust for the year 

ended 31 March 2013 which comprise the Statement 

of Comprehensive Income, the Statement of Financial 

Position, the Statement of Changes in Taxpayers’ Equity, the 

Statement of Cash Flow and the related notes 1 to 28. The 

financial reporting framework that has been applied in their 

preparation is applicable law and the accounting policies 

directed by Monitor – the independent regulator of NHS 

foundation trusts. 

This report is made solely to the Board of Governors and 

Board of Directors (“the Boards”) of Homerton University 

Hospital NHS Foundation Trust, as a body, in accordance 

with paragraph 4 of Schedule 10 of the National Health 

Service Act 2006. Our audit work has been undertaken so 

that we might state to the Boards those matters we are 

required to state to them in an auditor’s report and for no 

other purpose. To the fullest extent permitted by law, we do 

not accept or assume responsibility to anyone other than the 

trust and the Boards as a body, for our audit work, for this 

report, or for the opinions we have formed. 

Respective responsibilities of the accounting officer 

and auditor 

As explained more fully in the Accounting Officer’s 

Responsibilities Statement, the Accounting Officer is 

responsible for the preparation of the financial statements 

and for being satisfied that they give a true and fair view. 

Our responsibility is to audit and express an opinion on the 

financial statements in accordance with applicable law, the 

Audit Code of NHS Foundation Trusts and International 

Standards on Auditing (UK and Ireland). Those standards 

require us to comply with the Auditing Practices Board’s 

Ethical Standards for Auditors. 

Scope of the audit of the financial statements 

An audit involves obtaining evidence about the amounts 

and disclosures in the financial statements sufficient to 

give reasonable assurance that the financial statements 

are free from material misstatement, whether caused by 

fraud or error. This includes an assessment of: whether 

the accounting policies are appropriate to the trust’s 

circumstances and have been consistently applied and 

adequately disclosed; the reasonableness of significant 

accounting estimates made by the Accounting Officer; 

and the overall presentation of the financial statements. 

In addition, we read all the financial and non-financial 

information in the annual report to identify material 

inconsistencies with the audited financial statements and 

to identify any information that is apparently materially 

incorrect based on, or materially inconsistent with, the 

knowledge acquired by us in the course of performing 

the audit. If we become aware of any apparent material 

misstatements or inconsistencies we consider the 

implications for our report. 

Opinion on financial statements 

In our opinion the financial statements: 

• give a true and fair view of the state of the Trust’s affairs 

as at 31 March 2013 and of its income and expenditure 

for the year then ended; 

• have been properly prepared in accordance with the 

accounting policies directed by Monitor – Independent 

Regulator of NHS foundation trusts; and 

• have been prepared in accordance with the 

requirements of the National Health Service Act 2006. 

Opinion on other matters prescribed by the National 

Health Service Act 2006 

In our opinion: 

• the part of the Directors’ Remuneration Report to be 

audited has been properly prepared in accordance with 

the National Health Service Act 2006; and 

• the information given in the Directors’ Report for the 

financial year for which the financial statements are 

prepared is consistent with the financial statements. 

Matters on which we are required to report by 

exception 

We have nothing to report in respect of the following 

matters where the Audit Code for NHS Foundation Trusts 

requires us to report to you if, in our opinion: 

• the Annual Governance Statement does not meet the 

disclosure requirements set out in the NHS Foundation 

Trust Annual Reporting Manual, is misleading or 

inconsistent with information of which we are aware 

from our audit. We are not required to consider, nor 

have we considered, whether the Annual Governance 

Statement addresses all risks and controls or that risks 

are satisfactorily addressed by internal controls; 

• proper practices have not been observed in the 

compilation of the financial statements; or 

• the NHS Foundation Trust has not made proper 

arrangements for securing economy, efficiency and 

effectiveness in its use of resources. 

Certificate 

We certify that we have completed the audit of the 

accounts in accordance with the requirements of Chapter 

5 of Part 2 of the National Health Service Act 2006 and the 

Audit Code for NHS Foundation Trusts. 

Heather Bygrave (Senior Statutory Auditor) 

for and on behalf of Deloitte LLP 

Chartered Accountants and Statutory Auditor 

St. Albans, United Kingdom 

Date: 29 May 2013 


Statement of comprehensive income for the year ended 31 March 2013 

2012/13 2011/12 

NOTE £000 £000 

Revenue 

Operating income from continuing operations 3 255,575 243,677 

Operating expenses (excluding impairments) 4 (248,579) (234,150) 

Impairments charged to operating expenses 4 (3,529) (916) 

Operating surplus 3,467 8,611 

Finance costs: 

Finance income 7 206 145 

Finance expenses-finance liabilities 7 (174) (187) 

Finance expenses-unwinding of discount on provisions 16 (16) (19) 

Public dividend capital dividends payable 18 (3,184) (3,296) 

Total finance costs (3,168) (3,357) 

Retained surplus for the year 299 5,254 

Other comprehensive income 

Net revaluation gains and impairment (losses) on land, property, plant and equipment 245 (2,197) 

Total comprehensive income for the year 544 3,057 

The Trust reported a surplus of £3,828,000 in 2012/13 (£6,170,000 in 2011/12) before taking into account impairments. 

The notes on pages 120 to 145 form part of these Accounts. 



Statement of financial position as at 31 March 2013 

Non-current assets 

31 March 2013 31 March 2012 

NOTE £000 £000 

Intangible assets 8 431 642 

Property, plant and equipment 9 115,658 115,121 

Total non-current assets 116,089 115,763 

Current assets 

Inventories 11 1,388 1,121 

Trade and other receivables 12 12,626 13,456 

Other financial assets 13 - - 

Cash and cash equivalents 14 29,621 30,556 

Total current assets 43,635 45,133 

Total assets 159,724 160,896 

Current liabilities 

Trade and other payables 15 (16,142) (18,185) 

Borrowings 15 (257) (257) 

Provisions 15 (1,005) (1,685) 

Tax payable 15 (5,586) (5,204) 

Other liabilities 15 (5,040) (5,403) 

Total current liabilities (28,030) (30,734) 

Net current assets 15,605 14,399 

Total assets less current liabilities 131,694 130,162 

Non-current liabilities 

Borrowings 15 (3,537) (3,794) 

Provisions 15 (1,109) (641) 

Total non current liabilities (4,646) (4,435) 

Total assets employed 127,048 125,727 

Financed by taxpayers’ equity 

Public dividend capital 18 84,877 84,100 

Retained earnings SOCITE 21,078 20,768 

Revaluation reserve SOCITE 21,093 20,859 

Total taxpayers’ equity 127,048 125,727 

Statement of Changes in Taxpayers’ Equity (SOCITE) can be found on page 118. 

The financial statements on pages 116 to 145 were approved by the Board and signed on its behalf by: 



Date: 29 May 2013 


Statement of changes in taxpayers’ equity (SOCITE) 2012/13 

Public dividend Retained Revaluation Total 

capital (PDC) earnings reserve 

£000 £000 £000 £000 

Balance at 31 March 2012 84,100 20,768 20,859 125,727 

Changes in taxpayers’ equity for 2012/13 

Total comprehensive income for the year: 

Retained surplus for the year - 299 - 299 

Impairments and reversals - - (1,711) (1,711) 

Net gain on revaluation of tangible assets - - 1,956 1,956 

Transfer due to disposal of assets - 11 (11) - 

New PDC received 777 - - 777 

Balance at 31 March 2013 84,877 21,078 21,093 127,048 

Statement of changes in taxpayers’ equity 2011/12 

Public dividend Retained Revaluation Total 

capital (PDC) earnings reserve 

£000 £000 £000 £000 

Balance at 31 March 2011 83,175 15,428 23,142 121,745 

Total comprehensive income for the year: 

Retained surplus for the year - 5,254 - 5,254 

Impairments and reversals - - (2,254) (2,254) 

Net gain on revaluation of tangible assets - - 57 57 

Transfer due to disposal of assets - 86 (86) - 

New PDC received 925 - - 925 

Balance at 31 March 2012 84,100 20,768 20,859 125,727 



Statement of cash flows for the year ended 31 March 2013 


NOTE £000 £000 

Net cash inflow from operating activities 19 11,104 21,507 

Cash flows from investing activities 

Interest received 206 145 

Payments for intangible assets (68) (323) 

Payments for property, plant and equipment (9,358) (5,134) 

Net cash outflow from investing activities (9,220) (5,312) 

Net cash inflow before financing 1,884 16,195 

Cash flows from financing activities 

Public dividend capital received 777 925 

Loans repaid to the DH (226) (226) 

Other loans repaid (31) (31) 

Interest paid (174) (187) 

PDC dividends paid (3,165) (3,208) 

Net cash outflow from financing (2,819) (2,727) 

Net increase in cash and cash equivalents (935) 13,468 

Cash and cash equivalents brought forward as at 1 April 30,556 17,088 

Cash and cash equivalents carried forward at 31 March 29,621 30,556 


Notes to the Accounts 

1. Accounting policies 

Monitor has directed that the financial statements of NHS 

foundation trusts shall meet the accounting requirements 

of the NHS Foundation Trust Annual Reporting Manual 

(ARM) which has been agreed with HM Treasury. 

Consequently, these financial statements have been 

prepared in accordance with the 2012/13 ARM issued 

by Monitor. The accounting policies contained in that 

manual follow International Financial Reporting Standards 

(IFRS) and HM Treasury’s Financial Reporting Manual to 

the extent that they are meaningful and appropriate to 

NHS foundation trusts. The accounting policies have been 

applied consistently in dealing with items considered 

material in relation to the accounts. 

1.1 New and revised standards and 

interpretations 

The following Standards, amendments and interpretations 

have been issued by the International Accounting 

Standards Board (IASB) and International Financial 

Reporting Interpretations Committee (IFRIC) but are not yet 

required to be adopted or are not yet effective: 

• IFRS 7 Financial Instruments: Disclosures – amendment 

Offsetting financial assets and liabilities 

• IFRS 9 Financial Instruments 

• IFRS 10 Consolidated Financial Statements 

• IFRS 11 Joint Arrangements 

• IFRS 12 Disclosure of Interests in Other Entities 

• IFRS 13 Fair Value Measurement 

• IAS 1 Presentation of Financial Statements on Other 

Comprensive Income 

• IAS 12 Income Taxes Amendment 

• IAS 27 Separate Financial Statements 

• IAS 28 Associates and Joint Ventures 

• IAS 19 (Revised 2011) Employee Benefits 

• IAS 32 Financial Instruments: Presentation – 

amendment Offsetting financial assets and liabilities 

The Directors anticipate that the adoption of these 

standards in future periods will have no material impact 

on the financial statements. All other revised and new 

Standards have not been listed here as they are not 

considered to have an impact on the Trust. Monitor does 

not permit the early adoption of Accounting Standards, 

amendments and interpretations that are in issue at the 

reporting date but effective at a subsequent reporting 

period. 

1.2 Accounting convention 

These accounts have been prepared under the historical 

cost convention, modified by the revaluation of properties, 

and, where material, current asset investments and 

inventories to fair value as determined by the relevant 

Accounting Standard. 

1.3 Income measurement 

Income is accounted for by applying the accruals 

convention. Income in respect of services provided is 

recognised when, and to the extent that, performance 

occurs and is measured at the fair value of the 

consideration receivable. The main source of income for 

the Trust is contracts with commissioners in respect of 

healthcare services. 

Where income is received for a specific activity which is to 

be delivered in the following financial year, that income is 

deferred. 

Income from the sale of non-current assets is recognised 

only when all material conditions of sale have been met 

and is measured as the sums due under the sale contract. 

1.4 Expenditure on employee benefits 

1.4.1 Short-term employee benefits 

Salaries, wages and employment-related payments are 

recognised in the period in which the service is received 

from employees. The cost of annual leave entitlement 

earned but not taken by employees at the end of the 

period is recognised in the financial statements to the 

extent that employees are permitted to carry forward leave 

in the following period. 

1.4.2 Pension costs 

Past and present employees are covered by the provisions 

of the NHS Pensions Scheme. Details of the benefits 

payable under these provisions can be found on the NHS 

Pensions website at www.nhsbsa.nhs.uk/pensions. The 

scheme is an unfunded, defined benefit scheme that 

covers NHS employers, General Practices and other bodies, 

allowed under the direction of the Secretary of State in 

England and Wales. The scheme is not designed to be run 

in a way that would enable the Trust to identify its share of 

the underlying scheme assets and liabilities. Therefore, the 

scheme is accounted for as if it were a defined contribution 

scheme: the cost to the Trust of participating in the scheme 

is taken as equal to the contributions payable to the 

scheme for the accounting period. 

Employers pension cost contributions are charged to 

operating expenses as and when they become due. 

The employer contribution payable in 2012/13 was 

£13.9m (2011/12 £13.5m, and is estimated to be £14.2m 

2013/14). 



Additional pension liabilities arising from early retirements 

are not funded by the scheme except where the retirement 

is due to ill-health. The full amount of the liability for the 

additional costs is charged to the operating expenses at the 

time the trust commits itself to the retirement, regardless of 

the method of payment. 

1.5 Expenditure on other goods and services 

Expenditure is accounted for by applying the accruals 

convention. Expenditure on goods and services is 

recognised when and to the extent that they have been 

received, and measured at the fair value of those goods 

and services. Expenditure is recognised in operating 

expenses except where it results in the creation of a non 

current asset such as property, plant and equipment. 

1.6 Property, plant and equipment 

1.6.1 Recognition 

Property, plant and equipment is capitalised where: 

• it is held for use in delivering services or for 

administrative purposes; 

• it is probable that future economic benefits will flow 

to, or service potential be provided to, the Trust; 

• it is expected to be used for more than one financial 

year; 

• the cost of the item can be measured reliably; 

• it individually has a cost of at least £5,000; or 

• they form a group of assets which individually have 

a cost of more than £250, collectively have a cost 

of at least £5,000, where the assets are functionally 

interdependent, they have broadly simultaneous 

disposal dates and are under single managerial control; 

or 

• it forms part of the initial setting-up cost of a new 

building, or unit. 

Where a large asset, for example a building, includes 

a number of components with significantly different 

asset lives, for example plant and equipment, then these 

components are treated as separate assets and depreciated 

over their useful economic lives. 

1.6.2 Measurement 

i) Valuation 

All property, plant and equipment is measured initially at 

cost, representing the cost directly attributable to acquiring 

or constructing the asset and bringing it to the location and 

condition necessary for it to be capable of operating in the 

manner intended by management. All assets are measured 

subsequently at fair value. 

Land and buildings used for the trust’s services or for 

administrative purposes are stated in the Statement of 

Financial Position at their revalued amounts, being the 

fair value at the date of revaluation less any subsequent 

accumulated depreciation and impairment losses. 

Revaluations are performed with sufficient regularity to 

ensure that carrying amounts are not materially different 

from those that would be determined at the end of the 

reporting period. 

Fair values are determined as follows: 

• Land and non-specialised buildings – market value for 

existing use; and 

• Specialised buildings - Modern Equivalent Asset (MEA) 

value, as adjusted for wear and tear. 

All land and buildings are restated to fair value in 

accordance with IAS 16 and Monitor guidance, using 

professional valuations every five years and an interim 

valuation on an annual basis to ensure that fair values 

are not materially different from the carrying amounts. 

Valuations are carried out by professionally qualified 

valuers in accordance with the Royal Institute of Chartered 

Surveyors (RICS) Appraisal and Valuation Manual based 

on MEA. A full valuation of land, buildings and dwellings 

was carried out by DVS Property (Independent Chartered 

Surveyors). Buildings were valued on a MEA basis as at 31 

March 2013. 

In order to derive relevant build costs, DVS Property 

gave regard to the RICS Build Cost Indices in consultation 

with their own building surveyor. In accordance with the 

RICS and Treasury’s Financial Reporting Manual Valuation 

Guidelines, an ‘instant build’ approach was assumed in 

that the Modern Equivalent Assets would be constructed 

at the date of valuation without phasing or lead in periods. 

It also assumes the site is cleared and ready to take the 

new buildings and therefore there is no allowance for the 

demolition of any existing buildings or site preparation. 

Assets in the course of construction for service or 

administration purposes are carried at cost, less any 

impairment loss. Cost includes professional fees but 

not borrowing costs, which are recognised as expenses 

immediately, as allowed by IAS 23 (Borrowing Costs) 

for assets held at fair value. Assets are revalued and 

depreciation commences when they are brought into use. 

ii) Subsequent expenditure 

Where subsequent expenditure enhances an asset beyond 

its original specification, the directly attributable cost 

is capitalised. Where subsequent expenditure restores 

the asset to its original specification, the expenditure is 

capitalised and any existing carrying value of the item 

replaced, is charged to operating expenses. 


iii) Depreciation 

Items of property held at current value, are depreciated 

over their remaining useful economic lives (UEL) as assessed 

by the NHS Foundation Trust’s professional valuers in a 

manner consistent with the consumption of economic 

or service delivery benefits. Freehold land is considered 

to have infinite life and is not depreciated. Leaseholds 

are depreciated over the primary lease term. Plant and 

Equipment initially held at current cost, is depreciated over 

the estimated UEL. 

Property, plant and equipment which has been reclassified 

as ‘Held for Sale’ ceases to be depreciated. Assets in the 

course of construction are not depreciated until the asset is 

brought into use. 

The following UELs apply to each individual asset category 

based on standard asset lives adjusted for local use and 

expected technology changes: 

• Land - Land is not depreciated because it is considered 

to have infinite life 

• Non-residential buildings and dwellings - average 

remaining useful economic life of the building block 

in accordance with the Independent Qualified Valuers 

report 

• Plant and Machinery - 5 to 15 years 

• Transport Equipment - 7 years 

• Furniture and Fittings - 3 to 10 years 

• Office and IT Equipment - 3 to 5 years 

• Mainframe IT Type Installation - 5 to 9 years 

• Computer Software Licenses - the shorter of 5 years or 

length of licenses 

iv) Revaluation 

Increases in asset values arising from revaluations are 

recognised in the revaluation reserve, except where, and 

to the extent that, they reverse an impairment previously 

recognised in operating expenses, in which case they are 

recognised in operating income. 

Decreases in asset values and impairments are charged 

to the revaluation reserve to the extent that there is an 

available balance for the asset concerned, and thereafter 

are charged to operating expenses. 

Gains and losses recognised in the revaluation reserve are 

reported in the Statement of Comprehensive Income as an 

item of ‘other comprehensive income’. 

v) Impairment 

Impairments that are due to a loss of economic benefits 

or service potential in the asset are charged to operating 

expenses. If sufficient revaluation reserve is available a 

compensating transfer is made from the revaluation reserve 

to the income and expenditure reserve of an amount equal 

to the lower of: 

i) the impairment charged to operating expenses; and 

ii) the balance in the revaluation reserve attributable to that 

asset before the impairment. 

An impairment arising from a loss of economic benefit or 

service potential is reversed when, and to the extent that, 

the circumstances that gave rise to the loss are reversed. 

Reversals are recognised in operating income to the extent 

that the asset is restored to the carrying amount it would 

have had if the impairment had never been recognised. 

Any remaining reversal is recognised in the revaluation 

reserve. Where, at the time of the original impairment, 

a transfer was made from the revaluation reserve to the 

income and expenditure reserve, an amount is transferred 

back to the revaluation reserve when the impairment 

reversal is recognised. 

1.6.3 De-recognition 

Assets intended for disposal are reclassified as ‘Held for 

Sale’ once all the following criteria are met: 

• The asset is available for immediate sale in its present 

condition subject only to terms which are usual and 

customary for such sales; 

• The sale must be highly probable i.e.: 

i) Management are committed to selling the asset; 

ii) An active programme has begun to find a buyer and 

complete the sale; 

iii) The asset is being marketed at a reasonable price; 

iv) The sale is expected to be completed within 12 

months of the date of classification and as ‘Held for 

Sale’; and 

v) The actions needed to complete the plan indicate 

it is unlikely that the plan will be terminated or that 

significant changes will be made to it. 

Following reclassification, the assets are measured at the 

lower of their existing carrying amount and their ‘fair value 

less costs to sell’. Depreciation ceases to be charged and 

assets are not revalued, except where the ‘fair value less 

costs to sell’ falls below the carrying amount. Assets are 

de-recognised when all material sale contract conditions 

have been met. 

Property, plant and equipment which is to be scrapped or 

demolished does not qualify for recognition as ‘Held for 

Sale’ and instead is retained as an operational asset and the 

asset’s economic life is adjusted. The asset is de-recognised 

when scrapping or demolition occurs. 



1.6.4 Donated assets 

Donated and grant funded property, plant and equipment 

assets are capitalised at their fair value on receipt. The 

donation/grant is credited to income at the same time, 

unless the donor has imposed a condition that the future 

economic benefits embodied in the grant are to be 

consumed in a manner specified by the donor, in which 

case, the donation/grant is deferred within liabilities and is 

carried forward to future financial years to the extent that 

the condition has not yet been met. 

The donated and grant funded assets are subsequently 

accounted for in the same manner as other items of 

property, plant and equipment. 

1.7 Intangible assets 


Intangible assets are non-monetary assets without physical 

substance which are capable of being sold separately 

from the rest of the Trust’s business or which arise from 

contractual or other legal rights. They are capitalised when 

they are capable of being used in the Trust’s activities for 

more than one year, and can be valued and have a cost of 

at least £5,000. 

i) Internally generated intangible assets 

Internally generated goodwill, brands, mastheads, 

publishing titles, customer lists and similar items are not 

capitalised as intangible assets. 

Expenditure on research is not capitalised. 

Expenditure on development is capitalised only where all 

the following can be demonstrated: 

• the project is technically feasible to the point of 

completion and will result in an intangible asset for sale 

or use; 

• the Trust intends to complete the asset and sell or use it; 

• the Trust has the ability to sell or use the asset; 

• the way in which intangible assets will generate 

probable future economic or service delivery benefits 

e.g. the presence of a market for its output or, where 

it is to be used for internal use, the usefulness of the 

asset; 

• adequate financial, technical or other resources are 

available to the Trust to complete the development and 

sell or use the asset; and 

• the Trust can measure reliably the expenses attributable 

to the asset during development. 

ii) Software 

Software which is integral to the operation of hardware 

e.g. an operating system is capitalised as part of the 

relevant item of property, plant and equipment. Software 

which is not integral to the operation of hardware e.g. 

application software, is capitalised as an intangible asset. 

Costs associated with maintaining software are recognised 

as an expense when incurred. 

Capitalised computer software is amortised over the 

expected useful economic life. 

1.7.2 Measurement 

Intangible assets are recognised initially at cost, comprising 

all attributable costs needed to create, produce and prepare 

the asset to the point that it is capable of operating in a 

manner intended by management. Subsequently intangible 

assets are measured at fair value. Increases in asset values 

arising from valuations are recognised in the revaluation 

reserve, except where, and to the extent that, they reverse 

an impairment previously recognised in operating expenses, 

in which case they are recognised in operating income. 

Decreases in asset values and impairments are charged 

to the revaluation reserve to the extent that there is an 

available balance for the asset concerned, and thereafter 

are charged to operating expenses. Gains and losses 

recognised in the revaluation reserve are reported in the 

Statement of Comprehensive Income as an item of ‘other 

comprehensive income’. Intangible assets held for sale are 

measured at the lower of their carrying amount or ‘fair 

value less cost to sell’. 

1.7.3 Amortisation 

Intangible assets are amortised over their expected useful 

economic lives in a manner consistent with consumption of 

economic or service delivery benefits. Currently intangibles 

are amortised over five years. 

1.8 Government grants 

Government grants are grants from Government bodies 

other than income from Primary Care Trusts or NHS 

Foundation Trusts for the provision of services. Grants 

from the Department of Health are accounted for as 

Government grants. Where the Government grant is used 

to fund revenue expenditure, it is taken to the Statement of 

Comprehensive Income to match that expenditure. 

1.9 Inventories 

Inventories are valued at the lower of cost and net 

realisable value. 


1.10 Cash and cash equivalents 

Cash and cash equivalents comprise cash in hand and 

on demand deposits and other short term highly liquid 

investments that are readily convertible to a known amount 

of cash and are subject to an insignificant risk of changes 

in value. These balances exclude monies held in the Trust’s 

bank account belonging to patients (see third party assets 

in note 1.19 below). 

Account balances are only set off where a formal 

agreement has been made with the bank to do so. In 

all other cases overdrafts are disclosed within payables. 

Interest earned on bank accounts and interest charged on 

overdrafts is recorded respectively as “finance income” and 

“finance cost” in the periods to which they relate. Bank 

charges are recorded as operating expenses in the periods 

to which they relate. 

1.11 Financial instruments and financial liabilities 


Financial assets and financial liabilities which arise from 

contracts for the purchase or sale of non-financial items 

(such as goods or services) which are entered into in 

accordance with the Trust’s normal purchase, sale or usage 

requirements are recognised when the goods or services are 

delivered. 

Financial assets or financial liabilities in respect of 

assets acquired or disposed of through finance leases 

are recognised and measured in accordance with the 

accounting policy for leases described below. 

Regular purchases or sales are recognised and derecognised, 

as applicable, using the Trade date. 

All other financial assets and financial liabilities are 

recognised when the Trust becomes a party to the 

contractual provisions of the instrument. 

1.11.2 De-recognition 

All financial assets are de-recognised when the rights to 

receive cash flows from the assets have expired or the Trust 

has transferred substantially all of the risks and rewards of 

ownership. Financial liabilities are de-recognised when the 

obligation is discharged, cancelled or expires. 

1.11.3 Classification and measurement 

i) Financial assets and financial liabilities at ‘Fair value 

through Income and Expenditure’ 

Financial assets and financial liabilities at ‘Fair value 

through Income and Expenditure’ are financial assets or 

financial liabilities held for trading. A financial asset or 

liability is classified in this category if acquired principally 

for the purpose of selling in the short-term. Derivatives 

are also categorised as held for trading unless they are 

designated as hedges. Derivatives which are embedded 

in other contracts but which are not ‘closely-related’ to 

those contracts are separated out from those contracts 

and measured in this category. Assets and liabilities in 

this category are classified as current assets and current 

liabilities. 

These financial assets and financial liabilities are recognised 

initially at fair value, with transaction costs charged to the 

income and expenditure account. Subsequent movements 

in the fair value are recognised as gains and losses in the 

Statement of Comprehensive Income. 

ii) Loans and receivables 

Loans and receivables are non-derivative financial assets 

with fixed or determinable payments which are not quoted 

in the active market. They are included in current assets. 

The Trust’s loans and receivables comprise: current 

investments; cash and cash equivalents; NHS receivables; 

accrued income; and other receivables. 

Loans and receivables are recognised initially at fair value, 

net of transactions costs, and are measured subsequently 

at amortised cost, using the effective interest method. 

The effective interest rate is the rate that discounts exactly 

estimated future cash receipts over the expected life of the 

financial asset or, when appropriate, a shorter period, to 

the net carrying amount of the financial asset. 

Interest on loans and receivables is calculated using the 

effective interest method and credited to the Statement of 

Comprehensive Income. 

iii) Available-for-sale financial assets 

Available for sale financial assets are non-derivative financial 

assets which are either designated in this category or not 

classified in any of the other categories. They are included 

in long-term assets unless the Trust intends to dispose 

of them within 12 months of the Statement of Financial 

Position date. 

Available-for-sale financial assets are recognised initially 

at fair value, including transaction costs, and measured 

subsequently at fair value, with gains or losses recognised in 

reserves and reported in the Statement of Comprehensive 

Income as an item of ‘other comprehensive income’. When 

items classified as ‘available for sale’ are sold or impaired, 

the accumulated fair value adjustments recognised are 

transferred from reserves and recognised in ‘Finance Costs’ 

in the Statement of Comprehensive Income. 

iv) Other financial liabilities 

All other financial liabilities are recognised initially at fair 

value, net of transaction costs incurred, and measured 



subsequently at amortised cost using the effective interest 

method. The effective interest rate is the rate that discounts 

future cash payments over the expected life of the financial 

liability or, when appropriate, a shorter period, to the net 

carrying amount of the financial liability. 

They are included in current liabilities except for amounts 

payable more than 12 months after the Statement of 

Financial Position date, which are classified as long-term 

liabilities. 

Interest on financial liabilities carried at amortised cost is 

calculated using the effective interest method and charged 

to Finance Costs. Interest on financial liabilities taken out to 

finance property, plant and equipment or intangible assets 

is not capitalised as part of the cost of those assets. 

v) Determination of fair value 

For financial assets and financial liabilities carried at fair 

value, the carrying amounts are determined from quoted 

market prices, independent appraisals and analysis of 

discounted cash flows. 

vi) Impairment of financial assets 

At the Statement of Financial Position date, the Trust 

assesses whether any financial assets, other than those 

held at ‘fair value through income and expenditure’ are 

impaired. Financial assets are impaired and impairment 

losses are recognised, if and only if, there is objective 

evidence of impairment as a result of one or more events 

which occurred after the initial recognition of the assets 

and which has an impact on the estimated future cash 

flows of the asset. 

For financial assets carried at amortised cost, the amount of 

the impairment loss is measured as the difference between 

the asset’s carrying amount and the present value of the 

revised cash flows discounted at the asset’s original effective 

interest rate. The loss is recognised in the Statement of 

Comprehensive Income and the carrying amount of the 

asset is reduced directly or through the use of an allowance 

account/bad debt provision. 

1.12 Leases 

1.12.1 Finance leases 

i) Lessee 

Where substantially all risks and rewards of ownership of a 

leased asset are borne by the Trust, the asset is recorded as 

Property, Plant and Equipment and a corresponding liability 

is recorded. The value at which both are recognised is the 

lower of the fair value of the asset or the present value 

of the minimum lease payments, discounted using the 

interest rate implicit in the lease. The interest rate is that 

which produces a constant periodic rate of interest on the 

outstanding liability. 

The assets and liabilities are recognised at the inception 

of the lease, and are de-recognised when the liability 

is discharged, cancelled or expires. The annual rental is 

split between the repayment of the liability and a finance 

cost. The annual finance cost is calculated by applying 

the implicit interest rate to the outstanding liability 

and is charged to ”Finance Costs” in the Statement of 

Comprehensive Income. 

ii) Lessor 

Assets leased to others under agreements, which transfer 

substantially all the risks and rewards of ownership, with 

or without ultimate legal title are also classified as finance 

leases. When assets are held subject to a finance lease the 

present value of the lease payments, discounted at the rate 

of interest implicit in the lease, is recognised as a receivable. 

The difference between the total payments receivable 

under the lease and the present value of the receivable is 

recognised as unearned finance income, which is allocated 

to accounting periods to reflect a constant periodic rate of 

return. 

1.12.2 Operating leases 

i) Lessee 

Other leases are regarded as operating leases and the 

rentals are charged to operating expenses on a straight line 

basis over the term of the lease. Operating lease incentives 

received are added to the lease rentals and charged to 

operating expenses over the life of the lease. 

ii) Lessor 

Assets leased to third parties under agreements which 

do not transfer substantially all the risks and rewards of 

ownership are classified as operating leases. The leased 

assets are included within Property, Plant and Equipment in 

the Trust’s Statement of Financial Position and depreciation 

is provided on the depreciable amount of these assets on 

a systematic basis in accordance with the Trust’s policy. 

Lease income is recognised on a straight-line basis over the 

period of the lease unless another systematic basis is more 

representative of the accruing benefit. 

1.12.3 Leases of land and buildings 

Where a lease is for land and buildings, the land 

component is separated from the building component and 

the classification for each is assessed separately. Leased land 

is treated as an operating lease. 


1.13 Provisions 

The Trust provides for legal and compensation obligations 

that are of certain timing or amount at the Statement of 

Financial Position date on the basis of the best estimate of 

the expenditure required to settle the obligation. Where 

the effect of the time value of money is significant, the 

estimated risk-adjusted cash flows are discounted using 

HM Treasury’s short (0-5 years), medium (6-10 years), 

long (beyond 10 years) discount rate which are -1.8%, 

-1.0% and 2.2% in real terms, except for early retirement 

provisions and injury benefit provisions which both use HM 

Treasury’s pension discount rate of 2.35% in real terms. 

i) Clinical negligence costs 

The NHS Litigation Authority (NHSLA) operates a risk 

pooling scheme under which the Trust pays an annual 

contribution to the NHSLA, which, in return, manages 

all clinical negligence claims. Although the NHSLA is 

administratively responsible for all clinical negligence cases, 

the legal liability remains with the Trust. The total value 

of clinical negligence provisions carried by the NHSLA on 

behalf of the Trust is disclosed at note 17. 

ii) Non-clinical risk pooling 

The Trust participates in the Property Expenses Scheme and 

the Liabilities to Third Parties Scheme. Both are risk pooling 

arrangements under which the Trust pays an annual 

contribution to the NHSLA and in return receives assistance 

with the cost of claims arising. The annual membership 

contributions and any ‘excesses‘ payable in respect of 

particular claims are charged to operating expenses when 

the liability arises. 

1.14 Contingencies 

Contingent assets (that is assets arising from past events 

whose existence will only be confirmed by one or more 

future events not wholly within the Trust’s control) are not 

recognised as assets, but are disclosed in note where an 

inflow of economic benefits is probable. 

Contingent liabilities are not recognised, but are disclosed 

in a note, unless the probability of a transfer of economic 

benefits is remote. Contingent liabilities are defined as: 

• Possible obligations arising from past events whose 

existence will be confirmed only by the occurrence of 

one or more uncertain future events not wholly within 

the Trust’s control; or 

• Present obligations arising from past events but for 

which it is not probable that a transfer of economic 

benefits will arise or for which the amount of 

the obligation cannot be measured with sufficient 

reliability. 

1.15 Public Dividend Capital 

Public Dividend Capital (PDC) is a type of public sector 

equity finance based on the excess of assets over liabilities 

at the time of establishment of the predecessor NHS Trust. 

HM Treasury has determined that PDC is not a financial 

instrument within the meaning of IAS 32 (Financial 

Instruments). 

An amount, reflecting the cost of capital utilised by 

the NHS foundation trust, is payable as PDC each year. 

The charge is calculated at the rate set by HM Treasury 

(currently 3.5%) on the average relevant net assets of the 

NHS Foundation Trust during the financial year. Relevant 

net assets are calculated as the value of all assets less the 

value of all liabilities, except for: 

i) donated assets (including lottery funded assets), 

ii) net cash balances held with the Government Banking 

Services (GBS); excluding cash balances held in GBS 

accounts that relate to a short-term working capital 

facility; and 

iii) any PDC dividend balance receivable or payable. 

In accordance with the requirements laid down by the 

Department of Health (as the issuer of PDC), the dividend 

for the year is calculated on the actual average relevant net 

assets as set out in the ‘pre-audit’ version of the annual 

accounts. The estimated dividend is not revised should any 

adjustment to net assets occur as a result the audit of the 

annual accounts. 

1.16 Value Added Tax 

Most activities of the Trust are outside the scope of VAT 

and, in general, output tax does not apply and input tax on 

purchases is not recoverable. Irrecoverable VAT is charged 

to the relevant expenditure category or included in the 

capitalised purchase cost of fixed assets. Where output tax 

is charged or input VAT is recoverable, the amounts are 

stated net of VAT. 

1.17 Corporation Tax 

Homerton University Hospital NHS Foundation Trust is 

a health service body under the definition of section 

519A Income and Corporation Taxes Act (ICTA) 1988 

and accordingly is exempt from taxation in respect of 

income and capital gains within categories covered by 

this Act. There is a power for HM Treasury to disapply the 

exemption in relation to specified activities of a foundation 

trust (section 519A (93) to (8) ICTA 1988). The Trust is not 

within the scope of corporation tax in respect of activities 

which are not related to, or ancillary to, the provision of 

healthcare, as the profits derived from these activities do 

not exceed £50,000 per annum. 



1.18 Foreign exchange 

The functional and presentational currency of the Trust is 

sterling. 

A transaction which is denominated in a foreign currency is 

translated into the functional currency at the spot exchange 

rate on the date of payment for the transaction. 

Where the Trust has assets or liabilities denominated in a 

foreign currency at the Statement of Financial Position date: 

• Monetary items (other than financial instruments 

measured at ‘fair value through income and 

expenditure’) are translated at the spot exchange rate 

on 31 March; 

• Non-monetary assets and liabilities measured at 

historical cost are translated using the spot exchange 

rate at the date of the transaction; and 

• Non-monetary assets and liabilities measured at fair 

value are translated using the spot exchange rate at 

the date the fair value was determined. 

Exchange gains or losses on monetary items (arising on 

settlement of the transaction or on re-translation of the 

Statement of Financial Position date) are recognised in 

income or expense in the period in which they arise. 

Exchange gains or losses on non-monetary assets and 

liabilities are recognised in the same manner as other gains 

and losses on these items. 

1.19 Third party assets 

Assets belonging to third parties (such as money held on 

behalf of patients) are not recognised in the accounts 

since the Trust has no beneficial interest in them. However, 

they are disclosed in a separate note in the accounts 

in accordance with the requirements of HM Treasury’s 

Financial Reporting Manual. See note 27 for details. 

1.20 Losses and special payments 

Losses and special payments are charged to the relevant 

functional headings on a cash basis, including losses which 

would have been made good through insurance cover 

had foundation trusts not been bearing its own risk (with 

insurance premiums then being included as normal revenue 

expenditure). 

The total value and number of special payments is shown in 

note 29 to the accounts. 

Trust has had a significant number of material transactions 

with Government Departments and their agencies. These 

entities are listed in note 22. 

The Trust also receives revenue and capital payments from 

the Homerton University Hospital NHS Foundation Trust 

Charitable Fund. The Charity is registered with the Charity 

Commissioners (Charity Number 1061659) and has its own 

Trustees drawn from the NHS Foundation Trust Board. It 

produces a set of annual accounts and an annual report 

(separate to that of the NHS Foundation Trust based on UK 

GAAP and Charities SORP). 

Although the Trust has no ownership interest in the Charity, 

the composition of the charity trustees result in it being 

deemed a subsidiary under IAS 27 (Consolidated and 

Separated Financial Statements). HM Treasury has granted 

dispensation to the application of IAS 27 (revised) by NHS 

foundation trusts in relation to the consolidation of NHS 

charitable funds for 2011/12 and 2012/13. 

1.22 Partially completed spells 

Partially completed spells recognise the value of unfinished 

treatment episodes for which Trusts are entitled to accrue 

income but would not actually receive funding until the 

episode is complete. 

The estimation is based on the average Healthcare Resource 

Group (HRG) price by specialty and point of delivery of the 

fully coded spells in the preceding months. 

1.23 Key areas of estimation and judgement 

The key areas of estimation and judgement used in the 

preparation of the accounts have been disclosed within 

other sections of the accounting policy notes. These 

include: 

• Provisions for impairments of receivables, injury benefit 

claims, early retirements and others (note 5,12 & 16); 

• Estimates of partially completed patient episodes (note 

1.22); and 

• Depreciation rates applied to property, plant and 

equipment (note 9). 

• Valuation methologies and external indices applied to 

the valuation conducted by the District Valuer (note 9). 

1.21 Related parties 

Government departments and their agencies are 

considered by HM Treasury to be related parties. During 

the year Homerton University Hospital NHS Foundation 


2. Segmental analysis 

All activities of the Trust are considered to be one segment, Healthcare. There are no individual reportable segments on which 

to make disclosures. 

3. Operating income from continuing operations 


£000 £000 

3.1 Income from activities 

Elective income 23,165 21,759 

Non-elective income 50,159 47,272 

Outpatient income 34,582 32,994 

A&E income 10,183 9,061 

Non PbR activity income 56,528 54,393 

Community income 46,810 47,200 

Private patient income 549 588 

Other non-protected clinical income 12,558 9,890 

234,534 223,157 

Other operating income 

Research and development 867 504 

Education and training 11,750 11,708 

Donated assets and deferred income recognition 189 1,477 

Non-patient care services to other bodies 2,549 2,571 

Other income 5,686 4,260 

Total other operating income 21,041 20,520 

Total operating income 255,575 243,677 

Other income includes rent of £1.3m ( 2011/12 - £1.1m), staff recharges of £1.4m (2011/12 - £1.5m), nursery income of 

£0.1m (2011/12 - £0.4m), and catering income of £0.3m (2011/12 - £0.3m). 

Clinical income from non-mandatory services provided by the Trust is £0.5m, relating to private patient activity. 

3.2 Operating income by source 


£000 

2011/12 

£000 

NHS Foundation Trusts 4,076 4,113 

NHS Trusts 1,132 1,059 

Strategic Health Authorities 12,150 11,367 

Primary Care Trusts 228,557 216,518 

Department of Health 571 541 

NHS Other 100 50 

Local Authorities 4,231 3,659 

Non NHS: Private Patients 549 588 

Non NHS: Overseas Patients 380 41 

NHS Injury Scheme (was Road Traffic Act) 718 830 

Other operating income 3,111 4,911 

Total 255,575 243,677 

There is no disclosure requirement of Private Patient Income as the statutory limitation in section 44 of the 

2006 Act was repealed with effect from 1 October 2012 by the Health and Social Care Act 2012. 

NHS Injury Scheme income is subject to a nationally prescribed provision for doubtful debts of 12.6% 

(2011/12 10.5%) to reflect expected rates of collection. 



4. Operating expenses 

4.1 Operating expenses by type 


£000 

2011/12 

£000 

Services from other NHS foundation trusts 464 266 

Services from other NHS trusts 380 558 

Services from other NHS bodies 32 1 

Purchase of health care from non-NHS bodies 329 377 

Directors’ costs 1,056 1,220 

Non-Executive Directors’ costs 125 124 

Staff costs 166,298 157,471 

Supplies and services - clinical (excluding drug costs) 17,005 14,741 

Supplies and services - general 1,711 1,765 

Establishment 3,619 3,054 

Research and development (non salary cost) 31 139 

Transport 1,774 1,780 

Premises 28,897 28,647 

Increase in bad debt provision 599 52 

Drugs costs 12,941 11,049 

Depreciation on property, plant and equipment 5,444 5,588 

Amortisation of intangible assets 279 423 

Audit fees 80 79 

NHSLA insurance premium 5,203 4,683 

Loss on disposal of plant & equipment - 2 

Other 2,311 2,131 

Total (excluding impairment) 248,579 234,150 

Impairments of property, plant and equipment 3,529 916 

Total (including impairment) 252,108 235,066 

4.2 Operating leases 


£000 

2011/12 

£000 

4.2.1 Operating lease rentals 

Hire of plant and machinery 343 370 

Hire of building 81 90 

424 460 


Land and buildings Other leases Total Total 

4.2.2 Operating lease commitments £000 £000 £000 £000 

Annual commitments on leases expiring: 

Within 1 year 69 260 329 405 

Between 1 and 5 years 106 255 361 671 

Greater than 5 years - - - - 

Total 175 515 690 1,076 


4.3 Salary and pension entitlements of senior managers 

a) Remuneration 

Name and Title 2012/13 2012/13 2012/13 2011/12 

Directors Other Salary Salary 

Fletcher T - Chief Executive 

(from January 2013) 

Hallett N - Chief Executive 

(until December 2012) 

salary 

£000 

remuneration 

£000 

(bands of 

£5,000) 

£000 


£5,000) 

£000 

35-40 - - n/a 

115-120 - 115-120 145-150 

Coakley J - Medical Director 90-95 105-110 200-205 200-205 

Farrar J - Director of Finance 130-135 - 130-135 130-135 

Sheldon C - Chief Nurse and Director of Governance 100-105 - 100-105 95-100 

Jones D - Chief Operating Officer 

25-30 - - n/a 


Fletcher T - Chief Operating Officer (until December 2012) 90-95 - 90-95 110-115 

Clements C - Director of Workforce (until May 2012) 55-60 - 55-60 95-100 

Cassidy M - Chairman 40-45 - 40-45 40-45 

Stewart D - Non Executive Director 10-15 - 10-15 10-15 

Redmond I - Non Executive Director 10-15 - 10-15 10-15 

Griffiths C - Non Executive Director 10-15 - 10-15 10-15 

Gieve J- Non Executive Director 10-15 - 10-15 5-10 

Treves V - Non Executive Director (from April 2012) 10-15 - 10-15 n/a 

Hay S - Non Executive Director 

0-5 - 0-5 10-15 

(until August 2012) 

Keith M - Non Executive Director 

(until February 2013) 

10-15 - 10-15 10-15 

b) Pension Benefits 

Name and title 

Real increase 

in pension at 

age 60 

Real increase 

in lump sum 

at age 60 

Total accrued 

pension at 

age 60 at 31 


Total accrued 

lump sum at 

age 60 at 31 


Cash 

Equivalent 

Transfer Value 

at 31 March 


Cash 

Equivalent 

Transfer Value 

at 31 March 


Real Increase 

in Cash 

Equivalent 

Transfer 

Value 

Fletcher T - Chief Executive 


Hallett N - Chief Executive 

(until December 2012) 


£2500) 

£000 


£2500) 

£000 


£5000) 

£000 


£5000) 

£000 

£000 £000 £000 

2.5-5 7.5-10 25-30 85-90 424 368 48 

- 10-12.5 60-65 210-215 - 1,383 - 

Coakley J - Medical Director 0-2.5 0-2.5 80-85 240-245 1,780 1,675 69 

Farrar J - Director of Finance 0-2.5 2.5-5 0-5 35-40 180 142 36 

Jones D - Chief Operating Officer 


Sheldon C - Chief Nurse and 

Director of Governance 

Clements C - Director of Workforce 

(until April 2012) 

0-2.5 0-2.5 5-10 25-30 124 95 5 

0-2.5 5-7.5 20-25 70-75 335 289 40 

- - 25-30 75-80 470 462 - 

130 ANNUAL REPORT 2012/13


There were no payments in the year in respect of “golden hellos”, compensation for loss of office, or benefits in kind for any 

of the senior managers. As Non-Executive Directors do not receive pensionable remuneration, there are no entries in respect 

of pensions for Non-Executive Directors. 

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

a member at a particular point in time.The benefits valued are the member’s accrued benefits and any contingent spouse’s 

pension payable from the scheme. A CETV is a payment made by a pension scheme, or arrangement to secure pension 

benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the 

benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued 

as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which the 

disclosure applies. The CETV amounts, and from 2004/05 the other pension amounts, include the value of any pension 

benefits in another scheme or arrangement which the individual has transferred to the NHS Pension Scheme. They also 

include any additional pension benefit accrued to the member as a result of their purchasing additional pensionable service 

in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and 

Faculty of Actuaries. 

Real Increase in CETV - This reflects the increase in CETV effectively funded by the employer. It takes account of the increase 

in accrued pension due to inflation and contributions paid by the employee (including the value of any benefits transferred 

from another pension scheme or arrangement). The CETV at 31 March 2012 is discounted by the HM treasury discount rate. 

A common market valuation factor is then applied to the difference between this and the CETV as at 31 March 2013 to 

calculate the real increase in CETV. 

c) Median salary 

Reporting bodies are required to disclose the relationship between the remuneration of the highest-paid Director in their 

organisation and the median remuneration of the organisation’s workforce. 

The remuneration of the highest-paid Director in Homerton University Hospital NHS Foundation Trust in financial year 2012- 

13 was £201,963 (2011-12 £202,500). This was 5.6 times (2011/12; 6.2 times) the median remuneration of the workforce, 

which was £35,879 (2011/12; £32,830). 

In 2012/13, no employees received remuneration in excess of the highest-paid Director. 

Total remuneration includes salary, non-consolidated performance-related pay, benefits-in-kind as well as severance 

payments. It does not include employer pension contributions and the Cash Equivalent Transfer Value of pensions. 

d) Tax arrangements of public sector appointees 

The Trust has one appointee who falls within the definition of PES(2012)17 published by HMRC in 2012/13. 

This person has been engaged between 23 August 2012 and 31 March 2013 for more than £220 a day for more than six 

months. In this case assurance has been received of their tax obligations. 

e) Director and Governor expenses 

In 2012/13 the Trust paid £106 (2011/12-£109) as expenses to Executive and Non-Executive Directors and £40 (2011/12 - 

£34) to Governors. 

ANNUAL REPORT 2012/13 131

5. Staff costs and staff numbers 

5.1 Staff costs 


Permanently Other Total Total 

Employed 

£000 £000 £000 £000 

Salaries and wages 122,264 - 122,264 118,772 

Social Security costs 11,277 - 11,277 10,793 

Employer contributions to NHS Pensions Agency 13,880 - 13,880 13,474 

Bank and agency staff - 19,933 19,933 15,652 

147,421 19,933 167,354 158,691 

5.2 Average number of persons employed 


Permanently Other Total Total 

Employed 

Number Number Number Number 

Medical and dental 411 - 411 394 

Healthcare assistants and other support staff 413 - 413 249 

Nursing, midwifery and health visiting staff 1,030 - 1,030 1,089 

Nursing, midwifery and health visiting learners 23 - 23 29 

Scientific, therapeutic and technical staff 546 - 546 598 

Administration and estates 712 - 712 664 

Bank and agency staff - 396 396 324 

Other 5 - 5 7 

Total 3,140 396 3,536 3,354 

5.3 Employee benefits 

There are no individual employee benefit costs for 2012/13 (2011/12 Nil). 

5.4 Retirements due to ill-health 

2012/13 2012/13 2011/12 2011/12 

Number £000 Number £000 

Early retirements agreed on the grounds of ill-health 3 268 1 6 



5.5 Staff exit packages 

Number of Number of Total number of 

compulsory other departures exit packages 

redundancies agreed by cost band 

8. Intangible fixed assets 

All Intangible fixed assets relate to software licenses. 

8.1 2012/13 

£000 

Gross cost at 1 April 2012 4,485 

Additions - purchased 68 

Gross cost at 31 March 2013 4,553 

Amortisation at 1 April 2012 3,843 

Provided during the year 279 

Amortisation at 31 March 2013 4,122 

Net book value 

Purchased at 1 April 2012 642 

Purchased at 31 March 2013 431 

8.2 2011/12 

£000 

Gross cost at 1 April 2011 4,162 

Additions - purchased 323 

Gross cost at 31 March 2012 4,485 

Amortisation at 1 April 2011 3,420 

Provided during the year 423 

Amortisation at 31 March 2012 3,843 


Purchased at 1 April 2011 742 

Purchased at 31 March 2012 642 



9. Property, plant and equipment 

9.1 As at 31 March 2013 

Land 

Buildings 

excluding 

dwellings 

Assets under 

construction 

Plant and 

Machinery 

Transport 

Equipment 

Information 

Technology 

Furniture & 

Fittings 

£000 £000 £000 £000 £000 £000 £000 £000 

Total 

Cost or valuation at 26,142 88,460 1,484 21,556 75 8,321 1,317 147,355 

1 April 2012 

Additions - purchased - 4,262 687 3,573 - 836 - 9,358 

Additions - donated - - - - - - - - 

Other revaluations 1,536 420 - - - - - 1,956 

Impairments - loss - (5,240) - - - - - (5,240) 

Reclassifications - 390 (390) - - - - (0) 

Disposals - (93) (581) - - - (674) 

Cost or valuation 

at 31 March 2013 

27,678 88,292 1,688 24,548 75 9,157 1,317 152,755 

Depreciation at 

- 11,298 - 13,657 75 6,052 1,152 32,234 

1 April 2012 

Provided during the year - 2,450 - 2,038 - 887 69 5,444 

Disposals - - - (581) - (581) 

Depreciation 


- 13,748 - 15,114 75 6,939 1,221 37,097 


- Purchased at 1 April 2012 26,142 75,435 1,484 4,372 - 2,269 141 109,843 

- Donated at 1 April 2012 - 1,727 - 3,527 - - 24 5,278 

Total at 1 April 2012 26,142 77,162 1,484 7,899 - 2,269 165 115,121 


- Purchased at 

27,678 72,857 1,688 9,434 - 2,218 96 113,971 

31 March 2013 

- Donated at 

- 1,687 - - - - - 1,687 

31 March 2013 

Total at 31 March 2013 27,678 74,544 1,688 9,434 - 2,218 96 115,658 

Analysis of property, 

plant, and equipment 

2012/13: 


Buildings 

excluding 

dwellings 

Assets under 

construction 


Machinery 

Transport 

Equipment 

Information 

Technology 

Furniture & 

fittings 

£000 £000 £000 £000 £000 £000 £000 £000 


- Protected assets 

27,678 72,857 - - - - - 100,535 


- Unprotected assets 

- 1,687 1,688 9,434 - 2,218 96 15,123 


Total at 31 March 2013 27,678 74,544 1,688 9,434 - 2,218 96 115,658 

Total 


9. 2 As at 31 March 2012 


at 1 April 2011 


Buildings 

excluding 

dwellings 

Assets under 

construction 


Machinery 

Transport 

Equipment 

Information 

Technology 

Furniture & 

Fittings 

£000 £000 £000 £000 £000 £000 £000 £000 

26,142 88,285 2,217 20,351 75 7,753 1,251 146,074 

Additions - purchased - 2,293 813 1,434 - 487 28 5,055 

Additions - donated - - - 1,152 - - - 1,152 

Other revaluations - 57 - - - - - 57 

Impairments - loss - (3,170) - - - - - (3,170) 

Reclassifications - 995 (1,546) 406 - 107 38 - 

Disposals - - - (1,787) - (26) - (1,813) 

Total 


at 31 March 2012 

26,142 88,460 1,484 21,556 75 8,321 1,317 147,355 

Depreciation at 1 April 2011 - 8,547 - 13,575 75 5,213 1,047 28,457 

Provided during the year - 2,751 - 1,869 - 863 105 5,588 

Disposals - - - (1,787) - (24) - (1,811) 

Depreciation 


- 11,298 - 13,657 75 6,052 1,152 32,234 


- Purchased at 1 April 2011 26,142 77,966 2,217 3,754 - 2,540 176 112,795 

- Donated at 1 April 2011 - 1,772 - 3,022 - - 28 4,822 

Total at 1 April 2011 26,142 79,738 2,217 6,776 - 2,540 204 117,617 


- Purchased 


26,142 75,435 1,484 4,372 - 2,269 141 109,843 

- Donated at 31 March 2012 - 1,727 - 3,527 - - 24 5,278 

Total at 31 March 2012 26,142 77,162 1,484 7,899 - 2,269 165 115,121 

Analysis of property, 

plant and equipment 


Buildings 

excluding 

dwellings 

Assets under 

construction 


Machinery 

Transport 

Equipment 

Information 

Technology 

Furniture & 

fittings 

Total 


- Protected assets at 31 


- Unprotected assets at 31 


£000 £000 £000 £000 £000 £000 £000 £000 

26,142 77,162 - - - - - 103,304 

- - 1,484 7,899 - 2,269 165 11,817 

Total at 31 March 2012 26,142 77,162 1,484 7,899 - 2,269 165 115,121 



9.3 Assets held at market value 

At 31 March 2013 the Trust held land assets at market 

value for existing use of £27,678,200 (31 March 2012, 

£26,142,000). 

9.4 Valuation of land & buildings 

The buildings have been valued as at the 31 March 2013 

using a Modern Equivalent Asset basis of valuation, as 

discounted for wear and tear. 

Land has been revalued at the 31 March 2013 at market 

value for existing use. 

Both valuations were carried out by the District Valuer 

(DVS Property) whose address is the Westminster Valuation 

Office, Wingate House, London. W1D 5BU. 

Buildings have estimated useful economic lives ranging 

from 7 years to 60 years. 

9.5 Assets held under finance leases and hire 

purchase contracts at 31 March 2013 

The Trust did not hold any finance leases or hire purchase 

contracts during 2012/13. 

10. Fixed asset investments 

There were no fixed asset investments held at 31 March 

2013 (31 March 2012 - Nil). 

11. Inventories 

11.1 Inventories 


£000 £000 

Drugs 820 810 

Consumables 450 181 

Energy 118 130 

Total at net realisable value 1,388 1,121 

11.2 Inventories recognised in expenses 


£000 £000 

Total inventories recognised 

as an expense in the period 16,417 13,331 

12. Trade and other receivables 

12.1 Amounts falling due within one year 


£000 £000 

NHS receivables 4,069 5,323 

Provision for impaired receivables (1,198) (652) 

Prepayments 530 894 

Accrued income 3,830 3,562 

PDC receivable 102 121 

Other receivables 5,293 4,208 

Total 12,626 13,456 

12.2 Analysis of the provision for impaired 

receivables 


£000 £000 

At 1 April 652 619 

Arising during the year 599 52 

Utilised during the year (53) (19) 

At 31 March 1,198 652 

By age: 


£000 £000 

Up to three months old 109 27 

In three to six months old 127 20 

Over six months old 962 605 

Total 1,198 652 

12.3 Age analysis of unimpaired trade 

receivables 


£000 £000 

Up to three months old 4,962 3,750 

In three to six months old 513 618 

Over six months old 476 2,504 

Total 5,951 6,872 

13. Other financial assets 


£000 £000 

Cost or valuation at 1 April - 25 

Disposals - (25) 

Cost or valuation at 31 March - - 


14. Cash and cash equivalents 


£000 £000 

Balance as at 1 April 30,556 17,088 

Net change in year (935) 13,468 

Balance at 31 March 29,621 30,556 

Of which: 

Commercial banks and cash in hand 118 73 

Cash with the Government Banking Service 29,488 30,458 

Other current investments 15 25 

Total cash and cash equivalents in the statement of cash flows 29,621 30,556 

15. Liabilities 

Restated 


£000 £000 

15.1 (i) Current liabilities: Amounts falling due within one year 

NHS payables 2,468 5,201 

Trade payables - Capital 251 481 

Other payables 6,627 7,638 

Payments received on account 241 164 

Accruals 6,555 4,701 

Trade and other payables 16,142 18,185 

Loans 257 257 

Tax payable 5,586 5,204 

Deferred income 5,040 5,403 

Provisions 1,005 1,685 

Total amounts falling due within one year 28,030 30,734 

15.1 (ii) Non current liabilities: Payables due after more than one year 


£000 £000 

Provisions 1,109 641 

Loans 3,537 3,794 

4,646 4,435 

15.1 (iii) Total payables 

32,676 35,169 



15.2 Loans - payment of principal falling due: 


£000 £000 

Within one year 257 257 

Between one and two years 257 257 

Between two and five years 503 664 

After five years 2,777 2,873 

Total 3,794 4,051 

Of which: 


£000 £000 

Wholly repayable within five years 105 157 

Wholly repayable after five years, not by instalments - - 

Wholly or partially repayable after five years by instalments 3,689 3,894 

Total 3,794 4,051 

15.3 Prudential Borrowing Limit: 


£000 £000 

Prudential Borrowing Limit set by Monitor 50,800 45,500 

Working capital facility limit 10,000 8,500 

Total Prudential Borrowing Limit 60,800 54,000 

The Trust had a Prudential Borrowing Limit (PBL) of £60.8m in 2012/13 (£54m in 2011/12). The Trust did not draw down on 

its working capital facility during the year ended 31 March 2013 or during the year ended 31 March 2012. 

The Trust is required to comply and remain within its PBL.This is made up of two elements: 

i) The maximum cumulative amount of borrowing. This is set by reference to the four ratio tests set out in Monitor’s 

Prudential Borrowing Code. The performance against these financial ratios over the past two years is as follows: 

Actual ratios Approved PBL Actual ratios Approved PBL 

Financial ratio 2012/13 ratios 2012/13 2011/12 ratios 2011/12 

Minimum dividend cover 2.90 1.00 3.65 1.00 

Minimum interest cover 48.30 3.00 68.33 3.00 

Minimum debt service cover 20.70 2.00 30.40 2.00 

Maximum debt service to revenue 0.18% 2.50% 0.19% 2.50% 

ii) The amount of any working capital facility approved by Monitor. 

The Trust has an agreed working capital facility of £10m (£8.5m in 2011/12). The Trust did not draw down on its working 

capital facility during the year ended 31 March 2013 or the year ended 31 March 2012. 

Further information on the Prudential Borrowing Code and Compliance Framework can be found on Monitor’s website. 


16. Provisions for liabilities and charges 

Pensions relating Pensions relating Clinical Redundancy Other 31 Mar 2013 31 Mar 2012 

to former Directors to former staff negligence Total Total 

£000 £000 £000 £000 £000 £000 £000 

At 1 April 81 606 56 132 1,450 2,325 1,282 

Arising during the year 469 - - 621 1,090 1,584 

Change in discount rate 7 57 - - - 64 26 

Utilised during the year (6) (43) (18) (19) (557) (643) (585) 

Released (98) (640) (738) - 

Unwinding of discount 2 14 - - - 16 19 

At 31 March 84 1,103 38 15 874 2,114 2,326 

Within one year 6 72 38 15 874 1,005 1,686 

Between one and five years 23 265 - - - 288 173 

After five years 55 766 - - - 821 467 

Total 84 1,103 38 15 874 2,114 2,326 

Pension related provisions as at 31 March 2013 included £1.2m relating to matters handled by the NHS Pensions Agency 

(NHSPA). Other provisions include £0.1m relating to historic issues with our employee records system, and other employee 

related provisions of £0.6m. 

17. Clinical negligence liability 

The amount provided by the NHSLA in respect of clinical negligence liabilities of the trust as at 31 March 2013 is 

£34,427,919 (2011/12- £29,089,314). 

18. Movement in public dividend capital 


£000 £000 

Public dividend capital as at 1 April 84,100 83,175 

New PDC received 777 925 

Public dividend capital as at 31 March 84,877 84,100 

The dividend payment for the year was £3.2m (2011/12 £3.3m). Further details on how the dividend was calculated is set 

out in note 1.15. 



19. Notes to the cash flow statement 

19.1 Reconciliation of operating surplus to net cash inflow from operating activities: 


£000 £000 

Total operating surplus 3,467 8,611 

Depreciation and amortisation 5,723 6,011 

Impairment 3,529 916 

Donated assets capitalised - (1,152) 

Increase in inventories (267) (96) 

Decrease/(Increase) in receivables 669 (4,690) 

(Decrease)/Increase in payables (1,500) 6,866 

(Decrease)/Increase in provisions (212) 1,043 

Other movements (305) 3,998 

Net cash inflow from operating activities 11,104 21,507 

19.2 Reconciliation of net cash flow to movement in net funds 


£000 £000 

(Decrease)/increase in cash in the period (935) 13,442 

Cash inflow from increase in liquid resources 257 257 

(Decrease)/increase in net funds resulting from cash flows (678) 13,699 

Net funds at 1 April 26,505 12,806 

Net funds at 31 March 25,827 26,505 

19.3 Analysis of changes in net debt 

At 1 April Cash changes At 31 March At 31 March 

2012 in year 2013 2012 

£000 £000 £000 £000 

GBS cash at bank 30,458 (970) 29,488 30,458 

Commercial cash at bank and in hand 73 45 118 73 

Debt due after one year (3,794) 257 (3,537) (3,794) 

Debt due within one year (257) - (257) (257) 

Current asset investments 25 (10) 15 25 

Total 26,505 (678) 25,827 26,505 

20. Contractual capital commitments 

There were £3.8m of commitments under capital expenditure contracts as at 31 March 2013 (31 March 2012 - £1.3m). 

21. Contingent liabilities 


£000 £000 

Liabilities to Third Parties Scheme (LTPS) member’s contribution (29) (14) 


22. Related party transactions 

Details of related party transactions with individuals are as follows: 

Name and role Related party details Payments to Income from 

related party related party 

£000 £000 

Imelda Redmond, Non Executive Director Director of Policy, Marie Curie Cancer Care 35 - 

Imelda Redmond, Non Executive Director Governor, City Academy - 35 

Charlie Sheldon, Chief Nurse Honorary Professor, City University 8 26 

Government Departments and their agencies are considered by HM Treasury as being related parties. During the year 

Homerton University Hospital NHS Foundation Trust has had a significant number of material transactions with Government 

Departments and their agencies. These entities are listed below: 

Name Relationship Income Expenditure Receivables Payables 

£000 £000 £000 £000 

East London NHS Foundation Trust NHS Foundation Trust 3,892 266 43 9 

Barts Health NHS Trust 1,012 4,881 318 1,783 

NHS Litigation Authority Insurer 50 5,195 - - 

NHS London SHA Strategic Health Authority 12,149 - 97 - 

London Borough of Hackney Local Authority 4,169 2,026 1,246 37 

Department of Health Department of Health 571 3,430 111 - 

NHS City and Hackney Commissioner 163,164 3,808 3,839 252 

NHS Croydon Commissioner 22,548 - 820 - 

NHS Pensions Agency Commissioner 13,880 - - 1,875 

NHS Waltham Forest Commissioner 8,085 - 824 - 

NHS Newham Commissioner 5,059 - - 64 

NHS Tower Hamlets Commissioner 4,770 - 169 - 

NHS Islington Commissioner 4,235 - - 13 

NHS Redbridge Commissioner 3,429 - 191 - 

South East Essex PCT Commissioner 1,968 - - 12 

NHS Enfield Commissioner 1,775 - - 112 

NHS Haringey Commissioner 4,917 - - 378 

HM Revenue & Customs - VAT Central Government WGA Body 4,952 - 648 - 

NHS Pension Scheme Central Government WGA Body - 13,880 - 1,875 

HM Revenue & Customs - 

NI Fund & PAYE Central Government WGA Body - 11,277 - 3,730 

The Trust has also received revenue and capital payments from the Homerton University Hospital NHS Foundation Trust 

Charitable Fund. The Charity is registered with the Charity Commission (Charity Number 1061659) and has its own Trustees 

drawn from the NHS Trust Board. It produces a set of annual accounts and an annual report (separate to that of the NHS 

Foundation Trust) and these documents are available on request from the Trust. 

All PCTs ceased to exist from 31 March 2013 and the outstanding debts and liabilities have been transferred over to the 

Department of Health. 

23. Private finance initiative transactions 

The Foundation Trust has no PFI schemes. 



24. Financial instruments 

IAS 32 (Financial Instruments: Disclosure and Presentation), IAS 39 (Financial Instrument Recognition and Measurement) and 

IFRS 7 (Financial Instruments: Disclosures) require disclosure of the role that financial instruments have played during the 

period in creating or changing the risks an entity faces in undertaking its activities. 

The Trust does not have any complex financial instruments and does not hold or issue financial instruments for speculative 

trading purposes. In light of the continuing service provider relationship the Trust has with primary care trusts and the way 

those primary care trusts are financed, the Trust is not exposed to the degree of financial risk faced by non NHS business 

entities. 

The Trust has limited powers to borrow or invest surplus funds and financial assets and liabilities are generated by day-to-day 

operational activities rather than being held to change the risks facing the Trust in undertaking its activities. 

The Finance and Perfomance Committee manages the Trust’s funding requirements and financial risks in line with the Board 

approved treasury policies and procedures and their delegated authorities. 

The Trust’s financial instruments comprise loans, provisions, cash at bank and in hand and various items, such as trade 

debtors and trade creditors, that arise directly from its operations. The main purpose of these financial instruments is to fund 

the Trust’s operations. 

25.1 Financial assets 

Fixed rate Floating rate Non-interest bearing Total 

£000 £000 £000 £000 

At 31 March 2013 15 29,607 11,994 41,616 

At 31 March 2012 25 30,531 12,439 42,995 

Financial assets consist of cash and cash equivalents and trade and other receivables excluding provisions less prepayments 

and PDC receivable. 

25.2 Financial liabilities 

Fixed rate Non-interest bearing Total 

£000 £000 £000 

At 31 March 2013 3,794 17,089 20,883 

At 31 March 2012 3,275 21,302 24,577 

Financial liabilities consist of current and non-current liabilities less deferred income, payment received on account and tax. 


25.3 Financial assets and liabilities 

At 31 March 2013 At 31 March 2012 

£000 £000 

25.3 (i) Financial assets (book and fair value) 

Cash 29,607 30,531 

Receivables within one year: 11,994 12,128 

Receivables after one year: 

- Agreements with commissioners to cover provisions - 311 

Other current investments 15 25 

Total 41,616 42,995 

25.4 (ii) Financial liabilities (book and fair value) 

Payables within one year 15,980 19,885 

Provisions under contract over one year 1,109 641 

Loans 3,795 4,051 

Total 20,884 24,577 

Notes 

a) Fair value is not significantly different from book value since, in the calculation of book value, the expected cash flows have 

been discounted by the HM Treasury’s discount rate of 2.35% in real terms (2011/12 - 2.2%) 

26. Third party assets 

The Trust held £11,136 of patients’ monies at 31 March 2013 (31 March 2012 - £1,288). This amount has been excluded 

from the cash at bank and in hand figure reported in the accounts. 

27. Intra-Government and other balances 

27.1 Receivable and Payable balances 

Receivables: 

Payables: 

amounts falling 

amounts falling 

due within one year due within one year 

At March 2013 At March 2013 

£000 £000 

English NHS Foundation Trusts 163 181 

English NHS Trusts 330 1,576 

Department of Health 111 - 

English Strategic Health Authorities 97 - 

English Primary Care Trusts 6,911 1,053 

Other NHS Whole of Government Accounts bodies 15 66 

Other Whole of Government Accounts bodies 1,948 5,643 

Total 9,575 8,519 



27.2 Income and expenditure values for the year 

Income 

Expenditure 

Year Ended March 2013 Year Ended March 2013 

£000 £000 

English NHS Foundation Trusts 4,076 1,682 

English NHS Trusts 1,130 5,307 

Department of Health 571 245 

English Strategic Health Authorities 12,150 7 

English Primary Care Trusts 228,557 3,818 

NHS Whole of Government Accounts bodies 92 6,310 

Other Whole of Government Accounts bodies 4,239 27,238 

Total 250,815 44,607 

28. Losses and special payments 

Total 

Number 

£000 

Losses 55 21 

Special payments 4 10 

Total 59 31 

Losses have been calculated on an accruals basis but exclude provisions for future losses. 



Homerton University Hospital 

Homerton Row 

London E9 6SR 

Tel: 020 8510 5555 

www.homerton.nhs.uk

Annual report and accounts 2012/13 - Homerton University Hospital

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